Facts and figures

Disease and epidemiology

Chronic obstructive pulmonary disease (COPD) is an under-diagnosed, life-threatening lung disease.1

COPD is an umbrella term used to describe chronic lung diseases in which breathing is severely restricted because of lung damage and inflammation. Both emphysema and chronic bronchitis are forms of COPD.1

Although COPD is preventable and can be managed,1 it continues to be an important cause of morbidity, mortality, and healthcare costs worldwide.

The World Health Organization (WHO) estimates 65 million people worldwide had moderate-to-severe COPD in 2004.2

Three million people died from COPD in 2005, which corresponds to 5% of all deaths globally.2

It is currently the fourth leading cause of death worldwide, and the WHO predicts it will rise to the third leading cause by 2030.1

COPD is a costly disease to manage and the annual healthcare bill in 2000 added up to more than €10 billion across the EU alone.3

 

Pathology and pathogenesis of COPD

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as a preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chroninc inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients.1

The chronic inflammation in COPD causes structural changes and progressive narrowing of the airways. In general, the inflammatory and structural changes in the airways increase with disease severity and do not stop with smoking cessation.1,4 The inflammation is also present outside the lungs since inflammatory cells and mediators can be detected in the circulatory system.1

There is increasing evidence that COPD is a complex systemic disease involving more than just the airways and lungs, with COPD patients having high rates of comorbidities. These include cardiovascular disease and metabolic disorders which have been linked to the systemic component of COPD inflammation.5

The most common symptoms of COPD are breathlessness, excessive production of sputum (a mixture of saliva and mucus in the airways) and a chronic cough. These symptoms will vary depending on the individual patient and the severity of their disease.1

 

Exacerbations

Exacerbations are episodes of worsening of patients' day-to-day symptoms and they lead to substantial morbidity and mortality.6

COPD exacerbations are associated with increased airway and systemic inflammation and physiological changes in the lungs.7,9 Symptoms of exacerbations include increased breathlessness, cough,10 mucus production, extreme fatigue and other signs of health deterioration. They are triggered mainly by respiratory viruses and bacteria, which infect the lower airway and increase airway inflammation.1,11

Exacerbations are frightening and distressing for patients12 and they can lead to poorer health and faster disease progression, including decline in lung function and a higher risk of death.6

Patients with frequent exacerbations have a worse quality of life compared with those who have no or infrequent exacerbations.6

Frequent exacerbators – patients who suffer more than one exacerbation per year – make up an identifiable patient phenotype.13 Frequent exacerbators have an increased risk of faster disease progression.6

Evidence shows that mortality at 12 months following hospital admission for an exacerbation of COPD is higher than the mortality observed at 12 months following hospital admission with myocardial infarction.14

Research among patients suggests that an exacerbation can be every bit as terrifying and bewildering as a heart attack6,12,15 and patients often say it feels like they are drowning or suffocating because breathing becomes so difficult.16,17

One patient survey revealed that many COPD patients confessed they had given up hope of ever being able to live a normal life again.15

COPD patients with frequent exacerbations have increased airway inflammation in the stable state.18

COPD patients with symptoms of chronic bronchitis/ chronic cough and sputum are at higher risk of COPD exacerbations than those without this COPD chronic bronchitic phenotype.19

 

Treatment and management of COPD

The GOLD strategy document recommends that treatment plans should include smoking cessation strategies as well as the use of medication to manage the symptoms of COPD, its related complications and comorbid conditions.1

Treatment plans for COPD should include non-medicinal interventions, such as risk factor reduction, patient counselling, and pulmonary rehabilitation.1

Smoking cessation is the single most effective and cost-effective way to reduce exposure to COPD risk factors.20

Smoking cessation can prevent or delay the development of airflow limitation or reduce its progression and can have a substantial effect on subsequent mortality.21

Bronchodilator therapy is central to the symptomatic management of COPD.1

The GOLD strategy document recommends the addition of inhaled corticosteroid (ICS) therapy to bronchodilators for the treatment of patients with severe COPD who experience repeated exacerbations.1

