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Copyright 2003 U.P.I.
November 13, 2003 Thursday
LENGTH: 1018 words
HEADLINE: COPD affects millions and costs billions
DATELINE: WASHINGTON, Nov. 13 (UPI)
BODY:
For the first time, women have surpassed men as victims of Chronic
Obstructive Pulmonary Disease, a chronic and destructive condition that affects a staggering 24 million Americans and kills about 119,000 each year, researchers said Thursday.
COPD, as it is known, costs billions in healthcare, yet the condition continues to go largely unrecognized by patients and under-diagnosed by physicians. About 85 percent of all COPD cases can be attributed to cigarette smoking.
"It's the only cause of mortality in the United States that's gone up," Dr. Dennis E. Dhoerty, chief of pulmonary critical care at the University of Kentucky in Lexington and co-chairman of the National Lung Health Education Program with the COPD Coalition, told United Press International.
COPD follows heart disease, cancer, and stroke as a leading cause of U.S. deaths. The COPD death rate has skyrocketed 183 percent since 1965, Doherty said. "Since 1979, the death rate in women has gone up three-fold compared to men."
Women now account for more COPD cases because of their increased rates of smoking over the last four decades. The disease causes progressively impaired lung function that can include chronic bronchitis and emphysema. Doherty explained the inflammation in COPD is different from the airway inflammation in asthma because COPD affects a different layer of cells. "Over time, you lose the structure of the lung and the breathing tubes collapse in the middle of exhalation," Doherty said.
Experts say only half of those who have COPD actually are diagnosed, so a large swath of the U.S. population unknowingly carries the condition. It progresses slowly and many people mistake COPD for other ubiquitous symptoms, such as a common cold or shortness of breath due to old age or lack of physical fitness. "Most people don't complain to the doctor until they've lost 50 percent of their lung function," Doherty said.
To spotlight the issue, experts have gathered for the first National COPD Conference to raise public awareness.
Dr. William Bailey, a professor of medicine at the University of Alabama at Birmingham, director of the university's lung health center, and co-chairman of the conference, said doctors, patients, and lawmakers need to be aware of the huge medical and economical toll COPD has taken on the country.
"We estimate with current inadequate figures, there's probably a current cost of $35 billion total a year," Bailey told UPI. Those costs include health care costs and indirect costs. Bailey explained the figures are probably inadequate because COPD is so grossly under-diagnosed. "It's really enormous -- the economic impact is truly enormous, he said."
According to the American Lung Association, in 2002 the annual cost of COPD was $32.1 billion, including $19 billion in direct health expenses, such as hospital visits, $6.7 billion in indirect morbidity costs and $7.3 billion in indirect mortality costs. Indirect costs include loss of time at work due to illness or losing one's job altogether because of inability to work.
The economic toll not only affects on a national level, it also hits home. Because patients often are not diagnosed until their disease is advanced, they often run into difficulty continuing to work and perform everyday household activities, explained Dr. Claude Lenfant, former director of the National Heart, Lung and Blood Institute -- part of the National Institutes of Health in Bethesda, Md. -- and an adviser to the COPD Coalition.
"The burden on the families of these patients is enormous, in terms of the costs to the family," Lenfant told UPI. "COPD is a very slow process. It's not like having an infection. It creates all kind of health problems which require the patients to go see a physician."
Patients often lose so much ability to breathe normally while mildly exerting themselves, Lenfant added, that "in many instances they stop walking."
Such a situation can place the burden of transporting a COPD patient, such as for receiving medical care, on other household members, he said.
There is no cure for COPD. Current treatments are similar to asthma therapies, such as bronchial dilators to open airways and anti-inflammatory medications, but they only minimize symptoms. They do not go to the source of the problem.
Lenfant said the national COPD conference comes at a time when more scientists are taking an interest in COPD research. "There's lots of research going on now to understand how the disease develops," he said. "The reason for that is if you understand how the disease develops, than you can develop some intervention to stop the process. As a result of that, the pharmaceutical industry has gotten very interested in looking for possible medications."
More targeted drugs are being tested, Lenfant added, to see whether they cannot only reduce airway inflammation, but suppress it.
Dr. Norman H. Edelman, consultant for scientific affairs for the
American Lung Association in New York City, said increasing public awareness will increase the chances of earlier detection. A simple breathing test can determine if someone has COPD.
"ALA believes a lot of disability from COPD can be avoided or at least delayed by early recognition," Edelman told UPI. "We want people to know the signs of COPD so they can go to their doctors for breathing tests."
Signs include shortness of breath, excessive coughing of mucus, and wheezing.
Edelman also said though cigarette smoking accounts for the majority of COPD cases, about 10 to 15 percent are due to environmental factors, including secondhand smoke and air pollution.
"Particulates, fine, fine particles in soot and dust do play a role in many lung diseases, and in heart disease as well, and in COPD," Edelman said.
"That's why ALA is really concerned about the Environmental Protection Agency's recent relaxation, basically a decision not to enforce it rules concerning modifications for old power plants. It's a license to pollute."
Katrina Woznicki covers health issues for UPI Science News. E-mail |