COPD is a challenge to health systems across the world. As cigarette smoking increased during the 20th century so the prevalence of COPD increased in its wake. Acute exacerbations of COPD are the second most common cause of admission to UK hospitals. Over 5% of people aged over 60 in the UK are affected and seeking help to relieve their symptoms. Not all countries are as severely affected as the UK but in most countries across the world cigarette smoking is increasing and with it so is the prevalence of COPD. The World Health Organization predicts that by the year 2020, COPD will be the fourth most common cause of death worldwide.

Until quite recently there was little medical interest in COPD but a surge of interest has been stimulated by the development of simple measurements, and by inhaled drugs that relieve the symptoms at least in part. Although the damage caused by smoking cannot be reversed, the COPD patient's life quality can be significantly improved and in some cases their life expectancy improved too.

The research world has woken up to these possibilities and the burgeoning number of sessions at international meetings allocated to COPD is testament to the amount of new effort devoted to the disease. Now the pharmaceutical industry has developed a range of products of proven benefit; and more are on the way.

This book has an unusual format. It is not intended to be a textbook for the expert, and makes no attempt to be comprehensive in its coverage. Instead our contributors were asked to discuss COPD topics that the average clinician (doctors, nurses and allied health professionals) would be able to read easily and find interest in. The questioning format has allowed our contributors to select from the many issues that could be discussed and so inevitably some subjects have not been covered (so apologies if your pet concern is not described). Nevertheless we hope that there is plenty to interest all those who manage patients with COPD in primary and secondary care and they will be stimulated to want to know more about this all too common disorder. This is x PREFACE

a rapidly developing field with many exciting and interesting developments that are being translated into direct patient care.

We hope that those who read this book are left with an enthusiasm that COPD is not a 'no-hope' disorder and will want to do more for their patients. Much can and should be done that will benefit not only the patients directly but also their families and thus society. But if we are to succeed we need not only to recognize what can be done, we also have to put into place systems that ensure it really is done.

Mike Pearson Wisia Wedzicha

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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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