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Exacerbations in non-COPD patients: recognition?
  1. Gavin C Donaldson
  1. Correspondence to Dr G C Donaldson, Airway Disease Section, National Heart and Lung Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK; gavin.donaldson{at}

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COPD is a progressive lung disease that leads to significant impairment of quality of life and is the third leading cause of death worldwide.1 It is principally caused by tobacco smoking over many years through airway inflammation and oxidative stress to lung tissue. Patients exposed to smoke or occupational dusts are diagnosed with the disease when their post-bronchodilator FEV1/FVC ratio falls to <0.7.2 Disease severity is assessed differently by expressing the measured FEV1 as a percentage of the expected value for normal, healthy people of similar sex, age and height. The threshold value of <0.7 for the FEV1/FVC ratio is arbitrary and may not always identify people in the early stages of COPD with smoking-related lung damage.

COPD exacerbations (the flare-up of respiratory symptoms) are often triggered by viral or bacterial infection and cause patients sometimes to seek medical help. Attention has focused on those patients most susceptible to exacerbation as the disease appears to progress more rapidly in this group, and consequently, they …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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