New Approach Needed in Detecting and Treating Nation's No. 4 Killer: COPD
The term COPD may not strike fear in the hearts of most Americans like SARS or cancer, but that may soon change if the nation's lung specialists have their way.
"COPD is the fourth leading cause of death in the U.S., yet it is a disease that very few people know anything about, and it is increasing alarmingly in the U.S. and throughout the world," says A. Sonia Buist, MD, professor of medicine at Oregon Health & Science University in Portland.
At a time when other major causes of death such as heart disease and cancer are declining, the death rate for COPD, or chronic obstructive pulmonary disease, has skyrocketed by 163% in the last 30 years, and Buist says a rapid rise in COPD deaths among women is fueling that increase.
In an effort to reverse those disturbing trends, Buist and other COPD experts announced Thursday a new national campaign to increase awareness and detection of COPD among physicians and their patients at a briefing in New York City, sponsored by the American Medical Association.
What Is COPD?
COPD is a term that was introduced in the 1960's. It's an umbrella term for diseases of the lung, such as emphysema and chronic bronchitis, which result in a progressive and abnormal decline in lung function.
Most of the estimated 16 million people in the U.S. with COPD suffer from a combination of these diseases that cause inflammation and destruction within the lungs and make it difficult to breathe.
Smoking causes up to 90% of COPD cases in the U.S., but air pollution is also major contributor it in developing countries.
Researchers say everyone begins to experience a natural decline in the amount of air their lungs can hold (lung capacity) after about age 35. Nonsmokers lose about an average of two tablespoons of lung capacity per year. But smokers lose three to four times of their lung capacity annually, which dramatically increases their risk of death and disability caused by COPD.
Experts say confusion about the variety of terms used to describe the conditions involved in COPD has made it difficult for the public as well as the medical community to understand this very common disease.
In fact, Buist says the symptoms of COPD are often confused with the normal aging process. Those symptoms include:
Since these changes are gradual, researchers say the majority of people with COPD aren't diagnosed until they are hospitalized, and only about 25% to 50% of those with the disease are aware of it.
By the time most people with COPD do seek medical attention for these symptoms, typically while in their mid-50s, Buist says many have already lost up to half of their lung function.
Detecting COPD
Researchers say that early detection and treatment of COPD is the key to slowing the decline in lung function that occurs and preventing premature death from the disease.
That's why a new program initiated by the American College of Chest Physicians is targeting family doctors, internists, and other primary care providers to increase their awareness of COPD and encourage them to screen for this deadly disease as they would other chronic conditions such as diabetes, high blood pressure, and high cholesterol.
"In just the same way we identify people with high blood pressure, give them advice with lifestyle changes, and design the best treatment," says Michael C. Iannuzzi, MD, chief of pulmonary, critical care and sleep medicine at Mount Sinai Medical Center in New York City. "We have to have the same approach for COPD: measure, lifestyle change, treat."
Iannuzzi recommends that people with symptoms or risk factors for COPD, such as smoking, receive spirometry testing as a part of their regular health check-ups to screen for and diagnose COPD.
A spirometry test is a noninvasive test that measures lung function and is the only test that can confirm a suspected diagnosis of COPD. It involves exhaling into a machine attached to a computer that provides a measurement percentile based on the patient's age, height, and weight. Any number lower than 80% of the predicted measurement based on those factors is considered abnormal.
"Test your lungs, know your numbers," says Iannuzzi.
Treating COPD
Once a person is diagnosed with COPD, the single most effective treatment is smoking cessation.
"Drugs do not cure COPD. There is no pill that cures it. There is no spray that grows new lung, just as there is no pill that stops us from growing older," says Mark J. Rosen, MD, chief of pulmonary and critical care medicine at Beth Israel Medical Center in New York City.
Researchers say that stopping smoking is the only proven way to stop that accelerated loss of lung function that occurs in COPD. Once lung function is lost, it never comes back.
However, current treatments for COPD can significantly improve and extend the lives of people with it by targeting the symptoms of the disease, such as:
"Unfortunately, many physicians think the available treatment for COPD is limited, and it is not," says Iannuzzi.
Jennifer Warner - WebMD
