Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a slowly progressive disease
of the airways that is characterized by a gradual loss of lung function. In the
U.S., the term COPD includes chronic bronchitis, chronic obstructive bronchitis,
or emphysema, or combinations of these conditions.
The symptoms of COPD can range from chronic cough and sputum production to
severe disabling shortness of breath. In some individuals, chronic cough and
sputum production are the first signs that they are at risk for developing the
airflow obstruction and shortness of breath characteristic of COPD. In others,
shortness of breath may be the first indication of the disease.
In the U.S., the most important risk factor for COPD by far is cigarette
smoking. Pipe, cigar, other types of tobacco smoking and passive exposure to
cigarette smoke are also risk factors. Other documented causes of COPD include
occupational dusts and chemicals. Outdoor air pollution adds to the total burden
of inhaled particles in the lungs, but its role in causing COPD is uncertain.
The most important measure for preventing COPD—and for slowing disease
progression—is avoidance of smoking.
The diagnosis of COPD is confirmed by the presence of airway obstruction on
testing with spirometry. There is no known cure for COPD at the present time;
treatment is usually supportive, designed to relieve symptoms and improve
quality of life.
With continued exposure to cigarettes or noxious particles, the disease
progresses and individuals with COPD increasingly lose their ability to breathe.
Acute infections or certain weather conditions may temporarily worsen symptoms
(exacerbations), occasionally to the point where hospitalization may be
required.
According to the World Health Organization, COPD was the fourth leading cause
of death worldwide in 2000. It ranks fourth in the U.S. also and is projected to
move to third place by 2020.
Prevalence of
COPD—Chronic Bronchitis and Emphysema
There are approximately 16 million adult Americans with COPD. This number
includes about 14 million with chronic bronchitis and 2 million with emphysema
(figure 1). Many more may have COPD but not know it because the disease has not
yet become symptomatic.
Chronic
Bronchitis
The prevalence of chronic bronchitis increased in males and females from
1982-1996 and is higher in females than in males (figure 2). For females, the
rate increased about 65 percent (36.3 vs. 59.8 per 1,000) between 1982 and 1996.
For males, the rates increased about 50 percent (31.4 vs. 47 per 1,000) over the
same period. The difference in the rates was 4.9 per 1,000 in 1982, but
increased to 12.1 per 1,000 in 1996 indicating an increase in the disparity by
gender (figure 2).
The prevalence of chronic bronchitis is higher in whites than in blacks. The
rate increased by about 56 percent (34.9 vs. 54.4 per 1,000) for whites and by
about 69 percent (29.8 vs. 50.4 per 1,000) for blacks from 1982-1996. It is
worthwhile to note that the racial difference in the rates in 1982 is about the
same as in 1996 (5.1 vs. 4.0 per 1,000 population); however, the differences in
the rates were quite large between 1983 and 1995 (figure 3).
Emphysema
The prevalence of emphysema is fairly low in the general population (figure
1). Unlike chronic bronchitis, the rates for emphysema have been consistently
higher in males than in females (figure 4). The rates decreased for males by
about 52 percent (15.4 vs. 7.4 per 1,000), but increased slightly for females by
about 19 percent (5.4 vs. 6.4 per 1,000) from 1982-1996 indicating that the
gender disparity in the prevalence rates of emphysema over this period has
decreased (figure 4). The rates are higher in whites than in blacks (figure 5).
The prevalence rate for whites decreased by about 32 percent (11.4 vs. 7.7 per
1,000 population), but by only about 6 percent for blacks (3.4 vs. 3.2 per
1,000). The racial disparity in the prevalence rates for emphysema has also
decreased due to a falling rate in whites (figure 5).
Emergency
Treatments and Hospitalizations
Emergency treatment and hospitalizations may be required for COPD patients
experiencing an exacerbation. The rate of hospitalizations is higher in men than
women and increases with age. In 1997, there were an estimated 13.4 million
physician office visits and more than 600,000 hospitalizations for COPD.
Mortality
Mortality attributable to COPD has increased substantially in the U.S. over
the past 40 years. In 1998, approximately 107,000 Americans died of COPD. In
general, mortality rates are higher in males than in females and in whites than
blacks. Black females have consistently the lowest COPD mortality rates from
1982-1996 and the highest rate of increase in mortality has been in white
females (figure 6). These differences in mortality may be due to differences in
the rates of smoking among blacks and whites and men and women.
Cost of
COPD
The direct and indirect costs of COPD to the U.S. in 2000 were estimated to
be nearly $30.4 billion. Direct costs (expenditures for hospital care, physician
and other professional care, home care, nursing home care, and drugs) accounted
for $14.7 billion and indirect costs (lost earnings due to illness and lost
future earnings resulting from death) were $15.7 billion (figure 7).
Keeping on Top of Your Condition
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