COPD to become third leading cause of death by 2030

Chronic Obstructive Pulmonary Disease (COPD) is set to become the third leading cause of death worldwide in the next 15 years1, and New Zealand currently has the second highest hospitalisation rate for the disease in the OECD2.

Figures on deaths as a result of COPD show the disease affects an estimated 15% of New Zealanders over 45 years old3.

It is the fourth leading cause of death behind cancer, heart disease and stroke4, and our rate of hospitalisations is second only to Ireland in the OECD.

According to the World Health Organisation (WHO), the disease is growing in impact, with predictions that it will become the third leading cause of death worldwide by 20305.

COPD is a progressive, obstructive lung disease characterised by chronic poor airflow. Symptoms include frequent breathlessness and coughing and once established causes irreparable lung damage. It is treatable but not curable.

However, COPD often goes undiagnosed, as signs and symptoms of the disease only appear later in the disease course.

New Zealand experts are calling for earlier diagnosis in order to provide better quality of life for those living with COPD, as well as reducing the cost of the disease for the public health system.

GP Dr Jim Lello, who is currently reviewing the primary care records of a sample 325,000 patients in GP services around New Zealand who are treated for lung disease, says many people put off visiting the doctor because the symptoms of the disease are relatively common.

“Shortness of breath, a cough and sputum are all common and people are used to them, so it’s only when they get more severe or consistently affect someone’s life that they become noticeable,” says Dr Lello.

“There is a lot of wishing and hoping on the part of patients that it will go away, but it does creep up on people over the years.”

Dr Lello says it’s important for GPs to carry out the correct assessments for patients at high risk. “COPD is a primary care illness, GPs are the ones seeing it in the community most often, and so we are working to encourage more GPs to train their staff in spirometry testing, which is an accurate test of lung function, and to use questionnaire assessment tools as well.”

The COPD Assessment Test (CAT) online self-assessment test can be administered by a GP, or patients can do it themselves to get a score of how lung function is affecting their everyday life, he says.

“If it shows that it is negatively affecting you, then it’s important to visit your GP to discuss those results and start a dialogue about the potential treatments that we can prescribe to help alleviate symptoms, including medication and pulmonary exercises,” says Dr Lello.

University of Auckland Associate Professor Rob Young, a specialist physician and clinical researcher, says early detection is crucial as treatments can slow the deterioration of lung function when damage is minimal if patients quit smoking and seek help early enough.

“We estimate that up to 70% of patients with COPD could be unrecognised or undiagnosed, which is why it’s important that families get involved and encourage family members who smoke to go to their GP for lung function tests,” says Dr Young.

The importance of identifying COPD is made even more important with the discovery that smokers with this disease are three to four times more likely to get lung cancer, according to research by Dr Young.

“What we now know is that if you are a current or former smoker and have developed COPD, your risk of lung cancer is much higher, so the earlier you can quit smoking and start dealing with the disease, the more you can reduce your risk.”

For Māori, that message is even more important, says Dr Young, with the Māori population at higher risk of COPD and an even greater risk of lung cancer. “Studies show that Māori develop these diseases 5-10 years earlier and at much lower smoking levels than non-Māori, so detecting COPD early becomes even more essential.”

Asthma NZ Executive Director Linda Thompson says an early diagnosis of COPD can markedly improve a patient’s quality of life.

“They can be supported to give up smoking, encouraged to participate in regular exercise, and be commenced on appropriate medication, which includes annual free flu vaccinations and other vaccinations if appropriate.” Thompson says an important part of that diagnosis is spirometry, a ‘gold standard’ test which can detect loss of lung function even before the patient is aware of damage, but which needs specialist training to administer. The test is available at Asthma NZ sites around New Zealand.

“Protocols in general practice also need to be developed in-line with the global guidelines (GOLD) to ensure clients have the best possible health outcomes,” she adds. “The CAT score measures patient symptoms, exacerbations and quality of life and is dependent on the perception of the patient. Treatment and management is determined by symptoms, quality of life and spirometry measurements.”

New Zealand faces costs of $59.6 million per annum in COPD-related hospital admission costs alone6. This is without taking into account loss of productivity and absenteeism, or ongoing support costs.

A study published in the New Zealand Medical Journal in January this year found that “hospital admissions for COPD are costly and are overrepresented in high risk groups including rural, elderly, socioeconomically deprived, and Māori and Pacific peoples.”

“Effective interventions that are targeted to high risk groups are required to improve equity and reduce the burden of COPD7.”

An awareness campaign to highlight the symptoms and risk factors will take place in New Zealand on World COPD Day, 18 November, 2015.

References:

  1. WHO Chronic Respiratory Diseases Fact Page (Accessed October 2015)
  2. OECD Health Data 2011
  3. Asthma Foundation. COPD in New Zealand. 2012 (Accessed October 2015)
  4. MOH. Mortality and Demographic Data 2009. Wellington 2014 (Accessed October 2015)
  5. WHO Chronic Respiratory Diseases Fact Page (Accessed October 2015)
  6. Milne RJ, Beasley R. Hospital admissions for chronic obstructive pulmonary disease in New Zealand. New Zealand Medical Journal. 2015;128(140):2010-2019
  7. Milne RJ, Beasley R. Hospital admissions for chronic obstructive pulmonary disease in New Zealand. New Zealand Medical Journal. 2015;128(140):2010-2019.

 

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