Chronic Obstructive Pulmonary Disease: A Worldwide Problem

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Epidemiology

The highly cited, influential GBD studies estimated that COPD causes the death of at least 2.9 million people annually. Estimates of global mortality in 19903 were updated in 2006,14 and will be next available and expanded in 2012.15 The GBD highlights that COPD was the sixth leading cause of death in 1990, has been the fourth since 2000, and is projected to be the third by 2020. These estimates are likely to be conservative because they did not account for deaths whereby COPD is a contributory

Definition of COPD

Spirometry is the most common of the pulmonary function tests, and enables any health professional to make an objective measurement of airflow limitation and the degree to which it is reversible. As a diagnostic test for COPD, spirometry is a reliable, simple, noninvasive, safe, and nonexpensive procedure to detect airflow limitation. Trained technicians can meet quality goals for spirometry tests about 90% of the time.31 Early diagnosis of COPD should affect individual and population outcomes,

Risk factors

There are comprehensive lists of risk factors associated with the development and triggering of COPD exacerbations, available elsewhere.5, 10, 11, 12, 13 Some of them are amenable to modification whereas others are not, and some apply at the individual and/or group level, so that in all likelihood any strategy to limit each burden differs.38 The recent literature is packed with reports aimed at explaining COPD separately from smoking. Risk factors for developing COPD other than smoking tobacco

Spirometry screening

At this early stage, spirometry as a screening tool of disease has been explored in only α1-ATD probands and their relatives, smokers, and those workers with occupational exposures. Apart from marihuana consumers49, 50 and biomass exposure in selected developing countries,51 spirometry is unlikely to be successful for other types of exposures.

Although it is important to recognize that COPD does not exclusively affect smokers, it is the authors’ opinion that the current emphasis on COPD in

Burden of COPD in developing countries

On a global scale, about 50% of all households and about 90% of those in rural areas of developing countries use solid fuels (coal and biomass) as their main source of energy. Thus, one-half of the world’s population (up to 3 billion people) is exposed to the harmful effects of solid-fuel smoke produced by unvented open fires for heating and cooking.60, 61 The use of solid fuels is the most important source of indoor air pollution and is inversely associated with socioeconomic development,

Future

Several investigators,68 societies, and nonprofit international initiatives have elegantly outlined some of the burning pending questions on COPD burden now and in the foreseeable future, with an intention either to help funding agencies to prioritize limited resources in competitive decision making or to streamline alternative routes to reduce its overall massive burden. Publications include documents from the ATS/ERS,10, 69 GARD,6 GOLD,5 IPCRG,70 as well as from independent researchers.68, 71

Acknowledgments

The authors thank Professor Michael Studnicka for his helpful comments on the manuscript.

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    Disclosures: There are no relationships with a commercial company that have a direct financial interest in the subject matter or materials discussed in this article or with a company making a competing product.

    Conflict of interest statement: There are no conflicts of interest to report regarding the content of this review.

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