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The aim of this study was to quantify the global prevalence of chronic obstructive pulmonary disease (COPD) by means of a systematic review and random effects meta-analysis.PubMed was searched for population-based prevalence estimates published during the period 1990-2004. Articles were included if they: 1) provided total population or sex-specific estimates for COPD, chronic bronchitis and/or emphysema; and 2) gave method details sufficiently clearly to establish the sampling strategy, approach to diagnosis and diagnostic criteria.Of 67 accepted articles, 62 unique entries yielded 101 overall prevalence estimates from 28 different counties. The pooled prevalence of COPD was 7.6% from 37 studies, of chronic bronchitis alone (38 studies) was 6.4% and of emphysema alone (eight studies) was 1.8%. The pooled prevalence from 26 spirometric estimates was 8.9%. The most common spirometric definitions used were those of the Global Initiative for Chronic Obstructive Lung Disease (13 estimates). There was significant heterogeneity, which was incompletely explained by subgroup analysis (e.g. age and smoking status).The prevalence of physiologically defined chronic obstructive pulmonary disease in adults aged o40 yrs is ,9-10%. There are important regional gaps, and methodological differences hinder interpretation of the available data. The efforts of the Global Initiative for Chronic Obstructive Lung Disease and similar groups should help to standardise chronic obstructive pulmonary disease prevalence measurement.KEYWORDS: Chronic bronchitis, chronic obstructive pulmonary disease, emphysema, metaanalysis, prevalence, spirometry C hronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide [1]. In addition to generating high healthcare costs [2], COPD imposes a significant burden in terms of disability and impaired quality of life [3]. Unlike many leading causes of death and disability, COPD is projected to increase in much of the world as smoking frequencies rise and the population ages [4,5]. Despite the importance of this disease, the general perception is that the prevalence of COPD is not well measured. Accurate prevalence information is important for several reasons, including documentation of COPD's impact on disability, quality of life and costs, and for helping to inform public health planning [6]. It is also important to establish baseline prevalence rates so that researchers can monitor trends, including the success or failure of control efforts.Previous publications have reviewed the literature qualitatively, but not quantitatively [7,8].These reviews identified potential sources of interstudy variation that could affect reported prevalence estimates. Historically, COPD has been defined symptomatically as chronic bronchitis (CB), anatomically as emphysema, or, most recently, physiologically as airway obstruction [9]. The physiological definition has become the most common [10,11], although studies using other case definitions are still published. Even with growing consensus on the...

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Rationale: Poor adherence to asthma controller medications results in poor treatment outcomes. Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care. Methods: In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/ preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters. Measurements and Main Results: Refill adherence was measured using continuous medication acquisition (CMA) indices-the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P , 0.0001) and long-acting b-agonist adherence (CMA, 0.51 vs. 0.40; P 5 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P , 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P 5 0.03) and long-acting b-agonist adherence (CMA, 0.51 vs. 0.41; P 5 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P 5 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures. Conclusions: Negotiating patients' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes. Clinical trials registered with www.clinicaltrials.gov (NCT00217945 and NCT00149526).