Przewlekła obturacyjna choroba płuc
Epidemiologia
Przewlekła obturacyjna choroba płuc (POChP) stanowi istotne wyzwanie zdrowia publicznego, będąc czwartą najczęstszą przyczyną zgonów globalnie, z 3,5 mln zgonów w 2021 roku (około 5% wszystkich zgonów). Choroba dotyka około 213 mln osób (2,7% populacji światowej), z wyraźnym wzrostem częstości wraz z wiekiem – od 4,37% w grupie 40-49 lat do 24,03% u osób ≥70 lat. Palenie tytoniu pozostaje głównym czynnikiem ryzyka, odpowiadającym za ponad 70% przypadków w krajach wysoko rozwiniętych, jednak 25-45% pacjentów nigdy nie paliło. W krajach o niskich i średnich dochodach istotne znaczenie ma zanieczyszczenie powietrza w gospodarstwach domowych oraz narażenie zawodowe. Diagnostyka opiera się na spirometrii, z kryteriami FR (FEV1/FVC <0,70) i LLN, które wpływają na różnice w szacunkach rozpowszechnienia (odpowiednio 12,64% i 7,38% u osób ≥40 lat). POChP często współistnieje z innymi chorobami przewlekłymi (86,6% pacjentów ma ≥2 choroby współistniejące), co pogarsza rokowanie i jakość życia.
Epidemiologia i globalne obciążenie POChP
Przewlekła obturacyjna choroba płuc (POChP) stanowi poważny problem zdrowia publicznego na całym świecie. Aktualnie POChP jest czwartą najczęstszą przyczyną zgonów na świecie, powodując 3,5 miliona zgonów w 2021 roku, co stanowi około 5% wszystkich zgonów na świecie. POChP jest również ósmą główną przyczyną złego stanu zdrowia, mierzoną w latach życia skorygowanych niepełnosprawnością (DALY)1. Według danych Światowej Organizacji Zdrowia (WHO), liczba zgonów z powodu POChP wzrosła znacząco w ostatnich dekadach, a prognozy wskazują, że do 2030 roku POChP stanie się trzecią najczęstszą przyczyną śmierci na świecie23.
Globalne szacunki dotyczące rozpowszechnienia POChP wykazują znaczne zróżnicowanie w zależności od metodologii badań i przyjętych kryteriów diagnostycznych. Według danych z 2021 roku, POChP dotykała około 213 milionów osób (2,7% populacji globalnej), podczas gdy badania epidemiologiczne wskazywały na liczbę 384 milionów osób z POChP w 2010 roku, co odpowiadało globalnej chorobowości na poziomie 12%45. Badanie BOLD (Burden of Obstructive Lung Disease) ustaliło globalne rozpowszechnienie POChP na poziomie 10,1%, przy czym u mężczyzn wynosiło ono 11,8%, a u kobiet 8,5%6.
Istotnym spostrzeżeniem jest fakt, że prawie 90% zgonów z powodu POChP u osób poniżej 70 roku życia występuje w krajach o niskich i średnich dochodach12. Wzrost częstości występowania POChP w krajach rozwijających się między 1970 a 2000 rokiem jest prawdopodobnie związany ze zwiększoną częstością palenia tytoniu w tych regionach, wzrostem liczby ludności oraz starzeniem się społeczeństwa z powodu mniejszej liczby zgonów z powodu innych przyczyn, takich jak choroby zakaźne5.
Rozkład geograficzny POChP
Występowanie POChP wykazuje znaczne zróżnicowanie geograficzne. Najwyższe rozpowszechnienie POChP odnotowano w Ameryce (regionie WHO), a najniższe w regionach Azji Południowo-Wschodniej i Zachodniego Pacyfiku7. Metaanaliza wykazała wysoki poziom rozpowszechnienia POChP w regionie amerykańskim, z częstością występowania 22,93% według kryteriów stałego wskaźnika (FR)8.
W Stanach Zjednoczonych prawie 16 milionów dorosłych ma zdiagnozowaną POChP, a wielu więcej może nie wiedzieć, że choruje. W 2021 roku ponad 15 milionów Amerykanów (6,4%) zgłosiło, że zdiagnozowano u nich POChP9. W Kanadzie w latach 2011-2012 około 2,0 miliona Kanadyjczyków w wieku 35 lat i starszych żyło z rozpoznaniem POChP10.
W Chinach całkowite rozpowszechnienie POChP wzrosło z 2,70% w 1990 roku do 3,84% w 2010 roku, a łączna liczba pacjentów z POChP wzrosła o 66,73% z 30 milionów w 1990 roku do 50 milionów w 2010 roku11. W Brazylii częstość występowania POChP wynosi 17% (95% CI: 13-22), co jest wyższe niż szacunki dla populacji Ameryki Łacińskiej i światowej12.
Wzorce demograficzne w POChP
POChP dotyka głównie osoby powyżej 35-40 roku życia, a częstość występowania znacząco wzrasta wraz z wiekiem46. Według metaanalizy, rozpowszechnienie POChP według definicji stałego wskaźnika (FR) wzrosło z 4,37% u osób w grupie wiekowej 40-49 lat do 24,03% u osób w wieku 70 lat i starszych13. W Australii w 2022 roku jedna na czternaście osób (7,0%) w wieku 65 lat i starszych miała POChP, co stanowiło wyższy odsetek niż w jakiejkolwiek innej grupie wiekowej14.
Przez lata większość badań wskazywała, że częstość występowania i umieralność z powodu POChP są większe u mężczyzn niż u kobiet. Jednak dane z lat 2012-2013 z krajów rozwiniętych sugerują, że rozpowszechnienie POChP jest obecnie prawie równe u mężczyzn i kobiet, prawdopodobnie z powodu różnych wzorców palenia papierosów7. W niektórych krajach śmiertelność zmniejszyła się u mężczyzn, ale wzrosła u kobiet, co najprawdopodobniej wynika z tego, że wskaźniki palenia u kobiet i mężczyzn stają się coraz bardziej podobne5. Co więcej, niektóre badania sugerują, że kobiety mogą mieć większe ryzyko obturacji dróg oddechowych niż mężczyźni, pomimo narażenia na podobną dawkę tytoniu7.
Czynniki ryzyka POChP
Palenie tytoniu jest najważniejszym czynnikiem ryzyka rozwoju POChP, odpowiadającym za ponad 70% przypadków w krajach o wysokich dochodach16. Osoby z POChP, które obecnie palą, stanowią 34,5% diagnozowanych przypadków w USA9. Badania pokazują, że dorośli, którzy są aktualnymi codziennymi palaczami, mają większe prawdopodobieństwo zachorowania na POChP niż byli palacze (8,1% w porównaniu do 4,4%) lub osoby, które nigdy nie paliły (8,1% w porównaniu do 1,6%)14.
Jednak warto zauważyć, że szacunkowo od 25% do 45% pacjentów z POChP na całym świecie nigdy nie paliło15. W USA częstość występowania POChP u osób, które nigdy nie paliły, wynosi 2,2%7. Międzynarodowe badanie wykazało, że częstość występowania POChP u osób, które nigdy nie paliły, wynosi 12,2%7. W Polsce około 25% diagnozowanych przypadków to osoby niepalące16.
W krajach o niskich i średnich dochodach palenie tytoniu odpowiada za 30-40% przypadków POChP, a zanieczyszczenie powietrza w gospodarstwach domowych jest istotnym czynnikiem ryzyka16. Zanieczyszczenie powietrza w gospodarstwie domowym dotyka prawie 3 miliardy ludzi na całym świecie15. W tych krajach powszechne jest używanie paliw z biomasy (drewno, odchody zwierząt, pozostałości upraw) lub węgla do gotowania i ogrzewania, co wiąże się z wysokim poziomem narażenia na dym1.
