COPD

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in America. 11.4 million Americans have COPD and another 12 million are likely to have it and not even know, and worldwide the disease effects nearly 600 million people and accounts for more than 2.2 million deaths each year. COPD includes emphysema and chronic bronchitis and is most commonly found in people over the age of 40 who are or were smokers. However, environmental exposures, such as, dust, chemicals or fumes in the workplace, also have a part to play in contracting COPD.

Education

Dr Heffner is a pulmonary critical care physician and one of his main roles is as President of the American Thoracic Society. The American Thoracic Society is the largest professional society that’s mission is to improve global health in the areas of respiratory medicine, clinical care medicine and sleep medicine. The American Thoracic Society is educating the American public to make them more aware of COPD, the factors that cause it and where they can find help. The society does this in many ways, one of which is by partnering with various other organizations in the development of clinical practice guidelines to inform both patients and clinicians, as well as improving clinical outcome. Heffner comments, “We are looking at the science of COPD guidelines, development and implementation on a global reach so, for example, we are sponsoring a workshop this coming June on the ideal methodologies for developing and implanting clinical practice guidelines to promote best clinical practices around COPD care. This will be attended by all the world’s major respiratory professional societies along with the national institutes of health.” Heffner adds that the American Thoracic Society also has many members who are experts at patient education and as such the society is able to develop patient education materials around COPD.

Causes

COPD is carried in the broad patient population. There are some patients who have alpha 1 antitrypsin deficiency which is a congenital enzyme defect wherein they can develop COPD in an accelerated rate affecting them in perhaps their fifth decade of life, if not earlier. It is accelerated by smoking and the conjunct of this congenital defect and smoking is a very strong indicator of advancing into obstructing lung disease. Heffner points out, “In the developed and un-developed world, smoking is the major cause of COPD, accounting for perhaps 85 percent of instances. Smokers then develop different forms of COPD, from early abnormalities that may remain relatively symptomatic for a number of years until a patient develops symptoms, at which point it may have already progressed to irreversible destruction of lung tissue.”

As well as smoking there are other possible causes of COPD. Mainly these are to do with smoke and smoky environments and more specifically in third world countries, homes that rely on burning wood and cow dung for heat, energy and cooking. Young children and adults inhaling this type of material may be at more risk of developing COPD.

Heffner has previously called for more stringent standards on fine particulate matter pollution, asked why he feels so strongly about this he answers, “We feel strongly because evidence does exist that fine particulates do increase mortality from many different directions. We know that they can be cancer causing, the lung can be a portal for entrance into the body – fine particles can make it down into the lower reaches of the lung and then transmit into the bloodstream and then be deposited in the coronary arteries. These fine particles can be associated with cardiac mortality and we feel that the evidence does require a very stringent prohibition as to the significance of these fine particles.” Heffner goes on to say that the American Thoracic Society research recognizes that fine particles are a degree higher than nano-particles and there is increasing awareness that nano-particles are similarly picked up by cells in the airway and deposited and distributed in ways that we are yet to discover or understand. However, it is understood that these nano-particles may have a serious consequence to health.

Possible prevention

It is important to have early detection systems in place and individuals should remove the removable risk factors, such as smoking or exposure to biomass fuels. In third world countries there is a major interest to educate the governments that other sources of fuel are necessary. Heffner believes that, “part of our treatment is prevention and a part of that are non-smoking campaigns where we have had some success in decreasing smoker rates. However, the tobacco industry has increased their marketing focuses in third world nation where smoking rates are on the rise.”

Costs

Healthcare costs associated with COPD are expected to be about $800 billion over the next 20 years. Heffner thinks this is an entirely realistic figure, “With the aging population and the onset of COPD in a symptomatic phase later in life, we are yet to see a downward turn of the epidemic of chronic pulmonary disease in the mortality and morbidity of COPD. This is in contrast to other conditions such as, heart disease, stroke and other vascular disorders. In the United States we will see a growth of the economic burden of COPD, but clearly worldwide we are still generations away from seeing a downward turn of the cost and financial problems related to COPD, but this will happen – it is just a case of when rather than if.”

The future

There has been an increased awareness of COPD in the public domain and also in international agencies and governments that the economic and suffering related to COPD is of major significance. Due to increased awareness, it is hoped more resources will be directed to understanding the pathogenesis of COPD and improving the clinical outcome. Asked his prediction for the next 10 – 20 years regarding COPD Heffner comments, “We will see new products on the market that may finally control or halt the progression, if not reverse, some of the tissue damage that occurs in COPD and offer opportunities for clinical outcome. Science is going to advance in terms of bringing these new interventions to clinicians, but perhaps more importantly is that we will see worldwide groups such as ATS (American Thoracic Society), ERS (European Respiratory Society) and GOLD (Global Initiative for Chronic Obstructive Lung Disease), coming together and coming up with an integrated, co-ordinated effort to disseminate best clinical practices that will penetrate to offices of industrial nations and small clinics and rural parts of the world.”

“smoking is the major cause of COPD, accounting for perhaps 85 percent of instances”

“we are yet to see a downward turn of the epidemic of chronic pulmonary disease in the mortality and morbidity of COPD”

Dr John Heffner, President of the American Thoracic Society