Materiały źródłowe

• #1 Emphysema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482217/

  Emphysema, as part of COPD, affects a large number of people worldwide. According to the Global Burden of Disease Study in 2016, there were an estimated 251 million cases of COPD globally. Approximately 90% of COPD-related deaths occur in low and middle-income countries. In 2019, COPD was the third leading cause of death worldwide, responsible for 3.23 million deaths. […] In the US, the prevalence of emphysema is estimated to be around 14 million cases. Among white male smokers, 14% are affected, while 3% of white male nonsmokers develop the disease. The prevalence is slightly lower for white female smokers and African Americans, although these groups tend to develop emphysema after less exposure compared to other patient populations. […] The incidence of emphysema is slowly increasing, primarily due to the rise in cigarette smoking and environmental pollution. Another contributing factor is the decreasing mortality rate from other causes, such as cardiovascular and infectious diseases, leading to a higher likelihood of living with COPD. […] Genetic factors also play a significant role in determining susceptibility to airflow limitation in patients. Emphysema severity is notably higher in individuals with coal worker pneumoconiosis, regardless of their smoking status.

• #2 Chronic obstructive pulmonary disease (COPD) – Epidemiology | BMJ Best Practice US

  https://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.

• #3 Chronic obstructive pulmonary disease – Wikipedia

  https://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.

• #4 Emphysema: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/298283-overview

  The Burden of Obstructive Lung Disease (BOLD) study showed that the global prevalence of COPD (stage II or higher) was 10.1%. This figure varied by geographic location and by sex with a pooled prevalence among men of 11.8% (8.6-22.2%) and among women of 8.5% (5.1-16.7%). The differences can, in part, be explained by site and sex differences in the prevalence of smoking. These rates are similar to rates observed in the Proyecto Latino Americano de Investigacion en Obstruccion Pulmonar (PLATINO study), which studied five countries in Latin America. […] The 2014 Surgeon General’s report found the risks for COPD were increasing, especially in women. Their risk for COPD is now similar to the risk among men. Women smokers in certain age groups are more than 38 times as likely to develop COPD, compared with women who have never smoked. Moreover, women are dying from COPD more frequently than men, and are more likely to develop severe COPD at younger ages.

• #5 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/807143-overview

  Hannover, Germany, on the other hand, has the lowest prevalence, of 8.6% for men and 3.7% for women. […] The differences can be explained in part by site and sex differences in the prevalence of smoking. […] As noted above, these reports are widely believed to be underestimates because COPD is known to be underdiagnosed and undertreated. […] Additionally, the prevalence in women is believed to be increasing. […] 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. […] Severe, early onset disease likely represents a distinct genotype and is more commonly seen in females, African Americans, and those with a maternal family history of COPD. […] A study by Mintz et al estimated the prevalence of unidentified COPD. […] Using the Lung Function Questionnaire (LFQ) and spirometry results, the study determined that approximately 1 in 5 patients (21%) aged 30 years or older with a history of smoking for 10 years or longer seen in a primary care center is likely to have COPD.

• #6 Chronic obstructive pulmonary disease (COPD) – Epidemiology | BMJ Best Practice US

  https://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. […] An international study reported that the prevalence of COPD in never-smokers is 12.2%. […] 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.

• #7 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/807143-overview

  Hannover, Germany, on the other hand, has the lowest prevalence, of 8.6% for men and 3.7% for women. […] The differences can be explained in part by site and sex differences in the prevalence of smoking. […] As noted above, these reports are widely believed to be underestimates because COPD is known to be underdiagnosed and undertreated. […] Additionally, the prevalence in women is believed to be increasing. […] 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. […] Severe, early onset disease likely represents a distinct genotype and is more commonly seen in females, African Americans, and those with a maternal family history of COPD. […] A study by Mintz et al estimated the prevalence of unidentified COPD. […] Using the Lung Function Questionnaire (LFQ) and spirometry results, the study determined that approximately 1 in 5 patients (21%) aged 30 years or older with a history of smoking for 10 years or longer seen in a primary care center is likely to have COPD.

