Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death worldwide and, by all reasonable projections, its incidence will increase. The worldwide burden of COPD morbidity and mortality is already large, and will become staggering in this century. In this issue of the journal, Meldrum et al describe the impact of COPD on the UK.¹ In their poignant review, they point out that while the main cause of COPD in the UK remains cigarette smoking, there is a substantial body of epidemiological evidence linking occupational exposures to dusts, gases/vapours, and …