Chronic Obstructive Pulmonary Disease
(COPD)
Chronic obstructive pulmonary disease
(COPD) is a group of diseases
characterized by airflow obstruction that
includes emphysema, chronic bronchitis,
asthma and diseases that are characterized
by obstruction to air flow and are
associated with breathing-related symptoms
(e.g., chronic cough, exertional dyspnea,
expectoration, and wheeze).
COPD can be present with or without
substantial physical impairment or
symptoms, and it is the fourth leading
cause of death in the United States.
However, COPD is often a silent and
unrecognized disease, chiefly in its early
phases. During 1993, the estimated direct
medical costs of COPD were $14.7 Billion.
Also during 1993, the estimated indirect
cost related to morbidity (e.g., loss of
work time and productivity) and premature
mortality was an additional $9.2 Billion,
for a total of $23.9 Billion. Healthy
People 2010 includes two objectives
related to COPD: to reduce the proportion
of adults whose activity is limited
because of chronic lung and breathing
problems to 1.5% (Objective 24-9) and to
reduce deaths from COPD among adults aged
>45 years to 60 deaths/100,000.
During 2000, an estimated 10 million
U.S. adults reported physician-diagnosed
COPD. However, data from NHANES III
estimate that approximately 24 million
U.S. adults have evidence of impaired lung
function, indicating that COPD is under
diagnosed.
During 2000, COPD was responsible for 8
million physician office and hospital
outpatient visits, 1.5 million emergency
department visits, 726,000
hospitalizations, and 119,000 deaths.
During the period analyzed, the most
substantial change was the increase in the
COPD death rate for women, from
20.1/100,000 in 1980 to 56.7/100,000 in
2000, compared with the more modest
increase in the death rate for men, from
73.0/100,000 in 1980 to 82.6/100,000 in
2000. In 2000, for the first time, the
number of women dying from COPD surpassed
the number of men dying from COPD (59,936
versus 59,118). Chronic Obstructive
Pulmonary Disease Surveillance United
States, 1971-2000 David M. Mannino,
M.D.1; David M. Homa, Ph.D.1. Lara J.
Akinbami, A1.D.2. Earl S. Ford, M.D.
Stephen C. Redd, M.D.
A recent American Lung Association
survey revealed that half of all COPD
patients (51%) say their condition limits
their ability to work. It also limits them
in normal physical exertion (70%),
household chores (56%), social activities
(53%), sleeping (50%), and family
activities (46%). None of the existing
medications for COPD has been shown to
modify the long-term decline in lung
function that is the hallmark of this
disease. Therefore, pharmacotherapy for
COPD is used to decrease symptoms and/or
complications.
Bronchodilator medications are central
to the symptomatic management of COPD.
Additional treatment includes antibodies,
oxygen therapy, and systemic
glucocorticosteroids. The efficacy of
inhaled glucocorticosteroids is under
study. Chronic treatment with steroids
should be avoided because of unfavorable
benefit-to-risk ratio. Pneumonia and
Influenza vaccines should be given to COPD
patients. To reduce and control symptoms
of chronic bronchitis, sufferers should
live a healthy lifestyle by exercising,
avoiding cigarette smoke and other air
pollutants, and eating well. Lung
transplantation is being performed in
increasing numbers and may be an option
for people who suffer from severe
emphysema.
COPD is a major cause of morbidity,
mortality, and disability in the United
States. Despite its ease of diagnosis,
COPD remains an under diagnosed disease,
chiefly in its milder and more treatable
form.
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