Pulmonary Rehabilitation* Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines

Andrew L. Ries, MD, MPH, FCCP (Chair); Gerene S. Bauldoff, RN, PhD, FCCP; Brian W. Carlin, MD, FCCP; Richard Casaburi, PhD, MD, FCCP; Charles F. Emery, PhD; Donald A. Mahler, MD, FCCP; Barry Make, MD, FCCP; Carolyn L. Rochester, MD; Richard ZuWallack, MD, FCCP; Carla Herrerias, MPH


CHEST. 2007;131(5):4S-42S. 

In This Article

Epidemiology of COPD

In the United States, COPD accounted for 119,054 deaths in 2000, ranking as the fourth leading cause of death and the only major disease among the top 10 in which mortality continues to increase.[5,6,7,8] In persons 55 to 74 years of age, COPD ranks third in men and fourth in women as cause of death.[9] However, mortality data underestimate the impact of COPD because it is more likely to be listed as a contributory cause of death rather than the underlying cause of death, and it is often not listed at all.[10,11] Death rates from COPD have continued to increase more in women than in men.[5] Between 1980 and 2000, death rates for COPD increased 282% for women compared to only 13% for men. Also, in 2000, for the first time, the number of women dying from COPD exceeded the number of men.[5]

Morbidity from COPD is also substantial.[5,12] COPD develops insidiously over decades and because of the large reserve in lung function there is a long preclinical period. Affected individuals have few symptoms and are undiagnosed until a relatively advanced stage of disease. In a population survey in Tucson, AZ, Burrows[13] reported that only 34% of persons with COPD had ever consulted a physician, 36% denied having any respiratory symptoms, and 30% denied dyspnea on exertion, which is the primary symptom. National Health and Nutrition Examination Study III data estimate that 24 million US adults have impaired lung function, while only 10 million report a physician diagnosis of COPD.[5] There are approximately 14 million cases of chronic bronchitis reported each year, and 2 million cases of emphysema.[14] The National Center for Health Statistics for 1996 reported prevalence rates of chronic bronchitis and emphysema in older adults (eg, persons ≥65 years of age) of 82 per 1,000 men and 106 per 1,000 women.[15] In 2000, COPD was responsible for 8 million physician office visits, 1.5 million emergency department visits, and 726,000 hospitalizations.[5] COPD accounts for > 5% of physician office visits and 13% of hospitalizations.[16] National Health and Nutrition Examination Study III data from 1988 to 1994 indicated an overall prevalence of COPD of 8.6% among 12,436 adults (average age for entire cohort, 37.9 years).[17] In the United States, COPD is second only to coronary heart disease as a reason for Social Security disability payments.

Worldwide, the burden of COPD is projected to increase substantially, paralleling the rise in tobacco use, particularly in developing countries. An analysis by the World Bank and World Health Organization ranked COPD 12th in 1990 in disease burden, as reflected in disability-adjusted years of life lost.[10]


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