Narażenie zawodowe jest również istotnym czynnikiem ryzyka, odpowiadającym za 14% ogólnego obciążenia POChP na świecie15. Dotyczy to narażenia na pyły organiczne i nieorganiczne, chemikalia oraz dym w wyniku pracy w rolnictwie, górnictwie lub przemyśle ciężkim17.
Inne czynniki ryzyka POChP obejmują:
- Zdarzenia wczesnego dzieciństwa, takie jak słaby wzrost w macicy, wcześniactwo oraz częste lub ciężkie infekcje układu oddechowego w dzieciństwie, które uniemożliwiają maksymalny rozwój płuc1
- Astmę w dzieciństwie1
- Rzadki stan genetyczny zwany niedoborem alfa-1 antytrypsyny, który może powodować POChP w młodym wieku1
- Zamieszkiwanie na terenach wiejskich, które wiąże się z wyższym ryzykiem POChP niż w przypadku mieszkańców miast15
Społeczno-ekonomiczne skutki POChP
POChP stanowi znaczące obciążenie ekonomiczne dla systemów opieki zdrowotnej, pacjentów i społeczeństwa. W Stanach Zjednoczonych koszty medyczne przypisywane POChP wśród dorosłych w wieku 45 lat i starszych oszacowano na 24 miliardy dolarów rocznie, z czego 11,9 miliarda dolarów przeznaczono na koszty leków na receptę1819. Szacuje się, że koszty leczenia POChP mogą wzrosnąć z 59,3 miliarda dolarów w 2010 roku do 90,6 miliarda dolarów do 2020 roku20.
W 2020 roku w USA odnotowano 247 314 (82,92 na 1 000 osób objętych programem Medicare w wieku 65 lat) hospitalizacji z POChP jako jakąkolwiek diagnozą oraz 165 248 (5,44 na 1 000 osób objętych programem Medicare w wieku 65 lat) hospitalizacji z POChP jako pierwszą wymienioną diagnozą9. Rocznie występuje co najmniej 30 milionów przypadków zaostrzeń POChP, co kosztuje 28 miliardów dolarów20.
Co istotne, gdyby wszyscy pacjenci w pełni przestrzegali przepisanych im leków na POChP, zaostrzenia mogłyby zostać zmniejszone o 25% do 30% rocznie, co dałoby oszczędności w wysokości 4 miliardów dolarów rocznie20.
POChP ma również znaczący wpływ na jakość życia. Spośród wszystkich osób z POChP w 2022 roku prawie dziewięć na dziesięć (86,6%) miało dwie lub więcej chorób przewlekłych. Dodatkowo prawie jedna na dziesięć (9,3%) dorosłych, którzy doświadczyli silnego lub bardzo silnego bólu cielesnego w ciągu czterech tygodni przed wywiadem, miała POChP14.
Nierówności w występowaniu POChP
Występowanie POChP jest zróżnicowane w zależności od wielu czynników demograficznych i społeczno-ekonomicznych. Według analizy America’s Health Rankings, populacje o wyższej częstości występowania POChP obejmują:
- Kobiety w porównaniu z mężczyznami
- Dorosłych w wieku 65 lat i starszych (częstość występowania wzrasta z wiekiem)
- Dorosłych rdzennych Amerykanów/mieszkańców Alaski i osoby wielorasowe w porównaniu z Azjatami i Latynosami
- Dorosłych z wykształceniem niższym niż średnie w porównaniu z osobami o wyższym poziomie wykształcenia (absolwenci szkół wyższych mają najniższą częstość występowania)
- Dorosłych o rocznym dochodzie gospodarstwa domowego poniżej 25 000 dolarów w porównaniu z dorosłymi o wyższych poziomach dochodów
- Dorosłych mieszkających na obszarach pozamiejskich w porównaniu z mieszkającymi na obszarach miejskich21
Populacje wiejskie są bardziej narażone na POChP niż mieszkańcy miast15. W badaniu z 2019 roku prowadzonym przez National Health Interview Survey wykazano, że częstość występowania POChP u dorosłych w USA była większa u osób mieszkających na obszarach pozamiejskich niż miejskich, odpowiednio 8,0% i 4,0%22.
Istnieją również różnice rasowe i etniczne w występowaniu POChP. Afroamerykanie, którzy nigdy nie palili, mają nieproporcjonalnie wysoką częstość występowania POChP, podczas gdy Latynosi mają niską częstość występowania POChP15.
Trendy w częstości występowania i chorobowości POChP
Globalne trendy w zakresie POChP wykazują niejednoznaczny obraz. Między 1990 a 2021 rokiem zmiany wynosiły -1,46% (95% przedział ufności [UI] -3,36% do 0,39%) w standaryzowanej względem wieku chorobowości, -37,12% (-43,37% do -27,68%) w śmiertelności i -36,98% (-42,37% do -28,54%) we wskaźniku DALY23. Oznacza to, że standaryzowane względem wieku wskaźniki poprawiły się, ale całkowite liczby wskazują na rosnące ogólne obciążenie POChP.
W Stanach Zjednoczonych częstość występowania POChP wśród dorosłych pozostała stabilna w latach 2011-2021 (z 6,1% do 6,0%) w większości podgrup i stanów. Jednak częstość występowania wzrosła wśród dorosłych w wieku 75 lat, osób mieszkających na obszarach wiejskich i osób, które kiedykolwiek paliły24.
W Kanadzie względny wzrost standaryzowanej względem wieku częstości występowania POChP wyniósł 33,6% wśród wszystkich Kanadyjczyków w wieku 35 lat i starszych; z 7,0% (1,1 miliona Kanadyjczyków) w latach 2000-2001 do 9,4% (2,0 miliona Kanadyjczyków) w latach 2011-201225. Jednocześnie ogólny standaryzowany względem wieku wskaźnik zachorowalności na POChP wśród Kanadyjczyków w wieku 35 lat i starszych spadł z 1201,9 do 914,8 na 100 000 mieszkańców w tym samym okresie; względny spadek o 23,9%25.
W Chinach wskaźnik umieralności z powodu POChP spadł do 47,30/100 000 i 66,24/100 000 w 2016 roku (odpowiednio czwarta i trzecia najczęstsza przyczyna śmierci), przy czym wskaźnik umieralności był wyższy na obszarach wiejskich niż miejskich. Chociaż wskaźnik umieralności z powodu POChP w Chinach spadł, pozostaje on wyższy niż średnia światowa, a liczba zgonów stanowi ponad 30% zgonów globalnych26.
Metaanaliza wykazała, że częstość występowania POChP znacznie wzrosła między okresami 2016-2019 a 2020-2022. Według kryteriów FR wynosiła ona 10,43% (95% CI 8,11%-12,99%) w okresie 2016-2019 i osiągnęła 15,17% (95% CI 11,67%-19,02%) w okresie 2020-202227.
Metody nadzoru i wyzwania w epidemiologii POChP
Nadzór nad POChP napotyka kilka wyzwań, które mogą wpływać na dokładność danych epidemiologicznych. Głównym problemem jest niedodiagnozowanie, ponieważ wielu pacjentów z POChP nie zostaje zdiagnozowanych lub jest diagnozowanych dopiero w późnym stadium choroby6. Szacuje się, że ponad 50% osób z objawami POChP nigdy nie zostało zdiagnozowanych z tą chorobą28.
