COPD is a major worldwide respiratory health problem. In North America, COPD is rare in persons younger than age 40, but very common among older individuals, with a prevalence of approximately 10 percent in those aged 55 to 85 years. The disease is more common in men than in women, but is predicted to decrease in incidence in men but not in women, a reflection of gender-based differences in smoking behavior. The World Health Organization estimates that COPD was the sixth leading cause of death in the world in 1990.2 In the United States, COPD is the fourth most common cause of death, the third most common cause of hospitalization, and the only leading cause of death that is increasing in prevalence. 3

The mortality of patients hospitalized for a COPD exacerbation is approximately 5 to 14 percent. 45 Mortality of COPD patients admitted to an intensive care unit for exacerbation is 24 percent.6 For patients aged 65 years or older discharged from the intensive care unit after treatment of a COPD exacerbation, the 1-year mortality is 59 percent, nearly double the expected 30 percent.6

COPD is an expensive public health problem in terms of direct economic costs (such as hospital admissions and outpatient treatments), indirect economic costs (such as lost years of life, disability, and loss of working capacity), and reduction in quality of life. 1,5,6,Z,,8.,9 and 1° The utilization of health care resources by elderly patients with COPD is immense, both during hospitalization and after discharge.4

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