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1 Burden of COPD Burden of COPD Ali Kocabaş Ali Kocabaş Cukurova University School of Medicine, Cukurova University School of Medicine, Adana Adana

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Burden of COPD. Ali Kocabaş Cukurova University School of Medicine, Adana. Why is COPD in the Spotlight?. Mortality of COPD is increasing Health care utilization is increasing Cost is very high COPD has a huge impact on quality of life Prevalence is much higher than appreciated. - PowerPoint PPT Presentation

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  • Burden of COPDAli KocabaCukurova University School of Medicine, Adana

  • 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

  • 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.

  • 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

  • How is the Burden of COPD Estimated?MortalityMorbidityPrevalenceCostQuality of life

  • 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

  • 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

  • Mortality in Turkey by Gender (2000)UHY-ME almas, 2000, Trkiye

  • Morbidity in COPDTraditional methodsPhysician visitsHospitalizationEmergency visits

    New methodsDALY

  • 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

  • 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

  • UHY-ME almas, 2000, Trkiye

    Major diseases lead DALY losts in Turkey

  • Prevalence of COPDRespiratory symptomsDoctor-diagnosed diseaseSpirometry

  • Spirometry is Needed for Diagnosis

    For the diagnosis and assessment of COPD, spirometry is the gold standardThe presence of a post-bronchodilator FEV1/FVC

  • Diagnosed and Undiagnosed COPD in NICE Study in Japan:COPD in NICE Study in Japan: Fukuchi et al. Respirology2004;9:458-65

    UndiagnosedDiagnosed

  • KOAHl hastalarda daha nceki solunum hastalklar tans (Japonya NICE almas) Fukuchi et al. Respirology 2004; 9: 458-465

  • 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

  • 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

  • Reasons for Underdiagnosis

    Lack of awareness among physicians and general populationLack of standart criteriumLack of symptoms in the early periodUnderuse of spirometryLack ofspirometry

  • 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

  • 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.

  • Prevalence of COPD in Adana (BOLD-Turkey Study, 2004)

  • Severity Status of COPD in Adana(BOLD-Turkey Study, 2004)

  • 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)

  • 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

  • BOLD Sudy in the World

  • Prevalence of COPD in Adana ( > 40 yrs) (%)(BOLD-Turkey Study, 2004)

  • 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

  • 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)

  • 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

  • Trends of Risk Factors

  • Mortality of COPD by Gender in US, 1980-2000YearNumber Deaths x 1000

  • Indoor Air Pollution

  • 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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