Smoking-related diseases: the importance of COPD.

SETTING

Smoking plays a major role in a variety of diseases. Despite a strong relationship between smoking and chronic obstructive pulmonary disease (COPD), cardiovascular disease and lung cancer attract greater attention.

OBJECTIVE

To assess the burden of illness produced by smoking.

DESIGN

Smoking-attributable risk (SAR) and smoking-attributable disease burden (mortality, morbidity, and cost) were estimated for four conditions: COPD, coronary heart disease (CHD), lung cancer, and stroke.

RESULTS

Smoking-attributable deaths worldwide were: 1772 580 COPD, 1277 000 CHD, 822 150 lung cancer, and 788 580 stroke. Smoking-attributable disability adjusted life years (DALYs) were: 47 232 000 COPD, 18 106 000 CHD, and 11 052 000 stroke. US smokingattributable costs were: dollar 26.0 billion CHD, dollar 24.9 billion COPD, and dollar 9.0 billion stroke. US smoking-attributable annual hospitalizations were: 520 000 COPD, 460 000 CHD, and 183 000 stroke.

CONCLUSIONS

Cardiovascular disease and lung cancer rank high in absolute estimates of disease burden. However, COPD has a more substantial smoking-attributable disease burden. COPD deserves more attention in the health care sector. Smoking cessation programs, pharmacological interruption of the pathophysiology of smoking-related COPD, and effective management of COPD should be key targets of intervention and research.