June 27, 2012

2009 Nov – Background on Chronic Obstructive Pulmonary Disease (COPD)

COPD is a lung disease that affects almost one in five Australians 40 or over. 1
 
Alarmingly, half of those with symptomatic COPD do not know they have it.2

While there is no cure for COPD, there are things people can do to breathe easier, keep out of hospital and improve their quality of life.

What is COPD?

  • Chronic Obstructive Pulmonary Disease (COPD) is a deadly long term disease of the lungs which causes shortness of breath.3 While COPD has no cure, there are things that people can do to breathe easier, keep out of hospital and improve their quality of life.
  • COPD is an umbrella term that includes emphysema and chronic bronchitis. 
  • There are four stages (I to IV) of COPD which rank the condition in terms of severity, with IV being the most severe.
  • COPD is characterised by:
    – Shortness of breath on minimal exertion
    – A repetitive cough with phlegm / mucus most days
    – History of cigarette smoking

    How does a person with COPD feel?

    Symptoms for an individual with COPD tend to creep up gradually. Breathlessness may lead those with the condition to cut back on physical activities.  This gradual decline continues until simple daily activities like showering, dressing or making a cup of tea, become almost impossible. Depression often affects those with COPD.

    What Causes COPD?

  • Cigarette smoking is the single largest cause of developing COPD.3 However despite being the highest risk group for COPD, regular smokers are less likely than the rest of the population to consider themselves at risk of developing COPD.3
  • Other known risk factors are passive smoking, exposure to environmental agents, including indoor and outdoor air pollutants and occupational dusts and chemicals.3
  • Women may be at greater risk than men of COPD from exposures at work and are more susceptible to COPD due to smaller lungs and airways and more sensitive airways.4

    Prevalence of COPD

  • The Australian Lung Foundation estimates that approximately 2.1 million Australians have some form of COPD.1,5 This represents one in five Australians over 40.  By 2050, this figure is expected to more than double to 4.5 million Australians.1

    – Of those with COPD currently, 1.2 million Australians1,5 have moderate to severe COPD (Stages II – IV), a stage at which symptoms are already affecting their daily lives.
    – Nearly 900,000 Australians1,5 have a mild form (Stage I) of COPD where symptoms may not yet be present. Many of these will go on to develop more severe COPD.

  • COPD is more common in any year than most common types of cancer, road traffic accidents, heart disease or diabetes.1
  • Half of Australians with symptomatic COPD (Stage II-IV) are unaware that they even have the disease,2 which means they are not taking the important steps to manage the condition before it reaches a more advanced and debilitating stage. 
  • People who unknowingly have COPD may mistake their symptoms as signs of ageing, lack of fitness or asthma – a simple lung function test from a GP can diagnose COPD.

    The Burden of COPD

  • In Australia, COPD is a leading cause of death and disease burden after heart disease, stroke and cancer6 – but it is still not a health priority area.
  • COPD is a significant cause of death in Australia.  Estimates range from 12,0006 where COPD was a contributing factor (or 9.5% of all deaths in 2005) to 16,0001 deaths a year as a result of COPD.
  • COPD is the second leading cause of avoidable hospital admissions in Australia.7
    – In fact, every day 1,000 COPD patients occupy Australian hospital beds, with an average cost of $3,700 per admission (average 7.5 day stay).8
  • In 2008, the total economic impact of COPD is estimated to be $98.2 billion of which $8.8 billion is attributed to financial costs and $89.4 billion to the loss of wellbeing.1
    – Of the financial costs ($8.8 billion), a large proportion is due to the loss of productivity due to COPD, ie lower employment, absenteeism and the workplace impact of premature death of Australians with COPD.1
    – The cost to the Australian health care system is estimated to be $900 million with hospital use contributing the largest share of health spending ($473 million).1
    -In addition to the above costs on the public and private sector purse, there are the costs that are harder to quantify – those of lost wellbeing as a result of COPD.  These are estimated to be some $90 billion.1
  • In terms of overall costs COPD is more costly per case than cardiovascular disease, osteoporosis or arthritis.1

