ABSTRACT
Patients with chronic obstructive pulmonary disease (COPD) characteristically complain about chronic cough, sputum production, and dyspnea, especially on exertion. They experience frequent exacerbations and, in more advanced disease, hospitalizations. COPD typically affects middle-aged and older persons who either smoke or have a smoking history, but the disorder does not occur exclusively in smokers. The American Thoracic Society defines COPD as a disease state characterized by the presence of airflow limitation due to chronic bronchitis or emphysema (1). In many patients the disease is relentlessly progressive, with increasing loss of lung function, leading to early disability and premature death. In this chapter we will first look at the definition of the disease. We focus on its progressive nature, and especially on risk factors for accelerated decline and survival. Subsequently, risk factors for other markers of disease progression such as exacerbation and hospitalization rates and loss of quality of life will be briefly discussed.