Główne przyczyny niedodiagnozowania zidentyfikowane w literaturze to brak wiedzy na temat choroby ze strony pacjentów i lekarzy, niedoszacowanie objawów oraz niedostateczne wykorzystanie spirometrii do ustalenia diagnozy29. W wielu krajach o niskich i średnich dochodach spirometria często nie jest dostępna, co może prowadzić do pominięcia diagnozy30.
Innym wyzwaniem jest fakt, że POChP często współistnieje z innymi chorobami, które mogą znacząco wpływać na wyniki pacjenta. Dlatego ważne jest, aby oceniać śmiertelność z powodu POChP jako przyczynę zarówno współistniejącą, jak i podstawową zgonu31. Śmiertelność z powodu POChP może być również niedoszacowana, ponieważ jest często wymieniana jako „czynnik przyczyniający się” raczej niż przyczyna śmierci32.
Systemy nadzoru POChP różnią się między krajami. W Stanach Zjednoczonych Centra Kontroli i Prewencji Chorób (CDC) monitorują POChP poprzez różne systemy nadzoru, a POChP jest uwzględniona w wskaźnikach chorób przewlekłych CDC9. W Kanadzie Agencja Zdrowia Publicznego Kanady (PHAC) współpracuje z prowincjami i terytoriami za pośrednictwem Canadian Chronic Disease Surveillance System (CCDSS) w celu gromadzenia i raportowania krajowych danych nadzoru nad POChP33.
Kryteria diagnostyczne i ich wpływ na dane epidemiologiczne
Kryteria diagnostyczne używane do identyfikacji POChP mogą znacząco wpływać na szacunki częstości występowania. Najczęściej stosowane kryteria diagnostyczne to:
- Stosunek stały (FR), który stwierdza, że obecność stosunku natężonej objętości wydechowej w ciągu jednej sekundy (FEV1) do natężonej pojemności życiowej (FVC) po podaniu bronchodylatatora mniejszego niż 0,70 potwierdza diagnozę
- Kryteria dolnej granicy normy (LLN), w których diagnoza opiera się na porównaniu wartości mierzonych spirometrią z wartościami referencyjnymi określonymi na podstawie zdrowych i niepalących osób29
Badania pokazują, że częstość występowania POChP różni się w zależności od zastosowanych kryteriów diagnostycznych. Ogólna częstość występowania POChP u osób w wieku 40 lat i starszych wynosiła 12,64% (95% CI, 10,75-14,65%) i 7,38% (95% CI, 5,47-9,55%) odpowiednio według definicji FR i LLN27.
Różne definicje POChP i brak spirometrii do potwierdzenia diagnozy utrudniają ilościowe określenie chorobowości i śmiertelności32. W przeszłości niedokładne definicje POChP i niedodiagnozowanie prowadziły do niedostatecznego raportowania tego stanu32.
Globalne inicjatywy i systemy nadzoru POChP
Światowa Organizacja Zdrowia (WHO) podejmuje działania mające na celu rozszerzenie diagnozy i leczenia POChP na wiele sposobów. POChP jest włączona do Globalnego Planu Działania WHO na rzecz Zapobiegania i Kontroli Chorób Niezakaźnych (NCD) oraz do Agendy Zrównoważonego Rozwoju ONZ 203030.
Pakiet Podstawowych Interwencji Światowej Organizacji Zdrowia w zakresie Chorób Niezakaźnych (PEN) został opracowany, aby pomóc w poprawie zarządzania chorobami niezakaźnymi w podstawowej opiece zdrowotnej w warunkach ograniczonych zasobów. PEN obejmuje protokoły oceny, diagnozy i zarządzania przewlekłymi chorobami układu oddechowego (astma i przewlekła obturacyjna choroba płuc) oraz moduły dotyczące poradnictwa w zakresie zdrowego stylu życia, w tym zaprzestania palenia tytoniu i samoopieki30.
Globalna Inicjatywa dla Przewlekłej Obturacyjnej Choroby Płuc (GOLD) opracowała strategię zarządzania POChP opartą na ciężkości choroby, używając połączonej oceny objawów, stopnia ograniczenia przepływu powietrza i liczby zaostrzeń34. Ta strategia jest często traktowana jako standard POChP i stanowi podstawę dla większości krajowych wytycznych35.
W Stanach Zjednoczonych cele zdrowotne Healthy People 2030 obejmują wiele celów związanych z chorobami układu oddechowego i POChP, w tym:
- Zmniejszenie liczby zgonów z powodu POChP wśród dorosłych w wieku 45 lat i starszych
- Zmniejszenie liczby wizyt na oddziałach ratunkowych z powodu POChP wśród dorosłych w wieku 45 lat i starszych
- Zmniejszenie liczby hospitalizacji z powodu POChP21
Przyszłe potrzeby w zakresie nadzoru nad POChP
Pomimo dostępności wielu źródeł danych do nadzoru nad POChP, nie istnieje kompleksowy system nadzoru, który przyczyniałby się do zapobiegania i kontroli POChP36. Istnieje potrzeba lepszych systemów nadzoru, które mogą:
- Dokładniej szacować rzeczywistą chorobowość POChP, w tym przypadki niezdiagnozowane
- Lepiej oceniać śmiertelność z powodu POChP jako zarówno przyczynę podstawową, jak i współistniejącą
- Monitorować zmiany w czynnikach ryzyka POChP, zwłaszcza w odniesieniu do palenia i zanieczyszczenia powietrza
- Oceniać skuteczność interwencji mających na celu zapobieganie i kontrolę POChP36
Ponadto należy podjąć wysiłki w celu opracowania modeli oceny i przewidywania wpływu zanieczyszczenia powietrza i czynników meteorologicznych na przyjęcia do szpitala pacjentów z rozpoznaniem POChP37.
Kluczowe jest również promowanie badań przesiewowych spirometrii dla wczesnego wykrywania POChP, szczególnie w grupach wysokiego ryzyka. Badania sugerują, że osoby w wieku 60 lat lub starsze z dodatnim wywiadem palenia powinny poddać się badaniu PFT (test funkcji płuc) w celu wykrycia POChP38.
Współchorobowość w POChP
POChP często współistnieje z innymi chorobami przewlekłymi, co może wpływać na rokowanie i jakość życia pacjentów. Spośród wszystkich pacjentów z POChP, 76,7% ma jedną lub więcej innych chorób przewlekłych, a 3,2% ma cztery lub więcej innych stanów39.
Częstość występowania POChP jest większa wśród osób ze zdiagnozowaną cukrzycą, nadciśnieniem, zaburzeniami nastroju i/lub lękowymi oraz astmą niż wśród osób bez tych chorób, co wskazuje współczynniki częstości większe niż jeden dla wszystkich czterech współistniejących stanów25.
Pacjenci z POChP mają zwiększone obciążenie chorobą w porównaniu do populacji ogólnej i szeroki zakres klinicznych współchorobowości, w tym zespół metaboliczny, bezdech senny, cukrzycę, depresję, osteoporozę, niewydolność serca, chorobę niedokrwienną serca, nadciśnienie płucne, raka płuc, zanik mięśni i kacheksję40.
Obecność współchorobowości była zgłaszana u 89,3% pacjentów hospitalizowanych z POChP w Polsce, a średni czas hospitalizacji wynosił 9,4 dnia (54,5% pacjentów hospitalizowanych z POChP było hospitalizowanych do 7 dni), a wskaźnik śmiertelności wewnątrzszpitalnej wynosił 6,8%37.
Starszy wiek, obecność chorób sercowo-naczyniowych, zaburzeń układu moczowo-płciowego lub zaburzeń układu pokarmowego były znacząco związane z wyższym ryzykiem śmierci wewnątrzszpitalnej37.
