ABSTRACT
Selection of topics for clinical practice guidelines development has to be guided by several objectives: to improve clinical outcomes, to limit unexplained variations in clinical practice, to concern a large number of patients, to reduce health care costs and/or improve health care organization, to guide clinical research (1). Most of these objectives are relevant in chronic obstructive pulmonary disease (COPD): this disease was the 6th leading cause of death in 1990, and is expected to be the 3rd in 2020. COPD is also a leading cause of disability and quality of life impairment; its global burden can now be estimated using a new standard epidemiological unit, the DALY (disability-adjusted life year), which combines years of life lost due to premature mortality and years lived with disability, and which can be calculated using estimates of incidence, mortality, duration and severity of the disease (2-4). In terms of global DALYs, COPD was in 12th position in 1990 and is expected to be in 5th position in 2020. It can be estimated that up to 5% of the adult population are concerned in industrialized countries. However, accurate epidemiological data on COPD prevalence are difficult to obtain, so that the real frequency of the various forms of the disease is largely unknown.