COPD remains a significant area of unmet medical need and there are currently no medications available which modify the course of the disease.1

Most treatments for COPD are used in both asthma and COPD and are not specifically developed for COPD. However, inflammation in COPD is very different from inflammation in asthma1 and this probably explains the different responses to medication seen in the two diseases.22,23

The inflammation seen in COPD is clearly different from that seen in asthma with a predominantly neutrophilic rather than eosinophilic bronchitis.22,24 

References

  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2013. www.goldcopd.org
  2. World Health Organization. Burden of COPD. http://www.who.int/respiratory/copd/burden/en/index.html
  3. Wouters EFM. Economic analysis of the confronting COPD survey: an overview of results. Respir Med 2003;97:S3-14.
  4. Hogg JC, Chu F, Utokaparch S, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 2004;350:2645-53.
  5. Fabbri LM & Rabe KF. From COPD to chronic systemic inflammatory syndrome? Lancet 2007;370:797-9.
  6. Wedzicha JA & Seemungal TAR. COPD exacerbations: defining their cause and prevention. Lancet 2007;370:786-96.
  7. Perera WR, Hurst JR, Wilkinson TM, et al. Inflammatory changes, recovery and recurrence at COPD exacerbation Eur Respir J 2007;29:527-34.
  8. Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in COPD severe exacerbations Am J Respir Crit Care Med 2006;173:1114-21.
  9. Saetta M, Di Stefano A, Maestrelli P, et al. Airway eosinophilia in chronic bronchitis during exacerbations. Am J Respir Crit Care Med 1994;150:1646-52.
  10. NICE Clinical Guidance. Management of exacerbations of COPD. Thorax 2004;59:i131-56.
  11. Seemungal T & Sykes A. Recent advances in exacerbations of COPD. Thorax 2008;63:850-2.
  12. Kessler R, Stahl E, Vogelmeier C, et al. Patient understanding, detection, and experience of COPD exacerbations. Chest 2006;130:133-42.
  13. Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disorder. N Engl J Med 2010;363:1128-38.
  14. Halpin D. Mortality in COPD: Inevitable or preventable? Insights from the cardiovascular arena. COPD 2008;5:3:187-200.
  15. British Lung Foundation (BLF): Breathing Fear: The COPD Effect. 2003. Available at http://www.lunguk.org
  16. Andenæs R, Kalfoss MH & Whal AK. Coping and psychological distress in hospitalized patients with chronic obstructive pulmonary disease. Heart Lung 2006;35:46-57.
  17. Goodridge D, Duggleby W, Gjevre J, et al. Caring for critically ill patients with advanced COPD at the end of life: a qualitative study. Intensive Crit Care Nurs 2008;24:162-70.
  18. Bhowmik A, Seemungal TA, Sapsford RJ, et al. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax 2000;55:114-20.
  19. Burgel PR, Nesme-Meyer P, Chanez P, et al. Cough and sputum production are associated with frequent exacerbations and hospitalizations in COPD subjects. Chest 2009;135:975-82.
  20. Anthonisen NR, Connett JE, Kiley JP, et al. Efficacy of smoking intervention and the use of inhaled anticholinergic bronchodilators on the rate of decline. The Lung Health Study. JAMA 1994;272:1497-505.
  21. Anthonisen NR, Skaens MA, Wise RA, et al. The effects of smoking cessation intervention on 14.5 year mortality: a randomized clinical trial. Ann Intern Med 2005;142:233-9.
  22. Barnes PJ. Corticosteroid resistance in airway disease. Proc Am Thorac Soc 2004;1:264-8.
  23. Barnes PJ. Mechanisms in COPD. Chest 2000;117:10S-14S.
  24. Sutherland ER & Martin RJ. Airway inflammation in chronic obstructive pulmonary disease: comparisons with asthma. J Allergy Clin Immunol 2003;112:819-27.

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