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abortion, accupuncture, ACE inhibitors, acne, ADHD, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anorexia, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, beta carotene, beta-blockers, bipolar disorder, birth, bleeding, blindness, blood pressure, body dysmorphic disorder, body mass, breast cancer, breast feeding, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cataracts, cervical cancer, chemotherapy, child psychiatry, children, cholesterol, clinical trial, clopidogrel, Clostridium difficile, cognitive behavioural therapy, colectomy, colic, colorectal cancer, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, Crohn's, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, DNA, Down's syndrome, eating disorders, echinacea, ECT, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, euthanasia, exercise, fat, fertility, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, general surgery, genetics, gerontology, GIK infusion therapy, GORD, gout, haemodialysis, hearing, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, IBD, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, invasive candidiasis, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, Marfan syndrome, media, medical ethics, medical research, medication, meningitis, mental illness, metabolic syndrome, migraine, miscarriage, mortality rate, MRSA, multiple sclerosis (MS), NCHDs, nephrology, neurology, OAB, obesity, obstetrics, occupational health, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, orthopaedics, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, practice, pre-eclampsia, pregnancy, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, radiotherapy, rectal cancer, reproductive health, research, resuscitation, rheumatoid arthritis, rheumatology, rhinitis, salt, SARS, schizophrenia, screening, seizures, self harm, sexual abuse, sexual health, sexually transmitted infections, SGA, sinusitis, skin cancer, sleep disorders, smoking, smoking ban, spinal injury, sports medicine, statins, stress, stroke, substance abuse, suicide, supplement, surgery, syncope, technology, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, urinary incontinence, vaccine, vitamins, weight, WHO, women's health, World Health Assembly

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Chronic long-term costs of COPD

Dr Jarlath Healy writes that chronic obstructive pulmonary disease may be more common than previously thought and estimates the cost of care in the longer term Recent research from a large international study published in The Lancet indicates that chronic obstructive pulmonary disease (COPD) is much more common that previously thought, and that the global burden of this disease has been significantly underestimated.

The Burden of Obstructive Lung Disease (BOLD) study measured the global incidence of COPD by collecting spirometry data from 9,425 adults in 12 sites, including China, Norway, South Africa and Australia amongst others.

The study found that the prevalence of COPD of GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II or higher (that is at least moderate COPD) was a massive 10.1 per cent in adults aged 40 and over (ref 1).

Whilst it would be unwise to extrapolate the overall global 10.1 per cent prevalence figure to the Irish population (the site-specific incidence of COPD in the BOLD study ranged from 22.2 per cent in men in Cape Town to 3.7 per cent in women in Hanover), this study does however suggest that many cases of COPD in Ireland are being overlooked.

Most authorities accept a rate of 4-5 per cent in the world’s adult population. In an Irish two-doctor rural general practice, by using questionnaire and spirometry over the past eight years, using GOLD criteria, I have confirmed 51 cases of COPD.

Allowing for the inability of all patients to reliably perform spirometry, this suggests that for each full-time Irish GP, there are at least 30 patients with COPD. This will vary with the practice patient age-profile and smoking prevalence, amongst other things.

In other words, each GP has the equivalent of at least one to 1.5 hospital medical wards full of COPD patients. With an average hospital stay of nine days per exacerbation, three to four times a year, you begin to see the cost and future workload.

COPD is a progressive disease, in which a patient’s lung function rapidly declines, resulting in significant disability and early death. However, if the disease is recognised, smoking cessation can slow the rate of lung function decline and effective treatment can significantly improve a patient’s symptoms.

Correct diagnosis

Therefore, the correct diagnosis of COPD, through spirometry, is of key importance. As well as treating a patient’s symptoms and improving quality of life, emerging research indicates that pharmacotherapy can have the potential to change the clinical course of COPD.

It is certainly clear from numerous clinical trials that drug treatments can reduce incidence of COPD exacerbations and reduce exacerbation-related hospitalisation.
There are also data suggesting a mortality benefit for treatment with a long-acting bronchodilator and an inhaled corticosteroid in a moderate to severe COPD population, although additional studies are required to determine whether this effect is statistically significant (ref 2).

A recent study with tiotropium suggests that over a one-year interval, lung function in tiotropium-treated individuals may be stable (ref 3). A longer–term study (the UPLIFT trial) evaluating the ability of tiotropium versus placebo to slow loss of lung function in over 6,000 COPD patients is in progress and is soon to be concluded.
If confirmed, tiotropium will be the only intervention other than smoking cessation which has been shown to slow the rate of lung function decline in COPD.

Ash Wednesday, which fell this year on February 6th, was National No Smoking Day and provided an opportunity to raise awareness of smoking-related diseases such as COPD.

Awareness days

It is easy to become cynical about these continual awareness days but, considering that COPD appears to be so under-recognised and that treatment can positively impact the course of COPD, then February 6th is as good a day as any to dust down that spirometer and set about diagnosing those 30 to 40 COPD patients that you have.

For more information on diagnosing and managing COPD, see www.goldcopd.com.

References:
1. Buist, AS, et al. Lancet 2007; 370: 741-750.
2. Calverley, PA. New Engl. J. Med. 2007; 356: 775-789.
3. Oostenbrink, JB, et al. Eur Respir J 2004; 23: 241-249.

