Preface

Chronic obstructive pulmonary disease (COPD) continues to cause disabling symptoms and impair the functional status and quality of life of millions of people worldwide. COPD is anticipated to become the third leading cause of death by the year 2020 [1]. Since the time of the last issue of Clinics in Chest Medicine on COPD published in December 2000, extraordinary efforts have been made by investigators and clinicians worldwide to gain an increased understanding of the pathogenesis and to refine the therapeutic management of this disabling disease. It has become recognized increasingly that heterogeneous clinical phenotypes of COPD exist, both with regard to varying degrees of emphysema and airways inflammation and remodeling in the lung, and with regard to the systemic manifestations and functional impact of the disease. It is also now well recognized that several factors in addition to lung function (including exercise tolerance and nutritional status among others) impact patient mortality risk. In recent years, investigations began to focus on unraveling differences in pathogenesis and genetic propensity to develop the varying COPD phenotypes. Increased emphasis has also been placed on assessing patient centered outcomes (such as exercise tolerance, symptoms, and health status) and measuring changes in lung function in response to various therapeutic interventions. The ability of treatment interventions to impact the systemic manifestations of COPD and to alter mortality also has become a subject of great interest.

I hope that this issue of Clinics in Chest Medicine will provide the reader with current state-of-the-art knowledge of these many aspects of COPD. The introductory article by Dr. MacNee discusses the many facets of the pathogenesis of COPD. The discussion relates many cellular and molecular events to the structural and functional changes found in the lungs of COPD patients. The article by Drs. Cote and Celli reviews current knowledge regarding predictors of mortality and discusses multi-dimensional tools used to assess disease severity and predict outcomes in COPD patients. The article by Drs. Hurst and Wedzicha discusses COPD exacerbations, which are recognized increasingly to play an important role in the decline in lung function and development of disability over time. The article by Drs. Remels, Schols, and colleagues provides a state-of-the-art discussion of the mechanisms of skeletal muscle dysfunction and systemic inflammation in COPD, and the article by Drs. Stone and Nici highlights other systemic manifestations of the disease, including the impact of COPD on the cardiovascular system. Ms. Reardon's comprehensive article on the adverse health effects of environmental tobacco smoke and Dr. Crothers' article on COPD among HIV-infected patients are also unique and very important novel contributions to this issue of Clinics in Chest Medicine.

It is now appreciated that effective management of COPD requires a multidisciplinary, long-term, integrated approach to care. From the therapeutic standpoint, Drs. Hanania and Sharafkhaneh provide a thorough update on pharmacologic treatment of COPD, and Dr. Anzueto discusses existing strategies to modify the disease. Increasingly, health care providers are recognizing that optimal comprehensive care of patients who have COPD also requires investment by and participation of the patient in his or her own care and effective partnership between patients and their health care providers. The article by Dr. Bourbeau and Ms. Nault provides a review of self-management strategies and effective means of patient—health care provider partnering in the management of COPD. The discussion by Drs. Ambrosino, Palmiero and Strambi considers existing and novel strategies to optimize the benefits of pulmonary rehabilitation. Finally, in the last several years, much knowledge has accrued regarding the benefits and risks of surgical therapies for COPD, and Drs. Lederer and Arcasoy review this topic in detail.

I thank each of the authors for their participation in this project, for their wonderful, scholarly contributions, and for their incredible hard work! I also extend my sincere gratitude to Sarah Barth and her colleagues at W.B. Saunders for their patience and efforts to bring this project to fruition. It has, indeed, been my great pleasure to have the opportunity to serve once again as a Guest Editor for Clinics in Chest Medicine and to work with such a superbly skilled and dedicated group of colleagues!