Assessment of Health-related Quality of Life in Different Phenotypes of COPD (article from 2017 Current Respiratory Medicine Reviews)

Introduction: Phenotypic characterization of COPD subjects may rely on clinical and physiological manifestations, imaging, assessment of patient-related outcomes (health related quality of life), COPD comorbidities, COPD exacerbations and systemic inflammation. The aim of the study was to evaluate and to analyze the health-related quality of life (HRQL) in COPD patients classified into different phenotypes.

Methods: 395 consecutive COPD patients were enrolled into the study. Spirometric data were analyzed (FEV1, FVC, FEV1/FVC). HRQL was assessed by the St. George Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ).

Results: The cohort consisted of 395 COPD patients with mean age 62.7 ± 9.4 years, 79 % were males. Patients were divided in 4 groups according to phenotypes: 44% of the patients were nonexacerbators, 35% frequent exacerbators with chronic bronchitis (CB), 12% frequent exacerbators without CB, and 8% were patients with asthma-COPD overlap syndrome (ACOS). There were statistically significant differences in HRQL and lung function between COPD phenotypes. Frequent exacerbators with chronic CB and without CB had the similar total SGRQ scores, CCQ scores and CAT, and these scores were worse in comparison with HRQL of non-exacerbators and patients with ACOS.

Conclusion: Frequent exacerbators with chronic CB and without CB have a more severe deterioration of the HRQL and worse lung function then non-exacerbators and patients with ACOS.

full text:

http://www.eurekaselect.com/154321

News alert: According to the last Pharma R&D 2017 Review, Respiratory Drugs the only group decreasing

Pharma R&D 2017 Review, presented recently new drugs by Therapy Groups. Cancer at the top increasing 20%, Respiratory Drugs the only group decreasing.
It is a huge paradox, in the time when we have the progressive increasing of prevalence and mortality of chronic respiratory diseases!!!

Respiratory diseases are STILL among the leading causes of death worldwide.  

Lung infections (mostly pneumonia and tuberculosis), lung cancer and chronic obstructive pulmonary disease (COPD) together accounted for 9.5 million deaths worldwide during 2008, one-sixth of the global total. The World Health Organization estimates that the same four diseases accounted for one-tenth of the disability-adjusted life-years (DALYs) lost worldwide in 2008.

The Global Burden of Disease (GBD) Study recently compared the contribution of major diseases to deaths and disability worldwide for 1990 and 2010. Among the leading causes of death, lower respiratory infections were ranked 3rd in 1990 and 4th in 2010, whereas COPD was ranked 4th in 1990 and 3rd in 2010. Lung cancer rose from 8th- to 5th- commonest cause of death, while tuberculosis fell from 6th to 10th position in the ranking.

The GBD Study also presented rankings for years lived with disability, among which asthma ranked 13th worldwide in 1990 and 14th in 2010, while COPD ranked 6th in 1990 and 5th in 2010. When premature deaths and disability were combined as DALYs  lost, lower respiratory infections were ranked the leading cause worldwide in 1990, and the 2nd most important cause of DALYs lost in 2010. Also among the 25 most important causes were COPD (ranked 6th in 1990 and 9th in 2010), tuberculosis (ranked 8th in 1990 and 13th in 2010) and lung cancer (ranked 24th in 1990 and 22nd in 2010).

The discovery of roflumilast for the treatment of chronic obstructive pulmonary disease (2016 Expert Opinion on Drug Discovery)

Dear Respiratory friends, we are happy to present you exciting story of  discovery of roflumilast for the treatment of COPD by great Italian team: Mario Cazzola, Luigino Calzetta, Paola Rogliani & Maria Gabriella Matera^.

Introduction: Cyclic adenosine monophosphate (cAMP) phosphodiesterase (PDE)4 is an intracellular target that can be exploited to the treat chronic obstructive pulmonary disease (COPD), given that it is expressed in all inflammatory cells implicated in this inflammatory airways disease. At the present time, roflumilast is the only PDE4 inhibitor that has received regulatory approval for use in patients with COPD.

