Facing COPD: Addressing the Current Global Public Health Crisis
A condition that affects approximately 300 million people in the world, is the third leading cause of death (excluding COVID-19), and it is estimated to cause 425 deaths per hour is also one of the most under-prioritized conditions in the world.
Chronic obstructive pulmonary disease (COPD), which can manifest as bronchitis and/or emphysema, is an extremely common, heterogeneous pulmonary disease. It results from the complex interplay of gene and environment over the course of a lifetime. It is also one of the most pressing global health crises in the world with severe implications for human morbidity and mortality, nationwide healthcare systems, and even the global economy.
In this blog, in honor of November being COPD Awareness Month, we will describe the urgent need to address COPD. The scale of the problem is such that it can feel intimidating and can lead people to feel unsure of where to begin, but fortunately, with the help of international advocacy efforts such as the international Speak Up for COPD campaign, the field has produced wide-ranging recommendations for addressing this global problem.
Understanding the Problem #
Public health crises impact the world in many ways. To understand the ways to address the challenges that COPD presents, it’s important to understand that COPD exists along a continuum, ranging from:
- People with no symptoms and no known risk factors to
- People with risk factors but have yet to develop symptoms to
- People with early and possibly undiagnosed COPD to
- People with a confirmed COPD diagnosis with various degrees of COPD manifestations
Let’s look at a few ways COPD causes widespread issues.
- COPD is becoming more common. One study estimated that nearly 600 million people are expected to be living with COPD in 20501.
- COPD affects an estimated 10% of human beings.1
- 40% of people with COPD are forced to reduce their working hours or even stop working altogether.2
COPD is a major strain on healthcare resources:
- COPD is one of the leading causes of hospital admissions.
- A systematic literature review paper investigating the ways COPD affects healthcare systems found that the more severe COPD becomes, the more it strains resources in terms of increased visits to primary care and general physicians and longer hospital stays, underscoring the importance of addressing exacerbations.3
- Further, the same review paper found that not only does worsening COPD contribute to a great deal of strain on healthcare resources, but also that more severe COPD is associated with more comorbidities and drives non-COPD hospitalizations, further incurring costs and resources.3
COPD affects the macroeconomy in a myriad of ways:
- A recently published study in Chest® estimated that the costs attributable to COPD in the United States in 2029 will be $60.5 billion, which is nearly double the estimated costs in 2019.4
- COPD is expected to cost the global economy $4.3 trillion between 2020 and 2050 if there is no investment in effective interventions.5
The Role of Prevention #
COPD is a complex, heterogeneous condition that can be caused by different factors. For this reason, prevention plays a crucial role in addressing the condition.
The COPD risk factor that people are most familiar with is cigarette smoking, but there are others, including biomass exposure, occupational exposures, air pollution, and even genetic, that can cause COPD.6 For this reason, it’s especially important that people understand the risk factors for COPD, what they can do to address these, and therefore reduce the incidence of COPD. On a broader scale, governments and healthcare systems can invest more public health campaigns and immunization and smoking-cessation efforts.7
Challenges in Early Diagnosis and Treatment #
Prevention is the first step in the continuum that intervention is necessary to address the COPD crisis. The next step in that continuum is when symptoms are first emerging. Early symptoms of COPD can include shortness of breath, cough, wheezing, and fatigue. This period is an especially impactful time because as COPD becomes more severe, the larger the impact each case has on healthcare resources and the economy. Early COPD diagnoses are rare, resulting in increased incidence in exacerbations.6 Why is this and what can be done about it?
First, a COPD diagnosis requires spirometry for a confirmatory diagnosis and spirometry is just not accessible across the world, despite recent technological improvements. Secondly, pulmonologists are not usually the first clinician that a patient with early COPD visits.8 Thus, it’s important for primary care physicians (PCPs) and nurses to be well-versed in COPD symptoms and how they differ from other common respiratory issues.8 PCPs are also much well-suited to address COPD and initiate the proper referral process when they have access to reliable and portable spirometry machines8, like ndd Medical Technologies’ EasyOne line of spirometry & PFT devices. Healthcare administrators can address this problem by investing in education of their clinicians, purchasing spirometry devices, and creating efforts to educate their patient populations who are at risk of developing of COPD to understand the signs and symptoms.
It’s also important to understand that exacerbations are a major driver of negative health outcomes in COPD; in fact, prevention of exacerbations is a primary goal of COPD management.6
Addressing COPD early improves outcomes and reduces the financial consequences of the existing way of address COPD.
Collaboration is Key #
COPD exists on a continuum. This continuum of COPD disease means that there are opportunities to make significant inroads at every stage.
Collaboration and therefore a multi-disciplinary approach is required:
- Governments and legislators must understand the impact of the current approach to COPD and recognize that what’s being done now is resulting in serious consequences on human beings and their economies. Prioritization of COPD is a public health concern of urgent necessity. Legislators can increase investments in prevention efforts in the form of smoking cessation and public health campaigns and in treating COPD.
