Why COPD is important

Chronic obstructive pulmonary disease (COPD) is one of the most common and important respiratory disorders in primary care. About 32,000 people die from COPD each year in the UK, and the disease results in considerable morbidity, impaired quality of life, time off work, and more hospital admissions and GP consultations than asthma. However, its diagnosis and effective management have been largely neglected, apart from patients being advised to stop smoking.

COPD is a spectrum of diseases that includes:

chronic bronchitis,

emphysema,

long-standing asthma that has become relatively unresponsive to treatment,

small airways disease.

The unifying feature of COPD is that it is a chronic, slowly progressive disorder characterised by airflow obstruction that is not fully reversible and varies very little from day to day and month to month.

COPD is caused mainly by cigarette smoking. However, only 20% of smokers will develop COPD and there are no clear pointers to what makes them particularly susceptible to the adverse effects of tobacco smoke. It is probable that there are genetic factors that increase susceptibility to smoking but, as yet, no chromosomal
abnormalities have been identified other than for alpha-1 antitrypsin deficiency. Family studies have found that siblings of people with emphysema are three to four times more likely than controls to develop COPD if they smoke. For people who are affected, stopping smoking is the only way to slow the progression of the disease.
There are as yet no drugs that significantly improve the disease or alter the rate of decline of lung function.

The 1990s saw great improvements in the management and organisation of asthma treatment in primary care. COPD, by contrast,has been largely ignored and rightly has been dubbed the ‘Cinderella respiratory disorder’. This situation began to change with the publication and widespread dissemination to GPs and practice
nurses of the British Thoracic Society (BTS) COPD Guidelines in December 1997. Since then there has been considerable interest in the disease and its management.

Research papers on COPD have flourished at both British and international meetings. The BTS Guidelines have set out five goals for COPD management:

early and accurate diagnosis,

best control of symptoms,

prevention of deterioration,

prevention of complications,

improved quality of life.

Guidelines are important in aiding accurate and appropriate clinical decision-making but are not useful unless disseminated to all primary care doctors and practice nurses in a simple, readily digestible format. The BTS COPD Consortium produced a four-page summary of the 1997 Guidelines, which was widely distributed to primary care. The Consortium will similarly distribute a short summary of the NICE guidelines shortly after publication, with more detailed information available to view and download from the BTS website. The full guideline appeared as a supplement of Thorax in March 2004.