COPD - The Blue-Collar Disease

Chronic obstructive pulmonary disease is the third leading cause of death in america

/ Author:  / Reviewed by: Joseph V. Madia, MD

Chronic Obstructive Pulmonary Disorder (COPD) affects nearly 12 million Americans, according to the National Heart Lung and Blood Institute (NHLBI), but there is still much to know about the disease. With COPD rates on the rise, the need to understand COPD is greater than ever.

As dailyRx has previously reported, COPD awareness has increased in America. While COPD's profile has been raised, that's not to say people truly understand the disease. COPD is a collection of lung diseases that reduce normal lung function, ultimately destroying the lungs. 

COPD consists of chronic bronchitis and emphysema. Most recently, it was discovered that patients with moderate to severe COPD were likely to have bronchiectasis. According to the NHLBI, COPD is the third leading killer in the United States.

dailyRx had the chance to talk to world-renowned lung expert Zab Mosenifar, M.D., Director of the Women's Guild Lung Institute at Cedars-Sinai Medical Center about COPD including its causes, who it affects and new treatments developments.

Where There's Smoke There's COPD

"The common cause of COPD is smoking, greater than 80 percent of COPD patients have a history of exposure to tobacco or one of its derivatives, smoking is the predominant cause of COPD, says Dr. Mosenifar." While that may be alarming, what is even more disconcerting about COPD is the number of smokers in America.

"Smoker rates in the United States has gone down a little bit in some states, but we still have close to 19 percent of the population, which is over 50-some million people who smoke in the country. Worldwide, smoking is a major challenge. There are about 300 million people in China who actively smoke. You can imagine that the death rate due to COPD has gone up in the last ten years or so," states Dr. Mosenifar.

COPD is already the fifth deadliest disease worldwide. A study by the World Health Organization (WHO), projects that by 2030, COPD will account for nearly eight percent of all deaths worldwide. Dr. Mosenifar agrees with this projection while adding, "death rate due to heart disease has dropped, death rate due to cancer has plateaued but death rate due to COPD has increased in the United States." 

Aside from smoking, another cause of COPD is by exposure to carbon monoxide through biomass fuels such as wood. "Non-smoking related COPD also is a challenge but less so in the US than worldwide. In China, they use biomass fuel to heat their homes," says Dr. Mosenifar." While biomass fuel is not an issue for Americans, second-hand smoke is, but according to Dr. Mosenifar that threat has been slowly reduced due to the ban of smoking in bars, restaurants and other public areas.

The Challenges of Diagnosing COPD

There are many obstacles in the way of diagnosing COPD according to Dr. Mosenifar. "It's fairly easy to diagnose COPD. A physician can do two things, take a good history and does a very simple test, spirometry," says Dr. Mosenifar.

Spirometry is a simple breathing test that measures lung function by how much air can be inhaled and exhaled.

While spirometry can be easily performed, it is not a tool many primary care physicians use or are familiar with. This can lead to improper COPD diagnosis.

"If you go to any physician's office and if you complain of chest pains, 95+ percent will do an Electrocardiogram (EKG). If you go to your primary care physician's office and complain of shortness of breath, I promise you 95+ percent would not do spirometry," says Dr. Mosenifar, "That's a big challenge and requires education of primary care physicians."

Bright Future for COPD Treatments

While COPD diagnosis can still be problematic, there have been great strides made in the treatment of COPD. "There is a better understanding of how to treat COPD in terms of interventions," says Dr. Mosenifar.  "We now have data suggesting that by interventions, which involve smoking cessation, use of various bronchodilators, anti-inflammatory agents, one could change the natural course of COPD," states Dr. Mosenifar.

Through the intervention programs, the natural lung function decline in COPD patients can be reduced. "You can kind of break that slope and improve the rate of decline of lung function, according to Dr. Mosenifar, "that has been shown through the use of inhaled steroids and other inhaled medication and some new modalities as well."

Another reason why COPD treatments have improved over the years is due to how doctors approach the disease. "We now know COPD is almost like an inflammatory disease," according to Dr. Mosenifar. Quitting smoking does not automatically mean a person is free from the risk of COPD. "Even after one stops smoking, for many years to come there's a kind of a very quiet inflammation that takes place. That quiet inflammation takes it toll and new therapies to be able to stop that cycle of inflammation will be critical," states Dr. Mosenifar.

COPD is the Blue-Collar Disease

While COPD has affected millions of people worldwide, it is still a disease predominantly affecting the middle class and lower-income individuals. "COPD, in general, is a blue-collar disease as opposed to heart disease. Heart disease is a white-collar disease, a lot of well-to-do people have developed cardiac disease and they have better access to care. If you compare 1,000 COPD patients to 1,000 cardiac patients, socioeconomically you will see that COPD patients are generally of lower socioeconomic status as opposed to heart disease or HIV patients," states Dr. Mosenifar.

"That's one of the disadvantages that COPD has. That's why COPD rates are much higher in states that socioeconomically are not as high. Let's say the state of Kentucky, Virginia, Mississippi or Alabama have very high smoking rates, up to as high as 30 percent, as opposed to California or Wisconsin which has a smoking rate of about 11 percent," according to Dr. Mosenifar.What that means for COPD patients is that better treatment, which is more costly, is unavailable leading to worsening symptoms.

The way to resolve the COPD issue and provide better diagnosis and treatment of COPD is through education. "This is a challenge of the public education, public services, public announcements, state funding and disseminating these kinds of issues. Not only among primary care physicians but among the general population," notes Dr. Mosenifar.

With COPD affecting millions of new individuals each year, the need for a better understanding of COPD is paramount. Being pro-active now, which includes better patient awareness and more funding for public education and research, could possibly lead to millions of individuals living longer, and better, lives with COPD.

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Review Date: 
January 5, 2012