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| The first 150 words of the full text of this article appear below. |
Chronic obstructive pulmonary disease (COPD) is a major cause
of morbidity and mortality in adults and has important health economic
consequences. Despite being such an important cause of health
impairment,1 the diagnosis of COPD is often made
relatively late in the natural history of the disorder when there is
already an appreciable fall in the forced expiratory volume in one
second (FEV1) and symptomatic deterioration, as the early
stages of the disease are relatively asymptomatic. COPD is formally
defined by spirometric criteria according to the British Thoracic
Society (BTS) guidelines on the management of COPD as a chronic slowly progressive disorder characterised by largely fixed airways obstruction (FEV1 <80% predicted and FEV1/FVC ratio of
<70% predicted).2 However, we now know that COPD is a
largely heterogeneous condition, consisting of a number of pathological
processes whose effects are modified by varied host
susceptibility.3 Some patients present with daily symptoms
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