Chronic obstructive pulmonary disease in 2025: where are we headed?

Chronic diseases became the leading killer in the USA in the 1960s. Over the next 40 yrs the age-adjusted mortality rate for heart disease, stroke and cancers steadily decreased, whereas the mortality rate for chronic obstructive pulmonary disease (COPD) steadily increased [2, 3]. There are a variety of reasons for this, although the history of the smoking epidemic with uptake by males in the first two decades of the century followed by uptake by females in the middle part of the century, explains some of this [4]. Another phenomenon was, paradoxically, decreasing rates of smoking subsequent to the 1964 publication of the USA Surgeon General’s report. The benefits for smoking cessation are more acute for cardiac disease, yet the lung damage done by smoking can exist for many years. Thus, many people who probably did not die from cardiac disease survived to develop and die from lung disease.