Areas covered: The preclinical, clinical and post-marketing development of roflumilast is described. Furthermore, a critical analysis of the clinical data and positioning of this drug is undertaken in this review

 

Expert opinion: The identification of a subset of COPD patients, namely those suffering from severe airflow obstruction with symptoms of chronic cough and sputum and a history of previous exacerbations, as a specific target for roflumilast with the goal of reducing exacerbations, was entirely casual because the delineation of a “chronic bronchitis” responder group was clearly a post-hoc finding. However, it was useful to design prospective clinical trials that demonstrated reduced exacerbations in this specific subset of patients towards whom roflumilast therapy is now targeted. However, these pivotal trials still do not provide more accurate identification of the type of exacerbation to be treated by roflumilast. The identification of the right biological COPD exacerbation phenotype and/or the right clinical COPD phenotype are the only means that could justify the use of roflumilast as a first line anti-inflammatory therapeutic approach.

full text:

http://www.tandfonline.com/doi/abs/10.1080/17460441.2016.1184642

Indacaterol–Glycopyrronium versus Salmeterol–Fluticasone for COPD (full text article from NEJM 2016)

Dear Respiratory Friends great news come from NEJM about dual bronchodilators in COPD!

Most guidelines recommend either a long-acting beta-agonist (LABA) plus an inhaled glucocorticoid or a long-acting muscarinic antagonist (LAMA) as the first-choice treatment for patients with chronic obstructive pulmonary disease (COPD) who have a high risk of exacerbations. The role of treatment with a LABA–LAMA regimen in these patients is unclear.

 

Methods

We conducted a 52-week, randomized, double-blind, double-dummy, noninferiority trial. Patients who had COPD with a history of at least one exacerbation during the previous year were randomly assigned to receive, by inhalation, either the LABA indacaterol (110 μg) plus the LAMA glycopyrronium (50 μg) once daily or the LABA salmeterol (50 μg) plus the inhaled glucocorticoid fluticasone (500 μg) twice daily. The primary outcome was the annual rate of all COPD exacerbations.

Results

A total of 1680 patients were assigned to the indacaterol–glycopyrronium group, and 1682 to the salmeterol–fluticasone group. Indacaterol–glycopyrronium showed not only noninferiority but also superiority to salmeterol–fluticasone in reducing the annual rate of all COPD exacerbations; the rate was 11% lower in the indacaterol–glycopyrronium group than in the salmeterol–fluticasone group (3.59 vs. 4.03; rate ratio, 0.89; 95% confidence interval [CI], 0.83 to 0.96; P=0.003). The indacaterol–glycopyrronium group had a longer time to the first exacerbation than did the salmeterol–fluticasone group (71 days [95% CI, 60 to 82] vs. 51 days [95% CI, 46 to 57]; hazard ratio, 0.84 [95% CI, 0.78 to 0.91], representing a 16% lower risk; P<0.001). The annual rate of moderate or severe exacerbations was lower in the indacaterol–glycopyrronium group than in the salmeterol–fluticasone group (0.98 vs. 1.19; rate ratio, 0.83; 95% CI, 0.75 to 0.91; P<0.001), and the time to the first moderate or severe exacerbation was longer in the indacaterol–glycopyrronium group than in the salmeterol–fluticasone group (hazard ratio, 0.78; 95% CI, 0.70 to 0.86; P<0.001), as was the time to the first severe exacerbation (hazard ratio, 0.81; 95% CI, 0.66 to 1.00; P=0.046). The effect of indacaterol–glycopyrronium versus salmeterol–fluticasone on the rate of COPD exacerbations was independent of the baseline blood eosinophil count. The incidence of adverse events and deaths was similar in the two groups. The incidence of pneumonia was 3.2% in the indacaterol–glycopyrronium group and 4.8% in the salmeterol–fluticasone group (P=0.02). 

Conclusions 

Indacaterol–glycopyrronium was more effective than salmeterol–fluticasone in preventing COPD exacerbations in patients with a history of exacerbation during the previous year.

