Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory disorder that is caused mainly by cigarette smoking and other exposures such as biomass and occupational dust exposure. It is an important cause of global morbidity and mortality. In the UK there are an estimated 3 million COPD patients but only around 1 million diagnosed and by the time COPD patients are diagnosed they usually have established disease. COPD accounts for 10% of hospital admissions. We now recognise that in order to prevent the development and progression of COPD, we need to detect patients early at GOLD Stage 1 and 2 of lung function and intervene with appropriate pharmacological therapies to reduce inflammation. COPD is a complex disorder with various phenotypes and differing trajectories across life. The presence of chronic mucous hypersecretion in smokers between ages of 30 and 50 is associated with FEV1 decline in later life and COPD. Thus interventions to target mucous will be important to develop.
Exacerbations of COPD are present at all stages of the disease but current prevention strategies have been aimed at more severe patients and there are few trials in less severe COPD. Exacerbations are associated with FEV1 decline especially if the exacerbation does not recover and we need more effective therapies for management of the actual exacerbation to accelerate recovery of the inflammation and prevent recurrence. Antivirals are important and development of improved rapid diagnostics will allow us to target the respiratory viruses. Prevention with vaccination for respiratory viruses will be important.
