By 2020,COPD is expected to become the third leading cause of death in the world. Despite these staggering statistics, many people with COPD continue to go undiagnosed or misdiagnosed and many appropriately diagnosed go under-treated.³ Part of the problem may well involve the perceptions and misperceptions that continue to envelop the disease.

The perception is that COPD is a disease of the elderly, but 50% of COPD patients are younger than 65 years.⁴ COPD is as common as asthma and diabetes in people aged 45–64 years,⁵ and patients under the age of 65 account for 67% of COPD office visits and 43% of hospitalizations.⁶ The perception is that COPD is a disease of men, but women accounted for 63% of all self-reported cases in 2000. The same year, COPD hospitalizations for women outnumbered those for men (404,000 versus 322,000)⁷ and, between 1980 and 2000, the COPD mortality rate in women increased 182%. In the 2000 Confronting COPD in America survey, over 90% of those surveyed were Caucasian. Only one tiny per cent of the 1,200 patients enrolled in the National Emphysema Treatment Trial (NETT) were minorities, yet data from New York City documents that of the 10,000 COPD hospitalizations per year, almost 50% are minorities. The new face of COPD is clearly younger, and there are more cases in women and minorities.

Another perception is that COPD is a self-induced disease. Patients often blame themselves, family members often blame the patients, and, according to the recently published national COPD Needs Assessment Survey, more than 90% of surveyed primary care physicians, pulmonologists, and respiratory therapists agree that COPD is a selfinduced disease.⁸ Certainly, the large majority of COPD patients have a smoking history,⁹ but only 15–20% of smokers develop significant COPD. Obviously, other factors—whether genetic or environmental—must play a role. It is also worth noting that smoking, poor eating habits, and a low exercise rate are often contributing factors to the development of cardiac disease, but cardiologists, their patients, and their patients’ families rarely appear to focus on ‘assigning blame’.

It is also perceived that morning cough and sputum production is a ‘normal smoker’s cough’ and that increasing shortness of breath with activity reflects increasing age, increasing weight, or deconditioning. The reality is that these are all potential symptoms of COPD. Far too often people cut back their activities to limit symptoms rather than seeking medical care. The National Lung Health Education Program (NLHEP) has pushed the use of spirometry in those exposed to risk factors or those with appropriate symptoms so that people will know their forced expiratory volume in one second (FEV₁); while most people seem to know their blood pressure and cholesterol level, only a fraction appears to know their level of lung function.

The perception is that COPD remains an untreatable disease.The reality is that therapeutic options continue to improve.¹⁰ Smoking cessation clearly slows the rate of deterioration in lung function. Bronchodilators can relieve symptoms, improve health status, increase exercise tolerance, and prevent and treat exacerbations. In patients with more severe disease and recurrent exacerbations, adding inhaled corticosteroids (ICSs) can further limit exacerbations and improve quality of life.