COPD develops over time and is an obstructive or restrictive expiratory airway due to chronic bronchitis, emphysema or asthma (Glass, 2014). Chronic obstructive pulmonary disease is the third leading cause of death (following cardiovascular disease and cancer) for most racial and ethnic groups in the United States (Mozaffarian, 2015) and is largely irreversible and fatal (CDC, 2018). It is projected that, with increasing prevalence of smoking in developing countries and aging populations, the prevalence of COPD will rise over the next 30 years.
Prevalence indicates how many people currently have the disease, and approximately 1 of every 13 Americans aged 18 years and older has COPD. Data is collected annually from two major surveys including the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS). In the United States, COPD is most common among Caucasians and those with a history of smoking.
Approximately 26 million Americans have been diagnosed with COPD and many more are thought to be as yet undiagnosed. It is seen more in men and women older than 40 years of age, and is often due to years of chronic smoking. It is more common in men than women, but rates of COPD among women increase as women smoke. It is estimated from previous studies that 8% of U.S. adults have been told by a healthcare provider that they have COPD (Kosacz, 2012; CDC, 2013; NCHS, 2016).
Incidence tells how many new cases are diagnosed each year. The incidence and prevalence of COPD vary by state (see earlier map) and worldwide statistics are unknown because more than 50% of people formally diagnosed with low pulmonary function were not even aware of it (CDC, 2015; Wheaton, et al., 2013). According to the World Health Organization WHO), approximately 65 million people have some form of COPD; however, much of the data on morbidity and mortality from COPD come from first-world countries. Incidence is estimated to be approximately 5% of all deaths worldwide (WHO, 2018). States with higher rates of smokers show a direct correlation to a higher incidence of COPD.
Morbidity and Mortality
[Material in this section is from Pietrangelo, 2015 unless otherwise cited.]
Morbidity is the term for the cost and consequences of a disease. Illness from COPD has a large impact on the American health system. According to CDC estimates, COPD costs our country approximately $50 billion annually in both direct and indirect health care (CDC, 2012). The cost of COPD for people over age 65 has increased to almost $30 billion in direct healthcare costs and another $20 billion in direct mortality and morbidity costs.
Additional costs include loss of work and ability to function; 51% state their ability to function at work is limited and 70% claim COPD limits their physical ability. Social and family activities are also limited because patients with COPD have difficulty walking, participating in leisure activities they once enjoyed, and even performing activities of daily living (ADLs) on their own.
Mortality is the statistic for actual deaths caused by a disease. In 2009, according to the American Lung Association, for 133,965 people COPD was the cause of death. One year later, 134,676 died from COPD—711 more deaths despite vigorous smoking cessation campaigns. More than half (52%) were in women; in the past, COPD had been higher among men but with cigarette smoking now equal between the genders, so also is the consequence of COPD.
Ethnicity reveals that 80% of COPD deaths are in non-Hispanic whites, and Hispanics had the least number of deaths (only 3,714 out of 133,965). African Americans had 7,539 deaths from COPD. Caucasians are at 3 times greater risk than Hispanics or African Americans to smoke and therefore die of COPD. Statistically, approximately 41 people out of 100,000 people die annually from COPD.
A correlation with rates of COPD is seen in states that have the highest smoking populations, notably the southeastern and midwestern states. Thirty-one percent of cases of COPD are attributable to environmental insults other than smoking; these include industrial pollutants—in factory workers who have never smoked and in developing countries. In disadvantaged homes, COPD may correlate with cooking using fossil fuels instead of electricity.
Survival rates are bleak. Female smokers are 13 times more likely to die from COPD than non-smoker females, and male smokers are at 12 times greater risk to die from COPD than counterpart non-smoking males.
Mark, the 62-year-old white male in our original case, is given the diagnosis of COPD and asks his healthcare provider how he developed it, whether there is a cure, and what is his prognosis. The provider tells him that his 20-year history of smoking, which equals 40 pack years* (20 years times 2 packs/day= 40), is the main cause of his COPD. He has additional risk factors of being a white male and working with industrial pollutants in his job. Unfortunately, there is no cure for him but he can receive treatment for the symptoms. His prognosis depends on his ability to stop smoking. The reality is that he has increased his morbidity by 12 times by choosing to smoke. The provider then explains how his lungs function and discusses treatment options.
*Pack years. Number of packs per day times the number of years smoked.
- One in three people have COPD.
- Women are more at risk of COPD than men.
- COPD is the third leading cause of death.
- Hispanics and African Americans are at the same risk of developing COPD.
- A 50-year old woman who smoked 1 pack daily for 30 years.
- A 70-year old man whose wife smokes outdoors only.
- A 63-year old woman who has never smoked but works in an industrial company as a secretary.
- A 50-year old man who smoked 2 packs of cigarettes per day for 25 years.
State a patient profile of a person who would be at greatest risk for developing COPD. What risk factors contribute to morbidity and mortality of COPD?