• #8 COPD Trends Brief – Prevalence | American Lung Association

  https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-prevalence

  In 2018, 2.0 million adults, or 1.6% of those ages 18 or older, had emphysema. […] Rates were greater among: Non-Hispanic white individuals compared to other racial and ethnic groups, Men compared to women, Those ages 65 and older compared to younger age groups. […] Historically, emphysema has been more common among men than women. However, rates converged over the last two decades as the rate among men decreased and the rate among females increased. […] In 2022, 11.7 million people, or 4.6% of adults, reported a diagnosis of COPD (chronic obstructive pulmonary disease, chronic bronchitis, or emphysema). […] Rates were greater among: Non-Hispanic white individuals compared to other racial and ethnic groups, Women compared to men, Those ages 65 and older compared to younger age groups. […] During 2007-2010, around 8.5 million adults had been diagnosed with COPD, but this may be an underdiagnosis as more than 18 million had evidence of impaired lung function consistent with COPD.

• #9 COPD | Chronic Disease Indicators | CDC

  https://www.cdc.gov/cdi/indicator-definitions/chronic-obstructive-pulmonary-disease.html

  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. […] COPD is a progressive disease in which the body becomes less able to take in enough oxygen as airflow is obstructed; the obstruction of airflow is associated with increased mortality. […] Early diagnosis and effective management and treatment can help to reduce the risk of premature mortality. […] 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. […] Risk factors for COPD-related hospitalization include patients with COPD who have a past history of similar events, severe airflow limitation, poor health status, increased age, presence of emphysema, leukocytosis, poor health-related quality of life and lack of regular physical activity.

• #10 Emphysema: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/298283-overview

  COPD was the third leading cause of death globally and accounted for more than 3.23 million deaths in 2019. In the United States, it is the sixth overall leading cause of death. In 2021, an estimated 14.2 million Americans (6.5%) reported that they were diagnosed with COPD. The prevalence of COPD varies considerably by state, from 3% in Hawaii to 11.8% in West Virginia. Statistically significant increases in COPD prevalence occurred in Colorado, Utah, and West Virginia in the last decade. The states with the highest COPD prevalence are clustered along the Ohio and lower Mississippi Rivers. […] Because the prevalence is based on the number of adults who have ever been told by any healthcare provider that they have emphysema or chronic bronchitis, the actual number is thought to be much higher. Most patients do not seek medical care until the disease is in its later stages and more than 50% of adults with low pulmonary function were not aware that they had COPD.

• #11 Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged ≥18 Years — United States, 2011–2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/72/wr/mm7246a1.htm

  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. […] 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 19992011. […] Approximately 25% of adults with COPD (3.8 million) reported having never smoked, similar to 19881994. […] The COPD National Action Plan provides a comprehensive framework for developing and implementing COPD prevention, treatment, and management strategies.

• #12 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Press

  https://nap.nationalacademies.org/read/13145/chapter/5

  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). […] COPD is responsible for about 700,000 hospitalizations annually in the United States. In recent years, the hospitalization rate among women has increased and is now similar to the rate among men. In 2009, more than 137,000 adults in the United States died from COPD (Kochanek et al., 2011). Age-adjusted mortality rates per 100,000 vary dramatically by state, from a low of 27.1 in Hawaii to a high of 93.6 in Oklahoma (CDC, 2008).

• #13 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/807143-overview

  Hannover, Germany, on the other hand, has the lowest prevalence, of 8.6% for men and 3.7% for women. […] The differences can be explained in part by site and sex differences in the prevalence of smoking. […] As noted above, these reports are widely believed to be underestimates because COPD is known to be underdiagnosed and undertreated. […] Additionally, the prevalence in women is believed to be increasing. […] 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. […] Severe, early onset disease likely represents a distinct genotype and is more commonly seen in females, African Americans, and those with a maternal family history of COPD. […] A study by Mintz et al estimated the prevalence of unidentified COPD. […] Using the Lung Function Questionnaire (LFQ) and spirometry results, the study determined that approximately 1 in 5 patients (21%) aged 30 years or older with a history of smoking for 10 years or longer seen in a primary care center is likely to have COPD.

• #14 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/807143-overview

  Hannover, Germany, on the other hand, has the lowest prevalence, of 8.6% for men and 3.7% for women. […] The differences can be explained in part by site and sex differences in the prevalence of smoking. […] As noted above, these reports are widely believed to be underestimates because COPD is known to be underdiagnosed and undertreated. […] Additionally, the prevalence in women is believed to be increasing. […] 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. […] Severe, early onset disease likely represents a distinct genotype and is more commonly seen in females, African Americans, and those with a maternal family history of COPD. […] A study by Mintz et al estimated the prevalence of unidentified COPD. […] Using the Lung Function Questionnaire (LFQ) and spirometry results, the study determined that approximately 1 in 5 patients (21%) aged 30 years or older with a history of smoking for 10 years or longer seen in a primary care center is likely to have COPD.

