FIRS The Global Impact of Respiratory Disease – Second Edition | Page 13

COPD Scope of the disease COPD affects more than 200 million people in the world [2], 65 million of whom have moderate or severe airway disease [2], and most studies show it is underdiagnosed by 72 to 93% [14]. This is higher than reported for hypertension, hypercholesterolaemia and many other important disorders. Misdiagnosis is also common [15]. The high prevalence and severity of illness make its economic cost high. The direct cost of COPD is 6% of total healthcare spending (€38.6 billion annually) in the European Union and accounts for 56% of the total cost of treating respiratory diseases [16]. The most important factor leading to the development of COPD is tobacco smoking. Tobacco smoke causes destruction of lung tissue (emphysema) and obstruction of the small airways with infl ammation and mucus (chronic bronchitis), leading to the cardinal symptoms of COPD, namely shortness of breath and cough. Indoor and outdoor air pollution, inhaled tobacco smoke and occupational dust, genetic syndromes (such as  1 -antitrypsin defi ciency), childhood pneumonia and other diseases that involve the airways (such as chronic asthma and TB) are also factors contributing to the development of COPD [17]. Prevention Discouraging individuals from starting to smoke tobacco and encouraging smokers to reduce and quit smoking are the fi rst and most important priorities in preventing COPD. Chimney cook stoves and other devices that decrease indoor smoke exposure lessen the 12 risk of respiratory infections in children and potentially the incidence of COPD in non- smokers, particularly in women. Childhood vaccines and prompt recognition and treatment of lower respiratory tract infections will minimise the airway injury that predisposes to COPD in adulthood. COPD may begin in childhood. Management of childhood asthma, controlling occupational exposure to dust and fumes, and other environmental controls could have substantial benefi ts in reducing the burden of COPD. Widespread population screening for COPD in asymptomatic adults is not recommended [18], but performing spirometry in populations with risk factors and respiratory symptoms is [19]. For example, clinicians should pursue a diagnosis for people exposed to smoke from cigarettes and biomass fuels, occupational dusts and chemicals, and having a family history of  1 -antitrypsin defi ciency. Treatment Spirometry is required to establish a clinical diagnosis of COPD and is the fi rst step in treatment. Using spirometry avoids misdiagnosis and assists in evaluating the severity of the airfl ow limitation. Identifi cation and reduction of exposure to risk factors are essential to prevent and treat the disease. Avoiding air pollution and other precipitating factors is also important. All individuals who smoke should be identifi ed and provided with assistance to enable them to quit. Vaccination against seasonal infl uenza can reduce the risk of severe exacerbations triggered by infl uenza [20]. Forum of Intern ational Respiratory Societies