Podsumowanie
POChP stanowi znaczące globalne wyzwanie dla zdrowia publicznego, będąc czwartą najczęstszą przyczyną zgonów na świecie i powodując znaczną chorobowość. Częstość występowania i wpływ POChP różnią się znacznie w zależności od regionu geograficznego, wieku, płci i czynników społeczno-ekonomicznych.
Główne czynniki ryzyka POChP obejmują palenie tytoniu, zanieczyszczenie powietrza w pomieszczeniach, narażenie zawodowe oraz czynniki genetyczne. Chociaż standaryzowane względem wieku wskaźniki POChP poprawiły się w ostatnich dekadach, całkowite obciążenie chorobą nadal rośnie ze względu na starzenie się populacji i ciągłe narażenie na czynniki ryzyka.
Poprawa nadzoru nad POChP, wczesna diagnostyka poprzez badania spirometryczne, zapobieganie poprzez ograniczenie narażenia na czynniki ryzyka oraz kompleksowe zarządzanie współistniejącymi chorobami są kluczowe dla zmniejszenia obciążenia tą chorobą. Globalne i krajowe inicjatywy mające na celu zapobieganie i kontrolę POChP odgrywają istotną rolę w poprawie wyników zdrowotnych i zmniejszeniu obciążenia ekonomicznego związanego z tą chorobą.
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Materiały źródłowe
- #1https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide, causing 3.5 million deaths in 2021, approximately 5% of all global deaths. […] Nearly 90% of COPD deaths in those under 70 years of age occur in low- and middle-income countries (LMIC). […] COPD is the eighth leading cause of poor health worldwide (measured by disability-adjusted life years). […] Tobacco smoking accounts for over 70% of COPD cases in high-income countries. In LMIC tobacco smoking accounts for 30-40% of COPD cases, and household air pollution is a major risk factor. […] COPD develops gradually over time, often resulting from a combination of risk factors: tobacco exposure from active smoking or passive exposure to second-hand smoke; occupational exposure to dusts, fumes or chemicals; indoor air pollution: biomass fuel (wood, animal dung, crop residue) or coal is frequently used for cooking and heating in low- and middle-income countries with high levels of smoke exposure; early life events such as poor growth in utero, prematurity, and frequent or severe respiratory infections in childhood that prevent maximum lung growth; asthma in childhood; and a rare genetic condition called alpha-1 antitrypsin deficiency, which can cause COPD at a young age.
- #2 WHO EMRO | Chronic obstructive pulmonary disease (COPD) | Health topicshttps://www.emro.who.int/health-topics/chronic-obstructive-pulmonary-disease-copd/index.html
Chronic obstructive pulmonary disease (COPD) is a life-threatening lung disease that interferes with normal breathing it is more than a smokers cough. According to the WHO estimates (2004), currently 64 million people have COPD and 3 million people died of COPD. WHO predicts that COPD will become the third leading cause of death worldwide by 2030. Almost 90% of COPD deaths occur in low- and middle-income countries, where effective strategies for prevention and control are not always implemented or accessible. […] COPD predicted to be third leading cause of death in 2030/ World Health Statistics 2008. […] Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach.
- #3 Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis | BMC Public Health | Full Texthttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-17686-9
According to the World Health Organization (WHO), COPD is considered among the top ten causes of death worldwide. […] In 2016, 251 million cases of COPD were recorded worldwide, according to estimates from the Global Burden of Disease (GBD) study. […] COPD is an important cause of mortality. Between 2009 and 2019, the mortality rate of COPD increased by 35.4%. […] Furthermore, WHO mortality and disease burden projections state that COPD will be the third leading cause of death worldwide by 2030. […] The main causes of underdiagnosis identified in the literature are lack of knowledge of the disease on the part of patients and physicians, underestimation of symptoms, and underuse of the spirometer to establish the diagnosis. […] The most frequently used diagnostic criteria are the fixed ratio (FR), which states that the presence of a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) post-bronchodilator less than 0.70 confirms the diagnosis, and the lower limit of normal (LLN) criteria, in which the diagnosis is based on the comparison of values measured by spirometry with reference values identified from healthy and non-smoking subjects.
- #4 Chronic obstructive pulmonary disease – Wikipediahttps://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by chronic respiratory symptoms and airflow limitation. GOLD defines COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms (shortness of breath, cough, sputum production or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction. […] As of 2021, COPD affected about 213 million people (2.7% of the global population). It typically occurs in males and females over the age of 35-40. In 2021, COPD caused 3.65 million deaths. Almost 90% of COPD deaths in those under 70 years of age occur in low and middle income countries. In 2021, it was the fourth biggest cause of death, responsible for approximately 5% of total deaths. The number of deaths is projected to increase further because of continued exposure to risk factors and an aging population.
- #5 Chronic obstructive pulmonary disease – Wikipediahttps://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease
Estimates of prevalence have considerable variation due to differences in analytical and surveying approach and the choice of diagnostic criteria. An estimated 213 million people had COPD in 2021, corresponding to a global prevalence of 2.7%, whereas epidemiological studies indicated an estimation of 384 million having COPD in 2010, corresponding to a global prevalence of 12%. The disease affects men and women. The increase in the developing world between 1970 and the 2000s is believed to be related to increasing rates of smoking in this region, an increasing population and an aging population due to fewer deaths from other causes such as infectious diseases. Some developed countries have seen increased rates, some have remained stable and some have seen a decrease in COPD prevalence. […] Around three million people die of COPD each year. In some countries, mortality has decreased in men but increased in women. This is most likely due to rates of smoking in women and men becoming more similar. A higher rate of COPD is found in those over 40 years and this increases greatly with advancing age with the highest rate found in those over 60 years.
- #6 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiologyhttps://emedicine.medscape.com/article/807143-overview
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. Tobacco smoking accounts for over 70% of COPD cases in high-income countries. In low- and middle-income countries, tobacco smoking accounts for only 30-40% of COPD cases, and household air pollution is a major risk factor. […] The exact prevalence of COPD worldwide is largely unknown, but estimates have varied from 7-19%. The Burden of Obstructive Lung Disease (BOLD) study found a global prevalence of 10.1%. Men were found to have a pooled prevalence of 11.8% and women 8.5%. […] The National Health Interview Survey reports the prevalence of emphysema at 18 cases per 1000 persons and chronic bronchitis at 34 cases per 1000 persons. While the rate of emphysema has stayed largely unchanged since 2000, the rate of chronic bronchitis has decreased. Another study estimates a prevalence of 10.1% in the United States. However, the exact prevalence of COPD in the United States is believed to be underestimated. This is largely due to the fact that it is an underdiagnosed (and undertreated) disease, because most patients do not present for medical care until the disease is in a late stage. […] Although current rates of COPD in men are higher than the rates in women, the rates in women have been increasing. COPD occurs predominantly in individuals older than age 40 years.
- #7 Chronic obstructive pulmonary disease (COPD) – Epidemiology | BMJ Best Practice UShttps://bestpractice.bmj.com/topics/en-us/7/epidemiology
COPD prevalence is highest in the World Health Organization region of the Americas and lowest in the South-East Asia and Western Pacific regions. The pooled global prevalence is 15.7% in men and 9.93% in women. […] Previously, most studies reported that the prevalence and mortality of COPD are greater in men than in women. […] However, data from 2012 to 2013 from developed countries suggest that COPD prevalence is now almost equal in men and women, probably due to different patterns of cigarette smoking. […] Some studies have also suggested that women may have a greater risk of airflow obstruction than men despite exposure to a similar dose of tobacco. […] An international study reported that the prevalence of COPD in never-smokers is 12.2%. […] This may be due to air pollution or indoor burning of solid fuels in low- and middle-income countries. In the US, the prevalence of COPD in never-smokers is 2.2%. Many of these cases are attributed to workplace exposures such as in the mining industry and in food preparation and serving.
