Portland, Ore.

The fourth leading cause of death worldwide, COPD goes hugely undiagnosed and untreated until it's too late

Oregon Health & Science University researcher Sonia Buist, M.D., reported today that deaths from the devastating lung disease known as chronic obstructive pulmonary disease (COPD) have risen dramatically during the past 30 years, with women accounting for much of the increase. Buist presented her findings at the American Medical Association media briefing on COPD in New York.

"This represents an alarming trend at a time when deaths from other diseases, including all cardiovascular disease, are declining," said Buist, professor of medicine (pulmonary and critical medicine) in the OHSU School of Medicine. Patients with COPD have irreversible inflammation of the lungs that gets worse over time, resulting in severely limited airflow caused by. It is usually brought on by exposure to noxious agents such as tobacco smoke, pollutants, and occupational hazards, such as dust, chemicals and gases.

COPD has long been thought of as a man's disease because the major risk factors in the developed world are smoking and occupational exposures, Buist explained. But during the 1930s and 1940s, women began smoking in large numbers, and then began moving in large numbers into the work place, exposing themselves to occupational hazards. During a 30-year time period, 1968 to 1998, deaths from COPD rose 163 percent, according to Buist, with women accounting for much of the enormous increase; death rates in men during this time period increased at a much slower rate, and have pretty much leveled off over the past few years.

A progressive disease that may take decades to develop, COPD is largely preventable. Up to 80 percent of COPD cases result from smoking alone, Buist explained. However, once COPD has firmly taken hold, it has a devastating effect on patients' lives. "They can't breathe. They may be dependent on oxygen. Their strength deteriorates considerably, and they are literally gasping for breath. However, if diagnosed early enough, active management can help prevent flare-ups and frequent trips to the hospital," she said.

"Unfortunately, most patients with COPD are not diagnosed until they are quite far along in the disease," Buist added. "COPD patients are usually in their mid-50s and don't recognize their shortness of breath as anything other than the natural result of aging or the symptom of long-term smoking. Subsequently, they often don't seek help until it's too late when as much as 50 percent of their lung function is irreversibly gone."

Patients who have advanced-stage COPD suffer from premature disability and mortality, and make frequent trips to the hospital for the treatment of debilitating flare-ups. "COPD is a very expensive disease, costing the United States about $30 billion annually; about 70 percent of this is due to the cost of treating flare-ups," Buist said.

To stem the tide of COPD, especially among women, Buist stressed the importance of educating the public and physicians about the symptoms of the disease, which include chronic cough and phlegm production, and some limitation of lung function. These symptoms, together with a history of exposure to risk factors, such as smoking or long-term exposure to occupational hazards, especially particulates, should prompt health care providers to do a simple breathing test called spirometry.

"Many patients and their physicians are confused about COPD because has many different names, COPD, emphysema, chronic bronchitis, making it difficult for the medical community to come to an agreement on its diagnosis and treatment," said Buist. "We need to raise awareness of the disease, especially among women, standardize the terminology, use spirometry to confirm the diagnosis, and manage COPD actively."

COPD awareness efforts

November has been designated National COPD Awareness month by President Bush. The first-ever National COPD conference, of which Buist is co-chair, will be held Nov. 13-14 (www.uscopd.com). World COPD will be Nov. 19 (www.goldcopd.com).

Particulars

A. Sonia Buist, M.D., is a professor of medicine (pulmonary and critical care medicine), public health and preventive medicine, and physiology and pharmacology in the OHSU School of Medicine. She is an internationally recognized expert on the prevalence and management of COPD.

Buist has been a member of a number of federal and international advisory groups, including the National Institutes of Health Study Sections; the U.S. Food and Drug Administration's Pulmonary and Allergy Advisory Group; the National Heart Lung and Blood Institute's (NHLBI) Pulmonary Advisory Committee and Advisory Council; the NIH Task Force on Research and Education for the Prevention of Lung Disease; and the NHLBI/World Health Organization Global Initiative on Chronic Obstructive Lung Disease.

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