Dudley Strategy for Tackling Health Inequalities 2010-15

7.6 CHRONIC OBSTRUCTIVE PULMONARY DISEASEBACKGROUNDIt is estimated that there are more than three million people in England living withchronic obstructive pulmonary disease (COPD), although only 835,000 have beendiagnosed. It causes more than 25,000 deaths a year. It is the second most commoncause of emergency admissions to hospital and the fifth largest cause ofreadmissions to hospital.The direct cost to the healthcare system is estimated to be between £810 million and£930 million a year. The economic cost is assessed as being even higher, with lostproductivity to employers and the economy estimated at £3.8 billion. COPD causesat least 20.5 million lost working days amongst men and 3.5 million days amongwomen every year. The social cost of COPD is related to quality of life becausesufferers are unable to participate in everyday activities such as gardening orhousework and 66% of sufferers were unable to take a holiday because of limitedmobility or disabling breathlessness.COPD is a term used to describe a group of conditions, mostly chronic bronchitis oremphysema. Asthma is usually included in this heading because of the similarities insymptoms and the burden on the healthcare system, but it is not a principalcontributor to premature mortality. The main symptoms are shortness of breath andreduced exercise ability. There is usually a cough and production of phlegm andpatients often have repeated chest infections. The lung damage is gradual in onsetand eventually irreversible, leading to disability and eventually death.INEQUALITIES AND COPDThere are established links between deprivation and lifestyle factors, but smoking isthe single most important, preventable risk associated with COPD. Giving upsmoking is one of the key things to achieve to reduce risk. Unfortunately, where lungdisease is severe it cannot be reversed, so early identification is essential to improvethe prognosis.Maternal smoking during pregnancy is associated with reduced lung function inschool aged children and it also affects foetal development of the respiratory system.There is strong evidence to suggest that exposure in pregnancy may predict thedevelopment of asthma and reduced lung function later in life. Taking up smoking ata young age (before 16) is also a predictor of increased risk of COPD at a later age.Inequalities due to COPD arise from the fact that smoking is more prevalent in lowersocioeconomic groups. 26% of routine and manual workers smoke compared with15% of those in managerial and professional occupations. Department of Healthestimates suggest that routine and manual workers represent approximately 50% ofthe people with COPD in England. Men aged between 20 and 64 who are employedin unskilled manual occupations in England and Wales are around 14 times morelikely to die from COPD than men in professional roles and are around seven timesmore likely than those in managerial and technical operations (Great Britain.Department of Health, 2010).136