"In the 30 years from 1968 to 1998, when mortality from all cardiovascular disease was falling, when mortality from coronary-artery disease went down 60 percent, COPD mortality rose 163 percent," said Dr. Buist, professor of medicine at the Oregon Health & Science University.
"The startling fact is that during this period, the death rate in men has pretty much leveled off--it may even have gone down a little," said Dr. Buist. "The very rapid increase in the deaths of women from COPD is what accounts for the huge increase."
COPD has long been thought of as a man's disease, according to Dr. Buist. This is because the major risk factors for COPD in the developed world are smoking and occupational exposures to pollutants, especially particulates. For a long time these risk factors really applied only to men.
"Starting in the 1960s we see women began to catch up to men," said Dr. Buist. "Women started smoking in large numbers in the 1930s and '40s. At the same time, women also began to move into the workplace, exposing them to occupational hazards, as well. COPD prevalence in men and women in the U.S. is now probably about equal, reflecting the equality in the smoking habits of men and women and the improved opportunities in the workforce for women."
There is a need for education about COPD, according to Dr. Buist. COPD is under diagnosed, with few doctors understanding the need to do lung function testing with patients exhibiting early symptoms. "We are not catching people in the early stages of the disease," said Dr. Buist. "We are not picking it up until the disease is very advanced and there is little that we can do for it."
"Everyone is confused by the variety of different terms, COPD, emphysema and chronic bronchitis. The confusion in the terms we use to describe the disease has created a barrier, making it very difficult for the medical community to reach an understanding of this incredibly common, difficult and expensive disease," said Dr. Buist. "Our confusion extends to defining who has COPD. Depending on how we define it -- do we ask, 'Has a doctor ever told you that you have...?' or base a diagnosis on the presence of chronic cough and sputum or on abnormal lung function -- we can end up with very different prevalence numbers."
COPD is usually first diagnosed in patients in their mid-50s. COPD is an expensive disease that causes premature disability, premature mortality and sends patients to the hospital over and over again for the treatment of debilitating exacerbations. Up to 70 percent of the cost of COPD in the U.S. is caused by exacerbations, according to Dr. Buist. "These are older patients who may have other illnesses," she said. "They frequently end up in the hospital."
"COPD is a disease with a significant impact on the quality of life," according to Dr. Buist. "These patients are miserable. They can't breath. They may be dependent on oxygen. They have little muscle strength and can't get around. They are literally gasping for breath."
"We need to make some very basic changes. We need to raise awareness of the risk of COPD for women. We also need to encourage the use of spirometry to make the diagnosis. Finally, we need to use standardized terminology for the disease," concluded Dr. Buist.
SPECIAL EMBARGO FOR RELEASE: 10 a.m. (ET) Thursday, Nov. 6, 2003
Media Advisory: To contact A. Sonia Buist, M.D., contact Tamara Hargens at 503-494-8231 or at firstname.lastname@example.org. On the day of the briefing, call the AMA's Science News Department at 312-464-2410.