In the five years since the publication of the first Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) report,¹ awareness of COPD has increased appreciably. The early hope that the problem of COPD would recede as smoking numbers fell has not been realised, partly because of the ageing population in developed countries and the increase in tobacco consumption and air pollution in developing economies.² This problem is strikingly illustrated by the high prevalence of COPD recorded in the PLATINO study from South America which used carefully standardised techniques to make comparisons between five large South American cities where the prevalence of COPD varied from 7.8% to 19%.³

The problem of COPD is therefore rather larger than many had anticipated, but we are not short of effective responses to it. Intensive smoking cessation programmes can produce long term benefits, although it may take many years before these become evident,⁴ while simply changing the form of heating used in developing countries can have more immediate effects.⁵ Several authoritative guidelines have evaluated different management strategies and produced coherent programmes for their implementation.^6,7 We now have safe long acting inhaled bronchodilator drugs that work throughout the day,⁸ while inhaled corticosteroids not only reduce the risk of exacerbation⁹ but may impact on mortality.¹⁰ Combining long acting β agonists and inhaled corticosteroids is more effective than either treatment alone,¹¹ and the treatment effects are apparent earlier than previously thought.¹² Pulmonary rehabilitation produces important clinical benefits in those who complete the programme¹³ and may help reduce hospital admissions.¹⁴ Oxygen therapy can improve exercise performance¹⁵ but is …