- #8 Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis | BMC Public Health | Full Texthttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-17686-9
The estimated overall prevalence of COPD in people aged 40 years and older was 12.64% (95% CI, 10.75-14.65%) and 7.38% (95% CI, 5.47-9.55%) according to the FR and LLN definitions, respectively. […] Estimates of the overall prevalence of COPD by sex indicate a high prevalence of irreversible airflow limitation in men compared to women according to the FR definition (prevalence of COPD was 15.47% in men versus a prevalence of 8.79% in women). […] Our meta-analysis found a high prevalence of COPD in the American region, with a prevalence of 22.93% according to the FR definition. […] The prevalence of COPD increased significantly between the 2016-2019 and 2020-2022 periods. According to the FR criteria, it was 10.43% (95% CI 8.11%-12.99%) in the 2016-2019 period and reached 15.17% (95% CI 11.67%-19.02%) in the 2020-2022 period.
- #9 COPD | Chronic Disease Indicators | CDChttps://www.cdc.gov/cdi/indicator-definitions/chronic-obstructive-pulmonary-disease.html
Chronic obstructive pulmonary disease (COPD) is 1 of the top 10 causes of death in the United States. […] Nearly 16 million U.S. adults have COPD, and many more do not know they have it. […] In 2021, more than 15 million Americans (6.4%) reported that they have been diagnosed with COPD. […] Among those diagnosed with COPD, 34.5% reported they were current smokers. […] In 2020, there were 247,314 (82.92 per 1,000 Medicare enrollees aged 65 years) hospitalizations with COPD as any diagnosis. […] In 2020, there were 165,248 (5.44 per 1,000 Medicare enrollees aged 65 years) hospitalizations with COPD as the first-listed diagnosis. […] Chronic obstructive pulmonary disease (COPD) accounts for the majority of deaths from chronic lower respiratory diseases, the sixth leading cause of death in the United States in 2021.
- #10 Asthma and Chronic Obstructive Pulmonary Disease (COPD) in Canada, 2018 – Canada.cahttps://www.canada.ca/en/public-health/services/publications/diseases-conditions/asthma-chronic-obstructive-pulmonary-disease-canada-2018.html
Chronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease which causes limitations in airflow. […] COPD primarily affects the population 35 years and older. The primary cause of COPD is tobacco smoking, including second hand or passive exposure. […] In 2011-2012 about 2.0 million Canadians aged 35 years and older were living with COPD. The number of new COPD cases per year has also declined between 2000-2001 and 2011-2012 while the number of Canadians living with the disease has increased for the same time period. […] COPD occurs more frequently among those who also have other chronic diseases and conditions (diabetes, hypertension, mood and/or anxiety disorders, or asthma) compared to those who do not have these conditions. […] The prevalence of COPD among Canadians aged 35 years and older increased steadily across the life span.
- #11 Current status and preventive strategies of chronic obstructive pulmonary disease in China: a literature review – Quan – Journal of Thoracic Diseasehttps://jtd.amegroups.org/article/view/52866/html
During the past few decades, the prevalence of COPD in China has increased such that the total prevalence of COPD in China has increased from 2.70% in 1990 to 3.84% in 2010. […] The total number of patients with COPD increased by 66.73% from 30 million in 1990 to 50 million in 2010. […] Overall, the prevalence of COPD in China is still increasing due to the aging of population in China (the population over 60 years old increased from 12.5% in 2009 to 18.1% in 2019) and the high air pollution and smoking rate (the smoking rate was 26.6% at the age of 15 years and above). […] Risk factors for COPD include independent factors such as genetics, causative environmental factors such as smoking, occupational dust exposure and chemical exposure, and indoor/outdoor air pollution. […] The results of a systematic analysis of studies from 2009 to 2015 showed that the main risk factors for COPD in China were tobacco exposure and the use of biofuels/solid fuels.
- #12 SciELO Brazil – Epidemiology of Chronic Obstructive Pulmonary Disease in Brazil: a systematic review and meta-analysis Epidemiology of Chronic Obstructive Pulmonary Disease in Brazil: a systematic review and meta-analysishttps://www.scielo.br/j/csc/a/Bk3RFBFzBmYxtmZP6HHZwYd/
In 2015, more than 37,000 people died in Brazil due to COPD, according to the Mortality Information System of the Unified Public Health System. […] The prevalence of COPD in Brazil was 17% (95%CI =13-22). The region of the country with the highest prevalence was the Central-Western (25%, 95%CI = 15-35), followed by the Southeastern region (23%, 95%CI = 16-30). The Southern region had the lowest prevalence among the studies (12%, 95%CI =16-30). […] The occurrence of COPD in this study was 17% (95%CI = 13-22), which is higher than the estimated 11.4% for the world population. Thus, the prevalence in Brazil exceeds the average of the world regions. […] The results of this meta-analysis evidenced that COPD predominantly affects people over 55 years old. The largest sample size in the studies occurred mostly after 2010. […] Finally, the results found in this study indicate that COPD is a frequently occurring problem in Brazil, higher than the estimates of Latin American and world population.
- #13 Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis | BMC Public Health | Full Texthttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-17686-9
The existing literature indicates that COPD increases significantly with aging, this was confirmed by our meta-analysis. The prevalence of COPD according to the FR definition increased from 4.37 to 24.03% in people in the age group 40-49 years and those aged 70 years and over, respectively. […] We found that smoking was associated with a high prevalence of COPD. Indeed, smoking is a well-recognized risk factor for COPD.
- #14 Chronic Obstructive Pulmonary Disease, 2022 | Australian Bureau of Statisticshttps://www.abs.gov.au/statistics/health/health-conditions-and-risks/chronic-obstructive-pulmonary-disease/latest-release
Chronic Obstructive Pulmonary Disease prevalence has remained steady over the last decade, from 2.4% in 201112 to 2.5% in 2022. […] One in fourteen (7.0%) people aged 65 years and over had COPD, more than any other age group. […] In 2022, 2.5% (638,100) of people had COPD: […] Prevalence was similar between males and females (2.4% and 2.6%). […] One in fourteen (7.0%) people aged 65 years and over had COPD, higher than any other age group. […] Adults aged 18 years and over who were current daily smokers were more likely to have COPD than either ex-smokers (8.1% compared to 4.4%) or those who have never smoked (8.1% compared to 1.6%). […] Of all people with COPD in 2022, almost nine in ten (86.6%) had two or more chronic conditions. Additionally, almost one in ten (9.3%) adults who experienced severe or very severe bodily pain in the four weeks prior to interview had COPD.
- #15 Epidemiology of Chronic Obstructive Pulmonary Disease – PubMedhttps://pubmed.ncbi.nlm.nih.gov/32800187/
Chronic obstructive pulmonary disease (COPD) affects about 300 million people worldwide, resulting in approximately 64 million disability-adjusted life years. […] Household air pollution affects almost 3 billion people worldwide and is a major risk factor for COPD. […] An estimated 25% to 45% of patients with COPD worldwide have never smoked. […] Fourteen percent of the overall COPD burden is attributable to occupational exposures. […] Rural populations are at higher risk for COPD than urban residents. […] African American never-smokers have a disproportionately high prevalence and Hispanic people have a low prevalence of COPD.
