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Chronic obstructive pulmonary disease (COPD) is the second most common long-term respiratory condition and it is estimated that exacerbations of COPD lead to over a million bed-days per year.1–3 In 2020/2021, the Quality and Outcomes Framework (QOF) data recorded 1.2 million people in England with a diagnosis of COPD and it is thought that an additional 2 million cases may be undiagnosed.1 2 The cause of COPD is inhalation of toxins, primarily cigarette smoke, which results in mucus hypersecretion and anatomical distortion in the large airways, fibrosis and obliteration of small airways and destruction of the parenchyma (emphysema). All three processes lead to ‘airflow obstruction’, that is, limitation of flow in expiration, particularly apparent when increased flow is required on exertion, leading to breathlessness and exercise limitation. The degree of airflow obstruction is an important predictor of complications such as exacerbations, respiratory failure and death.
The essential step prior to initiating any …
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Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).
Provenance and peer review Commissioned; externally peer reviewed.
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