 

full text from todays NEJM:

http://www.nejm.org/doi/full/10.1056/NEJMoa1516385#t=article

World COPD Day 2015

World COPD Day is organized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in collaboration with health care professionals and COPD patient groups throughout the world. Its aim is to raise awareness about chronic obstructive pulmonary disease (COPD) and improve COPD care throughout the world
Each year GOLD chooses a theme and coordinates preparation and distribution of World COPD Day materials and resources. World COPD Day activities are organized in each country by health care professionals, educators, and members of the public who want to help reduce the burden of COPD.
The first World COPD Day was held in 2002. Each year organizers in more than 50 countries worldwide have carried out activities, making the day one of the world's most important COPD awareness and education events.

World COPD Day 2015 is taking place on Wednesday, November 18 around the theme “It’s Not Too Late.” This positive message was chosen to emphasize the meaningful actions people can take to improve their respiratory health, at any stage before or after a COPD diagnosis.

COPD 2015 Guidelines: The 2015 update of the Global Initiative for Chronic Obstructive Lung Disease

In 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) released a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD. It recommended a major revision in the management strategy for COPD that was presented in the original 2001 document. Updated reports released in January 2013, January 2014, and January 2015 are based on scientific literature published since the completion of the 2011 document but maintain the same treatment paradigm. Assessment of COPD is based on the patient’s level of symptoms, future risk of exacerbations, the severity of the spirometric abnormality, and the identification of comorbidities. The 2015 update adds an Appendix on Asthma COPD Overlap Syndrome, material prepared jointly by the GOLD and GINA Science Committees.

 

The GOLD 2015 report is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs based on available health care systems. The quadrant management strategy tool is designed to be used in any clinical setting; it draws together a measure of the impact of the patient’s symptoms and an assessment of the patient’s risk of having a serious adverse health event in the future. Many studies have assessed the utility/relevance of this new tool. Evidence will continue to be evaluated by the GOLD committees and management strategy recommendations modified as required.

GOLD has been fortunate to have a network of international distinguished health professionals from multiple disciplines. Many of these experts have initiated investigations of the causes and prevalence of COPD in their countries, and have developed innovative approaches for the dissemination and implementation of the GOLD management strategy. The GOLD initiative will continue to work with National Leaders and other interested health care professionals to bring COPD to the attention of governments, public health officials, health care workers, and the general public to raise awareness of the burden of COPD and to develop programs for early detection, prevention and approaches to management.

The GOLD 2015 report: direct link

www.goldcopd.org/uploads/users/files/GOLD_Report_2015_Apr2.pdf

Millions of smokers have undiagnosed COPD

More than half of smokers with normal spirometry had some form of respiratory-related impairment associated with COPD, Dr. Elizabeth A. Regan and the Genetic Epidemiology of COPD (COPDGene) investigators reported in JAMA Internal Medicine.

The findings imply that up to 35 million current and former smokers older than age 55 years in the United States may have some form of respiratory-related impairment associated with COPD that has gone undiagnosed with standard spirometry, the researchers wrote (JAMA Internal Med. 2015 June 22 (doi:10.1001/jamainternmed.2015.2735). 

They found that 55% of current and former smokers older than age 55 years in the study who did not meet the spirometric criteria for COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] 0 score) had significant respiratory disease. Their conclusion was based on seven metrics: chronic bronchitis (seen in 12.6% of the GOLD 0 participants), history of severe respiratory exacerbations (seen in 4.3%), dyspnea score of at least 2 (seen in 23.5%), quantitative emphysema exceeding 5% (seen in 9.8%), quantitative gas trapping exceeding 20%, (seen in 12.2%), St. George’s Respiratory Questionnaire (SGRQ) total score exceeding 25 (seen in 26%), and a 6-minute walk distance of less than 350 m (seen in 15.4%).

In 108 never smokers, none had chronic bronchitis or respiratory exacerbations, 3.7% had dyspnea, 8.3% had quantitative emphysema exceeding 5%, 10.2% had quantitative gas trapping exceeding 20%, 3.7% had SGRQ scores above 25, and 3.7% had a 6-minute walk distance of less than 350 m.

