The World Bank and World Health Organization (WHO) predict that by 2020, COPD will be ranked fifth in terms of the worldwide burden of disease [27]. The WHO also estimates that 1.1 billion people currently smoke. Assuming that 14% of smokers develop COPD, one could estimate that 150 million either have or will develop COPD — a number equivalent to the entire population of Russia.

In the United Kingdom during 1999/2000, there were 28million days of certified incapacity due to diseases of the respiratory system [30]. Over 10% of all acute medical admissions to hospital are due to exacerbations of COPD, and with an average length of stay of 10 days, these represent some 2.8 million hospital-bed days annually in the UK.

Morbidity from COPD is not confined to wealthy countries. Smoking prevalence is high and rising in many poorer regions, with China in particular likely to see huge death rates from smoking-related disease in the coming decades. Many of the statistics available in the UK or in the US are not collated in such countries, so that the effect of COPD can only be estimated. Some estimates of the global incidence of COPD in such countries are detailed in Table 1.2 [28,29].

But morbidity is not the only concern. Airflow limitation is associated with premature death, and the World Health Organization statistics attribute 2.74 million deaths worldwide to COPD in the year 2000. It is the fourth commonest cause of death in the USA, China and United Kingdom. In the United States,

Table 1.2 Prevalence of chronic obstructive pulmonary disease in poorer countries in 1990. Adapted from [28].


Former socialist economies Established market economies Sub-Saharan Africa India

Latin America and Caribbean Other Asian countries and islands Middle Eastern crescent World

Male/ Female/ 1000 1000

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A Disquistion On The Evils Of Using Tobacco

A Disquistion On The Evils Of Using Tobacco

Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.

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