The term Chronic Obstructive Pulmonary Disease (COPD)
refers to pathologies characterized by airflow limitation (AL) such as chronic
bronchitis and emphysema. COPD is a common, costly and preventable disease that
has substantial implications for the health of the European population. COPD is a
treatable disease, when AL is progressive and not fully reversible. However, COPD is
often underestimated and under-treated.
Approximately 200 000-300 000 people die every year in Europe because of COPD. It represents the fifth leading cause of mortality in the developed
world (Lopez et al, 2001) and the third cause of death in the UE-25 (Niederlander et al, 2006). COPD is the main reason
for mortality associated with respiratory diseases, accounting for 3.8% of
total deaths and is also estimated to be the seventh cause of loss of
disability adjusted life years (Mannino and Buist, 2007). Moreover, significant augmentations in
COPD prevalence and mortality are envisaged in the future; the most well known
projection comes from the authoritative and widely quoted Global Burden of
Disease study, which envisaged that COPD would rise to the third leading cause
of death worldwide in 2020 (Murray and Lopez, 1997).
The main elements of COPD are chronic bronchitis and
emphysema: (Siafakas, 2006). COPD has significant
extra-pulmonary effects that may contribute to the severity in individual
patients. Its pulmonary element is characterized by AL that is not fully
reversible. The airflow limitation is usually progressive and associated to an
abnormal inflammatory response of the lung to noxious particles or gases (GOLD,
Exposure to noxious agents (e.g. tobacco active and
passive tobacco smoking, occupational factors and air pollution) causes a rapid
deterioration in the lung function, increasing the risk for exacerbations.
These exacerbations lead to a progressive worsening until the end stage of the
disease, characterized by severe airflow limitation, chronic respiratory
failure, different co-morbidities and severe systemic complications.
Major efforts in the field of prevention are necessary to
avoid an important augmentation in end-stage patients, needing long term oxygen
therapy and assisted ventilation, which would prolong their life but cause
great suffering and costs.