• #15 Chronic Obstructive Pulmonary Disease, 2022 | Australian Bureau of Statistics

  https://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. […] In 2022, 2.5% (638,100) of people had COPD: […] 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.

• #16 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/807143-overview

  Hannover, Germany, on the other hand, has the lowest prevalence, of 8.6% for men and 3.7% for women. […] The differences can be explained in part by site and sex differences in the prevalence of smoking. […] As noted above, these reports are widely believed to be underestimates because COPD is known to be underdiagnosed and undertreated. […] Additionally, the prevalence in women is believed to be increasing. […] 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. […] Severe, early onset disease likely represents a distinct genotype and is more commonly seen in females, African Americans, and those with a maternal family history of COPD. […] A study by Mintz et al estimated the prevalence of unidentified COPD. […] Using the Lung Function Questionnaire (LFQ) and spirometry results, the study determined that approximately 1 in 5 patients (21%) aged 30 years or older with a history of smoking for 10 years or longer seen in a primary care center is likely to have COPD.

• #17 Emphysema: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/298283-overview

  The Burden of Obstructive Lung Disease (BOLD) study showed that the global prevalence of COPD (stage II or higher) was 10.1%. This figure varied by geographic location and by sex with a pooled prevalence among men of 11.8% (8.6-22.2%) and among women of 8.5% (5.1-16.7%). The differences can, in part, be explained by site and sex differences in the prevalence of smoking. These rates are similar to rates observed in the Proyecto Latino Americano de Investigacion en Obstruccion Pulmonar (PLATINO study), which studied five countries in Latin America. […] The 2014 Surgeon General’s report found the risks for COPD were increasing, especially in women. Their risk for COPD is now similar to the risk among men. Women smokers in certain age groups are more than 38 times as likely to develop COPD, compared with women who have never smoked. Moreover, women are dying from COPD more frequently than men, and are more likely to develop severe COPD at younger ages.

• #18 Emphysema: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/298283-overview

  Alpha-1 antitrypsin deficiency (AATD) is among the most prevalent potentially fatal genetic disorders in the United States and occurs approximately equally in men and women. The incidence of AADT in the White population is estimated between 1/2500 and 1/3000. Among patients with COPD, up to 3% have AATD. The overwhelming majority of individuals with AATD have not been diagnosed; approximately 10% of the individuals in the United States estimated to have AATD have received a diagnosis. AATD has been identified in virtually all populations but is most common in individuals of Scandinavian, British, Spanish, and Portuguese descent.

• #19 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Press

  https://nap.nationalacademies.org/read/13145/chapter/5

  The overwhelming risk factor for COPD is cigarette smoking. Other important risk factors include a history of asthma; occupational exposures to dusts, gases, vapors, and fumes; exposure to biomass smoke; and respiratory infections such as tuberculosis. In the developing world, exposures to biomass smoke and respiratory infections are particularly important (Buist et al., 2007). Comorbid diseases include cardiovascular disease, osteoporosis, lung cancer, and depression. In addition, diseases such as pneumonia and pulmonary hypertension are often complications of COPD (Decramer et al., 2008; Holguin et al., 2005). […] Although there have been a number of investigations of outcome-specific data for COPD, there is no U.S. surveillance system that is characterized by data collection, analysis, and interpretation that is ongoing and systematic. Apart from the use of vital statistics for describing mortality from COPD, the use of other data sources to examine COPD-specific outcome data has been a relatively recent phenomenon.

• #20 Chronic Obstructive Pulmonary Disease, 2022 | Australian Bureau of Statistics

  https://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. […] In 2022, 2.5% (638,100) of people had COPD: […] 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.

• #21 COPD | Chronic Disease Indicators | CDC

  https://www.cdc.gov/cdi/indicator-definitions/chronic-obstructive-pulmonary-disease.html

  Disease-management programs, in addition to pharmacologic or surgical interventions, have been shown to reduce hospitalization among patients with severe COPD at risk for acute exacerbations of COPD. […] Smoking cessation is key to the prevention and management of COPD. […] Elimination of tobacco use or exposure may be the most effective way to reduce COPD because almost 80% of COPD deaths are attributable to smoking.

