With 8.7 percent of residents suffering from chronic obstructive pulmonary disease, Tennessee has one of the highest rates of COPD in the country. During November, National COPD Awareness Month, it seemed appropriate to share data and insights into the third leading cause of death in the United States and in Tennessee.
Unlike most major illnesses, chronic lower respiratory diseases have actually increased in frequency over the past three decades, and the numbers rise even higher when factoring in those who are misdiagnosed or underdiagnosed. Currently, close to 15 million Americans are living with known COPD. However, Jamie Sullivan, senior director of Public Policy and Outcomes for the COPD Foundation, noted, “The NIH estimates there are about 12 million nationally who have COPD symptoms but haven’t received a diagnosis.”
Sullivan continued, “There tend to be more women who are misdiagnosed than men.” Compounding the issue, COPD tends to affect women disproportionately with a national average of 6.7 percent having COPD compared to 5.2 percent of men. “That disparity between men and women is actually worse in Tennessee than in the nation.” Sullivan said data from the Behavioral Risk Factor Surveillance System shows the COPD rate for women in Tennessee is 11.7 percent compared to 6.7 percent for men.
The Volunteer State, she added, has the third highest rate of COPD overall in the country at 8.7 percent compared to the national average of 6.3 percent. Tennessee trails only Kentucky and Alabama in prevalence.
Deb McGowan, senior director of Health Outcomes for the COPD Foundation, noted the reasons behind Tennessee’s higher rates are multifactorial including environmental issues and smoking rates in the South. Although Tennessee has made significant strides in sharing smoking cessation strategies, nearly a quarter of the state’s adult men (24.7 percent) and one-fifth of the state’s adult women (19.7 percent) still smoke.
While there can be a genetic component to COPD, McGowan said smoking leads the way as a key contributor to the chronic illness. A quarter of those with COPD have never smoked with the condition likely linked to genetics, occupational and environmental pollutants, leaving the other 75 percent related to smoking.
Sullivan added, “Definitely exposure to tobacco is the main risk factor, but it’s not just current smokers who are at risk, it’s people who had a history of smoking.” She noted these are individuals who followed the recommendations and quit smoking but 10-15 years later begin to have trouble with their breathing.
The COPD Foundation embarked on a listening tour this past summer and spent time in East Tennessee to learn more about the incidence rates for COPD. Sullivan said one thing they heard over and over again was the air quality in the valley exacerbated asthma and the ability to breathe easily. The problem isn’t limited to the eastern part of the state, however. The Asthma and Allergy Foundation of America routinely includes Tennessee’s largest cities in its annual list of “Most Challenging Places to Live with Asthma.” In 2014, Memphis ranked second, Chattanooga sixth, Nashville 38th and Knoxville 41st.
In addition to smoking history and environment, Sullivan said other risk factors include a history of asthma, early nutrition and prenatal events, early childhood infections, age, and socio-demographic status. She noted nearly one in five adults with annual incomes under $15,000 (19 percent) have COPD.
As with most chronic diseases and conditions, early detection, intervention and education improve quality of life and reduce healthcare costs and economic burden. McGowan said providers could help by being more aware of COPD when taking a patient’s personal history. Instead of asking if someone smokes, McGowan urges physicians and nurses to ask if an individual has ever smoked. “Around 100 cigarettes lifetime is where you start thinking differently,” she said of risk factors for COPD. Additionally, McGowan said providers should be attuned to any respiratory symptoms that seem to be ongoing.
“We don’t have to have a patient hit the hospital before we test them,” she noted of diagnosing COPD. “You do that through spirometry testing. It’s a simple breathing measure and can be done in a primary care office.”
Although billable, McGowan said most outpatient clinics and practices are not aggressively utilizing the test to screen appropriate patients with symptoms. Many practices don’t have spirometers … or if they do, too often the equipment is sitting on a shelf collecting dust. Yet, she noted, getting that early diagnosis is critical to properly educating and treating patients. She added a number of studies have shown “patients who are uneducated and not activated in their care are twice as likely to be admitted to the hospital.”
Unfortunately, she continued, “We find a lot of patients don’t even know how to use their inhalers correctly. Not all inhalers work the same.” She added patients should call their doctor if they aren’t getting relief from their inhaler, have a fever, stronger cough, more productive cough, or noticeable discoloration in mucus. “All those signs and symptoms indicate you’re heading down the wrong path.”
McGowan said a common, easy way for patients to think about COPD is to use the ‘green, yellow, red light’ approach. The green light, she explained, is no change in what a patient is able to do. A yellow light means a patient is showing some symptoms and signs and should call a doctor. The red light means nothing is working, and the patient should proceed directly to the ER. “It’s more about taking care of yourself and being aware of your body every day,” she said of managing COPD.
Sullivan added, “We do have resources that are designed for healthcare providers. We also have resources they can use with their patients.” The Pocket Consultant Guide (PCG) even has an app attached to it for information on the go. Physicians could also join a moderated online community with discussion about particularly difficult cases and various treatment options. Additionally, there is a quarterly digital magazine tailored to providers. To sign up for the magazine or access other resources, go online to copdfoundation.org.
Moving the Science Forward
Jamie Sullivan, senior director of Public Policy & Outcomes for the COPD Foundation, said there has been a major push to increase awareness of the disease and craft a national action plan. “It’s the third leading cause of death and there is no coordinated federal response,” she said of efforts to get a COPD program within the Centers for Disease Control & Prevention’s Chronic Disease Division. She said such recognition would help bring coordinated efforts to public awareness campaigns, detection and treatment options.
On the research front, Sullivan said 75,000 COPD patients across the country would be recruited in the next year for a major patient-driven registry. “We are trying to really change the way COPD research is done,” she explained. “We started the Patient Powered Research Network, which is funded by a contract from PCORI (Patient-Centered Outcomes Research Institute). It’s one of 29 networks that have formed this year for comparative effectiveness research and to speed recruitment for clinical trials.”
She added, “We need physicians’ help. To transform the way research is done, we need to get to the patients.” Sullivan said the easiest way to connect patients to support and information on clinical trials is to refer them to the COPD Foundation website (copdf.co/copdpprn) or Information Line: 866-316-COPD (2673). The phone line, answered by patients and caregivers, is open Monday-Friday from 9 am-9 pm Eastern (8 am-8 pm Central).
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