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...

The total cost of evaluating and providing care to reproductive-aged PCOS women in the United States is dollar 4.36 billion. Because the cost of the diagnostic evaluation accounted for a relatively minor part of the total costs (approximately 2%), more widespread and liberal screening for the disorder appears be a cost-effective strategy, leading to earlier diagnosis and intervention and possibly the amelioration and prevention of serious sequelae.

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Disease management appears to improve the detection and care of patients with depression. Further research is needed to assess the cost-effectiveness of disease management in depression, and consideration should be given to more widespread implementation of these programs.

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