• #22 Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged ≥18 Years — United States, 2011–2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/72/wr/mm7246a1.htm

  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. […] 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 19992011. […] Approximately 25% of adults with COPD (3.8 million) reported having never smoked, similar to 19881994. […] The COPD National Action Plan provides a comprehensive framework for developing and implementing COPD prevention, treatment, and management strategies.

• #23 Chronic obstructive pulmonary disease (COPD) – Epidemiology | BMJ Best Practice US

  https://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. […] An international study reported that the prevalence of COPD in never-smokers is 12.2%. […] 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.

• #24 Chronic obstructive pulmonary disease (COPD) – Epidemiology | BMJ Best Practice US

  https://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. […] An international study reported that the prevalence of COPD in never-smokers is 12.2%. […] 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.

• #25 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Press

  https://nap.nationalacademies.org/read/13145/chapter/5

  The overwhelming risk factor for COPD is cigarette smoking. Other important risk factors include a history of asthma; occupational exposures to dusts, gases, vapors, and fumes; exposure to biomass smoke; and respiratory infections such as tuberculosis. In the developing world, exposures to biomass smoke and respiratory infections are particularly important (Buist et al., 2007). Comorbid diseases include cardiovascular disease, osteoporosis, lung cancer, and depression. In addition, diseases such as pneumonia and pulmonary hypertension are often complications of COPD (Decramer et al., 2008; Holguin et al., 2005). […] Although there have been a number of investigations of outcome-specific data for COPD, there is no U.S. surveillance system that is characterized by data collection, analysis, and interpretation that is ongoing and systematic. Apart from the use of vital statistics for describing mortality from COPD, the use of other data sources to examine COPD-specific outcome data has been a relatively recent phenomenon.

• #26 Emphysema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482217/

  Emphysema, as part of COPD, affects a large number of people worldwide. According to the Global Burden of Disease Study in 2016, there were an estimated 251 million cases of COPD globally. Approximately 90% of COPD-related deaths occur in low and middle-income countries. In 2019, COPD was the third leading cause of death worldwide, responsible for 3.23 million deaths. […] In the US, the prevalence of emphysema is estimated to be around 14 million cases. Among white male smokers, 14% are affected, while 3% of white male nonsmokers develop the disease. The prevalence is slightly lower for white female smokers and African Americans, although these groups tend to develop emphysema after less exposure compared to other patient populations. […] The incidence of emphysema is slowly increasing, primarily due to the rise in cigarette smoking and environmental pollution. Another contributing factor is the decreasing mortality rate from other causes, such as cardiovascular and infectious diseases, leading to a higher likelihood of living with COPD. […] Genetic factors also play a significant role in determining susceptibility to airflow limitation in patients. Emphysema severity is notably higher in individuals with coal worker pneumoconiosis, regardless of their smoking status.

• #27 Emphysema: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/298283-overview

  Alpha-1 antitrypsin deficiency (AATD) is among the most prevalent potentially fatal genetic disorders in the United States and occurs approximately equally in men and women. The incidence of AADT in the White population is estimated between 1/2500 and 1/3000. Among patients with COPD, up to 3% have AATD. The overwhelming majority of individuals with AATD have not been diagnosed; approximately 10% of the individuals in the United States estimated to have AATD have received a diagnosis. AATD has been identified in virtually all populations but is most common in individuals of Scandinavian, British, Spanish, and Portuguese descent.

• #28 Emphysema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482217/

  Emphysema, as part of COPD, affects a large number of people worldwide. According to the Global Burden of Disease Study in 2016, there were an estimated 251 million cases of COPD globally. Approximately 90% of COPD-related deaths occur in low and middle-income countries. In 2019, COPD was the third leading cause of death worldwide, responsible for 3.23 million deaths. […] In the US, the prevalence of emphysema is estimated to be around 14 million cases. Among white male smokers, 14% are affected, while 3% of white male nonsmokers develop the disease. The prevalence is slightly lower for white female smokers and African Americans, although these groups tend to develop emphysema after less exposure compared to other patient populations. […] The incidence of emphysema is slowly increasing, primarily due to the rise in cigarette smoking and environmental pollution. Another contributing factor is the decreasing mortality rate from other causes, such as cardiovascular and infectious diseases, leading to a higher likelihood of living with COPD. […] Genetic factors also play a significant role in determining susceptibility to airflow limitation in patients. Emphysema severity is notably higher in individuals with coal worker pneumoconiosis, regardless of their smoking status.

