Most people have never heard of it, and have no idea what the acronym means. But it's the fourth leading cause of death in the United States and the sixth in the world, and it costs $32 billion a year in this country alone.

COPD, short for chronic obstructive pulmonary disease, is an umbrella term that refers to irreversible airflow obstruction and which includes chronic bronchitis and emphysema. The disease has no cure. While death rates for other diseases include stroke and heart disease were decreasing, the mortality for COPD jumped 163 percent from 1968 to 1998. By 2020, experts say, it will be the third biggest killer in the world. "It's a common disease that has reached epidemic proportions," says Richard S. Irwin, president of the American College of Chest Physicians, who moderated an American Medical Association panel on COPD last week. Women are driving that trend, adds A. Sonia Buist, a professor of medicine at Oregon Health & Science University in Portland. In 2000, for the first time, deaths among women were higher than those among men from COPD. About 24 million Americans are estimated to suffer from COPD, only 10 million of whom are diagnosed and only 6 million of whom are being treated. Those numbers help explain why November has been designated COPD Awareness Month. Why the increase? Buist attributed it mostly to increases in smoking and in exposures to other risk factors, especially in developing countries, as well as to the changing age structure of the population. "More people are living into the COPD years," she says. Smoking is, in fact, the No. 1 cause of COPD, in the United States accounting for 80 to 90 percent of cases. Why are women increasingly affected? Because they started smoking and joining the workforce in the 1940s and are now seeing the result of those exposures. One of the problems is that we all lose lung function as we get older, and the symptoms of COPD too often are confused with those of normal aging. Those symptoms include shortness of breath, increased effort to breathe, chronic cough, increased mucus production and frequently clearing of the throat. Once lung damage has happened, it can't be reversed. The best you can do is to stop the damage in its tracks, and the best way to do that is to stop smoking.

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