Chronic obstructive pulmonary disease (COPD) has for too long been seen as a self-inflicted progressive disorder of smokers towards the end of life with few treatment options beyond symptom control. There has been no major progress in treatment or prevention for decades. The global burden of COPD is predicted to continue to increase in the future. To achieve better outcomes and ultimately prevent at least some forms of COPD, a complete rethink is needed. A new Commission published in The Lancet, Towards the elimination of chronic obstructive pulmonary disease, provides the framework. It proposes to classify COPD into five different types according to the main risk factors—genetics, early-life events, pulmonary infections, tobacco smoke exposure, and air pollution—to draw attention to the potential of early intervention and prevention.

Tobacco exposure is still an important risk factor for COPD. New Zealand aims to be the first country to eliminate tobacco use by introducing legislation for a so-called smoke-free generation, gradually increasing the age at which cigarettes can be legally bought. Anyone born on or after Jan 1, 2009, will be forbidden from buying cigarettes. The legislation will also drastically reduce the nicotine content in cigarettes and allow them to be sold only in dedicated shops. The New Zealand parliament voted through the first draft of the bill on July 26. Other countries, such as Denmark and Malaysia, are considering similar rules. However, vaping will continue to be allowed in New Zealand and tobacco companies are already shifting their marketing efforts to electronic nicotine delivery systems (ENDS), under the guise of aiding smoking cessation. However, ENDS often contain more nicotine than cigarettes, and many target adolescents and young adults by using appealing designs and flavours. They contain chemicals that are harmful to the lungs and long-term effects are likely to be contributing to the burden of COPD. The best outcome for lung health is for both tobacco and vaping to be eliminated worldwide.

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