Intended for healthcare professionals


Chronic obstructive pulmonary disease

BMJ 2003; 326 doi: (Published 15 May 2003) Cite this as: BMJ 2003;326:1046
  1. David Price (, general practice airways group professor of primary care respiratory medicine,
  2. Martin Duerden (, senior lecturer in therapeutics
  1. Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY
  2. Department of Medicines Management, Keele University, Keele, Staffordshire ST5 5BG

    The lack of a national service framework should not allow us to ignore it

    Chronic obstructive pulmonary disease causes significantly more mortality and morbidity than other causes of airflow limitation in adults1 but is underdiagnosed and under-recognised. The World Health Organization estimates that chronic obstructive pulmonary disease is the fourth leading cause of death worldwide, with 2.74 million deaths in 2000, and this burden is growing rapidly.2 The main cause is cigarette smoking, and the United Kingdom is now experiencing the ravages of a past high prevalence of smoking in its ageing population. Costs for 1996-7 showed that the NHS spent more than £818m ($1.3bn; €1.2bn) on the disease.3

    In the United Kingdom chronic obstructive pulmonary disease accounts for as many as one in eight medical admissions.1 Emergency admissions for chronic obstructive pulmonary disease have recently risen dramatically, contributing notably to the hospital bed crisis.4 Annual admissions peak in early January, due, in part, to increased respiratory illness, acute exacerbations, and reduced primary care support over the holidays.5 6

    The prevalence of chronic obstructive pulmonary disease is greatest in socioeconomically deprived people; the differential effect between higher and lower social groups is perhaps greater for chronic obstructive pulmonary …

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