• #29 Emphysema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482217/

  Emphysema, as part of COPD, affects a large number of people worldwide. According to the Global Burden of Disease Study in 2016, there were an estimated 251 million cases of COPD globally. Approximately 90% of COPD-related deaths occur in low and middle-income countries. In 2019, COPD was the third leading cause of death worldwide, responsible for 3.23 million deaths. […] In the US, the prevalence of emphysema is estimated to be around 14 million cases. Among white male smokers, 14% are affected, while 3% of white male nonsmokers develop the disease. The prevalence is slightly lower for white female smokers and African Americans, although these groups tend to develop emphysema after less exposure compared to other patient populations. […] The incidence of emphysema is slowly increasing, primarily due to the rise in cigarette smoking and environmental pollution. Another contributing factor is the decreasing mortality rate from other causes, such as cardiovascular and infectious diseases, leading to a higher likelihood of living with COPD. […] Genetic factors also play a significant role in determining susceptibility to airflow limitation in patients. Emphysema severity is notably higher in individuals with coal worker pneumoconiosis, regardless of their smoking status.

• #30 Chronic Obstructive Pulmonary Disease (COPD) in Canada – Data Blog – Public Health Infobase | Public Health Agency of Canada

  https://health-infobase.canada.ca/datalab/copd-blog.html

  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. […] The increase in the number of Canadians living with COPD is being driven by the aging of the population. […] The likelihood of having COPD increases with age. In 20122013, 15% of seniors between the ages of 65 and 69 were living with COPD; for seniors aged 85 years and older, 26% were living with COPD. […] The proportion of Canadians living with COPD varies geographically. In 20122013, the provincial and territorial proportions ranged from 7% to 23%. […] The age-standardized prevalence of COPD among men and women in Canada was 9.5%.

• #31 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Press

  https://nap.nationalacademies.org/read/13145/chapter/5

  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). […] COPD is responsible for about 700,000 hospitalizations annually in the United States. In recent years, the hospitalization rate among women has increased and is now similar to the rate among men. In 2009, more than 137,000 adults in the United States died from COPD (Kochanek et al., 2011). Age-adjusted mortality rates per 100,000 vary dramatically by state, from a low of 27.1 in Hawaii to a high of 93.6 in Oklahoma (CDC, 2008).

• #32 Chronic obstructive pulmonary disease (COPD) – Epidemiology | BMJ Best Practice US

  https://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.

• #33 Chronic obstructive pulmonary disease – Wikipedia

  https://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.

• #34 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Press

  https://nap.nationalacademies.org/read/13145/chapter/5

  Data relevant to surveillance of COPD are currently available from a number of national and international sources. In the United States, these sources include vital statistics (Lewis et al., 2009), hospital data reporting (http://www.healthgrades.com; Lindenauer et al., 2006), Medicare (Wennberg et al., 2004; http://www.hospitalcompare.hhs.gov), Medicaid (Bindman et al., 2008), Veterans Administration (Joo et al.. 2007, 2008a; Singh, 2009), population-based surveys (Mannino et al., 2000), and health insurance claims databases (Mapel et al., 2006; McKnight et al., 2005). Examples of international sources of COPD surveillance have been published from meta-analyses of clinical trials (Puhan et al., 2009a,b; Strassmann et al., 2009), the U.K. General Practice Research Database (Khan et al., 2010; Levy et al., 2007; Smith et al., 2008; Soriano et al., 2001), and health administrative data in Canada (Gershon et al., 2009). […] 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.

• #35 Chronic Obstructive Pulmonary Disease (COPD) in Canada – Data Blog – Public Health Infobase | Public Health Agency of Canada

  https://health-infobase.canada.ca/datalab/copd-blog.html

  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. […] The increase in the number of Canadians living with COPD is being driven by the aging of the population. […] The likelihood of having COPD increases with age. In 20122013, 15% of seniors between the ages of 65 and 69 were living with COPD; for seniors aged 85 years and older, 26% were living with COPD. […] The proportion of Canadians living with COPD varies geographically. In 20122013, the provincial and territorial proportions ranged from 7% to 23%. […] The age-standardized prevalence of COPD among men and women in Canada was 9.5%.

