Preface Chronic obstructive pulmonary disease (COPD) causes enormous distress and generates immense cost worldwide. The problem is growing, particularly in the third world, and it has been predicted that COPD will become the third most common cause of mortality in the world in 2020. As the major cause of COPD is tobacco smoking it is of utmost importance that scientific societies all over the world aim to change smoking habits and reduce smoking prevalence. Smoking cessation is also the most effective treatment of COPD, both as disease prevention and as treatment in already established disease. Since the 1970s, therapeutic nihilism has moved towards a more optimistic attitude regarding therapeutic alternatives in COPD. Research focused on inflammatory and physiological mechanisms has substantially increased during the last 10 years. This has led to an increased understanding of the pathophysiology of the disease, which has resulted in improved treatment. Thus, in parallel to smoking-cessation programmes, other treatment modalities have been shown to be successful. Physiotherapy and pharmacotherapy have been extensively studied and the knowledge regarding what these therapeutic approaches can offer is constantly growing. The importance of nutritional aspects and adjustment in daily life activities have made dieticians and occupational therapists important members of the treatment team. Vaccination programmes, treatment of infections and lung volume reduction surgery are other therapeutic alternatives that have contributed to the improved care of COPD patients. It is now 8 years since the first European Respiratory Monograph on "Management of Chronic Obstructive Pulmonary Disease" was published and a lot has happened during this time. Therefore, there is an urgent need to raise this subject again and it is my pleasure to present an updated version of the previous COPD Monograph, which forms a comprehensive overview of most aspects of this serious disease. K. Larsson Editor in Chief Eur Respir Mon, 2006, 38, viii. Printed in UK -all rights reserved. Copyright ERS Journals Ltd 2006 European Respiratory Monograph ISSN 1025-448x. viii