Fundacio´n Caubet-CIMERA Illes Balears, Bunyola, Spain.
Proc Am Thorac Soc. 2011 Aug;8(4):363-7. doi: 10.1513/pats.201102-017RM.
Chronic obstructive pulmonary disease (COPD) has been a major public health problem during the 20th century, and will remain a challenge for the foreseeable future. Worldwide, COPD is in the spotlight, because its high prevalence, morbidity, and mortality create formidable challenges for healthcare systems. However, there remain many ongoing, contentious issues in COPD, including the definition and staging of COPD itself. Similarly, it appears that there is no consensus as yet on how, when, and where spirometry and other tools (symptoms assessment, imaging, biomarkers, and so on) should be conducted and implemented to screen, label, and treat for COPD, if any. Our current knowledge on the epidemiology, risk factors, and clinical presentation of COPD has been reasonably well documented in several previous reviews. We aim to summarize new developments surrounding the epidemiology of COPD, both at the population and at the clinical level, in comparison with other major burden contributors, while debating old and novel risk factors. Cigarette smoking is the principal causal factor, but other factors play a role in causing and triggering COPD. Likely, the clinical presentation of COPD and its contributing phenotypes within the remainder of the 21st century will be different than the "blue bloaters" and "pink puffers" observed one or two generations ago. Hopefully, the COPD clinical course will shift to better outcomes and prognosis than in the past.
慢性阻塞性肺疾病（COPD）是 20 世纪的主要公共卫生问题之一，在可预见的未来仍将是一个挑战。在全球范围内，COPD 备受关注，因为其高患病率、发病率和死亡率给医疗保健系统带来了巨大的挑战。然而，COPD 仍存在许多悬而未决的争议问题，包括 COPD 的定义和分期。同样，似乎在如何、何时以及何地进行并实施肺功能检查和其他工具（症状评估、影像学、生物标志物等）以筛查、标记和治疗 COPD 方面尚未达成共识，如果有的话。我们目前对 COPD 的流行病学、危险因素和临床表现的了解在之前的几次综述中已经有了合理的记录。我们旨在总结 COPD 流行病学在人群和临床层面的新发展，与其他主要负担因素进行比较，同时讨论旧的和新的危险因素。吸烟是主要的致病因素，但其他因素也在导致和引发 COPD 中发挥作用。很可能，在 21 世纪剩余时间内，COPD 的临床表现及其在剩余人群中的表型将与一两个世代前观察到的“蓝肿者”和“粉红喘鸣者”不同。希望 COPD 的临床病程能比过去有所改善，预后更好。