- #16 Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged â¥18 Years â United States, 2011â2021 | MMWRhttps://www.cdc.gov/mmwr/volumes/72/wr/mm7246a1.htm
Approximately 25% of adults with COPD (3.8 million) reported having never smoked, similar to 1988-1994. In addition to cigarette smoking, secondhand smoke and occupational and environmental exposures are also risk factors for developing COPD among nonsmokers. Therefore, promotion of smoke-free environments and workplace interventions can help reduce or eliminate COPD-related risk factors.
- #17 Current status and preventive strategies of chronic obstructive pulmonary disease in China: a literature review – Quan – Journal of Thoracic Diseasehttps://jtd.amegroups.org/article/view/52866/html
The prevalence and mortality of COPD in Chinese smokers is at a high level. […] There are 300 million smokers in China and 740 million people are exposed to secondhand smoke. […] Therefore, it is important to strengthen tobacco control legislation, prohibit smoking in public places and publicize tobacco hazards especially for adolescents. […] Household indoor air pollution from contaminated fuel combustion is an important public health problem in China and even worldwide. […] In summary, biofuel exposure levels are high in Chinese women. Measures should be taken to reduce the exposure to contaminated fuels such as biofuels and coal, thus reducing the risk of COPD. […] Occupational exposure is a risk factor for COPD and includes occupational exposure to organic and inorganic dust, chemicals, and smoke exposure resulting from work in agriculture, mining or heavy industry. […] Therefore, it is necessary to strengthen the management of safety protection measures (such as wearing protective masks) for occupationally exposed people and ensure the integrity of ventilation equipment in the workplace, reducing the risk of COPD in occupationally exposed people.
- #18 Explore Chronic Obstructive Pulmonary Disease in the United States | AHRhttps://www.americashealthrankings.org/explore/measures/COPD
Percentage of adults who reported ever being told by a health professional that they had chronic obstructive pulmonary disease, emphysema or chronic bronchitis. […] Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that slowly damages air sacs in the lungs, decreasing airflow and making it difficult to breathe. Chronic lower respiratory diseases, mainly COPD, are the sixth-leading cause of death in the United States. […] Risk factors for COPD include cigarette smoking, secondhand smoke exposure, exposure to smoke from burning fuels, asthma and long-term exposure to lung irritants. […] Medical costs attributed to COPD among adults age 45 and older were estimated to be $24 billion annually, with $11.9 billion of that going toward prescription drug costs. […] According to Americas Health Rankings analysis, populations with a higher prevalence of COPD include: Women compared with men. […] The best way to prevent COPD is to never smoke or stop smoking immediately. […] Healthy People 2030 has multiple goals related to respiratory diseases and COPD, including: Reducing COPD deaths among adults age 45 and older.
- #19 Explore Chronic Obstructive Pulmonary Disease in the United States | AHRhttps://www.americashealthrankings.org/explore/measures/COPD/COPD_nonmetro?population=COPD_nonmetro
6.4% […] Percentage of adults who reported ever being told by a health professional that they had chronic obstructive pulmonary disease, emphysema or chronic bronchitis […] Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that slowly damages air sacs in the lungs, decreasing airflow and making it difficult to breathe. Chronic lower respiratory diseases, mainly COPD, are the sixth-leading cause of death in the United States. The symptoms of COPD include shortness of breath, wheezing, chest tightness, needing to clear the throat frequently and having a chronic cough. […] Risk factors for COPD include cigarette smoking, secondhand smoke exposure, exposure to smoke from burning fuels, asthma and long-term exposure to lung irritants. […] Medical costs attributed to COPD among adults age 45 and older were estimated to be $24 billion annually, with $11.9 billion of that going toward prescription drug costs.
- #20 Epidemiology of Chronic Lung Diseaseshttps://www.uspharmacist.com/article/epidemiology-of-chronic-lung-diseases
According to the American Lung Association, more than 35 million Americans have a preventable chronic lung disease. […] COPD, which has a prevalence of more than 12 million (possibly 24 million, including undiagnosed cases), is typically irreversible. […] At least 30 million cases of acute exacerbation of COPD occur annually, at a cost of $28 billion. […] Cigarette smoking was the primary cause in 80% to 90% of all COPD cases. […] The number of deaths worldwide from COPD is expected to rise from 2.2 million in 1990 to 4.7 million in 2020. […] The CDC projects that COPD treatment costs could rise from $59.3 billion in 2010 to $90.6 billion by 2020. […] If all patients were fully compliant with their prescribed medication for COPD, exacerbations could be reduced by 25% to 30% annually, at a savings of $4 billion per year.
- #21 Explore Chronic Obstructive Pulmonary Disease in the United States | AHRhttps://www.americashealthrankings.org/explore/measures/COPD/COPD_nonmetro?population=COPD_nonmetro
According to Americas Health Rankings analysis, populations with a higher prevalence of COPD include: Women compared with men. Adults ages 65 and older. The prevalence increases with age. American Indian/Alaska Native and multiracial adults compared with Asian and Hispanic adults. Adults with less than a high school education compared with those with higher levels of educational attainment. College graduates have the lowest prevalence. Adults with an annual household income less than $25,000 compared with adults with higher income levels. Adults living in nonmetropolitan areas than those living in metropolitan areas. […] Healthy People 2030 has multiple goals related to respiratory diseases and COPD, including: Reducing COPD deaths among adults age 45 and older. Reducing emergency visits for COPD among adults age 45 and older. Reducing hospitalizations for COPD.
- #22 Chronic obstructive pulmonary disease (COPD) – Epidemiology | BMJ Best Practice UShttps://bestpractice.bmj.com/topics/en-us/7/epidemiology
COPD is the third leading cause of death worldwide, causing 3.23 million deaths in 2019, with 90% of deaths in low- and middle-income countries. […] Globally, deaths from COPD increased by 23% from 1990 to 2017 and COPD and related deaths are estimated to increase to 5.4 million by 2060. […] COPD is more common in older people, especially those ages 65 years and older, regardless of urbanization. […] The prevalence of COPD in the US was estimated at 14% postbronchodilator test results based on data from 2007 to 2010. […] The death rate due to COPD in the US increased over 100% between 1969 and 2013. […] A 2019 National Health Interview Survey revealed that the prevalence of COPD in US adults was greater in those living in non-metropolitan areas than in metropolitan areas, at 8.0% and 4.0%, respectively.
- #23 Global, regional, and national burden of chronic obstructive pulmonary disease and its attributable risk factors from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021 | Respiratory Research | Full Texthttps://respiratory-research.biomedcentral.com/articles/10.1186/s12931-024-03051-2
Chronic obstructive pulmonary disease (COPD) continues to be a significant issue, leading to premature death or reduced quality of life. Its important to assess the current burden of COPD and its risk factors on a geographical basis to guide health policy. […] Data on the prevalence, deaths, and disability-adjusted life years (DALYs) related to COPD, and risk-attributable burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database. […] Between 1990 and 2021, the changes were -1.46% (95% uncertainty interval [UI] -3.36% to 0.39%) in age-standardized prevalence, -37.12% (-43.37% to -27.68%) in mortality, and -36.98% (-42.37% to -28.54%) in DALYs rate. In 2021, a total of 213.39 million prevalent cases of COPD were estimated. […] The overall burden of COPD has been increasing despite improvements in some rates since 1990. Its crucial to focus on interventions such as smoking cessation and addressing environmental and occupational exposures.
