More proactive detection and diagnosis is neededs, says a report on the growing global burden of the disease.
Earlier surveillance and treatment for patients at risk of COPD is needed to address the unsustainable pressure the disease places on patients and health systems around the world, the European Respiratory Society Congress heard this week.
Australia is part of an international COPD report released this week at the ERS congress in Vienna, which wraps up today.
The Speak Up for COPD Coalition’s Global State of COPD Report calls for action to address the massive burden of disease through a raft of recommendations including more proactive detection and diagnosis, as well as access to timely and appropriate care.
Speaking to The Medical Republic from Vienna, Professor Christine Jenkins from the George Institute said the report reflected the shifts in understanding that research in longitudinal studies had shown “that people with COPD acquire a lifetime of different risks and exposures that contribute to their disease”.
“Although it is diagnosed usually mid to late adult life, it evolves from childhood, from early-life respiratory infection to socio-economic status, prematurity, household air pollution etc.,” she said.
“It is therefore a disease of a lifetime of accumulated hazards, rather than simply due to smoking and we are seeing more and more non-smoking COPD, especially in women. This is even more marked in low-income countries.”
Professor Jenkins said not reaching optimal lung growth through childhood and adolescence was an important risk factor for COPD. This was an issue that affected all countries regardless of whether they were high or low-income.
“It is almost certainly important for Indigenous Australians,” she said.
Professor Jenkins, who is also a professor of respiratory medicine at UNSW and a clinical professor at the University of Sydney, contributed to the 16-page report, “The Global State of COPD”.
The report is based on secondary research as well as interviews with clinical and patient experts, with a particular focus on 10 countries, including Australia, Belgium, Brazil, Canada, China, Malaysia, Nigeria, Poland, Saudi Arabia and the UK.
Coalition partners include the Global Allergy & Airways Patient Platform, International Federation of Ageing, COPD Foundation, International Coalition of Respiratory Nurses, International Pharmaceutical Federation, with funding from pharma companies AstraZeneca, Roche, Sanofi and Regeneron.
The report’s authors said that while accurate estimates of the number of people living with COPD were difficult to obtain as many people may be undiagnosed, recent epidemiological data suggested there were 213 million people currently living with COPD. Other estimates have put that figure much higher, at up to 391 million.
“COPD is the third leading cause of death worldwide (excluding covid-19): every hour, 425 people die of the condition,” the authors wrote.
“It contributes significantly to premature mortality: 90% of COPD deaths occur in people younger than 70 who live in low- and middle-income countries.”
The authors said COPD would cost the global economy $4.3 trillion between 2020 and 2050 without investment in effective interventions.
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“And yet awareness of, and political attention to, COPD remain inadequate: a 2022 Ipsos poll conducted in 14 countries showed that 45% of the public and 31% of policymakers did not know that COPD was a lung disease, and only 5% of policymakers considered it a priority,” they wrote.
“It is imperative to enhance awareness and prioritisation of COPD among health system decision-makers: this is a key starting point to drive effective system change that will improve both health outcomes and, ultimately, improve people’s lives.”
The report lists a number of what it calls “building blocks for meaningful change” and these include:
- Protecting population health: reducing prevalence and risk factors. This could be boosted through expanding the delivery of smoking cessation services, investing in better environmental protection measures, and supporting the delivery of vaccination programs.
- Identifying COPD early: proactive detection and diagnosis. Recommendations included developing public awareness campaigns, improving access to spirometry and integrating COPD into lung health check-ups.
- Facilitating timely access to comprehensive care. This could be achieved by upskilling the entire health workforce, incentivising the effective delivery of best-practice COPD care and expanding access to pulmonary rehabilitation.
- Strengthening government strategies, research and data, through developing comprehensive national strategies, building robust national COPD databases and investing in research and innovation.
Professor Jenkins said the understanding of COPD needed to change in Australia, in particular a shift towards focussing on lung health and how it can be maximised from birth – even pre-term.
“A better understanding of this will help remove the stigma that is attached to much of lung disease, but particularly COPD as if the patient is to blame – a very narrow view, even of smoking,” she told TMR.
“We need to understand that lungs don’t look after themselves, but we can look after them ourselves for much better lifetime outcomes.”
