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Rees: The management of common chronic respiratory disorders

Chronic respiratory disorders account for 7% of deaths globally and 4% of the disease burden worldwide and they affect people of all ages and all socioeconomic groups. We have chosen to address the management of three of the most common problems presenting to doctors in primary and secondary care: chronic obstructive pulmonary disease (COPD), asthma and chronic cough. Asthma and COPD remain common in high-income countries and are becoming more common in low- and middle-income countries around the world, where there may be specific risks, such as the use of biomass fuel. The prevalence of asthma has increased in children and adults over the last few decades, and COPD may soon be the third most common cause of death in the world. Most people will have experienced coughing at some time, and it is the most common reason for medical consultations in many countries. A persistent chronic cough remains a symptom that is often associated with significant underlying disease.

The cost of lung disease is considerable in terms of individual suffering but also in terms of health care expenses and lost work productivity. Exposure to a number of substances at work may itself initiate or exacerbate a number of these conditions; however, despite this evidence of the importance of respiratory disease, it remains an area for which funding for research and management is insufficient in many countries. For asthma and COPD, advances in treatments have led to many effective interventions that help to effectively control symptoms and improve quality of life for patients, and national and international guidelines have been developed to help in the delivery of care. In patients with a chronic cough, effective therapeutic possibilities become much more limited once the common causes have been excluded.

However, cures for chronic respiratory disorders remain elusive. In most patients asthma can be well controlled by effective therapy with minimal side-effects, but treatment needs to be continued to maintain this control. New avenues of treatment are emerging from basic research investigating pathophysiology, genetics and newer mediators, but ways to turn off the underlying airway hyper-responsiveness remain to be found. In cases of COPD, the underlying causes are generally well known and future cases could be prevented by public health measures that address the prevalence of tobacco smoking and pollution of the indoor and outdoor environment. Once developed, the structural changes of COPD are much less likely to be reversible and management is aimed largely at relieving symptoms and preventing further damage.

The authors of the three articles in this issue of Hamdan Medical Journal have taken a practical approach to the management of these common conditions and we hope that this will bring readers up to date with the current approach to treatment and the possibilities for future developments. These chronic respiratory conditions require a joint approach from both patients and health workers and we hope that the information provided in this issue will lead to an improvement in the outlook for the many patients who continue to live with these problems.

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