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
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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