Posted in Respiratory on 12 February 2008
Tags: COPD, lung disease

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abortion, accupuncture, ACE inhibitors, acne, ADHD, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anorexia, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, beta carotene, beta-blockers, bipolar disorder, birth, bleeding, blindness, blood pressure, body dysmorphic disorder, body mass, breast cancer, breast feeding, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cataracts, cervical cancer, chemotherapy, child psychiatry, children, cholesterol, clinical trial, clopidogrel, Clostridium difficile, cognitive behavioural therapy, colectomy, colic, colorectal cancer, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, Crohn's, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, DNA, Down's syndrome, eating disorders, echinacea, ECT, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, euthanasia, exercise, fat, fertility, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, general surgery, genetics, gerontology, GIK infusion therapy, GORD, gout, haemodialysis, hearing, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, IBD, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, invasive candidiasis, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, Marfan syndrome, media, medical ethics, medical research, medication, meningitis, mental illness, metabolic syndrome, migraine, miscarriage, mortality rate, MRSA, multiple sclerosis (MS), NCHDs, nephrology, neurology, OAB, obesity, obstetrics, occupational health, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, orthopaedics, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, practice, pre-eclampsia, pregnancy, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, radiotherapy, rectal cancer, reproductive health, research, resuscitation, rheumatoid arthritis, rheumatology, rhinitis, salt, SARS, schizophrenia, screening, seizures, self harm, sexual abuse, sexual health, sexually transmitted infections, SGA, sinusitis, skin cancer, sleep disorders, smoking, smoking ban, spinal injury, sports medicine, statins, stress, stroke, substance abuse, suicide, supplement, surgery, syncope, technology, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, urinary incontinence, vaccine, vitamins, weight, WHO, women's health, World Health Assembly

«Previous article | Next article»

Chronic long-term costs of COPD

Dr Jarlath Healy writes that chronic obstructive pulmonary disease may be more common than previously thought and estimates the cost of care in the longer term Recent research from a large international study published in The Lancet indicates that chronic obstructive pulmonary disease (COPD) is much more common that previously thought, and that the global burden of this disease has been significantly underestimated.

The Burden of Obstructive Lung Disease (BOLD) study measured the global incidence of COPD by collecting spirometry data from 9,425 adults in 12 sites, including China, Norway, South Africa and Australia amongst others.

The study found that the prevalence of COPD of GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II or higher (that is at least moderate COPD) was a massive 10.1 per cent in adults aged 40 and over (ref 1).

Whilst it would be unwise to extrapolate the overall global 10.1 per cent prevalence figure to the Irish population (the site-specific incidence of COPD in the BOLD study ranged from 22.2 per cent in men in Cape Town to 3.7 per cent in women in Hanover), this study does however suggest that many cases of COPD in Ireland are being overlooked.

Most authorities accept a rate of 4-5 per cent in the world’s adult population. In an Irish two-doctor rural general practice, by using questionnaire and spirometry over the past eight years, using GOLD criteria, I have confirmed 51 cases of COPD.

Allowing for the inability of all patients to reliably perform spirometry, this suggests that for each full-time Irish GP, there are at least 30 patients with COPD. This will vary with the practice patient age-profile and smoking prevalence, amongst other things.

In other words, each GP has the equivalent of at least one to 1.5 hospital medical wards full of COPD patients. With an average hospital stay of nine days per exacerbation, three to four times a year, you begin to see the cost and future workload.

COPD is a progressive disease, in which a patient’s lung function rapidly declines, resulting in significant disability and early death. However, if the disease is recognised, smoking cessation can slow the rate of lung function decline and effective treatment can significantly improve a patient’s symptoms.

Correct diagnosis

Therefore, the correct diagnosis of COPD, through spirometry, is of key importance. As well as treating a patient’s symptoms and improving quality of life, emerging research indicates that pharmacotherapy can have the potential to change the clinical course of COPD.

It is certainly clear from numerous clinical trials that drug treatments can reduce incidence of COPD exacerbations and reduce exacerbation-related hospitalisation.
There are also data suggesting a mortality benefit for treatment with a long-acting bronchodilator and an inhaled corticosteroid in a moderate to severe COPD population, although additional studies are required to determine whether this effect is statistically significant (ref 2).

A recent study with tiotropium suggests that over a one-year interval, lung function in tiotropium-treated individuals may be stable (ref 3). A longer–term study (the UPLIFT trial) evaluating the ability of tiotropium versus placebo to slow loss of lung function in over 6,000 COPD patients is in progress and is soon to be concluded.
If confirmed, tiotropium will be the only intervention other than smoking cessation which has been shown to slow the rate of lung function decline in COPD.

Ash Wednesday, which fell this year on February 6th, was National No Smoking Day and provided an opportunity to raise awareness of smoking-related diseases such as COPD.

Awareness days

It is easy to become cynical about these continual awareness days but, considering that COPD appears to be so under-recognised and that treatment can positively impact the course of COPD, then February 6th is as good a day as any to dust down that spirometer and set about diagnosing those 30 to 40 COPD patients that you have.

For more information on diagnosing and managing COPD, see www.goldcopd.com.

References:
1. Buist, AS, et al. Lancet 2007; 370: 741-750.
2. Calverley, PA. New Engl. J. Med. 2007; 356: 775-789.
3. Oostenbrink, JB, et al. Eur Respir J 2004; 23: 241-249.

Posted in Respiratory on 12 February 2008
Tags: COPD, lung disease