COPD Uncovered Report - Education For Health

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Chapter 2 – The growing pace and changing face of COPD 6 In the next decade, COPD – a disease that has been largely unknown and misunderstood until recent years – will become the third leading cause of death. It is a chronic, progressive disease of the airways that affects 210 million people worldwide, leading to three million deaths every year 1 . And there is no cure. What is COPD? Chronic obstructive pulmonary disease (COPD) is a debilitating, life-threatening and progressive lung disease that interferes with normal breathing. COPD refers to emphysema and chronic bronchitis – two commonly co-existing diseases of the lung. COPD is not curable, but it can be treated. Due to lung deterioration, people with COPD experience symptoms like chronic shortness of breath and cough 15 that impact the ability to lead an active and productive life. COPD is a severely debilitating disease. People with COPD experience progressive lung deterioration that leads to chronic shortness of breath, cough and other airwayrelated symptoms 15 . These symptoms cause profound disability, limiting work and other daily activities such as shopping, performing household chores, or caring for others. For COPD sufferers this means nearly 28,000 years of lost productivity annually worldwide as measured by disability-adjusted life years (DALYs) 16 . DALYs are a measure of years of productive life lost due to disabilities and early deaths. Currently, COPD ranks tenth among disorders that cause the greatest worldwide burden in terms of DALYs, far exceeding more widely known diseases such as diabetes and asthma 16 . This ranking is projected to rise in coming decades, further highlighting the urgent need to address COPD as a serious threat to public health. Disability-Adjusted Life Years (DALYs) Attributable to Disorders Causing the Greatest Burden Worldwide Rank Disorder Number of DALYs (x103 ) 1 Lower respiratory infections 91.3 2 HIV/AIDS 84.4 3 Unipolar depressive disorders 67.2 4 Diarrhoeal diseases 61.9 5 Ischaemic heart diseases 58.6 6 Cerebrovascular disease 49.2 7 Malaria 46.5 8 Road traffic accidents 38.7 9 Tuberculosis 34.7 10 Chronic obstructive pulmonary disease 27.7 11 Congenital abnormalities 27.3 12 Hearing loss – adult onset 26.0 13 Cataracts 25.2 14 Measles 22.4 15 Violence 21.4 16 Self-inflicted injuries 20.7 17 Alcohol use disorders 20.3 18 Protein energy malnutrition 16.9 19 Falls 16.2 20 Diabetes mellitus 15.4 21 Schizophrenia 16.1 22 Asthma 15.3 23 Osteoarthritis 14.8 24 Vision loss, age-related and other 14.1 25 Cirrhosis of the liver 13.9 Source: Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. Jean Bousquet and Nikolai Khaltaev, editors. World Health Organization 2007 16 .
Chapter 2 – The growing pace and changing face of COPD Despite the disability associated with COPD, approximately half of people remain undiagnosed and therefore inadequately managed. COPD is diagnosed by assessing symptoms, checking medical history – including the number of years a patient has spent smoking (pack years) – and measuring airway limitation by a simple spirometry test that determines lung function 15 . Even though spirometry is an important health measurement and commonly used for diagnosis, patients remain undiagnosed for several reasons. COPD progresses slowly over time, and sufferers may mistake their symptoms as lack of fitness or signs of aging. Current or former smokers may be less likely to talk about symptoms they feel are a result of their smoking. Additionally, as sufferers of COPD present with symptoms that obstruct their lungs, doctors may diagnose the cause as asthma – especially if spirometry is not performed. There is also the factor that COPD has varying definitions, and until recent years, has not been widely known. Management of COPD varies greatly, leading to suboptimal outcomes for patients. COPD cannot be cured, so treatments aim to slow the decline in lung function by relieving symptoms and avoiding exacerbations – episodes when symptoms become severe enough to require resource-intensive and expensive emergency care. Bronchodilators, for 7 example, have been shown to improve lung function and also reduce the number of exacerbations 17 . Healthcare professionals have an increasing armory of medication and processes for the management of COPD which includes bronchodilators to widen the airways and make breathing easier, antiinflammatory corticosteroids to treat and prevent exacerbations, and nicotine replacement therapy to help patients give up cigarettes 15 . Due to the highly addictive nature of smoking, cessation therapy is successful in 12–35% of cases, and long-term success rates can be lower 18 . And depending on the severity, healthcare professionals may use oxygen therapy and rehabilitation, including dietary review, during hospitalization for treatment of exacerbations 15 . There are a number of powerful factors contributing to an increase in COPD. The primary cause of COPD is cigarette smoke 15 . Today, 1.3 billion people smoke, a number that includes an increase among women and individuals in developing countries. Preventative measures such as smoking cessation are increasingly important, especially because of the slow, progressive onset of COPD. However, it does not mean smoking cessation should precede medical management. Many former smokers develop symptoms and are diagnosed a decade or two after they stop. And the reality is that people still smoke. It is highly addictive and achieving an entirely smoke-free society may be impossible. Even if everyone stopped smoking today, the rates of COPD would still continue to increase for the next 20 years 4 . Globally 55–75% of COPD patients are current or former smokers. This percentage is higher in countries where smoking is more prevalent 19 . Smoking isn’t the only factor of COPD. There are a host of other factors that also contribute to the disease, including indoor air pollution and occupational exposure. Even asthma is thought to be a factor. Thirty-five percent of people with COPD in countries of low and middle income developed the disease after exposure to indoor smoke from biomass fuels, commonly used for cooking and heating 4 . In the workplace, dusts and chemicals also considered risk factors. Nineteen percent of COPD cases in the U.S. were attributable to workplace exposure 4 .
Page 1 and 2: Authors: Monica Fletcher, Thys van
Page 3 and 4: Foreword Society faces a major thre
Page 5: Chapter 1 - Two transformative gene
Page 9 and 10: Chapter 3 Counting the costs of COP
Page 11 and 12: Chapter 3 - Counting the costs of C
Page 17 and 18: Chapter 4 Conclusion --Moving to ac
Page 19 and 20: Appendix COPD Uncovered 19 The Init
Page 21 and 22: References 1 World Health Organizat

COPD Uncovered Report - Education For Health

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