Chronic obstructive pulmonary disease (COPD) is a major health epidemic, which has important consequences for patients and community, and still receives insufficient attention from the health care professionals and scientists. COPD is a leading cause of chronic morbidity (affects 210 million people) and mortality (causes 3 million deaths per year) worldwide, and according to the World Health Organization (WHO), it is the fifth most common cause of death and the 10th most burdensome disease. The first definition of chronic obstructive pulmonary disease (COPD) can be found in the 60’s and incorporates both terms “emphysema” and “chronic bronchitis”. According to the Global Initiative for obstructive lung diseases (GOLD), COPD is defined as a “preventable and treatable disease with some significant extra-pulmonary effects that may contribute to the severity in individual patients. The pulmonary component is characterized by airflow limitation, which is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, such as cigarette smoke”. COPD is clinically characterized by symptoms like cough, sputum production, and/or dyspnea. The diagnosis is confirmed by spirometry and accordingly has four stages, from mild (GOLD stage I) to very severe (GOLD stage IV). Patients with COPD typically have a decrease in both FEV1 and a FEV1/FVC ratio of less than 0.7. Using this ratio as cut-off point for all patients is currently questioned as it may underestimate COPD in the young and overestimate COPD in older populations. The GOLD definition has become globally accepted for the diagnosis of COPD and some crucial components of this definition have been incorporated by the European Respiratory Society (ERS) and by the American Thoracic Society (ATS).

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M.C.J.M. Sturkenboom (Miriam)
Erasmus University Rotterdam
Erasmus MC Rotterdam, Additional support for printing of the thesis was kindly provided by: Astellas Pharma Europe B.V., AstraZeneca B.V., Bayer Schering Pharma B.V., Boehringer Ingelheim B.V., GlaxoSmithKline B.V., J.E. Jurriaanse Stichting, Nederlands Bijwerkingen Fonds, Royal Dutch Association for the Advancement of Pharmacy (KNMP), and Stichting Astma Bestrijding, in the Netherlands.
Erasmus MC: University Medical Center Rotterdam

Afonso, A.S.M. (2011, April 15). Epidemiology and treatment effects in Chronic Obstructive Pulmonary Disease. Erasmus University Rotterdam. Retrieved from