Abstract

Over 26,000 people died of chronic obstructive pulmonary disease (COPD) in England and Wales in 1999.1 The disease is a common cause of consultations in primary care and accounts for as many as 1 in 8 medical admissions.2 Patients with stable COPD, the focus of this article, experience chronic symptoms such as breathlessness, cough, sputum production, wheeze and chest tightness, which worsen slowly over time. We do not deal here with the management of severe acute exacerbations, which are caused by an additional (often infective) process.