COPD: CDC Report Suggests Progress in Prevention

Laurie Barclay, MD

April 30, 2013

Prevention of chronic obstructive pulmonary disease (COPD) has improved in the United States during the last decade, according to CDC surveillance results published online April 25 and in the July issue of Chest.

"The main findings of this report are a decrease in prevalence as well as age-adjusted mortality in men for patients with COPD," Brian W. Carlin, MD, assistant professor of medicine at Drexel University School of Medicine in Pittsburgh, Pennsylvania, told Medscape Medical News after reviewing the report. "Also noted was a decrease in hospitalizations."

Smoking is the leading risk factor for COPD, which has significant associated morbidity, disability, and reduced quality of life. COPD contributes to chronic lower respiratory disease, which is the third leading cause of mortality in the United States. In 2008, the estimated direct economic cost of COPD and asthma was $53.7 billion.

"With 39% of surveyed COPD patients reporting they continue to smoke, there is an opportunity for physicians to counsel patients and refer them to smoking cessation programs," Chest Editor-in-Chief Richard S. Irwin, MD, said in a news release. "Given the data contained in the CDC report, our hope is that we will see mortality rates decline [further] in future years."

The investigators analyzed data in US data systems from 1999 through 2011 for adults aged at least 25 years. Overall age-adjusted prevalence of COPD declined from 1999 through 2011 (P = .019) and was 6.5% (~13.7 million) in 2011.

The age-adjusted hospital discharge rate for COPD fell significantly (P = .001) from 1999 through 2010, despite the lack of significant overall trends for physician office and emergency room visits. During that period, Medicare claims declined overall (P = .045), among men (P = .022), and among those aged 65 to 74 years (P = .033).

"These us to realize that the advances in and subsequent use of the therapies in the field of COPD are now being found to be successful [for] patients with COPD," said Dr. Carlin, who is also chairperson of the National Lung Health Education Program.

COPD Statistics for 2010

  • 10.3 million (494.8/10,000) physician office visits,

  • 1.5 million (72.0/10,000) emergency room visits,

  • 699,000 (32.2/10,000) hospital discharges,

  • 312,654 (11.2/1000) Medicare hospital discharge claims submitted, and

  • 133,575 deaths (63.1/100,000).

During 1999 to 2010, there was no change in overall age-adjusted death rate. However, death rates decreased among those aged 55 to 64 years (P = .002) and 65 to 74 years (P < .001), Hispanics (P = .038), Asian/Pacific Islanders (P < .001), and men (P = .001). In contrast, death rates increased among adults aged 45 to 54 years (P < .001) and among American Indian/Alaska Natives (P = .008).

"The American Indian population had higher COPD prevalence, hospitalizations and death rates than other specific racial or ethnic groups," said Janet Croft, PhD, from the CDC's Division of Population Health, in the news release. "This population would likely benefit from additional assistance in smoking cessation efforts."

Prevalence, Medicare hospitalizations, and deaths clustered by geographic region.

"Various guidelines have been developed (eg, smoking cessation, early disease detection, pharmacologic, and nonpharmacologic therapies) over the last decade," Dr. Carlin said. "Implementation of such guideline recommendations by healthcare providers may in part have played a role in these study findings. It is great to know that the therapies we are providing are resulting in improved patient care."

In terms of additional research, he recommends continued surveillance for COPD.

"Further research as to the reasons for such reductions in prevalence, age-adjusted mortality in men, and hospitalizations should be conducted," Dr. Carlin concluded. "This will help us to further refine the early detection and management of patients who have COPD."

This study received no external funding. One of the study authors has financial disclosures involving GlaxoSmithKline, Novartis Pharmaceuticals, Pfizer, AstraZeneca Forest Laboratories, Creative Educational Concepts, and Up-to-Date. The other study authors and Dr. Carlin have disclosed no relevant financial relationships.

Chest. Published online April 25, 2013. Abstract