|Dr Vince Mak, Consultant Physician||Department of Respiratory and Critical Care Medicine,
Central Middlesex Hospital, Park Royal,
London NW10 7NS, UK
Chronic Obstructive Pulmonary Disease (COPD), which encompasses both chronic bronchitis and emphysema, is one of the commonest respiratory conditions of adults in the the developed world. Chronic Obstructive Pulmonary Disease poses an enormous burden to society both in terms of direct cost to healthcare services and indirect costs to society through loss of productivity. The exact prevalence of COPD is difficult to determine because of problems with definition and coding. Sometimes it is difficult to differentiate between COPD and chronic severe asthma, and patients with mild to moderate disease may not be identified as suffering from COPD.
In the western world, COPD is probably the fourth commonest cause of death in middle aged to elderly men after ischaemic heart disease, lung cancer and cerebrovascular disease. In the UK, it is estimated that 18% of males and 14% of females aged 40-68 years may have developed features of COPD, and in the USA, 13.6% of males and 11.8% of females aged 65-74 years are thought to have COPD. According to statistics produced by the American Lung Association, 15 million Americans suffer from COPD and it claimed the lives of 87,000 Americans in 1992.
In the UK, respiratory conditions are the third commonest cause of chronic sickness in working aged people age 45-64 years, is the commonest cause of respiratory related death (fig.1), and COPD accounts for 56% of days of certified incapacity due to respiratory conditions in males. In 1989, an estimated $7 billion was spent on provision of care for patients with COPD in the USA, with a further cost of $8 billion due to lost productivity.
Fig.1: Mortality from COPD in the UK
Despite the high prevalence and enormous cost to healthcare and
society, COPD has received scant attention in comparison to other respiratory conditions
such as asthma and lung cancer. This is likely to be because COPD is thought of as a
self-inflicted disease with few effective treatments, and mainly affects a more elderly,
and therefore less vocal population. COPD is not such an obvious killer like lung cancer
and therefore receives a less emotive response. Respiratory physicians around the world
now believe the attitude of little can done for this self inflicted disease is not
justifiable. Attempts have been made to redress this deficit with the recent introduction
of guidelines in the managment and care of patients with COPD by both the American
Thoracic Society and European Respiratory Society. The British Thoracic Society guidelines
are due to be published very shortly, but are unlikely to differ very from much from the
American and European versions.
|The definition of COPD|
|The causes of COPD|
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