In the last 8 years the FEV₁ (forced expiratory volume in 1 s) of a ‘typical’ patient with chronic obstructive pulmonary disease (COPD) has fallen by ∼400 ml. However, the knowledge of those caring for this hypothetical patient has grown rapidly in this same period and Thorax has played a vital role in this change of fortune. In 2003 there were 1698 citations to COPD articles in PubMed, compared with 1494 in the first 6 months of 2010 alone, a remarkable growth in the interest in and perhaps quality of research in this field.

Many themes have been considered in this last 8 years, not least how to diagnose the disease. Swanney et al1 defined population norms for the lower limit of normal of the FEV₁/forced vital capacity (FVC) ratio to avoid overdiagnosis of airflow obstruction in the elderly. However, not all were convinced, especially when there appeared to be no difference in mortality when the definition was varied in this way.2 The absence of bronchodilator reversibility proved to be an unreliable defining feature in COPD,3 and the treatment guidelines changed to reflect this new research.4 Classifying patients with GOLD (global initiative for chronic obstructive lung disease) stage 1 disease (reduced FEV₁/FVC but FEV₁ >80% predicted) proved difficult as some patients were not reproducibly obstructed. However, those with symptoms did show more rapid decline in lung function,5 were more likely to have previous bronchitic symptoms6 and responded physiologically to inhaled bronchodilators.7 So, contrary to earlier views, GOLD stage 1 may be a clinically relevant entity after all.

COPD is …