COPD: 24 M Americans have it, half undiagnosed: Physicians lagging behind epidemic

The number of persons with chronic obstructive pulmonary disease is rising at epidemic levels and proportions, said at a recent press briefing sponsored by the National Heart, Lung and Blood Institute (NHLBI).

A litany of data was presented to underscore the scope of the problem:

• In the United States, 24 million people have chronic obstructive pulmonary disease (COPD), about half of whom have not been diagnosed.

• COPD is now the 4th leading cause of death, killing more than 120,000 Americans annually

• While death rates for other major diseases, such as cancer, heart disease, stroke, and for accidents have all decreased over the past three decades, the mortality rate for COPD has increased by >100 percent

• Among women, the annual mortality rate for COPD has increased by almost 300 percent since 1980.

• COPD-related hospitalizations have increased by >40 percent during the past 30 years

• Each year COPD disables >900,000 people, mostly working-aged adults.

• Annual healthcare and lost productivity costs exceed $37 billion.

COPD encompasses both chronic bronchitis and emphysema. The most common cause of the disease is smoking, and yet about 45 million Americans still smoke, and 9 in 10 deaths from COPD occur in smokers.

But smoking trends cannot fully account for rising incidence in women, said the chairman of the Department of Medicine, New York-Presbyterian/Weill Cornell Medical Center.

Probable causes of COPD include exposure to occupational dust or chemicals, infections, and low socioeconomic status. The rare genetic form affects persons with alpha-1 antitrypsin deficiency. Ongoing research is exploring the ability of antioxidants to block the associated lung tissue destruction.

COPD has joined the so-called silent killer diseases (eg, hypertension, osteoporosis), because many people do not know they have it until the disease has advance and they have developed symptoms that limit their activity and reduce their quality of life.

That is why it is so important to be screened, particularly smokers, but others as well. It is only by screening with the simple spitometry test that COPD can be detected early.

Primary care physicians might need to update their concepts and attitudes and approaches to the patient with respect to COPD, the director of the Lung Disease Division of the NHLBI said.

Physicians should think about COPD in the context of other conditions that the patient may have, such as diabetes or heart disease. COPD is often masked by the co-morbidities that go along with it. So it would be important for the primary care physician to probe a little bit more, to ask about various aspects of the patient’s breathing status.

If physicians get a sense that a patient may have some shortness of breath and may have some respiratory conditions, they can ask some questions and do a simple spirometry test relatively quickly right in their office.

They want physicians to know that there are tools, new approaches, and medications that are available that people can take early and that may have an impact on their quality of life.