• #36 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Press

  https://nap.nationalacademies.org/read/13145/chapter/5

  The overwhelming risk factor for COPD is cigarette smoking. Other important risk factors include a history of asthma; occupational exposures to dusts, gases, vapors, and fumes; exposure to biomass smoke; and respiratory infections such as tuberculosis. In the developing world, exposures to biomass smoke and respiratory infections are particularly important (Buist et al., 2007). Comorbid diseases include cardiovascular disease, osteoporosis, lung cancer, and depression. In addition, diseases such as pneumonia and pulmonary hypertension are often complications of COPD (Decramer et al., 2008; Holguin et al., 2005). […] Although there have been a number of investigations of outcome-specific data for COPD, there is no U.S. surveillance system that is characterized by data collection, analysis, and interpretation that is ongoing and systematic. Apart from the use of vital statistics for describing mortality from COPD, the use of other data sources to examine COPD-specific outcome data has been a relatively recent phenomenon.

• #37 Surveillance of chronic obstructive pulmonary disease in high-risk ind | COPD

  https://www.dovepress.com/surveillance-of-chronic-obstructive-pulmonary-disease-in-high-risk-ind-peer-reviewed-fulltext-article-COPD

  We previously reviewed the association between COPD and lung cancer, and proposed that early detection of COPD is important for lung cancer surveillance. The present study is the second to describe the utilization of regional mass screening for lung cancer 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.

• #38 Surveillance of chronic obstructive pulmonary disease in high-risk ind | COPD

  https://www.dovepress.com/surveillance-of-chronic-obstructive-pulmonary-disease-in-high-risk-ind-peer-reviewed-fulltext-article-COPD

  Chronic obstructive pulmonary disease (COPD), although a rapidly growing health problem worldwide, is substantially underdiagnosed and frequently misdiagnosed. The Nippon COPD Epidemiology study reported that the prevalence of airflow limitation, defined as a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) less than 70%, was 10.9%, but only 9.4% of patients with airflow limitation had actually been diagnosed with COPD. […] The purpose of this project was to identify which individuals should be examined by PFT for the purpose of detecting COPD. Almost a quarter of study participants were considered to be COPD candidates and were recommended to undergo on-site PFT, and 11.4% of these were diagnosed with COPD. We therefore conclude that approximately 2.4% of Japanese individuals aged 40 years or older who undergo routine lung cancer screening may have COPD.

• #39 COPD | Chronic Disease Indicators | CDC

  https://www.cdc.gov/cdi/indicator-definitions/chronic-obstructive-pulmonary-disease.html

  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. […] COPD is a progressive disease in which the body becomes less able to take in enough oxygen as airflow is obstructed; the obstruction of airflow is associated with increased mortality. […] Early diagnosis and effective management and treatment can help to reduce the risk of premature mortality. […] 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. […] Risk factors for COPD-related hospitalization include patients with COPD who have a past history of similar events, severe airflow limitation, poor health status, increased age, presence of emphysema, leukocytosis, poor health-related quality of life and lack of regular physical activity.

• #40 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Press

  https://nap.nationalacademies.org/read/13145/chapter/5

  The overwhelming risk factor for COPD is cigarette smoking. Other important risk factors include a history of asthma; occupational exposures to dusts, gases, vapors, and fumes; exposure to biomass smoke; and respiratory infections such as tuberculosis. In the developing world, exposures to biomass smoke and respiratory infections are particularly important (Buist et al., 2007). Comorbid diseases include cardiovascular disease, osteoporosis, lung cancer, and depression. In addition, diseases such as pneumonia and pulmonary hypertension are often complications of COPD (Decramer et al., 2008; Holguin et al., 2005). […] Although there have been a number of investigations of outcome-specific data for COPD, there is no U.S. surveillance system that is characterized by data collection, analysis, and interpretation that is ongoing and systematic. Apart from the use of vital statistics for describing mortality from COPD, the use of other data sources to examine COPD-specific outcome data has been a relatively recent phenomenon.

• #41 Chronic Obstructive Pulmonary Disease, 2022 | Australian Bureau of Statistics

  https://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. […] In 2022, 2.5% (638,100) of people had COPD: […] 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.

• #42 Chronic Obstructive Pulmonary Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559281/

  COPD is primarily present in smokers and those greater than age 40. Prevalence increases with age and it is currently the third most common cause of morbidity and mortality worldwide. In 2015, the prevalence of COPD was 174 million and there were approximately 3.2 million deaths due to COPD worldwide. However, the prevalence is likely to be underestimated due to the underdiagnosis of COPD. […] The prognosis of COPD is variable based on adherence to treatment including smoking cessation and avoidance of other harmful gases. Patients with other comorbidities (e.g., pulmonary hypertension, cardiovascular disease, lung cancer) typically have a poorer prognosis. The airflow limitation and dyspnea are usually progressive.

