Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease is a major cause of death and disability in the United States. The most important risk factor for COPD is cigarette smoking. Thus, COPD is largely a preventable condition. Other risk factors may include air pollution, childhood infections, heredity, advanced age, airway hyperresponsiveness, and occupational exposures. Some risk factors, including male sex and socioeconomic status, may gain their influence through associations with cigarette smoking or living conditions. More attention to primary, secondary, and tertiary prevention of COPD is required.

In order to reduce the burden of illness associated with COPD, greater efforts in smoking prevention and smoking cessation are required. Other measures include reductions in air pollution, influenza vaccination programs, and augmentation therapy for those with severe alpha-antitrypsin deficiencies. Once persons are afflicted with COPD, high quality medical care is essential.

Improved efforts in the prevention and management of COPD will require education directed toward patients, the general public, and health care providers. Considerably more research in education and prevention is necessary; this includes epidemiologic research to clarify the risk factors for dysfunction, biomedical research to substantiate information on the chemical markers of lung injury, expansion of the protease-inhibitor hypothesis, and evaluation of genetic predisposition toward the disease. Health services research will be required in order to create improved measures of health outcome, evaluate the cost-effectiveness of treatment programs, and improve the efficiency and effectiveness of both preventive and tertiary treatment programs. More research is necessary on cigarette use, access to care, and occupational exposures among members of underrepresented minority groups. Finally, it will be necessary to conduct more research to identify methods to help the general public adhere to preventive measures and to help COPD patients adhere to prescribed therapies.