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Pam Rodino, NHS respiratory therapist, performs a spirometer test on patient Wanda Borgeson, 73, in the NHS Pulmonary Lab. Borgeson, who has smoked for 45 years, is being evaluated for complaints of wheezing and shortness of breath. She said she’s seen a number of other physicians who have not been able to give her relief for her symptoms or a medical diagnosis for her problems. |
The epidemic of cigarette smoking that began after World War II is taking a toll in the United States and in Europe in the form of chronic obstructive pulmonary disease (COPD). COPD is the fourth leading cause of death in the U.S., and by 2020, is estimated to become the third-leading cause of death, said Stephen Rennard, M.D., Larson Professor of Medicine at UNMC.
COPD includes emphysema and chronic bronchitis — diseases that are characterized by obstruction of air flow. COPD now kills 119,524 Americans annually. Between 15 million and 30 million people in the United States are affected by COPD. In terms of the magnitude of major public health problems, COPD dwarfs many other more widely known diseases, Dr. Rennard said.
Though more than 80 percent of COPD is caused by cigarette smoking, a surprising number of people with COPD in the United States and Europe don’t believe there’s much that can be done to help their condition. In addition, those people don’t often ask for treatment, according to the results of an international survey conducted in 2000-01 of 3,000 people in the United States and Europe who suffer from COPD. The participants, who live in the United States, Canada, France, Italy, Germany, the Netherlands, Spain and the United Kingdom, were randomly screened from a group of almost 202,000 households.
In addition to smoking, other causes of COPD are asthma, air pollution, genetic factors and other exposure.
Survey finds little public awareness of COPD
Dr. Rennard and six other internationally renowned lung specialists recently published the first in a series of articles in the European Respiratory Journal addressing some of the issues raised by the survey. Dr. Rennard was lead author of the first article. The lung specialists are members of a scientific advisory board that designed and analyzed the survey.
Funded by GlaxoSmithKline pharmaceutical company, the survey was designed to gauge the current understanding of COPD among those with the disease. Dr. Rennard and his colleagues were surprised by the results and want to see some action come out of the survey.
“There’s very little public awareness of COPD in terms of what it is, how to treat it, what patients should expect, and how the health-care system should deal with it,” Dr. Rennard said. “This lack of awareness is a fundamental problem. The survey gave us insight into a condition in which public perception is a major problem.”
“A public awareness campaign would increase recognition that COPD is a disorder we can’t cure, but which can be treated in ways that can benefit patients. Patients can benefit from treatment and rehabilitation that improve lung function and allow people to engage in more activity.”
Survey results
In the survey, more than one-third of participants said their breathlessness caused work problems (absenteeism or diminished performance) during the past year, two-thirds said their physical or leisure activities were restricted, and one-third slept badly, had difficulty performing household chores or found their sex life impaired. At least one hospitalization in the last year was reported by 12.8 percent of respondents and 13.8 percent said they had emergency care due to respiratory difficulties.
Only 20 percent of the participants could correctly name their illness, and 46.2 percent continued to smoke despite the fact that smoking not only played a key role in their disorder, but also was an aggravating factor.
The survey reported 64 percent of the participants’ COPD was treated by general practitioners and 19.6 percent by specialists. Less than half (45 percent) reported having had a lung function test. Fifty-five percent said they received basic treatment in the form of bronchodilators, but 39 percent received no medication.
Signs of COPD
“We have COPD treatments available that aren’t being taken advantage of,” Dr. Rennard said. “Physicians may not know their patients have COPD because they don’t measure the lung function very often. The patient may not have any complaints, sometimes they’ve come to expect coughing and shortness of breath as something that goes with the territory and don’t really believe that anything can be done about it. I think physicians reflect that same attitude.”
He said smoker’s cough may be the first sign of COPD, although it may take 30 or 40 years for some people to lose enough lung function to cause enough symptoms to seek a diagnosis. Dr. Rennard recommends all smokers get a lung function test that measures how much air a patient can blow out of their lungs.
“Most people accept the smoker’s cough as being normal but it’s not. Many people may believe the shortness of breath they get, the cough they have or their sputum production is just part of aging, but in fact, those are signs of disease,” Dr. Rennard said. “People shouldn’t accept those symptoms.”
Treatments available
“If someone gets lung cancer, has a heart attack or stroke, we would treat it,” he said. “Even if the patient were a smoker we wouldn’t hesitate to offer treatment, even though smoking is a major cause of those conditions. There shouldn’t be any reason why someone should be denied treatment just because they’re a smoker. It’s better to quit smoking if you can, but even if you can’t stop smoking, there are treatments that will help.”
Dr. Rennard said people with COPD frequently will give up activities that cause shortness of breath — like exercise and climbing stairs — before they ever recognize they have a problem. He said sometimes coughing can cause fractured ribs, disturb their sleeping and disturb other people. “It’s becoming increasing clear that COPD can affect things outside the lungs,” he said. “It can cause systemic effects like weakness, depression, and make heart conditions worse.
“Quitting smoking is not a lifestyle choice like going through yellow lights. Smoking is primarily an addictive disorder. It’s not that smokers can sort of say, ‘I’m going to stop when the lights are yellow and I’m not going to go through any red ones anymore. It’s a very difficult one for them to address and most of them have tried.”