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• EDITORIAL: COPD—more than just tobacco smoke 

On Sept 12—16, Vienna hosts the European Respiratory Society's annual congress, the largest in pulmonary medicine in the world. As a prelude to the meeting, The Lancet today is devoted to chronic obstructive pulmonary disease (COPD). WHO estimates that 210 million people have COPD worldwide. This number could be higher because many people with COPD often do not seek medical help until the disease worsens. COPD is now an umbrella term to cover emphysema and chronic bronchitis, among others, all of which used to be considered separate conditions. The disease is the fourth leading cause of death in the world, but by 2030 it is expected to be the third, behind ischaemic heart disease and cerebrovascular disease.

With such a high burden, emphasis on better diagnosis, management, and identification of at-risk groups must be achieved . . .

For a long time COPD has been thought of as a smokers' disease, and not without reason. Those who smoke damage their lungs and create the pathophysiological environment for this disease. However, as Holger Schünemann points out in a Comment in today's issue, a worldwide ban on tobacco would indeed benefit health substantially both at the population and individual level—yet the world is not ready for such a bold ban. Sundeep Salvi and Barnes explore the aetiology of COPD and highlight the need for greater focus on risk factors other than smoking. They argue that smoking is not the biggest risk factor for COPD, and that this has been reported as early as 1963. Interest in COPD in non-smokers has increased in the past 5 years, although smoking has still remained the emphasis of most research. . . .

Chronic asthma is also of interest because it carries a greater risk of developing COPD than that caused by smoking. If asthma development is on the increase around the world, COPD incidence is likely to increase as well, perhaps even more so than the current predictions. Biomass fuel (coal, wood, and charcoal) has an exposed population of 3 billion, compared with 1 billion for those exposed to tobacco—making such fuel an important target in COPD prevention. This problem is not just one for developing countries. Even if over half of those who have COPD are non-smokers, the battle against smoking and health promotion to quit smoking should continue. However, the identification and education of those who are at risk from other inhalation exposures, both at home and at work, especially in developing countries, also needs to become a priority.

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