Chronic obstructive pulmonary disease (COPD) is often a silent and unrecognized disease, despite being the third leading cause of death in the United States. The disease is often overlooked, particularly in its early phases, and may go untreated for long periods of time. But could greater awareness among clinicians of the prevalence of COPD and effective screening tools reduce the burden of this common disease?

[Photo: Ms. Radmila Choate (left) and Dr. David Mannino]

In a new article from the University of Kentucky College of Public Health, two investigators review the classification, epidemiology, clinical presentation, and assessment of patients with this disease. The article appears in the April 2017 issue of the Journal of Clinical Outcomes Management. The authors are Ms. Radmila Choate, a research analyst in the College and PhD student in epidemiology/biostatistics, and Dr. David Mannino, professor and chair, preventive medicine and environmental health.

COPD is characterized by fixed airflow obstruction with breathing-related symptoms, such as chronic cough, exertional dyspnea, expectoration, and wheeze. These symptoms may occur in conjunction with airway hyperresponsiveness and overlap with other chronic diseases such as asthma. Although COPD is a nonspecific term referring to a set of conditions that develop progressively as a result of a number of different disease processes, it most commonly refers to chronic bronchitis and emphysema. These conditions can be present with or without significant physical impairment.

After an extensive review of the literature, the authors found that while smoking remains the most important risk factor for COPD in much of the developed world, other risk factors including genetic factors and occupational or environmental exposures remain important. In 2011, 13.7 million adults aged ≥ 25 years were diagnosed with COPD in the United States, and as many as 12 million adults may have yet-undiagnosed COPD. In 2010, COPD was responsible for an estimated 10.3 million physician office visits and 1.5 million emergency room visits, and was estimated to be the second leading cause of disability-adjusted life years lost among the U.S. population. COPD has primary, secondary, and tertiary prevention strategies. The treatment of COPD has improved in recent years, with new therapies improving patient quality of life.

The authors conclude that COPD remains a common disease that is a leading cause of morbidity and mortality, both in the United States and worldwide. Most cases of COPD are attributable to smoking. Although its incidence among men has plateaued, it continues to increase among women. COPD, particularly in its early stages, is under-diagnosed in the United States. They further note that an increased awareness among physicians of the prevalence of mild COPD and the importance of spirometry in diagnosing the disease is essential to combating the disease.