    COPD diagnosis and treatment

  • While there is no cure for COPD, there is strong medical evidence to show that early diagnosis, combined with disease management programs at the early stages of the disease could reduce the burden of COPD, improving quality of life, slowing disease progression, reducing mortality and keeping people out of hospital.3
  • Lower costs and burden of disease can result if diagnosis is achieved early and optimally assessed, especially as treatment can reduce exacerbations. 2,9-13

    Treatment

    The key aims of COPD treatment are to improve quality of life, increase the capacity for exercise and ultimately, keep people well and out of hospital. There is no cure for COPD, however there are a number of steps people with COPD can take to breathe easier and improve their quality of life.
  • Stop smoking – helps improve symptoms and slow down the rate the disease progresses.
  • Inhaled medications – make the airways wider and help make breathing easier.
  • Pulmonary rehabilitation – Pulmonary rehabilitation reduces breathlessness, fatigue, anxiety and depression, improves exercise capacity, emotional function and health-related quality of life and enhances patients’ sense of control over their condition. Pulmonary rehabilitation reduces hospitalisation and has been shown to be cost-effective.
  • Support groups/services – as COPD worsens and patients feel less able to carry on their normal activities, patients become increasingly isolated.  Support groups/services can help meet the emotional and social needs of people with the condition, helping them realise that they are not alone.
  • Oxygen therapy – helps people with advanced lung disease to get the extra oxygen that they need and be more active. 
  • People over 40 with a history of cigarette smoking should speak with their GP if they do any of the following:
    – Cough several times most days
    – Bring up phlegm or mucous most days
    – Are short of breath compared with others their age

    The Australian Lung Foundation

  • The Australian Lung Foundation is the premier organisation for lung health in Australia, providing medical and support group representation nationwide.
  • The Australian Lung Foundation was established in 1990 to reduce the significant and debilitating cost of lung disease and is the leading facilitator of research and professional development in lung disease.
  • The Australian Lung Foundation offers LungNet – a national network of patient support groups for people with COPD and other lung conditions.  Patients are supported with information via http://www.lungfoundation.com.au/  a quarterly health education newsletter, telephone information and toll free support hotline (1800 654 301).
  • For further information please contact:

    Heather Allan, Director COPD Program, The Australian Lung Foundation
    (07) 3251-3634

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    References

    1. Access Economics. Economic impact of COPD and cost effective solutions. 2008.
    2. Buist AS, McBurnie MA, Vollmer WM et al. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet 1 September 2007; 370: 741-750
    3. McKenzie DK, Frith PA, Burdon et al on behalf of The Australian Lung Foundation. The COPDX Plan: Australian and New Zealand Guidelines for the Management of Chronic Obstructive Pulmonary Disease 2008, found at http://www.copdx.org.au/
    4. Petty T. The Rising Epidemic of COPD in Women: Why women are more susceptible; how treatment should differ.  Women’s Health in Primary Care Dec 1999;2(12)
    5. Buist AS, McBurnie MA, Vollmer WM et al. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet 1 September 2007; 370: 741-750
    6. AIHW. Australia’s Health 2008, Canberra May 2008.
    7. Page A, Abrose S, Glover J et al. Atlas of Avoidable Hospitalisations in Australia: ambulatory care-sensitive conditions.  Adelaide PHIDU. University of Adelaide.  2007
    8. Crockett AJ, Cranston JM, Moss JR. Economic Case Statement. Chronic Obstructive Pulmonary Disease. Australian Lung Foundation, Sept 2002
    9. Fletcher C, Peto R. The natural history of chronic airflow obstruction. B Med J 1977;1:1645-1648
    10. Abramson M et al. Managing chronic obstructive pulmonary disease. Aust Prescr 2007;30:64-7. Available at: http://www.australianprescriber.com/magazine/30/3/64/7
    11. Lacasse Y, Brosseau L, Milne S et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Review. 2001; Issue 4
    12. Griffiths TL, Phillips CJ, Davies S et al.  Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme.  Thorax  2001;56:779-784
    13. Golmohammadi K, Jacobs P, Sin DD.  Economic evaluation of a community-based pulmonary rehabilitation program for chronic obstructive pulmonary disease.  Lung  2004;182:187-196