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Not long ago treatment of chronic obstructive pulmonary disease (COPD) was viewed with a sense of nihilism.1 Patients were chronically and irreversibly debilitated. Treatments brought only brief palliative relief, and most had serious side effects. Worst of all, many patients were hopelessly addicted to nicotine, and the frustration of watching patient after patient continue to destroy their lungs in spite of their warnings caused many doctors to give up on even diagnosing the disease. Sceptics could point to the relative lack of efficacy of inhaled steroids in COPD. Cynics could question the motives of those who want to help persons who have destroyed their own health.
The last decade has seen the introduction of new treatments for COPD, which in turn have brought a new perspective and sense of energy.1 It is not uncommon in medicine that the discovery of new treatments results in a surge of new interest in a disease. Many examples of this phenomenon are notable in recent history: sleep apnoea, pulmonary hypertension and erectile dysfunction are but a few. The release of the long-acting anticholinergic drug tiotropium, the approval of combined long-acting β2 agonist/corticosteroid inhalers for COPD, development of new nebulised agents and release of innovative medications for nicotine addiction have provided us with new effective tools for COPD. Advocacy groups for COPD have multiplied and grown worldwide. In countries where it is allowed, …
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