How important is COPD?

The most up-to-date figures suggest that 1.5% of the UK population have been diagnosed with COPD – a total of 900,000 people. Men are more likely to be affected than women, with prevalence rates of 2% in men aged 45–65 years and 7% in men over 75. The rates for women are rising, however, which is probably related to their increased smoking over the last 20 years.These figures are likely to be an under-estimate of the true prevalence, because much COPD may be mis-labelled as asthma.Moreover, most mild COPD goes unrecognised because patients are relatively symptomatic, with only minor symptoms such as a smoker’s cough or mild breathlessness on exertion. As a result, they often don’t consult their doctor. Recent studies indicate that as few as 1 person in 4 with COPD is recognised.
In 1999, COPD accounted for 7.4% of all deaths among men and 4.1% among women in the UK. Mortality tends to be greater in urban areas, particularly in South Wales, the north-west of England and Scotland. There is a strong association with lower social class and poverty that can be explained only partly by the higher smoking rates of this group.

On a more global basis, the WHO estimates the prevalence of COPD to be 600 million world-wide. COPD is currently the fifth greatest cause of mortality world-wide, with over 2.5 million deaths recorded in 2000. By 2020, COPD is projected to become the third leading cause of death and the fifth leading cause of morbidity. Most other chronic diseases, including coronary artery disease, strokes and cancer, are likely to decrease over this period.

A project for the future – when suitable government funding ismade available – might be to screen smokers over the age of 45 years with spirometry (see Chapter 4) to detect early airflow obstruction before symptoms start. It will still be difficult to persuade people at risk to stop smoking but, if they are successful at this point of the disease, most of them will never develop symptomatic COPD. This will produce major personal benefits for them as well as a significant cost saving to the NHS.

As the disease progresses, patients become increasingly short of breath – washing, getting dressed and minimal exertion become difficult.The effect on lifestyle can be devastating, resulting in physical suffering, mood change and depression, together with social isolation. Many sufferers will have to accept early retirement, which
can create financial problems for them. Even at a less severe level,many activities are restricted:

doing jobs around the house,

hobbies (e.g. gardening),

choice of holiday venues.

When one partner is significantly restricted, a marriage may be put under considerable strain. An important part of COPD management is to be aware of these
problems. Addressing social and psychological needs as well as encouraging patients to take as much regular exercise as possible should form an integral part of their care. Information on disability grants and aids, such as the Blue (formerly Orange) Badge parking scheme for people with disabilities, may help improve their overall
quality of life.