burden of copd
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Burden of COPDAli KocabaCukurova University School of Medicine, Adana
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Why is COPD in the Spotlight?Mortality of COPD is increasingHealth care utilization is increasing Cost is very highCOPD has a huge impact on quality of lifePrevalence is much higher than appreciated
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Definition of COPDCOPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients.
Its pulmonary component is characterized by airflow limitation that is not fully reversible.
The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.
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Patterns of Co Patterns of Co-Morbidities in Morbidities in Newly Diagnosed COPD in UK Newly Diagnosed COPD in UK
2,699 patients with newly diagnosed COPD identified in UK General Practice Research DatabaseCompared to non-COPD cohort, COPD patients were at increased risk of:Pneumonia (RR 16)Osteoporosis (RR 3.1)Respiratory infections (RR 2.2)Myocardial infarction and angina (RR for both1.7)Fractures (RR 1.6)Glaucoma (RR 1.3)
Soriano et al CHEST 2005; 128: 2099-2107
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How is the Burden of COPD Estimated?MortalityMorbidityPrevalenceCostQuality of life
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Future Mortality (WHO 2007) 2002 2030Ischaemic heart disease Cerebrovascular disease Lower resp infection HIV/AIDSCOPDPerinatal disorders Diarrhoeal disease TuberculosisLung cancerTraffic Accidents 54PLoS Medicine Nov 2006
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Of the six leading causes of death in the United States, only COPD has been increasing steadily since 1970Source: Jemal A. et al. JAMA 2005
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Mortality in Turkey by Gender (2000)UHY-ME almas, 2000, Trkiye
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Morbidity in COPDTraditional methodsPhysician visitsHospitalizationEmergency visits
New methodsDALY
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Morbidity in COPDMay be affected by co-morbid chronic conditions that are not directly related to COPD but may have an impact on health status or may negatively interfere with COPD managementMorbidity data are greatly affected by availability of hospital beds so should be interpreted with caution
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Global DALY (WHO 2007) 2002 20301. Perinatal disorders 2. Lower resp infection3. HIV/AIDS4. Unipolar depression5. Diarrhoeal disease 6. Ischaemic heart disease7. Cerebrovascular disease8. Road accidents 9. Malaria10.Tuberculosis11.COPD
117PLoS Medicine Nov 2006
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UHY-ME almas, 2000, Trkiye
Major diseases lead DALY losts in Turkey
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Prevalence of COPDRespiratory symptomsDoctor-diagnosed diseaseSpirometry
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Spirometry is Needed for Diagnosis
For the diagnosis and assessment of COPD, spirometry is the gold standardThe presence of a post-bronchodilator FEV1/FVC
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Diagnosed and Undiagnosed COPD in NICE Study in Japan:COPD in NICE Study in Japan: Fukuchi et al. Respirology2004;9:458-65
UndiagnosedDiagnosed
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KOAHl hastalarda daha nceki solunum hastalklar tans (Japonya NICE almas) Fukuchi et al. Respirology 2004; 9: 458-465
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Underdignosis of COPD
IBERPOC (Spain)40-69 age groupn:4035Prev. Of COPD % 9,1Undiagnosed% 78,2
NHANES III (US)> 17 years n:16084Low lung function%6,8 (FEV1/FVC
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Dagnosis Practice in COPD (Adana-2004)
Prevalence of COPD (Fix ratio) 19.1%Doctor-diagnosed Empysema ChronicBronchitis COPD Total COPD
Ever spirometrySpirometry in the last 12 months 0.0 8.4 0.6 8.4
5.8 0.6
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Reasons for Underdiagnosis
Lack of awareness among physicians and general populationLack of standart criteriumLack of symptoms in the early periodUnderuse of spirometryLack ofspirometry
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Management Practice of COPD (Adana-2004)
Patients with COPD)(%) Current smokers Counseling delivered by physicians in the last 12 monthsPharmacotherapy is recommended for cessation Vaccination in the last 12 monthsDrug use for breathing problems in the last 12 months 48.119.3
1.8
2.012.3
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Mannino, D. M et al. Thorax 2007;62:237-241Figure 1 Diagram depicting the decline of the lower limit of normal of the forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio with ageing, among white never-smoking women in the Third National Health and Nutrition Examination Survey.7 The dark shaded portion depicts elderly subjects who are "potentially overdiagnosed" and the light shaded portion depicts younger adults who are "potentially underdiagnosed" with obstructive lung disease.
