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, even if people quit smoking now, said Stephen Rennard, M.D., Larsen
Professor of Medicine, University of Nebraska Medical Center.
COPD includes emphysema and chronic bronchitis–diseases that are characterized
by obstruction to air flow. COPD currently kills 119,524 Americans annually.
Between 15 million to 30 million people in the U.S. are affected by COPD.
In terms of the magnitude of major public health problems, Dr. Rennard
said COPD dwarfs many other more widely known diseases.
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
dont believe theres much that can be done to help their condition and
dont often ask for treatment, according to the results of an international
survey conducted in 2000 and 2001 of 3,000 people in the United States
and Europe who suffer from COPD. The participants, who live in the U.S.,
Canada, France, Italy, Germany, the Netherlands, Spain and the United Kingdom,
were randomly screened from a group of almost 202,000 households.
Other causes of COPD are asthma, air pollution, genetic factors and
other exposure.
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.
Theres 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 cant 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.
The survey found 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,
while 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, however
39 percent received no medication.
We have COPD treatments available that arent being taken advantage
of, Dr. Rennard said. Physicians may not know their patients have COPD
because they dont measure the lung function very often. The patient may
not have any complaints, sometimes theyve come to expect coughing and
shortness of breath as something that goes with the territory and dont
really believe that anything can be done about it. I think physicians reflect
that same attitude.
He said smokers 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 smokers cough as being normal but its 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 shouldnt accept those
symptoms.
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 wouldnt hesitate
to offer treatment, even though smoking is a major cause of those conditions.
There shouldnt be any reason why someone should be denied treatment just
because theyre a smoker. Its better to quit smoking if you can, but even
if you cant 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 that they have a problem. He said sometimes
coughing can cause fractured ribs, disturb sleeping and other people. He
said, Its becoming increasing clear that COPD can affect things outside
the lungs. 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. Its not that smokers
can sort of say, Im going to stop when the lights are yellow and Im
not going to go through any red ones anymore. Its a very difficult one
for them to address and most of them have tried.