Dr. Regan of National Jewish Health and the University of Colorado, Denver, and her associates gathered data from 21 sites across the United States regarding 8,872 current or former smokers who were between the ages of 45 and 80 years and were classified using GOLD spirometric criteria based on postbronchodilator spirometry: 4,388 had a GOLD 0 score, defined as a normal postbronchodilator ratio of FEV₁ to forced vital capacity exceeding 0.7 and an FEV₁ percentage of at least 80% predicted; 794 patients had a GOLD 1 score, defined as mild COPD; and 3,690 had a GOLD 2-4 score, defined as moderate to severe COPD.

Compared with 108 never smokers, the GOLD 0 group had a worse quality of life score (mean SGRQ total score 17.6 for GOLD 0 and 7 for never smokers) and a lower 6-minute walk distance (447 m vs. 493 m). In a subset of 300 patients in the GOLD 0 group whose CT scans were visually scored, 42% (127) had evidence of emphysema or airway thickening. In a subset of 100 never smokers, 10% had evidence of emphysema or airway thickening.

Current guidelines do not include treating smokers with normal spirometry, but physicians recognize the role of medication in treating symptoms and effective treatments need to be determined for GOLD 0 patients, the researchers said. Respiratory medications were being prescribed to 20% of the GOLD 0 participants in COPDGene who had at least one impairment, yet these patients reported more symptoms.

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD 2015 UPDATE

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.

Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified.

Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. 

Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes.

World COPD Day 2014

Today is World COPD Day 2014! Please feel free to talk about ‪#‎COPD‬ every day and every possible moment, but not only today! Spreed the word! COPD remains the important cause of death at the global level!
World COPD Day is organized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in collaboration with health care professionals and COPD patient groups throughout the world. Its aim is to raise awareness about chronic obstructive pulmonary disease (COPD) and improve COPD care throughout the world

Each year GOLD chooses a theme and coordinates preparation and distribution of World COPD Day materials and resources. World COPD Day activities are organized in each country by health care professionals, educators, and members of the public who want to help reduce the burden of COPD.

The first World COPD Day was held in 2002. Each year organizers in more than 50 countries worldwide have carried out activities, making the day one of the world's most important COPD awareness and education events.

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COPD: The Differences Between The Diseases We Donate To, And The Diseases That Kill Us

Julia Belluz created the infographic below to compare how much money is donated to fight various disease and how many people in the USA die from those same diseases. She wrote: The choices we make about where to donate money for health causes aren't always rational. We are probably more often driven to give by a disease that has touched a loved one than by utilitarian calculations about which illnesses impact the most people or receive the least investment from pharmaceutical companies.

You can see COPD discrepancy on the graphic which is pretty striking, and certainly worth thinking about!

There are no important and less important diseases, but we can see this simplistic approach in health care systems all over the world!

The Burden of COPD: Update 2014

Chronic obstructive pulmonary disease (COPD) is a long-term condition that causes inflammation in the lungs, damaged lung tissue and a narrowing of the airways, making breathing difficult. There are many different types of the condition, although little is known about what causes this variation and the best way to manage the different versions of the disease.

Governments, industry and the general public need to be more aware of the high burden of COPD at the global level
More research is needed on the different variations of COPD and their economic burden on societies 
There is a lack of reliable data on the incidence of COPD – member states should improve reporting

COPD Istanbul 2014: International update on COPD

I would like to share with you my experience and impressions about the COPD Istanbul 2014, which took place in Istanbul, Turkey at 8-10 March 2014. The main topic of the Congress was COPD. The conference was attended by a wide range of professionals (more than 500 persons) such as industry leaders, university academics and researchers from all the regions including Turkey, Middle East, Asia, North Africa and Europe. It was high level meeting, the speakers were world known leader in COPD and in Respiratory medicine:

