Preface

A disorder as common and complex as a chronic obstructive pulmonary disease (COPD) requires frequent updates to our knowledge base. This book provides such a platform. It is written by experts in the field who share a common desire to provide contemporary and critical knowledge on COPD.

Chapter 1 describes the evolution of our knowledge of COPD through the decades while emphasizing the need for contextualization to successfully integrate research with practice today. Chapter 2 is a state-of-the-art compilation of all that is essential and evolving in COPD. It discusses "hot topics" in COPD, a "multi-aspect" exploration of COPD. The reader will certainly appreciate the discursive journey into the contemporary conceptions of COPD, moving from pathogenesis to treatment. Chapter 3 is an excellent summary of recent scientific findings on inflammation in COPD and is testimony to the ardor of the author in filtering through the vast amount of basic research in this area to present the data systematically, succinctly, and concisely.

Chapters 4 and 5 offer a change in emphasis, form, and content. They present the results of two retrospective single-center observational studies describing the risk factors associated with repeated hospitalization for exacerbation of COPD in different cultures and locales. These series contribute to the existing literature by their description of local statistics while highlighting the need for effective strategies to reduce the heavy burden of exacerbation of COPD throughout the world. The reader is thus reminded of the need to consider local and global factors when implementing strategies to reduce COPD exacerbation.

Chapter 6 discusses therapeutics for COPD, specifically pulmonary rehabilitation. It elucidates the benefits and practical aspects of a comprehensive pulmonary rehabilitation program for patients with COPD. Chapter 7 delves further into specific therapeutics and precision medicine, highlighting the role of phenotypes and endotypes in directing inhaled therapy in COPD. Finally, Chapter 8 points toward the future. Under careful consideration is the intriguing plausibility of intratracheal administration of biologically active molecules as a delivery tool or as therapeutic agents for the treatment and prevention of COPD.

I hope that this publication will prove useful for all who share an academic interest in progressive scientific research and best practices in COPD. Last and not least,

I would like to express my appreciation to the chapter authors as well as Author Service Manager Martina Scerbe at IntechOpen for her contribution and assistance in making this publication a reality.

> **Kian Chung Ong** Mount Elizabeth Medical Centre, Singapore

> > **1**

community.

**Chapter 1**

*Kian Chung Ong*

**1. Introduction**

Introductory Chapter:

of the disease with particular subject characteristics.

**2. Evaluating COPD in different contexts**

Contextualizing Chronic

Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) afflicts more than 390 million people globally [1] and is the third leading cause of death worldwide [2]. COPD is also a heterogeneous and complex malady, varying in severity and clinical presentation. The commonness and the complexity of this disorder require contextualization in balancing global scientific development with the local milieu, and the general aspects

Perhaps more so than other common respiratory disorders such as bronchial asthma, the construal of COPD varies according to demographic, cultural, socioeconomic, geographical, and even political contexts. Patients' anamnesis and conceptions of the illness not only vary across the world but also according to the chronological period that the disease is diagnosed. Change in nomenclature has contributed somewhat to the latter. Nowadays, terms like "chronic bronchitis" and "emphysema" are less often used in clinical diagnosis, and in their place, the acronym COPD has become widely accepted across the globe by laymen and professionals. The benefit of standard terminology is not solely titular since the definition of the disease can only be agreed upon once everyone has accepted what it should be called, at least in clinical practice. For this, we are heavily indebted to the unifying work developed and continually updated by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) [3] in enabling clinicians and researchers to figuratively speak the same language. Some readers may recall an epoch when COPD was confusingly construed as overlapping conditions of chronic bronchitis, emphysema, and asthma within the confines of chronic airflow limitation. In appreciation of GOLD, standard definitions of COPD have been refined and gained widespread acceptance, thus fostering mutual understanding and expedient communication within the medical

Nonetheless, such universality in evaluating COPD tends to mask the particularity of COPD as it presents in various contexts. The term COPD confers varying connotations among diverse individuals and people groups. For instance, diagnosis of COPD will likely evoke more unease among people where the disease is less common than
