Chronic obstructive pulmonary disease. Mortality and mortality reduction.

Chronic obstructive pulmonary disease (COPD) affects an estimated 15 million Americans and is the fourth most common cause of death in the US. Despite an improved understanding of the disease, treatment has changed little over the past 20 to 30 years and COPD remains a major health problem worldwide. Smoking is the major risk factor for COPD, accounting for some 90% of cases. Therefore, smoking cessation remains the most important intervention. Other available pharmacotherapeutic options include corticosteroids, bronchodilators, antibiotics for the treatment of acute exacerbations, mucokinetic agents, and oxygen for the advanced stages of the disease. Recent data investigating the use of dornase alfa (recombinant human deoxyribonuclease I) in patients with acute exacerbations of COPD were disappointing and failed to demonstrate a mortality benefit. While it is likely that ongoing research will optimise the use of older agents and identify new treatment options for patients with COPD, smoking cessation will probably remain the most important intervention and should be a key focus of future initiatives aimed at controlling this disease.