COPD: The Unnoticed Epidemic

Most people have never heard of it, and have no idea what the acronym means. But it's the sixth leading cause of death in the world, and it costs billions a year in healthcare.

COPD, short for chronic obstructive pulmonary disease, is essentially an umbrella term that refers to irreversible airflow obstructing and which includes chronic bronchitis and emphysema. Patients often say that they feel "hungry for air." 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 Dr. Richard S. Irwin, president of the American College of Chest Physicians, who moderated an American Medical Association panel on COPD Thursday.

Women are driving that trend, adds Dr. 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, and why medical professionals are pushing for doctors and patients alike to recognize the disease in its own right.

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 number one cause of COPD, in the United States accounting for some 80 percent to 90 percent of cases. That number is probably less in developing countries where other exposures (for example, certain cooking fuels) are more common.

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.

The disease is grossly under diagnosed, even though diagnosis can be as simple as spirometry, a classic breathing test that some argue should become the fifth vital sign. "Only 15 percent of people with COPD in the U.S. have had a breathing test," Buist says. Half of COPD patients are being treated by family doctors without spirometry.

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 (you guessed it) stop smoking. In fact, the only two things that have been shown to improve mortality are oxygen supplementation in people with low blood oxygen and quitting smoking.

Drugs such as bronchodilators and inhaled steroids can control various symptoms but right now, that's it as far as pharmacotherapies go. "The prospect of something novel soon is not particularly good," says Dr. Alan R. Leff, a professor of medicine, pediatrics, anesthesia and critical care and the University of Chicago.

Exercise, however, does have benefits. It "doesn't change the lung but it allows you to do more with the lungs you have," says Dr. Mark J. Rosen, a professor of medicine at Albert Einstein College of Medicine in New York City.

More information

To learn more about COPD, visit the Global Initiative for Chronic Obstructive Lung Disease.

Reference Source 101

For more information on how to prevent other diseases, use
PreventDisease.com's "Quick Prevention Resources".