The big three concept: a way to tackle the health care crisis?

Tobacco use is the leading preventable cause of death and morbidity in the world. Chronic obstructive pulmonary disease (COPD), lung cancer, and cardiovascular disease (CVD) are the three major smoking-induced diseases that co-exist and can be detected at an early stage by screening, but are usually recognized in an advanced stage and treated as single entities. New epidemiologic data indicate a common origin of these diseases in susceptible individuals, and potential disease modification. Further exploration of a holistic concept of the Big Three smoking-induced diseases-COPD, lung cancer, and CVD-may be one way of reducing the burden of illness for individuals and society. This includes a reshift from reactivity to proactivity. Future treatment and management approaches should thus be focused on disease prevention. In this article, the Big Three concept is suggested, which aims for (1) identification of susceptible smokers; (2) screening for early diagnosis; (3) development of new treatment modalities that target shared disease mechanisms, thus having the potential to affect more than one of the comorbidities; and (4) increased awareness of these co-existing diseases and modification of current guidelines across specialties.