Facts about COPD

The following are some interesting facts about COPD:

1. COPD is ranked as the 7th most burdensome disease in the world
2. COPD is now the 3rd most common cause of death, behind only heart attack and cancer
3. Many studies have shown that the causes of death in patients with mild COPD are predominantly cancer and cardiovascular disease
4. As COPD severity increases, deaths due to non-malignant respiratory disease are increasingly common
5. In practice, the mortality of patients with COPD has been found to be predicted by air-flow limitation, hypercapnia, hypoxemia, low exercise capacity, smoking habits, dyspnea, low body mass index, and exposure to biomass smoke (wood stoves, wildfires leaf burning, etc.)
6. Two of the most common comorbidities of patients with COPD are depression and anxiety, which increase mortality.
7. Studies show about 35.5% of people who continuously smoke develop COPD, while only 7.8% of those who never smoked develop the disease.
8. Studies show that depression increases the risk of death in COPD
9. Studies show that anxiety increases the risk of death in COPD. One study showed it increased the risk of death by 1.25%
10. A longitudinal cohort study showed that continuous smokers hasd a much steeper decline in lung function than those who stopped smoking.
11. A study found that with an increasing duration of smoking is related to an increased risk of death, and may be associated with the connection with smoking and depression.
12. When patients with COPD develop heart failure, this is considered end stage COPD
13. Patients with COPD have a life expectancy of five years, according to the American Heart Association
14. One of the main differences between asthma and chronic obstructive pulmonary (COPD) disease is that asthma is completely reversible with time or treatment, and COPD is not completely reversible. The only way to differentiate the two is by performing a pulmonary function test, with testing before and after inhaling a bronchodilator.
15. The airway obstruction in COPD, unlike that in asthma, is considered permanent or, at most, partially reversible; that is, usually little change is seen in spirometry after the administration of a bronchodilator.
16. COPD patients are rarely used in clinical trials of drugs such as bronchodilators (albuterol, levalbuterol, Advair, Brovana, Symbicort, Dulera) because they do not have the response to bronchodilators as do patients with asthma.
17. COPD and Asthma often co-exist, and in many cases one may lead to the other
18. COPD patients with asthma tend to have greater reversibility with bronchodilators, and have elevated eosinophil levels in induced sputum, and higher concentrations of exhaled nitric oxide, similar to patients with pure asthma.
19. However, asthma may increase the level of hyper-responsiveness of the air passages to various stimuli, and this may increase the risk of developing respiratory symptoms
20. Studies show COPD patients with greater reversibility to have a slower decrease in FEV1, and may be a predictor of longevity.
21. The annual decrease in FEV1 is higher among active smokers and bronchial hyper responsiveness.
22. Patients with COPD who have a positive bronchodilator response seem to respond most often and most strongly to inhaled corticosteroids, the effects being longer lasting when these are combined with a long-acting beta agonist.
23. Exercise training has been shown to increase exercise capacity, reduce dyspnea, and improve quality of life among patients with COPD. However, the response to such a program varies among patients.
24. Ortega et al concluded that COPD patients with positive bronchodilator reversibility could be a subgroup with different characteristics. They have lower exercise capacity, shorter shuttle-walk distance, and worse quality-of-life scores.
25. Ortega et al showed that patients with positive reversibility had a shorter time to exhaustion in endurance exercise testing, and a shorter shuttle-walk-distance.
26. Ortega et al also concluded that patients with positive bronchodilator reversibility achieved a similar degree of improvement in several parameters compared with COPD patients with no bronchodilator reversibility.
27. Ortega et all concluded that COPD patients with severe bronchial hyper-reactivity are predisposed to more respiratory symptoms.
28. Ortega found thatCOPD patients with positive reversibility probably do not have more dyspnea than those with negative reversibility, although they do have worse quality of life.
29. Ortega also determined that there was no difference in quality of life for COPD patients in stage IV, showing, perhaps, that reversibility has less effect with increasing obstruction and age.  However, in stage IV corticosteroids are more commonly used, meaning the disease may be better controlled. 
30. Ortega concluded that inhaled corticosteroids can improve a range of clinical and functional parameters in patients with COPD regardless of their bronchodilator responsiveness.
31. COPD patients with bronchodilator reversibility may require different treatment than COPD patients with no bronchodilator reversibility.

References:

1. References:Lou, Peian, Peipei Chen, Pan Zhang, Jiaxi Yu, Yong Wang, Na Chen, Lei Zhang, Hongmin Wu, and Jing Zhao, “Effects of Smoking, Depression and Anxiety on Mortality of COPD Patients: A Prospective Study,” Respiratory Care, January, 2014, Volume 59, Number 1, pages 54-61
2. “Heart failure patients living longer, but long-term survival still low,” Journal of the American Heart Association, May 15, 2013, http://newsroom.heart.org/news/heart-failure-patients-living-longer-but-long-term-survival-still-low accessed 5/ 14/14
3. Ortega, Francisco, Eduardo Marquez-Martin, Borja Valencia, Pilar Cejudo, Ana Rodriquez, Jose Luis Lopez-Campos, and Emilia Barrot, “Impat of Bronchodilator Responsiveness on Quality of Life and Exercise Capacity in Patients With COPD,” Respiratory Care, January, 2014, volume 59, number 1, pages 81-89

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