The course of
COPD has traditionally been equated with an accelerated decline in the forced expiratory volume in one second (FEVi) over time in patients with
COPD, compared to healthy individuals. However, other important clinical outcomes associated with
COPD also worsen over time and should also be considered in conceptualizing the course of
COPD. These include health status,
breathlessness related to
activities of daily living, exercise capacity, the frequency of exacerbations, and peripheral
muscle weakness. These outcomes are often quite responsive to
therapy of
COPD. Presently there is no evidence that any treatment other than smoking cessation can normalise the rate of decline of FEVi, and therefore be considered as modifying the physiologic course of the disease. Thus, smoking cessation reigns as the primary disease modifying strategy in
COPD. Even though there are a number of
smoking cessation products on the market and smoking prevalence continues to decrease marginally each year, more needs to be done to provide comprehensive programmes to help people quit smoking. In the US in 2004, 37.5% of preventable deaths were found to be tobacco-related. The FEVi does not reflect the clinical manifestations or the total burden of this multidimensional illness. As novel therapeutic agents become available that may alter the underlying pathology of
COPD, additional markers and outcomes of
disease progression will be needed to provide a more comprehensive assessment. There has been increasing interest in predicting and assessing mortality as it is the final outcome of
disease progression. In this review we have considered three approaches toward modifying the course of
COPD: smoking cessation, reduction in lung hyperinflation through medical and surgical approaches, and long-term
pharmacotherapy.