For a long time, many doctors have had a relatively nihilistic approach to patients with chronic obstructive pulmonary disease (COPD). The disease was deemed self-inflicted (smoking) and relentlessly progressive, and the available interventions made little difference. Are these notions (still) correct?

It is now known that the disease can also be acquired without smoking—including as a result of outdoor and indoor air pollution (biomass cooking and heating), especially in third world countries.1 It is also known that stopping smoking completely reverses decline in lung function to pretty much the levels of non-smokers.2 Finally—and perhaps most importantly—doctors can now make a difference to patients, although they sometimes fail to do so. It does require a proper perspective on what matters to the patient, as opposed to some measure of lung function such as the forced expiratory volume (FEV₁). Patients talk about limited physical capacity, exacerbations, quality of life (QOL) and mortality, not about their lung function. Level …