Epidemiology and costs of chronic obstructive pulmonary disease
Authors: K. R. Chapman, D. M. Mannino, J. B. Soriano, P. A. Vermeire, A. S. Buist, M. J. Thun, C. Connell, A. Jemal, T. A. Lee, M. Miravitlles, S. Aldington, R. Beasley
Journal: European Respiratory Journal (2005)

the Burden of Obstructive Lung Disease (BOLD) initiative to facilitate standardised burden studies at an international level; and 3) the ongoing discussions to set up large, long-term cohorts of patients to better define the natural history of COPD.These programmes, together with the dissemination of GOLD in .70countries, are helping to spread a more positive message about COPD and raise awareness of its importance.This International Research Workshop on the Global Burden of COPD was organised with the aid of an unrestricted grant from GlaxoSmithKline R&D (Greenford, Middlesex, UK).The current authors were able to convince .30researchers, most of them with an international reputation in COPD epidemiology, health economics and related areas of research, to share their experiences and vision about COPD in Vancouver, Canada.The success of the workshop was guaranteed by the quality and diversity of its speakers from five continents.The participants were from the World Health Organization (WHO), GOLD, ATS and ERS, and included cancer and cardiovascular epidemiologists.The programme was divided into three main sessions: burden; natural history and surrogates; and policy.Each speaker provided a mini-paper summarising his/her presentation.The current authors would like to sincerely thank the European Respiratory Journal for considering and disseminating these proceedings.Finally, a sad note is required.Professor Romain Pauwels was supportive of this workshop from its conception and aimed to participate actively.However, he was unable to attend due to his fragile health and finally passed away on January 3, 2005.It is to his tireless effort to fight lung disease with an international, scientificevidence approach that these proceedings are dedicated.COPD has been a major public health problem during the twentieth century and will remain a challenge for the foreseeable future.Indeed, even if all smokers quit smoking today, the toll of COPD would continue for several generations, since there are so many people worldwide who are already afflicted.COPD epidemiology, or the study of COPD and its determinants at the population level and its partner discipline, outcomes research, or the study of costs by quantifying the burden of COPD to society and comparing it with other diseases will show their true value if a collaborative, multidisciplinary action is undertaken. WORLDWIDE EPIDEMIOLOGY OF COPD AND BOLD SummaryWorldwide, COPD is in the spotlight, since the high prevalence, morbidity and mortality present challenges for healthcare systems.The inconsistent use of terminology for COPD, and the lack of widely accepted diagnostic standards for the diseases that are included in the coding within the COPD spectrum have contributed to the inaccuracy of mortality data for COPD.The approach of using the single term COPD (rather than individual coding for chronic bronchitis, emphysema and chronic airway obstruction) is being championed in global and national guidelines, with the expectation that this will improve awareness, simplify the coding and, ultimately, lead to greater accuracy in death certification for COPD.In 2000, there were more deaths in the USA from COPD among females than males.In contrast to the trend for cardiovascular diseases, death rates from COPD have been rising steadily over the past few decades.This striking increase in COPD as a cause of death is projected to occur because of the worldwide epidemic of smoking, and the changing global demographics where more people in developing countries are living longer and, therefore, are at risk of COPD for longer.Prevalence estimates may vary widely depending on which spirometric criteria are used.The BOLD initiative, which is a programme designed to provide strictly standardised, rigorous and practical methods for estimating the prevalence and social and economic burden of COPD, is described.