Chronic Obstructive Pulmonary Disease:
Diagnostic Considerations
MARVIN DEWAR, M.D., J.D., and R. WHIT CURRY, JR., M.D.
University of Florida College of Medicine, Gainesville, Florida
T
he global burden of chronic
obstructive pulmonary disease
(COPD) is increasing; the disease
is projected to be the third leading
cause of death and fifth leading cause of over-
all disability worldwide by 2020.1 Men and
women seem to be at an equal risk, and the
death rate attributable to COPD is increasing
significantly in both sexes.1,2 The economic
consequences of COPD are substantial. In
2002, the estimated total societal cost of
COPD in the United States was $32 billion.2
Definition
COPD is a heterogeneous disorder that
encompasses traditional clinical entities such
as emphysema and chronic bronchitis.3,4
The Global Initiative for Chronic Obstruc-
tive Lung Disease (GOLD),5 a
collaborative effort from the
National Heart, Lung, and
Blood Institute; the National
Institutes of Health; and the
World Health Organization,
defines COPD as a usually pro-
gressive disease with airf low
limitation that is not fully reversible and
that is associated with an abnormal inflam-
matory response of the lungs to noxious
particles or gases.
Patients with COPD present with a
variety of clinical findings, including ele-
ments of chronic bronchitis and emphy-
sema.6-8 Although COPD and asthma are
both associated with airflow obstruction
and inflammation of the lung and airways,
asthma-related airflow obstruction is more
reversible and the disease course is more
variable than with COPD.6,8,9
Risk Factors
Exposure to tobacco smoke is the most
significant risk factor for COPD, with 80 to
90 percent of all cases attributable to smok-
ing.6 Evidence linking tobacco smoke expo-
sure and COPD predominantly comes from
population-based studies that have consis-
tently shown that smoking is associated with
diminished lung function, more frequent
respiratory symptoms, and increased COPD-
related deaths.5,10-13 Pipe and cigar