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C obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the USA and throughout the world.[1-3] In spite of this, it remains a relatively neglected disease both in terms of public awareness and in public-health planning. The impact of COPD is particularly felt in developing countries despite the paucity of information on epidemiology and management of this disease in such countries. This impact was recently uncovered by the BREATHE study.[4-7] The findings of this large epidemiological study conducted in 10 countries in the Middle East and North Africa, provided the first international collaborative attempt to document the prevalence and burden of COPD in that region of the world. Its findings were derived from interviews of over 60,000 respondents in the general population. Although the prevalence of COPD in all participating countries combined was around 4%, this prevalence rate may be have been underestimated, especially since other risk factors frequent in that part of the world including water-pipe smoking and exposure to burning biomass fuel, were not considered in the determination of prevalence. Another important finding of the BREATHE study was the documentation of largely unsatisfactory standards of care in the different countries where it was conducted. Indeed, lesser than one-third of COPD cases were diagnosed, lesser than onethird evaluated for lung function, and lesser than one-third received appropriate treatment for COPD. In addition, less than 10% of treatment was compliant with the international GOLD guidelines. In addition to its human impact, COPD is responsible for considerable healthcare costs in that region as it is in other countries.

The Saudi guidelines for chronic obstructive pulmonary disease: A fresh "Real-World" approach to COPD