- #24 Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged â¥18 Years â United States, 2011â2021 | MMWRhttps://www.cdc.gov/mmwr/volumes/72/wr/mm7246a1.htm
Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States. Overall COPD prevalence declined during 1999-2011. From 2011 to 2021, prevalence of COPD among adults remained stable overall (6.1% to 6.0%) and in most subgroups and states; prevalence increased among adults aged 75 years, those living in rural areas, and those who ever smoked. Disparities based on rural residence and smoking status increased. An estimated 14.2 million (6.5%) U.S. adults had physician-diagnosed COPD in 2021. Overall prevalence remained unchanged since 2011. The prevalence of COPD among adults aged 45 years declined from 2011 to 2021, consistent with the trend during 1999-2011. The variation in the prevalence of COPD by states is likely related to factors including differences in smoking rates, occupations or industries with higher risk for COPD, and access to health care for screening and detection of COPD. Evidence-based strategies, especially those tailored for adults disproportionately affected, can reduce COPD prevalence, and address the continued need for prevention, early diagnosis, treatment, and management.
- #25 Asthma and Chronic Obstructive Pulmonary Disease (COPD) in Canada, 2018 – Canada.cahttps://www.canada.ca/en/public-health/services/publications/diseases-conditions/asthma-chronic-obstructive-pulmonary-disease-canada-2018.html
The relative increase in the age-standardized prevalence of COPD was 33.6% among all Canadians aged 35 years and over; from 7.0% (1.1 million Canadians) in 2000-2001 to 9.4% (2.0 million Canadians) in 2011-2012. […] The incidence rates of COPD in Canada for 2011-2012 increased steadily for both males and females across the life span. […] Between 2000-2001 and 2011-2012, the overall aged-standardized incidence rate of COPD among Canadians aged 35 years and older declined from 1201.9 to 914.8 per 100,000 population; a 23.9% relative decrease. […] Throughout the observation period (2000-2001 to 2011-2012), all-cause mortality rates were consistently higher among Canadians aged 35 years and older living with COPD compared to those without. […] The prevalence of COPD was greater among those with diagnosed diabetes, hypertension, mood and/or anxiety disorders, and asthma, than among those without, as indicated by prevalence ratios greater than one for all four comorbid conditions.
- #26 Current status and preventive strategies of chronic obstructive pulmonary disease in China: a literature review – Quan – Journal of Thoracic Diseasehttps://jtd.amegroups.org/article/view/52866/html
With the extensive development of industry, the large increase of coal energy consumption and the increasing number of automobiles, outdoor air pollutants are also increasing in China. […] In summary, higher concentrations of air pollutants (PM10, PM2.5, SO2, NO2, CO, etc.) may induce higher COPD morbidity, mortality and COPD exacerbations. […] At present, COPD is the fourth leading cause of death both globally and in China. […] The mortality rate decreased to 47.30/100,000 and 66.24/100,000 in 2016 (fourth and third leading causes of death, respectively), with a higher mortality rate in rural areas than in urban areas. […] Although the mortality rate of COPD in China has decreased, the mortality rate is still higher than the global average, and the number of deaths accounts for more than 30% of global deaths.
- #27 Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis | BMC Public Health | Full Texthttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-17686-9
The estimated overall prevalence of COPD in people aged 40 years and older was 12.64% (95% CI, 10.75-14.65%) and 7.38% (95% CI, 5.47-9.55%) according to the FR and LLN definitions, respectively. […] Estimates of the overall prevalence of COPD by sex indicate a high prevalence of irreversible airflow limitation in men compared to women according to the FR definition (prevalence of COPD was 15.47% in men versus a prevalence of 8.79% in women). […] Our meta-analysis found a high prevalence of COPD in the American region, with a prevalence of 22.93% according to the FR definition. […] The prevalence of COPD increased significantly between the 2016-2019 and 2020-2022 periods. According to the FR criteria, it was 10.43% (95% CI 8.11%-12.99%) in the 2016-2019 period and reached 15.17% (95% CI 11.67%-19.02%) in the 2020-2022 period.
- #28 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/5
Chronic lung disease includes the conditions of chronic obstructive pulmonary disease (COPD), sleep-disordered breathing, and interstitial lung disease. This report has chosen to focus on COPD because it is the third leading cause of death in the United States (after heart disease and malignant neoplasms) (Kochanek et al., 2011) and is a substantial financial burden for the American economy. Many issues related to surveillance of COPD will apply equally to the other chronic lung conditions. […] COPD is a common chronic disease. Most estimates of COPD place its prevalence in the adult population at 5 to 10 percent, although these estimates vary by the specific criteria used. Data from the Third National Health and Nutrition Examination Survey (NHANES III), the most recent national health survey that included spirometry, showed a prevalence of COPD in adults of 6.8 percent (Mannino and Buist, 2007). Over 50 percent of people with evidence of COPD have never been diagnosed with this disease. This proportion is even higher among people with mild disease, which is most amenable to intervention (Mannino and Braman, 2007).
- #29 Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis | BMC Public Health | Full Texthttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-17686-9
According to the World Health Organization (WHO), COPD is considered among the top ten causes of death worldwide. […] In 2016, 251 million cases of COPD were recorded worldwide, according to estimates from the Global Burden of Disease (GBD) study. […] COPD is an important cause of mortality. Between 2009 and 2019, the mortality rate of COPD increased by 35.4%. […] Furthermore, WHO mortality and disease burden projections state that COPD will be the third leading cause of death worldwide by 2030. […] The main causes of underdiagnosis identified in the literature are lack of knowledge of the disease on the part of patients and physicians, underestimation of symptoms, and underuse of the spirometer to establish the diagnosis. […] The most frequently used diagnostic criteria are the fixed ratio (FR), which states that the presence of a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) post-bronchodilator less than 0.70 confirms the diagnosis, and the lower limit of normal (LLN) criteria, in which the diagnosis is based on the comparison of values measured by spirometry with reference values identified from healthy and non-smoking subjects.
- #30https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
COPD should be suspected if a person has typical symptoms, and the diagnosis confirmed by a breathing test called spirometry, which measures how the lungs are working. In low- and middle-income countries, spirometry is often not available and so the diagnosis may be missed. […] COPD is included in the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCDs) and the United Nations 2030 Agenda for Sustainable Development. […] WHO is taking action to extend diagnosis of and treatment for COPD in a number of ways. […] The WHO Package of Essential Noncommunicable Disease Interventions (PEN) was developed to help improve NCD management in primary health care in low-resource settings. PEN includes protocols for the assessment, diagnosis and management of chronic respiratory diseases (asthma and chronic obstructive pulmonary disease), and modules on healthy lifestyle counselling, including tobacco cessation and self-care. […] Reducing tobacco smoke exposure is important for both primary prevention of COPD and disease management.
- #31 COPD | Chronic Disease Indicators | CDChttps://www.cdc.gov/cdi/indicator-definitions/chronic-obstructive-pulmonary-disease.html
Because COPD often coexists with other diseases that may significantly influence patient outcomes, it is important to assess mortality from COPD as a contributing, as well as underlying, cause of death. […] Early diagnosis and effective management and treatment can help to reduce the risk of premature mortality.
- #32 Chronic Obstructive Pulmonary Disease: Epidemiology, Pathophysiology, and Clinical Evaluation | Thoracic Keyhttps://thoracickey.com/chronic-obstructive-pulmonary-disease-epidemiology-pathophysiology-and-clinical-evaluation/
Although COPD is a leading cause of morbidity and mortality worldwide, its prevalence varies across countries. […] The imprecise, variable definitions of COPD and the lack of spirometry to confirm the diagnosis make it difficult to quantify morbidity and mortality. […] Mortality from COPD is also likely to be underestimated because it is often cited as a âcontributory factorâ rather than a cause of death. […] In the past, imprecise definitions of COPD and underdiagnosis have resulted in underreporting of the condition. […] Approximately 14 million people in the United States have COPD, increasing by 42% since 1982. […] The prevalence of diagnosed COPD has increased in the UK in women from 0.8% in 1990 to 1.4% in 1997, but did not change over the same period in men.
