Understanding the Chronic Obstructive Pulmonary Disease Increasing Prevalence and Trends

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death across the globe. It is a widespread, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow restriction caused by airway and alveolar abnormalities, which are mainly induced by prolonged exposure to noxious particles or gases.

There are two types of Chronic Obstructive Pulmonary Disease namely, Emphysema and Chronic Bronchitis. Among the Chronic Obstructive Pulmonary Disease symptoms, the most common is chronic and progressive dyspnea. Coughing with sputum production occurs in up to 30% of patients. These COPD symptoms may vary from day to day and may continue for several years before the onset of airflow restriction.

The causes of Chronic Obstructive Pulmonary Disease are usually long-term exposure to irritants that damage the lungs and airways. The other causes include Pipe, cigar, and other types of tobacco smoke. In addition, tobacco use is among the most significant risk factors of Chronic Obstructive Pulmonary Disease, however other environmental exposures such as biomass fuel consumption and air pollution may also be potential risk factors e. Aside from exposures, host factors predispose people to develop COPD, these include though not restricted only to genetic problems, aberrant lung development, and accelerated aging. 

Primary COPD screening involves either a formal risk assessment via a pre-screening questionnaire and, if this comes positive, diagnostic spirometry testing or screening spirometry without the use of a bronchodilator is done. Spirometry also known as pulmonary function test, or PFT is the most effective and widely used way for Chronic Obstructive Pulmonary Disease diagnosis. The other methods for Chronic Obstructive Pulmonary Disease diagnosis include genetic testing, chest x-ray, CT scan, sputum examination, electrocardiogram (ECG or EKG), and others. 

Chronic Obstructive Pulmonary Disease Epidemiology Insights

The recently published report  Chronic Obstructive Pulmonary Disease Epidemiology Forecast highlights that there were 34 million diagnosed prevalent cases of COPD in 7MM. US accounted for the highest COPD prevalence with 17 million cases. Among the European nations, Germany reported the highest prevalence followed by Italy and France. In terms of age-specific diagnosed prevalent population the group of  55–64 years reported the highest number of cases in the United States, it is estimated that approximately 4.6 million people in this group were suffering from COPD in the United States in the year 2020. On the basis of severity of airflow limitation, COPD is classified as GOLD 1, GOLD 2, GOLD 3, and GOLD 4, respectively. Half of the diagnosed prevalent cases of COPD i.e., approx 8.7 million in the US were falling into GOLD 2 criteria. Whereas, GOLD 1, GOLD 3, and GOLD 4 had approximately 2.9 million, 4.5 million, and 1.2 million cases respectively which accounted 17%, 26%, and 7% of total cases. In addition, among total diagnosed prevalent cases of COPD based on symptoms and exacerbation history, 53.36% were acquired by GOLD A. Whereas the rest of the cases were occupied by other types as GOLD B (26.7%), GOLD C (8.2%), and GOLD D (11.7%).

Furthermore, according to DelveInsight analysis, the majority of cases of COPD are female as compared to males, in the US. Overall, in the 7MM, females are predominantly high in number. In 2020, the number of males affected by this disease contributed to more than 6.5 million total diagnosed prevalent population of COPD in the United States. In comparison, there were around 10.8 million female cases in 2020. The ratio of female to male diagnosed prevalent cases is 5:3. But in EU-5 and Japan, the diagnosed cases of males represent the majority of the COPD cases.

Chronic Obstructive Pulmonary Disease Epidemiological Trends

COPD is still a major cause of morbidity and mortality around the world. The rising trends in COPD prevalence, morbidity, and mortality seen in the latter half of the twentieth century have not been replicated in the United States. Over the last decade, COPD prevalence, hospitalizations, and deaths have remained stable or decreased. This is most likely due to the improved COPD therapies. Future trends in COPD will most likely be driven by factors such as longer population survival, other occupational and environmental exposures, and the rising prevalence of asthma. Globally, air pollution and chronic respiratory infections such as tuberculosis will continue to be important predictors of future trends. 

Driving Factors for Chronic Obstructive Pulmonary Disease

Tobacco use is the leading cause of Chronic Obstructive Pulmonary Disease, which includes chronic bronchitis and emphysema. It raises the chances of developing and dying from COPD. Every year, tobacco kills more than 8 million people. In addition, smoking is another factor causing COPD. Smoking is responsible for 85 to 90% of COPD cases. The number of smokers worldwide has risen to 1.1 billion in 2019. Female smokers are nearly 13 times more likely to die from COPD than nonsmokers; male smokers are nearly 12 times more likely to die from COPD than nonsmokers.

Moreover, the other factors driving COPD prevalence include Exposure to air pollution, Working with chemicals, dust, and fumes, a genetic condition called Alpha-1 deficiency, a history of childhood respiratory infection, and others.

Furthermore, the prevalence of COPD is increasing drastically in recent years due to the higher smoking prevalence and aging populations in many countries. In addition, the awareness of the disease and the advancements in diagnostic tools are also among the driving factors.  

COVID-19 and Its Impact on COPD

COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a pandemic with significant morbidity and mortality. The disease ranges in severity from asymptomatic infections to mild self-limiting upper respiratory tract disease, severe pneumonia with respiratory failure, or death. Although comorbidities are important factors influencing patient prognosis, there is a lack of evidence and experience with COVID-19 treatment. Patients with chronic respiratory diseases, particularly Chronic Obstructive Pulmonary Disease (COPD), are at a higher risk of COVID-19 infection due to a lack of underlying lung reserve and increased expression of the angiotensin-converting enzyme 2 (ACE-2) receptor in the small airways. Comprehensive analyses of the risks, disease severity, and clinical course in COVID-19 patients with COPD, on the other hand, are lacking. According to the World Health Organization, by 2030, approximately 8200 people worldwide will die from COPD every day, and patients' life expectancy appears to have decreased in recent years.

Moreover, the drastic changes in daily life by the COVID-19 impacted everyone. COPD patients were predicted to be more vulnerable than the general population to the resulting psychological symptoms and disorders such as post-traumatic stress disorder, fear, anxiety, depression, and suicidal ideation. COPD patients who have comorbid anxiety and depression experienced worsening symptoms, culminating in fear of self-isolation, excessive worry, loss of social support, and physical withdrawal (on top of the social distancing measures implemented due to the pandemic). 

Furthermore, COVID-19 infection in COPD patients sometimes progressed to intolerable dyspnea, hypoxia, dry cough, and excessive fatigue with or without sputum production in the absence of appropriate and timely treatment, and prior to the availability of vaccines. Some patients developed pneumonia, required hospitalization, ICU admission, and, in some cases, death.

Expected Roadblocks

Lack of understanding of the clinical course and clinical relevance may represent a missed opportunity to make the correct diagnosis. Many people are still not aware of the disease as a result many cases remain undiagnosed and unreported. In addition, the cost of treatment for COPD is mostly high, which increases with disease progression, and the cost for COPD gets almost doubled with disease progression. As a result majority of individuals are opting for self-treatment options. In addition, to date, no Chronic Obstructive Pulmonary Disease treatment is available for the cure of the disease but only to slow the progression of the disease.

FAQs