• #43 COPD in People with HIV: Epidemiology, Pathogenesis, Management, and P | COPD

  https://www.dovepress.com/copd-in-people-with-hiv-epidemiology-pathogenesis-management-and-preve-peer-reviewed-fulltext-article-COPD

  As survival among PWH has improved with the use of antiretroviral therapy (ART), COPD has become an increasingly important comorbidity. […] People with HIV (PWH) are particularly vulnerable to the development and progression of COPD, with both higher rates of COPD and an earlier and more rapid decline in lung function than in the general population, even after accounting for cigarette smoking and other known risk factors, such as intravenous drug use. […] A recent retrospective study evaluating comorbidities in PWH based on hospital discharge data found that COPD was the most common comorbidity across the 10-year study period and that COPD prevalence was higher among PWH than among those without HIV (23.5% versus 14.0%). […] Prevalence estimates of COPD among PWH have ranged from 3.4% to over 40% in prior studies; notably, most of these have been conducted in Europe and North America.

• #44 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Press

  https://nap.nationalacademies.org/read/13145/chapter/5

  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). […] COPD is responsible for about 700,000 hospitalizations annually in the United States. In recent years, the hospitalization rate among women has increased and is now similar to the rate among men. In 2009, more than 137,000 adults in the United States died from COPD (Kochanek et al., 2011). Age-adjusted mortality rates per 100,000 vary dramatically by state, from a low of 27.1 in Hawaii to a high of 93.6 in Oklahoma (CDC, 2008).

• #45 Epidemiology and costs of hospital care for COPD in Puglia | Multidisciplinary Respiratory Medicine | Full Text

  https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-6-5-299

  In the period 2005-2007, there were 73,721 hospital admissions for COPD registered in Puglia (25,690 in 2005; 24,153 in 2006 and 23,878 in 2007) of which 34.3% were women, with no significant variation in the three years. […] The overall cost of COPD for Apulian hospital trusts was 272,293,182.85 over the 3-year period. […] The analysis of data on hospital care, its costs and performance may be an important indicator of how effectively community care functions, while the lack of reduction in admissions for COPD should lead decision makers to question both the appropriateness and quality of the care given.

• #46 The unmet global burden of COPD | Global Health, Epidemiology and Genomics | Cambridge Core

  https://www.cambridge.org/core/journals/global-health-epidemiology-and-genomics/article/unmet-global-burden-of-copd/042D7DFB56CAD8AA89BAABAD68D3D406

  An estimated 328 million people have COPD worldwide. […] In 15 years, COPD is expected to become the leading cause of death worldwide. […] More than 90% of COPD-related deaths occur in LMICs. […] According to the Global Burden of Disease (GBD), COPD is already the third leading cause of death worldwide, something that WHO had not predicted to occur until 2030. […] The economic impact of COPD among LMICs is expected to increase to 1.7 trillion by 2030. […] Air pollution is the biggest environmental cause of death worldwide, with HAP accounting for about 3.54 million deaths every year. […] Three billion people worldwide are exposed to toxic amounts of HAP every day and HAP accounts for 3.54 million deaths annually. […] COPD remains underdiagnosed in many jurisdictions. […] The unmet global burden of COPD is a silent killer in LMICs.

• #47 Chronic Obstructive Pulmonary Disease | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602725/all/Chronic_Obstructive_Pulmonary_Disease?q=Failure+Heart

  Although the true prevalence of COPD is difficult to determine, COPD is estimated to affect approximately 15 million people in the US. […] Prior to the COVID-19 pandemic, COPD and other chronic lower respiratory diseases represented the third leading cause of death in the US. In 2020, COVID-19 was the third leading underlying cause of death after heart disease and cancer, with COPD and chronic lower respiratory disease ranking sixth. The mortality rate for COPD has steadily increased since 2012, and globally the burden remains high. The World Health Organization estimated that approximately 3.2 million deaths were caused by COPD in 2015, accounting for 5% of all worldwide deaths that year. […] COPD is protracted in time and is responsible for more years lived with disability (3.6%) than all other respiratory diseases combined.