- #33 Chronic Obstructive Pulmonary Disease (COPD) in Canada – Data Blog – Public Health Infobase | Public Health Agency of Canadahttps://health-infobase.canada.ca/datalab/copd-blog.html
COPD is a chronic disease that is characterised by shortness of breath, cough and sputum production. The disease is progressive (i.e. it tends to get worse over time) and debilitating. It primarily affects the population age 35 years and older. Long-term exposure to lung irritants is the primary cause of COPD. In Canada and other developed nations, the primary irritant that causes COPD is tobacco smoke. […] The Public Health Agency of Canada (PHAC) works with the provinces and territories, through the Canadian Chronic Disease Surveillance System (CCDSS), to collect and report national surveillance data on COPD. […] Over 2 million (10%) Canadians aged 35 years and older were living with diagnosed COPD in 20122013. […] The number of Canadians aged 35 years and older living with diagnosed COPD increased by 82% from 1.1 million to a little over 2 million between 20002001 and 20122013.
- #34 Epidemiology, severity, and treatment of chronic obstructive pulmonary | COPDhttps://www.dovepress.com/epidemiology-severity-and-treatment-of-chronic-obstructive-pulmonary-d-peer-reviewed-fulltext-article-COPD
In 2013, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) updated the management strategy on COPD based on severity using a combined assessment of symptoms, degree of airflow limitation, and number of exacerbations. This study quantified prevalence and incidence of COPD in the United Kingdom and estimated disease severity by GOLD 2013 categories A/B (low risk) and C/D (high risk). […] Overall prevalence was 33.3 per 1,000 persons (95% confidence interval [CI]: 33.1-33.6); 66.4% were classified as GOLD A/B and 33.6% as C/D. […] A total of 27,224 newly diagnosed COPD patients were identified with mean age 67 years at diagnosis; 53.0% were male. Incidence was 2.2 per 1,000 person-years (95% CI: 2.2-2.3); 68.7% were classified in categories A/B and 31.3% in C/D, of which 17.2% did not receive COPD maintenance medication.
- #35 Chronic obstructive pulmonary disease | Nature Reviews Disease Primershttps://www.nature.com/articles/nrdp201576
This paper demonstrates that the cross-sectional association found between mortality from chronic lung disease and gross national income is also reflected in an association between the change in mortality from chronic lung disease and the change in gross national income. […] This paper shows that the prevalence of airflow obstruction is strongly associated with the prevalence of smoking, as judged by the mean pack years smoked, and that the prevalence of a low FVC is strongly associated with poverty. […] This is an early paper from Barker and Osmond showing that mortality rates from chronic airway disease later in adult life is associated with mortality in the same areas from bronchitis and pneumonia among children half a century earlier. […] This document reviews the evidence for the diagnosis and management of patients with stable COPD. It was signed by all of the major medical societies interested in clinical practice.
- #36 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/5
A major goal of surveillance is to promote interventions for the prevention and control of COPD, and to evaluate the effectiveness of these interventions through ongoing surveillance of various process and health outcomes. This process may happen at the national, regional, and local levels. Although hospitals do not report quality-of-care indicators for COPD to the Joint Commission and the Centers for Medicare Medicaid Servicesâthey do for acute myocardial infarction, heart failure, and pneumoniaâlimited evidence suggests that such reporting, with quarterly feedback on performance to hospitals, has been associated with performance improvement (Jha et al., 2005; Williams et al., 2005). Despite the lack of national reporting, the reporting and feedback process for other diseases may be contributing to a growing interest in local performance improvement initiatives for COPD (Deprez et al., 2009; Roberts et al., 2009). […] While a number of data sources for surveillance of COPD are available as discussed above and throughout the chapter, there is no comprehensive surveillance system that contributes to the prevention and control of COPD.
- #37 Epidemiological Characteristics of 101,471 Patients Hospitalized with Chronic Obstructive Pulmonary Disease (COPD) in Poland in 2019: Multimorbidity, Duration of Hospitalization, In-Hospital Mortalityhttps://www.mdpi.com/2543-6031/91/5/29
This study aimed to characterize patients hospitalized with COPD in Poland in 2019 as well as to identify factors associated with the risk of in-hospital death and prolonged hospitalization among patients with COPD. […] The presence of comorbidities was reported in 89.3% of patients hospitalized with COPD, the average duration of hospitalization was 9.4 days (54.5% of patients hospitalized with COPD were hospitalized for up to 7 days), and the in-hospital mortality rate was 6.8%. […] Older age, presence of cardiovascular diseases, genitourinary disorders, or digestive disorders were significantly associated with a higher risk of in-hospital death. […] Findings from this nationwide registry-based survey may be used by clinicians during the development of guidelines on COPD management. […] Efforts should be made to develop models for assessing and predicting the impact of air pollution and meteorological factors on hospital admissions of patients diagnosed with COPD.
- #38 Surveillance of chronic obstructive pulmonary disease in high-risk ind | COPDhttps://www.dovepress.com/surveillance-of-chronic-obstructive-pulmonary-disease-in-high-risk-ind-peer-reviewed-fulltext-article-COPD
Those with a positive personal smoking history were significantly more likely to have COPD than those with a passive smoking history. […] The diagnosis rate of COPD rapidly increased in patients 60 years of age or older. […] From these results, we can suggest that individuals in this age-group with a positive smoking history should undergo PFT to detect COPD. […] In conclusion, COPD can be effectively detected using an established community-based lung cancer-screening program. Individuals 60 years of age or older with a positive smoking history should undergo PFT to detect COPD.
- #39 Chronic obstructive pulmonary disease in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network | CMAJ Openhttps://www.cmajopen.ca/content/3/1/E15
Patients with COPD are more likely to receive a diagnosis of every other comorbidity except Parkinsonism. […] Of all patients with COPD, 76.7% had 1 or more other chronic condition, and 3.2% had 4 or more other conditions. […] Anticholinergics were the most commonly prescribed medications, followed by short-acting -agonists, inhaled corticosteroids and long-acting -agonists. Most patients were prescribed multiple medications. […] We found the prevalence of physician-diagnosed COPD in Canadian primary care practices identified by the algorithms of the Canadian Primary Care Sentinel Surveillance Network to be similar to prevalence reported in other practice-based studies at about 3%4%. […] Comorbidity is extremely common, with most patients having at least one additional condition.
- #40 Prevalence of disability among adults with chronic obstructive pulmonary disease, Behavioral Risk Factor Surveillance System 2016â2017 | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229404
The prevalence of disabilities is rising steadily, reflecting an aging population and an increasing burden of chronic conditions affecting quality of life. There are scant national data on the prevalence of disability among individuals with chronic obstructive pulmonary disease (COPD). The main objective was to estimate the prevalence of common disabilities among US-based individuals diagnosed with COPD. […] Chronic obstructive pulmonary disease (COPD) has consistently remained among the top five causes of mortality and morbidity in the United States. It is estimated that 15.5 million adults in the United States have received a diagnosis of COPD, corresponding to 5.9% age-adjusted prevalence rate. […] Individuals with COPD have an increased burden of disease compared to the general population, and a wide range of clinical comorbidities including metabolic syndrome, sleep apnea, diabetes, depression, osteoporosis, cardiac failure, ischemic heart disease, pulmonary hypertension, lung cancer, muscle wasting, and cachexia.