Chronic Obstructive Pulmonary Disease
P re f a c e C h ro n i c O b s t r u c t i v e Pulmonary Disease
Peter J. Barnes, FRS, FMedSci Editor
Although major progress has been made in understanding COPD, many questions about COPD remain unanswered. We do not understand why only a minority of smokers develop airway obstruction, nor the complex interplay between different risk factors in addition to smoking and biomass smoke exposure. We do not understand how the underlying inflammatory process is linked to pathophysiology and disease progression and the reason inflammation and disease progression persist even after smoking cessation is not understood. The different phenotypes may respond differently to different treatments, but this is poorly understood. Although long-acting bronchodilators have proved to be the most effective therapies so far available, we still do not have treatments that suppress the underlying inflammatory process to prevent disease progression and exacerbations. This suggests that much more research is needed in the future. This issue brings together our current understanding of COPD and provides a sound up-to-date synopsis of the disease that will provide a valuable basis for future research into this devastating disease. I wish to thank all of the authors for their excellent articles and to keeping to the deadlines, and the publishers for putting together this volume.
Clin Chest Med 35 (2014) xiii http://dx.doi.org/10.1016/j.ccm.2013.11.003 0272-5231/14/$ – see front matter Ó 2014 Published by Elsevier Inc.
Peter J. Barnes, FRS, FMedSci National Heart and Lung Institute Imperial College, Dovehouse Street London, SW3 6LY, UK E-mail address: [email protected]
Chronic obstructive pulmonary disease (COPD) is a major global health problem that is increasing throughout the world, especially in developing countries. This increase reflects continuing cigarette smoking, which remains the commonest cause, but also relates to aging populations since COPD is a disease of the elderly and may be regarded as accelerated aging of the lung. In addition to cigarette smoking, other causal mechanisms, such as exposure to biomass fuels, air pollution, and poor nutrition, as well as poverty, are also recognized as contributory risk factors. COPD is now the third most prevalent cause of death in Western countries and its mortality is rising in developing countries. It has now become one of the most frequent causes of hospitalization. Although it is one of the most common chronic diseases, it is still poorly recognized among the general public and among doctors, with over half of the patients undiagnosed and many of the diagnosed cases mistreated. There is a major need to better understand this complex disease, which appears to include many poorly understood phenotypes. It is increasingly recognized that COPD occurs with several comorbidities, including cardiovascular and metabolic diseases and lung cancer, which have a major effect on clinical outcomes and management. This volume brings together current knowledge of COPD, written by international experts, and explores every aspect of the disease from epidemiology, through clinical presentation, to underlying mechanisms and clinical management.