- Healthcare administrators can look at the strain posed on their hospitals by COPD and invest in pulmonary function testing devices to improve early diagnostic rates and work to minimize exacerbation rates, thereby decreasing the need for hospitalizations.9 Addressing COPD early can help improve outcomes and reduce the financial consequences of the existing way of addressing COPD.
- Primary care clinical care teams can advocate to their organizations’ leadership on the need for increased prioritization of COPD while also better educating themselves on the risk factors of COPD and early signs of COPD and exacerbations. Care teams can also sharpen their ability to educate patients on how to best prevent COPD and manage their exacerbations.
- Individuals can better understand how to prevent COPD and recognize early signs and symptoms. In the case of people who have already received a diagnosis, they can better understand how to reduce the likelihood of developing an exacerbation and what to do once they see the initial inkling of a forthcoming flare-up.
Now is the time to make COPD a priority! #
Despite being widespread and a huge driver of disease and economic burden, COPD receives fewer resources within healthcare systems compared to other diseases of similar prevalence.10 Policymakers and healthcare administrators and professionals have an urgent responsibility to address COPD through nationwide investments in prevention, early diagnosis, and improved treatment.
Now is the time to make COPD a priority!
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Fletcher, M. J.; Upton, J.; Taylor-Fishwick, J.; Buist, S. A.; Jenkins, C.; Hutton, J.; Barnes, N.; Van Der Molen, T.; Walsh, J. W.; Jones, P.; Walker, S. COPD Uncovered: An International Survey on the Impact of Chronic Obstructive Pulmonary Disease [COPD] on a Working Age Population. BMC Public Health 2011, 11 (1), 612. https://doi.org/10.1186/1471-2458-11-612. ↩︎
Iheanacho, I.; Zhang, S.; King, D.; Rizzo, M.; Ismaila, A. S. Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review. Int. J. Chron. Obstruct. Pulmon. Dis. 2020, 15, 439–460. https://doi.org/10.2147/COPD.S234942. ↩︎ ↩︎
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Chen, S.; Kuhn, M.; Prettner, K.; Yu, F.; Yang, T.; Bärnighausen, T.; Bloom, D. E.; Wang, C. The Global Economic Burden of Chronic Obstructive Pulmonary Disease for 204 Countries and Territories in 2020–50: A Health-Augmented Macroeconomic Modelling Study. Lancet Glob. Health 2023, 11 (8), e1183–e1193. https://doi.org/10.1016/S2214-109X(23)00217-6. ↩︎
Venkatesan, P. GOLD COPD Report: 2024 Update. Lancet Respir. Med. 2024, 12 (1), 15–16. https://doi.org/10.1016/S2213-2600(23)00461-7. ↩︎ ↩︎ ↩︎
Habashi, L. The Global State of COPD: Driving Change to Tackle a Lung Health Crisis. ↩︎
Shahaj, O.; Meiwald, A.; Sudhir, K. P.; Gara-Adams, R.; Wark, P.; Cazaux, A.; Rios, A. E.; Avdeev, S. N.; Adams, E. J. Mapping the Common Barriers to Optimal COPD Care in High and Middle-Income Countries: Qualitative Perspectives from Clinicians. Int. J. Chron. Obstruct. Pulmon. Dis. 2024, 19, 1207–1223. https://doi.org/10.2147/COPD.S449659. ↩︎ ↩︎ ↩︎
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Stolz, D.; Mkorombindo, T.; Schumann, D. M.; Agusti, A.; Ash, S. Y.; Bafadhel, M.; Bai, C.; Chalmers, J. D.; Criner, G. J.; Dharmage, S. C.; Franssen, F. M. E.; Frey, U.; Han, M.; Hansel, N. N.; Hawkins, N. M.; Kalhan, R.; Konigshoff, M.; Ko, F. W.; Parekh, T. M.; Powell, P.; Rutten-van Mölken, M.; Simpson, J.; Sin, D. D.; Song, Y.; Suki, B.; Troosters, T.; Washko, G. R.; Welte, T.; Dransfield, M. T. Towards the Elimination of Chronic Obstructive Pulmonary Disease: A Lancet Commission. Lancet Lond. Engl. 2022, 400 (10356), 921–972. https://doi.org/10.1016/S0140-6736(22)01273-9. ↩︎
Written by
Tré LaRosa
Tré LaRosa is a consultant, scientist, and writer in the Washington, DC area with extensive experience working in research (basic, translational, and clinical) and on patient-reported outcomes. He has also written extensively on neuroscience, pulmonology, and respiratory conditions, including from the patient perspective. He enjoys learning, reading, writing, spending time outdoors, and telling everybody about his mini golden retriever, Duncan.