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Prevalence of COPD in Adana (BOLD-Turkey Study, 2004)
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Severity Status of COPD in Adana(BOLD-Turkey Study, 2004)
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PLATINO and BOLD
PLATINO five countries in Latin America (Brazil, Chile, Uruguay, Mexico, Venezuela)BOLD: 18 countries worldwide (China, Turkey, South Africa, Austria, Poland, Norway, Iceland, Canada, USA, Philippines, India, Estonia, Australia, UK, Portugal, India, Sweden, Netherlands)
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Scientific Objectives of PLATINO & BOLD
Measure the prevalence of COPD & its risk factors by age & sexEstimate the burden of COPDquality of life & activity limitationrespiratory symptomsuse of health care services
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BOLD Sudy in the World
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Prevalence of COPD in Adana ( > 40 yrs) (%)(BOLD-Turkey Study, 2004)
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Chart1
1167
19115
26116
24197
1898
1368
221111
Stage 1 COPD
Stage 2 COPD
Doctor Diagnosed COPD
Percent
Comparison of COPD Prevalence
agedist
Age40-4950-5960-6970+
China43262110
Turkey42301711
Austria29282617
South Africa40312010
Iceland36291817
Germany0000
agedist
000000
000000
000000
000000
China
Turkey
Austria
South Africa
Iceland
Germany
Age Groups (years)
Percent
Age Distribution
cursmoke
GenderMaleFemale
China545
Turkey5020
Austria1719
South Africa6040
Iceland1621
Germany00
cursmoke
000000
000000
China
Turkey
Austria
South Africa
Iceland
Germany
Gender
Percent
Prevalence of Current Smoking
eversmoke
GenderMaleFemale
China806
Turkey8030
Austria5941
South Africa8458
Iceland6161
Germany00
eversmoke
000000
000000
China
Turkey
Austria
South Africa
Iceland
Germany
Gender
Percent
Prevalence of Ever Smoking
Genprevstg1
GenderMaleFemale
China158
Turkey2910
Austria2726
South Africa2920
Iceland1818
Germany00
Genprevstg1
000000
000000
China
Turkey
Austria
South Africa
Iceland
Germany
Gender
Percent
Population Prevalence of GOLD Stage 1
Ageprevstg1
Age40-4950-5960-6970+
China462336
Turkey9193437
Austria10212651
South Africa15253445
Iceland6102643
Germany0000
Ageprevstg1
000000
000000
000000
000000
China
Turkey
Austria
South Africa
Iceland
Germany
AgeGroups (years)
Percent
Population Prevalence of GOLD Stage 1
pckyrsyg1
Pack YearsNever Smokers0-1010-2020+
China661323
Turkey661538
Austria20243037
South Africa11243236
Iceland1481036
Germany0000
pckyrsyg1
000000
000000
000000
000000
China
Turkey
Austria
South Africa
Iceland
Germany
Pack Years
Percent
Population Prevalence of GOLD Stage 1
Genprevstg2
GenderMaleFemale
China95
Turkey156
Austria1011
South Africa2217
Iceland99
Germany00
Genprevstg2
000000
000000
China
Turkey
Austria
South Africa
Iceland
Germany
Gender
Percent
Population Prevalence of GOLD Stage 2
Ageprevstg2
Age40-4950-5960-6970+
China241623
Turkey6101917
Austria39924
South Africa12202830
Iceland341522
Germany0000
Ageprevstg2
000000
000000
000000
000000
China
Turkey
Austria
South Africa
Iceland
Germany
AgeGroups (years)
Percent
Population Prevalence of GOLD Stage 2
pckyrsyg2
Pack YearsNever Smokers0-1010-2020+
China43616
Turkey441220
Austria791119
South Africa7202631
Iceland73619
Germany0000
pckyrsyg2
000000
000000
000000
000000
China
Turkey
Austria
South Africa
Iceland
Germany
Pack Years
Percent
Population Prevalence of GOLD Stage 2
defnbysite
Definition of COPDStage 1 COPDStage 2 COPDDoctor Diagnosed COPD
China1167
Turkey19115
Austria26116
South Africa24197
Iceland1898
Germany1368
Poland221111
defnbysite
China
Turkey
Austria
South Africa
Iceland
Germany
COPD Diagnosis
Percent
Comparison of COPD Prevalence
site by defn
Definition of COPDStage 1 COPDStage 2 COPDDoctor-Diagnosed COPD
China1167
Turkey19115
Austria26116
South Africa24197
Iceland1898
Germany1368
site by defn
1167
19115
26116
24197
1898
1368
Stage 1 COPD
Stage 2 COPD
Doctor Diagnosed COPD
Percent
Comparison of COPD Prevalence
- Cross-Site Comparisons: FEV1/FVC
- Cross-Site Comparisons: FEV1/FVC
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Cost of COPD in US
COPD is a very costly diseasedirect (diagnosis and management)indirect (cost of disability, missed work, premature mortality and family costs)Direct costs in US in2002 $18B, indirect costs $14.1BAnnual per capita expenditures for people with COPD nearly 2x those without COPD ($8,482 vs $3,511 in 1992 study)
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Why is the Burden of COPD Increasing Worldwide?
Changing of the age structure
Increase in exposure to risk factors (especially tobacco) in developing countries & in women
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Trends of Risk Factors
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Mortality of COPD by Gender in US, 1980-2000YearNumber Deaths x 1000
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Indoor Air Pollution
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COPD is a preventable and treatabledisease
Noticeable spike in Austrian males >70 years. Even in 40-49 yo, prevalence is about 8-15%Recent data from the US Centers for Disease Control and Prevention shows that while the mortality rates for COPD in men continue to rise in the US, a startling finding was the steep rise in mortality in women.
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