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Chronic obstructive pulmonary disease: a worldwide problem.

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Respiratory diseases receive little attention and funding in comparison with other major causes of global morbidity and mortality. Chronic obstructive pulmonary disease (COPD) has been a major public health problem and will remain a challenge for clinicians within the twenty-first century. Worldwide, COPD is in the spotlight because of its high prevalence, morbidity, and mortality, and creates formidable challenges for health care systems.

This review summarizes the magnitude of the COPD problem at the population and individual levels.

Genes and chronic obstructive pulmonary disease.

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The marked variability in individual susceptibility to the detrimental effects of smoking on lung function and other findings suggest a significant genetic contribution to chronic obstructive pulmonary disease (COPD). The only known genetic risk factor for COPD, severe a(1)-antitrypsin (AAT) deficiency, explains only 1% to 2% of cases of this disease. Screening for severe AAT should be done in all cases of COPD.

There is considerable interest in identifying susceptibility genes for COPD unrelated to severe AAT deficiency, as this could greatly enhance efforts to prevent, diagnose, and treat COPD by yielding novel insights into its pathogenesis.

Contribution of the environment and comorbidities to chronic obstructive pulmonary disease phenotypes.

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Chronic obstructive pulmonary disease (COPD) is characterized by significant disease heterogeneity. This heterogeneity suggests that various influences, including environmental and biological factors, probably contribute to the disease, but the validation of specific phenotypes has been problematic.

This article reviews differences in the presentation and progression of COPD in relation to environmental risk factors and comorbidities. The clustering of certain comorbidities in COPD could help to identify patients who share similar inflammatory pathways.

New research covering large patient populations with extensive clinical and biological characterization, and advanced analytical methods can expand the potential to identify COPD phenotypes and develop targeted therapies.

The Role and Potential of Imaging in COPD.

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Chronic obstructive pulmonary disease is a heterogeneous condition of the lungs and body. Techniques in chest imaging and quantitative image analysis provide novel in vivo insight into the disease and potentially examine divergent responses to therapy.

This article reviews the strengths and limitations of the leading imaging techniques: computed tomography, magnetic resonance imaging, positron emission tomography, and optical coherence tomography. Following an explanation of the technique, each section details some of the useful information obtained with these examinations.

Future clinical care and investigation will likely include some combination of these imaging modalities and more standard assessments of disease severity.

Defining patient-reported outcomes in chronic obstructive pulmonary disease: the patient-centered experience.

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Chronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality. Patients with COPD experience impaired health-related quality of life (HRQOL) and disability. However, many challenges exist in the evolving field of HRQOL measurement and interpretation.

This article defines HRQOL, discusses instruments used to measure HRQOL, and reviews related literature.

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