Recent advances in the assessment and management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a syndrome of progressive airflow limitation caused by an abnormal inflammatory reaction of the airways and lung parenchyma. It stems from chronic tobacco smoking, and indoor air pollution, and bronchospasm is the predominant cause of the symptoms. The condition is the result of environmental insult and host reaction that is likely to be genetically predetermined. Chronic obstructive pulmonary disease exhibits expiratory airflow limitation due to abnormalities in the airways and/or lung parenchyma. The disease begins with an asymptomatic phase and onset of the symptomatic phase develops with a fall in forced expiratory volume in one second (FEV1) below 70% of the predicted value. There is reduction in diffusing capacity, hypoxaemia and alveolar hypoventilation. However, it is intriguing why only a fraction of smokers develop clinically relevant COPD.