TY - JOUR T1 - Series on comprehensive management of end-stage COPD JF - European Respiratory Journal JO - Eur Respir J SP - 828 LP - 830 DO - 10.1183/09031936.00089207 VL - 30 IS - 5 AU - N. Ambrosino AU - R. Goldstein Y1 - 2007/11/01 UR - http://erj.ersjournals.com/content/30/5/828.abstract N2 - Chronic obstructive pulmonary disease (COPD) affects 6% of the general population and is a leading cause of morbidity and mortality worldwide. Severe and very severe disease, as defined by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV 1, show a prevalence of 4.5 and 2.2% in males 2, 3. COPD guidelines generally do not address patients with end-stage disease, although such patients are frequently seen in clinical practice by family physicians and respiratory specialists 2, 4. In the brief series starting in the current issue of the European Respiratory Journal, we review the management of such patients, beginning with the definition, epidemiology and natural history of their condition, as described by Viegi et al. 5. End-stage COPD patients have the most severe airflow limitation, the highest levels of dyspnoea and the worst health-related quality of life 6. Their condition has great impact on their ability to engage in activities and on their participation in social, professional and leisure activities. Their exercise tolerance is markedly reduced by dyspnoea and fatigue, and they have frequent respiratory exacerbations, which often result in hospitalisation. Their gas exchange is usually abnormal, with hypoxaemia requiring supplemental oxygen therapy, and hypercapnia requiring consideration of ventilatory support. These are the patients most likely … ER -