Antonio Anzueto, USA Ashraf Alzaabi, UAE Abdel Rahman Anani, Jordan Nasser Behbehani, Kuwait Francesco Blasi, Italy Miron Bogdan, Romania Demosthenes Bouros, Greece Jean Bousquet, France Vito Brusasco, Italy Mario Cazzola, Italy Alexander Chuchalin, Russia Alexandru Corlateanu, Moldovia Mukadder Calikoglu, Turkey Ronald Dahl, Denmark Giuseppe Di Maria, Italy Anh-Tuan Dinh Xuan, France Pinar Ergun, Turkey Leonardo Fabbri, Italy Mina Gaga, Greece Christina Gratziou, Greece Hakan Gunen, Turkey Gazi Gulbas, Turkey Nilgun Gurses, Turkey Nicola Alexander Hanania, USA Ashraf Hatem, Egypt Ismail Hanta, Turkey Loay El Husseini, Jordan Yavor Ivanov, Bulgaria Nadim Kanj, Lebanon Adel Khatab, Egypt Gunseli Kilinc, Turkey Kosta Kostov, Bulgaria Filiz Kosar, Turkey Jan Lotvall, Sweden

Bassam Mahboub, UAE Maria Gabriella Matera, Italy Florin Mihaltan, Romania Marc Miravitlles, Spain Arzu Mirici, Turkey Mostafa Moin, Iran Levent Cem Mutlu, Turkey Denis O'Donnell, Canada Mustafa Ozhan, Turkey Can Ozturk, Turkey Onder Ozturk, Turkey Clive Page, UK Reynold Panettieri, USA Alberto Papi, Italy Mehmet Polatli, Turkey Nikolaos Siafakas, Greece Joan Soriano, Spain Mecit Suerdem, Turkey Sema Umut, Turkey Omar Usmani, UK Esra Uzaslan, Turkey Thys Van der Molen, The Netherlands Mirna Waket, Lebanon Wisia Wedzicha, UK

1^st  Day of the COPD Istanbul 2014  was dedicated to hot topics in COPD:

Phenotyping the heterogeneity of COPD

Inhaled corticosteroids for COPD

Bench to bedside approach in COPD

New GOLD 2014 Staging: COPD Treatment from A to D

Outcomes for COPD

Pulmonary rehabilitation in COPD; highlights

Emerging therapies for COPD

Prof. Mario Cazzola, Italy and Prof. Gunseli Kilinc, Turkey. Opening Ceremony of COPD Istanbul 2014.

2^nd Day of the COPD Istanbul 2014 was dedicated to:

Overlap syndromes in COPD

COPD: markers and inflammation

COPD guidelines: the important thing is not to stop questioning

Exacerbation of COPD: New perspectives

Management of COPD with NIV

this my presentation: 

The assessment of management of stable COPD: an update 2014 by Corlateanu for COPD Istanbul 2014 from Alexandru Corlateanu

3rd Day of the COPD Istanbul 2014 was dedicated to:

Small airways in COPD – no longer silent

COPD: Effects beyond the Lungs

Prof. Nikos Siafakas, Greece. Closing ceremony of COPD Istanbul 2014

Finally we would like to thank COPD Istanbul 2014 Scientific committee and its Chair Prof. Mario Cazzola, Italy and Vice-chairs Prof. Nikos Siafakas, Greece and Prof. Gunseli Kilinc, Turkey for a successful Conference and remarkable annual organization which allowed taking part in different discussions, to acquire useful information and to establish relations with international specialists.

Janus Look in Pulmonology: COPD-Asthma overlap syndrome

In ancient Roman religion, Janus (his name in Greek is 'Ιανός - Ianós) is the god of beginnings and transitions, thence also of gates, doors, passages, endings and time. He is usually depicted as having two faces, since he looks to the future and to the past. The Romans named the month of January (Ianuarius) in his honor.

An overlap syndrome is a disease in which a patient presents with symptoms of two or more diseases. That is why Janus can be associated with overlap syndrome.

