ABSTRACT
The burden of chronic obstructive pulmonary disease (COPD) on the health care
system is enormous. COPD is currently the fourth leading cause of death in the
United States. It is predicted to be the fifth (currently 12th) leading cause of
DALY (Disability adjusted life year ¼ the sum of years lost because of premature morbidity and mortality, and years of life lived with disability adjusted for
the severity of disability) in the world by 2020 (1). Since 1979, deaths attributed
to COPD have increased 118%, and this is the only condition in which the death
rate has continued to rise (2,3). Over 16 million patients are afflicted with COPD
in the United States, with annual health care utilization including 17 million
office visits, 700,000 hospitalizations, and direct costs of care estimated to
exceed $14 billion annually (indirect costs exceed $10 billion) (4). When com-
pared with other conditions, COPD accounts for 5% of all office visits to phys-
icians and over 13% of all hospitalizations (5,6).
