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More awareness of COPD by primary care physicians can lead to early treatment and better care for this growing group of patients.
Chronic obstructive pulmonary disease (COPD) has become a substantial part of all adult primary care practices. If a primary care physician sees 20 to 40 adults a day, one to four of those patients will have COPD, and half of them will have unrecognized COPD, according to statistics from the U.S. National Health and Nutrition Examination Survey (NHANES).
An estimated 15 million Americans suffer from COPD, but with early diagnosis and treatment they can improve their quality of life and begin to breathe a little easier.
November is National COPD Awareness Month, an internationally-recognized event held annually to enhance exposure around COPD. Multiple organizations, including the National Heart Lung Blood Institute (NHLBI), the COPD Foundation and the American Lung Association (ALA) are sponsoring events to raise awareness about COPD and to provide patients and physicians with resources on COPD.
“There are some hints in data from large, recent studies that treatment can slow lung function decline in COPD, particularly early in disease,” MeiLan Han MD, associate professor in the Division of Pulmonary and Critical Care at the University of Michigan and spokesperson for the ALA tells Medical Economics. “Primary care physicians need to start appropriate medications, keep patients physically active through programs like pulmonary rehabilitation, and instill lifestyle changes, such as smoking cessation.”
COPD accounts for a considerable amount of morbidity in the U.S. In 2010, COPD led to 10.3 million physician office visits, 1.5 million emergency department visits and 699,000 hospital discharges. About 6.5% of U.S. adults aged 25 years and older were diagnosed with COPD in 2011, including 7.8% of women and 5.8% of men. Prevalence varies with ethnic origin, with 2.2% in Asians and Pacific Islanders, 3.6% in Hispanic individuals, 6.4% in black (non-Hispanic) individuals, 7.6% in white (non-Hispanic) individuals and 11.5% in Native Americans and Native Alaskans.
Socioeconomic factors, which affect access to care and treatment, play a role. According to the Centers for Disease Control, in the U.S. the prevalence of COPD in 2011 was 9.5% among individuals with less than a high school education, 6.8% among those with a high school education, and 4.6% among those with more than a high school education. A similar trend can be seen by annual household income: in 2011, prevalence was 9.9% in people with an annual household income of less than $25,000, 5.7% in those with $25,000–$49,999, 4.2% in those with $50,000–$74,999 and 2.8% in those with $75,000 or more.
The strongest risk factor for the development of COPD is tobacco smoking. However, occupational and environmental exposures may also be important. Data from both the U.S. and Canada suggest that one-quarter of COPD patients never smoked. Some of the predictors of COPD in never smokers include age 70 and older, self-reported asthma and low education level. Exposures to passive smoke and biomass fuel heating appear to increase COPD risks in women. Early-life environmental exposures or respiratory infections may also contribute to low peak achieved FEV1 that ultimately leads to the development of airflow obstruction.
Data from NHANES show that in 2007–2010, about 28.9 million (13.5%) adults had evidence of obstruction on the basis of spirometry. This suggests that more than half of Americans with evidence of COPD have not been diagnosed. American adults with evidence of obstruction who do have not being diagnosed with COPD tend to report better health, have fewer comorbid diseases and have better lung function, but they also have a higher risk of death compared with those without obstruction.
As part of National COPD Awareness Month, the NHLBI’s COPD Learn More Breathe Better® campaign encourages Breathe Better Network members and all those interested in raising COPD awareness to host events, lead discussions, and reach out to help people take the first step toward improving the lives of those with COPD.
The NHLBI, with input from federal and nonfederal partners, is developing a COPD National Action Plan to guide the nationwide effort to reduce the burden of COPD. The goals include:
· Empower people with COPD, their families, and caregivers to recognize and reduce the burden of COPD.
· Improve the prevention, diagnosis, treatment and management of COPD by promoting and sustaining the education and training of health care professionals.
· Collect, analyze, disseminate and report COPD-related public health data that drive change and track progress.
· Increase and sustain research to better understand the prevention, pathogenesis, diagnosis, treatment and management of COPD.
· Translate national policy, educational, and program recommendations into legislative, research and public health care actions.