Chronic obstructive pulmonary disease, or COPD, is a deadly lung disease primarily attributed to smoking. As a result, it receives fewer research dollars and not a lot of sympathy, according to international COPD expert Sonia Buist, M.D., Oregon Health & Science University. But a new study to be published in next week's Lancet indicates COPD is a very serious and growing threat, estimated to become the third leading cause of death worldwide by 2020.
"Chronic obstructive pulmonary disease continues to be an important cause of sickness, death and health care costs around the world. The challenge to all of us will be to implement cost-effective prevention and management strategies during the next few years to stem the tide of this disease and its costs," said Buist, lead author and professor of medicine (pulmonary and critical care medicine), physiology and pharmacology, and public health, and preventive medicine, OHSU School of Medicine.
Buist and colleagues from Kaiser Permanente Center for Health Research and around the world studied 9,425 people aged 40 and older from 12 countries. They found the prevalence of stage II or higher COPD, as confirmed by spirometry testing, a measure of air entering and leaving the lungs, was 10.1 percent: 11.8 percent for men and 8.5 percent for women. Most earlier studies that reported COPD prevalence included very mild disease.
According to the researchers, the growing COPD problem is due in part to the aging population ‑ the risk of COPD doubles for every 10 years of age older than 40 ‑ and the continuing use of tobacco, which is the biggest risk factor. The variation in prevalence between men and women is attributed in large part to differences in smoking habits and exposure to other environmental risk factors such as dusty occupations.
Wide variations of COPD prevalence exist across the 12 countries studied. Cape Town, South Africa, recorded the highest prevalence of combined stage II and III-plus COPD, with men at 22.2 percent and women at 16.7 percent; and Hannover, Germany, recorded the lowest prevalence, with men at 8.6 percent and women at 3.7 percent. The high rates in South Africa may be due to very high reported levels of previous tuberculosis and occupational exposures, the researchers suggest.
In conclusion, the researchers indicate that although smoking cessation is an increasingly urgent objective for an aging worldwide population, a better understanding of other factors that contribute to COPD is crucial to assist local public health officials in developing the best possible primary and secondary prevention policies for their regions.
The study was funded by unrestricted educational grants to the operations center at Kaiser Permanente Research Center from ALTANA, Aventis, AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Merck, Novartis, Pfizer, Schering-Plough, Sepracor, and University of Kentucky.
Additional local support for BOLD clinical sites was provided by: Boehringer Ingelheim China (GuangZhou, China); Turkish Thoracic Society, Boehringer-Ingelheim, and Pfizer (Adana, Turkey); ALTANA, Astra-Zeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck Sharpe & Dohme, Novartis, Salzburger Gebietskrankenkass and Salzburg Local Government (Salzburg, Austria); Research for International Tobacco Control, the International Development Research Centre, the South African Medical Research Council, the South African Thoracic Society GlaxoSmithKline Pulmonary Research Fellowship, and the University of Cape Town Lung Institute (Cape Town, South Africa); and Landspítali-University Hospital-Scientific Fund, GlaxoSmithKline Iceland, and AstraZeneca Iceland (Reykjavik, Iceland); GlaxoSmithKline Pharmaceuticals, Polpharma, Ivax Pharma Poland, AstraZeneca Pharma Poland, ZF ALTANA Pharma, Pliva Kraków, Adamed, Novartis Poland, Linde Gaz Polska, Lek Polska, Tarchomińskie Zakłady Farmaceutyczne Polfa, Starostwo Proszowice, Skanska, Zasada, Agencja Mienia Wojskowego w Krakowie, Telekomunikacja Polska, Biernacki, Biogran, Amplus Bucki, Skrzydlewski, Sotwin, and Agroplon (Cracow, Poland); Boehringer-Ingelheim and Pfizer Germany (Hannover, Germany); the Norwegian Ministry of Health's Foundation for Clinical Research, and Haukeland University Hospital's Medical Research Foundation for Thoracic Medicine (Bergen, Norway); AstraZeneca, Boehringer-Ingelheim, Pfizer, and GlaxoSmithKline (Vancouver, Canada); Marty Driesler Cancer Project (Lexington, Kentucky, USA); ALTANA, Boehringer Ingelheim (Phil), GlaxoSmithKline, Pfizer, Philippine College of Chest Physicians, Philippine College of Physicians, and United Laboratories (Phil) (Manila, Philippines); Air Liquide Healthcare P/L, AstraZeneca P/L, Boehringer Ingelheim P/L, GlaxoSmithKline Australia P/L, Pfizer Australia P/L (Sydney, Australia).