Burden of COPD

1. Burden of COPD Ali Kocabaş Cukurova University School of Medicine, Adana

2. Why is COPD in the Spotlight? • Mortality of COPD is increasing • Health care utilization is increasing • Cost is very high • COPD has a huge impact on quality of life • Prevalence is much higher than appreciated

3. Definition of COPD • COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. • Its pulmonary component is characterized by airflow limitation that is not fully reversible. • The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.

5. Patterns of Co Patterns of Co-Morbidities in Morbidities in Newly Diagnosed COPD in UK Newly Diagnosed COPD in UK • 2,699 patients with newly diagnosed COPD identified in UK General Practice Research Database • Compared to non-COPD cohort, COPD patients were at increased risk of: • Pneumonia (RR 16) • Osteoporosis (RR 3.1) • Respiratory infections (RR 2.2) • Myocardial infarction and angina (RR for both1.7) • Fractures (RR 1.6) • Glaucoma (RR 1.3) • Soriano et al CHEST 2005; 128: 2099-2107

6. How is the Burden of COPD Estimated? • Mortality • Morbidity • Prevalence • Cost • Quality of life

7. Future Mortality (WHO 2007) 20022030 Ischaemic heart disease Cerebrovascular disease Lower resp infection HIV/AIDS COPD Perinatal disorders Diarrhoeal disease Tuberculosis Lung cancer Traffic Accidents 4 5 PLoS Medicine Nov 2006

8. Of the six leading causes of death in the United States, only COPD has been increasing steadily since 1970 Source:Jemal A. et al. JAMA 2005

9. Mortality in Turkey by Gender (2000) UHY-ME Çalışması, 2000, Türkiye

10. Morbidity in COPD Traditional methods • Physician visits • Hospitalization • Emergency visits New methods • DALY

11. Morbidity in COPD • May be affected by co-morbid chronic conditions that are not directly related to COPD but may have an impact on health status or may negatively interfere with COPD management • Morbidity data are greatly affected by availability of hospital beds so should be interpreted with caution

12. Global DALY (WHO 2007) 20022030 1. Perinatal disorders 2. Lower resp infection 3. HIV/AIDS 4. Unipolar depression 5. Diarrhoeal disease 6. Ischaemic heart disease 7. Cerebrovascular disease 8. Road accidents 9. Malaria 10.Tuberculosis 11.COPD 7 11 PLoS Medicine Nov 2006

13. Major diseases lead DALY losts in Turkey UHY-ME Çalışması, 2000, Türkiye

14. Prevalence of COPD • Respiratory symptoms • Doctor-diagnosed disease • Spirometry

15. Revised 2006 Spirometry is Needed for Diagnosis • For the diagnosis and assessment of COPD, spirometry is the gold standard • The presence of a post-bronchodilator FEV1/FVC<.7 and FEV<80% predicted confirms the presence of airflow limitation that is not fully reversible • GOLD 2006

16. Diagnosed and Undiagnosed COPD in NICE Study in Japan: COPD in NICE Study in Japan: Fukuchi et al. Respirology2004;9:458-65 Undiagnosed Diagnosed

17. Underdignosis of COPD IBERPOC (Spain) 40-69 age group n:4035 Prev. Of COPD % 9,1 Undiagnosed % 78,2 NHANES III (US) > 17 years n:16084 Low lung function %6,8 (FEV1/FVC<0,7,FEV1<0,8) Undiagnosed %63,3 Arch Intern Med 2000; 160: 1682-1689

19. Dagnosis Practice in COPD (Adana-2004)

20. Reasons for Underdiagnosis • Lack of awareness among physicians and general population • Lack of standart criterium • Lack of symptoms in the early period • Underuse of spirometry • Lack ofspirometry

21. Management Practice of COPD (Adana-2004)

22. Figure 1 Diagram depicting the decline of the lower limit of normal of the forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio with ageing, among white never-smoking women in the Third National Health and Nutrition Examination Survey.7 The dark shaded portion depicts elderly subjects who are "potentially overdiagnosed" and the light shaded portion depicts younger adults who are "potentially underdiagnosed" with obstructive lung disease. Mannino, D. M et al. Thorax 2007;62:237-241

23. Prevalence of COPD in Adana(BOLD-Turkey Study, 2004)

24. Severity Status of COPD in Adana(BOLD-Turkey Study, 2004)

25. PLATINO and BOLD • PLATINO five countries in Latin America (Brazil, Chile, Uruguay, Mexico, Venezuela) • BOLD: 18 countries worldwide (China, Turkey, South Africa, Austria, Poland, Norway, Iceland, Canada, USA, Philippines, India, Estonia, Australia, UK, Portugal, India, Sweden, Netherlands)

26. Scientific Objectives of PLATINO & BOLD • Measure the prevalence of COPD & its risk factors by age & sex • Estimate the burden of COPD quality of life & activity limitation respiratory symptoms use of health care services

28. Finished: Austria, Canada, China, Germany, Iceland, Norway, Philippines, Poland, S. Africa, Turkey, USA In Progress: Australia, Sweden Under Discussion: Estonia, Portugal, Spain About to Start: India, Netherlands, UK BOLD Sudy in the World

29. Prevalence of COPD in Adana ( > 40 yrs) (%)(BOLD-Turkey Study, 2004)

31. Cross-Site Comparisons: FEV1/FVC<70% and FEV1<80%

32. Cross-Site Comparisons: FEV1/FVC<70% and FEV1<80%

33. Cost of COPD in US • COPD is a very costly disease direct (diagnosis and management) indirect (cost of disability, missed work, premature mortality and family costs) • Direct costs in US in2002 $18B, indirect costs $14.1B • Annual per capita expenditures for people with COPD nearly 2½x those without COPD ($8,482 vs $3,511 in 1992 study)

35. Why is the Burden of COPD Increasing Worldwide? • Changing of the age structure • Increase in exposure to risk factors (especially tobacco) in developing countries & in women

38. Trends of Risk Factors

39. Mortality of COPD by Gender in US,1980-2000 Number Deaths x 1000 Year

43. Indoor Air Pollution

45. COPD is a preventable and treatable disease