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CDC Pulmonary Expert Discusses 
New 2002 Report on COPD Trends
More Women Being Diagnosed; Early Detection Urged

August 2002 -- The information below is from a U.S. Centers for Disease Control and Prevention (CDC) telebriefing conference with Dr. David Mannino, CDC pulmonary disease expert.

Chronic Obstructive Pulmonary Disease, which is also known as COPD, includes patients who have chronic bronchitis, emphysema and some people with asthma. COPD is the fourth leading cause of disease in the United States. Some have described COPD as an asthma attack that never stops. Tobacco use is a key risk factor for COPD, although other risk factors include occupational exposures, infections, air pollution, sensitive airways and genetic factors. Lung function testing is needed to diagnose COPD.

The report released this month reports on trends and different measures of COPD in the United States over the past 30 years. In 2000, for the first time, the number of women in the U.S. dying from COPD surpassed the number of men. This report also finds that women visit emergency rooms and are hospitalized more often for COPD than are men. These data confirm that COPD is now a women's health disease.

The increase in these trends for women probably reflects the increase in smoking by women in the United States since the 1940s. People with COPD are twice as likely to report activity limitations as people without COPD. In addition to taking away years from a person's life, COPD also takes life away from a person's years.

The good news is that the number of men and women, age 25 to 54, with mild to moderate COPD has actually decreased over the past quarter century, suggesting that the increases that we're currently observing in hospitalizations and deaths may not continue indefinitely. We believe that this observation is a result of the overall decrease in smoking in the United States since the 1960s.

The main message from this report for physicians is that they should consider measuring pulmonary function in order to detect COPD in current and former smokers, age 45 and over, and anybody with respiratory problems.

The main message for members of the general public who have a history of smoking, asthma or respiratory symptoms is that they should discuss COPD with their physicians.

Recap of Question and Answer Session

CDC MODERATOR: You can get a full copy of the report by going to our website, which is www.cdc.gov. And if you select "In the News" on the left-hand corner of your screen, it will be listed under content. That will take you to a summary of the surveillance report, and then you can also obtain the full copy.

QUESTION:  How much of a difference are we looking at between men and women? Is it statistically significant, and could it be related to the fact that there are more, I mean, we're talking older people at this point when you're talking dying, how related is it to the fact that you have more older women at that age because of survival?

DR. MANNINO:
Many of the measures actually are significantly higher in women. Prevalence of the number of people who report they have COPD is significantly higher than women, as are I believe emergency room visits. I'd have to look at the various specifics of the report, but it is all in there. Because our measure of deaths actually counts every death in the country, women have about I think there are 7- or 800 more deaths among women than among men, and that of course is statistically significant, although both were right around 60,000.

Part of this is related perhaps to women living longer, and the evidence for this is that if you actually look at the age-adjusted mortality rates, they are still slightly lower among women than they are men, although the actual numbers are higher in women.

QUESTION: They're slightly lower among women?

DR. MANNINO: Yes, the mortality rates, although the actual number of deaths is higher in women.

QUESTION: In the deaths, are we talking about predominantly in the over 60/over 70 age group?

DR. MANNINO: Yes, COPD deaths predominantly occur in older people. Again, the specific numbers are all in the report.
 
QUESTION: Can you just address a little bit about the under diagnosis of this condition.

DR. MANNINO:
We have evidence from other reports that we have published, and it's briefly addressed in this report, that a substantial proportion of the population has objective evidence of COPD. In other words, in some of our national surveys, if you actually go out and measure lung function, you'll find a certain percentage of the population that has evidence of COPD. In our report, I think it was somewhere around 14 percent that had either a mild or a moderate COPD.

If you actually then look and ask those people who have been diagnosed with COPD, it's a relatively small proportion. Generally, it's in about the 30-percent range.

QUESTION: Just a question about asthma and COPD.

Asthma rates have been increasing in the last decade or so or two, and I'm wondering whether there's any link between asthma and COPD biologically.

DR. MANNINO: Yes, actually, there is. Within the pulmonary community, one typically sees diagrams of overlapping circles, with emphysema, chronic bronchitis and asthma. Clearly, the definition of asthma is variable air flow obstruction and the definition of COPD is fixed airflow obstruction.

One of the problems that one can see with asthma, particularly if it exists for a long time, is that some of the variation diminishes over time, particularly it is thought in people that aren't being adequately treated. And some evidence we have for this that isn't in this report, but we have another paper that's coming out shortly is that if you look at COPD deaths in the country, that somewhere between 15 and 20 percent of these occur in people who have never smoked, and of those, a history of asthma was one of the most significant risk factors for having a COPD-related death.

QUESTION: So part of the increase might be due to the increase in asthma?

DR. MANNINO: That is entirely possible.
 
QUESTION:  Could elaborate a little bit on the overall trend and diagnosis of COPD. I understand it's the fourth leading cause of death and that in 2002 10 million adults were diagnosed by doctors.

Has that been stable? Is it going up or down? Can you give us any trend?

DR. MANNINO: Yes, that is in the report. If you actually look at the report that they've been diagnosed with either chronic bronchitis or emphysema, that has stayed relatively stable over the 20 years that we report for that measure in this report.

QUESTION: Following up on the question earlier on the 15 to 20 percent of those who have never smoked, is that an increasing trend?

I mean, among those, are you seeing in that giant line that goes up, an increase in nonsmokers who are dying of COPD?

DR. MANNINO: Unfortunately, with the current mortality data that we have available, which does not ask specifically about smoking, we cannot tease that out, and we're currently working on some other databases where we may be able to get an answer to that; but we simply can't answer that.

QUESTION: And then looking at the data on your report, it seems that you almost quadruple the deaths in women from 1980 to 2000.

DR. MANNINO: Yes

QUESTION: And that's purely smoking? You're saying it's mostly smoking. That would be considered alarming in other places.


DR. MANNINO: I consider, we consider it alarming, and that's why we're reporting it, and that's what we feel is one of the messages of this report.

QUESTION: But most of that is smoking.

DR. MANNINO: Yes, we believe most of it is smoking. Generally, the life history of COPD development, or, actually, if you just look at cigarette smoking, people start smoking in their teens or early 20s, and they start developing COPD in mild cases, probably in their 40s and 50s, and start dying in their 60s and 70s.

So in that sense I think what we're seeing here is really related to the uptake of smoking by women in the United States in the 1940s and '50s, and then that continuing increase that has occurred through 1960s.

Source: U.S. Centers for Disease Control and Prevention (CDC)
 

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