• #48 3 Chronic Lung Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Press

  https://nap.nationalacademies.org/read/13145/chapter/5

  Data relevant to surveillance of COPD are currently available from a number of national and international sources. In the United States, these sources include vital statistics (Lewis et al., 2009), hospital data reporting (http://www.healthgrades.com; Lindenauer et al., 2006), Medicare (Wennberg et al., 2004; http://www.hospitalcompare.hhs.gov), Medicaid (Bindman et al., 2008), Veterans Administration (Joo et al.. 2007, 2008a; Singh, 2009), population-based surveys (Mannino et al., 2000), and health insurance claims databases (Mapel et al., 2006; McKnight et al., 2005). Examples of international sources of COPD surveillance have been published from meta-analyses of clinical trials (Puhan et al., 2009a,b; Strassmann et al., 2009), the U.K. General Practice Research Database (Khan et al., 2010; Levy et al., 2007; Smith et al., 2008; Soriano et al., 2001), and health administrative data in Canada (Gershon et al., 2009). […] 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.

• #49 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/chronic-obstructive-pulmonary-disease-and-related-disorders/chronic-obstructive-pulmonary-disease-copd

  In the United States, approximately 24 million people have airflow limitation, of whom approximately 16 million have a diagnosis of COPD. COPD is a leading cause of death, resulting in approximately 140,000 deaths each year in the United States. Prevalence, incidence, and mortality rates increase with age. Prevalence is higher in females, but total mortality is similar in both sexes. COPD seems to aggregate in families independent of alpha-1 antitrypsin deficiency (alpha-1 antiprotease inhibitor deficiency). […] COPD is increasing worldwide because of increases in smoking and reduction in mortality due to infectious diseases. In some regions, the widespread use of biomass fuels, such as wood, grasses, or other organic materials, also contributes to COPD prevalence. COPD mortality rates may be higher in medically underserved nations than in nations where medical care is more easily accessed. COPD accounted for 3.23 million deaths globally in 2019 and is the third leading cause of death. […] The COVID-19 pandemic posed a particular risk to patients with COPD. The mortality rate for patients with COPD and COVID-19 was 15% versus 4% in those without COPD.

• #50 The unmet global burden of COPD | Global Health, Epidemiology and Genomics | Cambridge Core

  https://www.cambridge.org/core/journals/global-health-epidemiology-and-genomics/article/unmet-global-burden-of-copd/042D7DFB56CAD8AA89BAABAD68D3D406

  An estimated 328 million people have COPD worldwide. […] In 15 years, COPD is expected to become the leading cause of death worldwide. […] More than 90% of COPD-related deaths occur in LMICs. […] According to the Global Burden of Disease (GBD), COPD is already the third leading cause of death worldwide, something that WHO had not predicted to occur until 2030. […] The economic impact of COPD among LMICs is expected to increase to 1.7 trillion by 2030. […] Air pollution is the biggest environmental cause of death worldwide, with HAP accounting for about 3.54 million deaths every year. […] Three billion people worldwide are exposed to toxic amounts of HAP every day and HAP accounts for 3.54 million deaths annually. […] COPD remains underdiagnosed in many jurisdictions. […] The unmet global burden of COPD is a silent killer in LMICs.

• #51 Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged ≥18 Years — United States, 2011–2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/72/wr/mm7246a1.htm

  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. […] 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 19992011. […] Approximately 25% of adults with COPD (3.8 million) reported having never smoked, similar to 19881994. […] The COPD National Action Plan provides a comprehensive framework for developing and implementing COPD prevention, treatment, and management strategies.

• #52 Explore Chronic Obstructive Pulmonary Disease in the United States | AHR

  https://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. […] 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.

• #53 Epidemiology – COPD Gene Study

  https://copdgene.org/epidemiology/

  COPDGene was initially funded by NIH because of interest in the genetic origins of the disease. […] These observations and changes to the original protocol were based on epidemiologic observations and they have led to COPDGene making unique contributions to the understanding of COPD across the world. […] COPDGene has shown pulmonary associated mortality in participant who do not meet current criteria for COPD in terms of the ratio of FEV1/FVC. […] COPDGene identified these participants because the study modified its design early in the process of recruitment to include people who were typically excluded from other studies of COPD. […] COPDGene has begun to translate its observations into recommendations for strategies that will generate better drug trial designs that incorporate Early COPD, COPD Subtypes, risk factors for progression to severe COPD and newly diagnosed COPD using newly identified criteria for the disease.

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