Multiple epidemiological studies demonstrate that in persons with obstructive airway disease, as many as half or more may have overlapping of asthma and COPD. The term Asthma COPD overlap syndrome (ACOS) was recognized and is appearing for the first time in GOLD 2014, but without clear definition and therapeutic options. A COPD-Asthma overlap syndrome is defined as an airflow obstruction that is not completely reversible, accompanied by symptoms and signs of increased obstruction reversibility. For the clinical identification of overlap syndrome COPD-Asthma Spanish guidelines proposed six diagnostic criteria. The major criteria include very positive bronchodilator test [increase in forced expiratory volume in one second (FEV1) ≥15% and ≥400 ml], eosinophilia in sputum, and personal history of asthma. The minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV1 ≥12% and ≥200 ml) on two or more occasions. The overlap syndrome COPD-Asthma is associated with enhanced response to inhaled corticosteroids due to the predominance of eosinophilic bronchial inflammation.The future clinical studies and multicenter clinical trials should lead to the investigation of disease mechanisms and simultaneous development of the novel treatment.

New review article on this Hot Respiratory topic just published in Journal of Cardio-Thoracic Medicine and its free for download.

2014 International Guidelines on COPD: Update of Global Initiative GOLD

Dear Respiratory friends today was launched Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2014! It is the last update of the most important global guidelines on COPD! 

The GOLD report is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs based on available health care systems. The quadrant management strategy tool is designed to be used in any clinical setting; it draws together a measure of the impact of the patient’s symptoms and an assessment of the patient’s risk of having a serious adverse health event in the future. More and more evidence is being produced to evaluate this strategy. Evidence will continue to be evaluated by the GOLD committees and management strategy recommendations modified as required.

Lung Health in Europe in 21 Century: COPD

The European Lung Foundation and the European Respiratory Society have launched a short version of the European Lung White Book, centred around a series of infographics focusing on the key statistics on epidemiology and burden of Respiratory diseases in Europe.

The book, which was launched in Brussels this week, is aimed at policymakers, the public and patients who are looking to quickly and updated access the information on the Respiratory health in Europe.

Today we are happy to present you infographics on COPD from European Lung White Book. 

World COPD Day 2013: one more chance to make some noise for COPD

The early stages of COPD are often unrecognized, in part because many individuals discount symptoms such as breathlessness, chronic cough, and bringing up phlegm as a normal part of getting older or an expected consequence of cigarette smoking.

 

World COPD Day in Moldova!

 

“Better awareness of COPD symptoms like chronic cough and breathlessness is key to improving early diagnosis,” says Dr. Marc Decramer, Chair of the Board of Directors of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD is the organizer of World COPD Day.

 

World COPD Day in Moldova!

COPD is diagnosed using a breathing test called spirometry. This test, which is painless and takes only a few minutes, measures the amount of air a person can breathe out, and the amount of time taken to do so. Researchers are also studying additional ways to identify COPD earlier in the course of disease.

There is no cure for COPD, which may also contribute to underdiagnosis of the disease. People whose breathlessness is more severe may find the possibility of finding out that they have COPD frightening, and avoid seeking treatment. “COPD treatment is most effective when begun early in the course of the disease,” says Dr. Jorgen Vestbo, Vice-Chair of the GOLD Board of Directors. “However, at all stages of disease, treatments are available that reduce symptoms such as breathlessness and enable people to participate more fully in daily life.” Furthermore, new medications hold the promise of treating COPD more effectively and with fewer side effects. Scientists are also studying disease markers that in the future may enable them to predict when a person’s COPD symptoms will get worse. “In order to reduce the burden of COPD, we have to identify more of the people who have it,” says Dr. Vestbo.

COPD occurs most often in patients who are over age 40 and who have a history of exposure to COPD risk factors. Worldwide, the most commonly encountered risk factor for COPD is cigarette smoking.  Other important risk factors include dusts and chemicals encountered on the job and smoke from biomass fuels (such as coal, wood, and animal dung) burned for cooking and heating in poorly ventilated dwellings, especially in developing countries.

Patients may be able to slow or even stop the progress of COPD by reducing their exposure to risk factors for the disease. Without treatment, however, COPD is generally a progressive disease, and as the disease gets worse patients become breathless during everyday activities such as climbing a flight of stairs, walking the dog, or even getting washed and dressed in the morning.

World COPD Day was first held in 2002, and has grown each year to become one of the most important COPD events globally. On World COPD Day, dozens of awareness-raising activities for health care professionals, COPD patients, the general public, and the media will take place in countries all over the world.