On March 27, 2015 the Centers for Disease Control and Prevention issued a report on chronic obstructive pulmonary disease (COPD), a group of progressive respiratory conditions, including emphysema and chronic bronchitis, characterized by airflow obstruction and symptoms such as shortness of breath, chronic cough, and sputum production. COPD is an important contributor to mortality and disability in the United States.
COPD is costly, with COPD-related medical costs estimated at $32 billion in the United States in 2010 and an additional $4 billion in absenteeism costs. Persons with COPD are less likely to be employed and more likely to be limited in the type of work they can do compared with persons without COPD.
To assess the state-level prevalence of COPD and the association of COPD with various activity limitations among U.S. adults, the CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). Among U.S. adults in all 50 states, the District of Columbia (DC), and two U.S. territories, 6.4% (an estimated 15.7 million adults) had been told by a physician or other health professional that they have COPD. Adults who reported having COPD were more likely to report being unable to work (24.3% versus 5.3%), having an activity limitation caused by health problems (49.6% versus 16.9%), having difficulty walking or climbing stairs (38.4% versus 11.3%), or using special equipment to manage health problems (22.1% versus 6.7%), compared with adults without COPD.
Prevalence of COPD ranged from 2.6% among those between 18 and 34 years of age to 12.3% among those 75 years old and older. In age-adjusted comparisons by race/ethnicity, Asians were the least likely to report COPD (2.0%), whereas adults who identified themselves as multiracial or American Indian/Alaska Native reported the highest prevalence (10.7% and 10.2%, respectively). Women were more likely to report COPD than men (6.6% compared with 5.4%). COPD prevalence was lower among employed adults (3.6%) compared with other employment categories. COPD prevalence was lower with greater educational level. COPD also varied by marital status, with divorced, widowed, or separated respondents being more likely to report COPD (9.1%) than married respondents (4.7%).
More than one third (38.0%) of adults with COPD were current smokers. COPD was more common among current smokers (14.3%) than former smokers (7.0%) or never smokers (2.8%). COPD was more common among respondents who reported not exercising in the past month compared with those who had exercised (8.8% versus 4.9%). Activity limitations were common among adults with COPD. Among adults with COPD, nonsmokers who also reported being physically active were least likely to report all of the activity limitation measures, whereas those not physically active, regardless of smoking status, were most likely to report the activity limitations. Smokers who have been diagnosed with COPD are encouraged to quit smoking, which can slow the progression of the disease and reduce mobility impairment. In addition, COPD patients should consider participation in a pulmonary rehabilitation program that combines patient education and exercise training to address barriers to physical activity, such as respiratory symptoms and muscle wasting.
Adults who reported having COPD were more likely to report being unable to work (24.3% versus 5.3% for adults without COPD), having activity limitation because of health problems (49.6% versus 16.9%), having difficulty walking or climbing stairs (38.4% versus 11.3%), and use of special equipment for health problems (22.1% versus 6.7%) compared with adults without COPD. State-specific prevalence of COPD ranged from 3.6% in Puerto Rico and 4.0% in Minnesota and South Dakota to more than 9% in West Virginia (9.4%), Alabama (9.6%), and Kentucky (10.3%). COPD prevalence was highest for states along the Ohio and lower Mississippi rivers.
COPD has been found to be associated with a lower likelihood of employment, comparable with that for stroke and greater than that associated with heart disease or hypertension. After accounting for age, U.S. adults with COPD are also more likely to collect Social Security Disability Insurance and Supplemental Security Income than those without the condition. Together, these results underscore the substantial economic burden of COPD, which only adds to the impaired quality of life experienced by persons with COPD.
Because there is currently no cure for COPD, public health efforts should focus on prevention, such as antismoking efforts, and treatment to slow the progression of the disease, manage comorbidities, and lessen symptoms. Smoking, the leading cause of COPD in the United States, is also associated with worse symptoms among persons with COPD, and smoking cessation has been shown to slow the progression of COPD. Among adults with COPD in these analyses, more than one third were current smokers. Current smoking was associated with a greater likelihood of three of the four activity limitations measured among those who reported being physically active. This result reinforces the importance of smoking cessation by COPD patients.
Not being physically active was associated with a greater likelihood of all the activity limitation measures among persons with COPD. This association might indicate that COPD affects patients' ability to be physically active, but not being physically active might also reinforce activity limitations. Although respiratory symptoms such as shortness of breath can cause activity limitations, COPD is also associated with muscle weakness, which can also contribute to limited mobility. Although physical activity might be challenging for persons with COPD, exercise training is an essential part of pulmonary rehabilitation. Pulmonary rehabilitation is a personalized program that includes both education and exercise components to improve management of breathing problems, increase stamina, and decrease shortness of breath. These programs should incorporate both strength and endurance (or aerobic) training.
The findings in this report are subject to at least three limitations. First, COPD diagnosis relied on self-report and not on evaluation by breathing tests or review of medical records. Second, this was a cross-sectional study. Therefore, it is not possible to determine whether the COPD or activity limitations came first. Finally, state response rates ranged from 29.0% to 60.3%; therefore, nonresponse bias might have affected the results.
Outside the clinical setting, the development of state and community environmental and policy efforts to address smoking and physical inactivity could improve outcomes for persons with COPD as well as for the general population. The CDC's Best Practices for Comprehensive Tobacco Control Programs—2014 is an evidence-based guide to help states develop and implement tobacco control programs. The CDC also has compiled a guide to community-based strategies to increase physical activity: The CDC Guide to Strategies to Increase Physical Activity in the Community.
See the CDC Report
See also Medical Law Perspectives April 2015 Report: COPD Liability Risks: When Taking a Breath Is Not Easy