Chronic Obstructive Pulmonary Disease: A Worldwide Problem
Section snippets
Epidemiology
The highly cited, influential GBD studies estimated that COPD causes the death of at least 2.9 million people annually. Estimates of global mortality in 19903 were updated in 2006,14 and will be next available and expanded in 2012.15 The GBD highlights that COPD was the sixth leading cause of death in 1990, has been the fourth since 2000, and is projected to be the third by 2020. These estimates are likely to be conservative because they did not account for deaths whereby COPD is a contributory
Definition of COPD
Spirometry is the most common of the pulmonary function tests, and enables any health professional to make an objective measurement of airflow limitation and the degree to which it is reversible. As a diagnostic test for COPD, spirometry is a reliable, simple, noninvasive, safe, and nonexpensive procedure to detect airflow limitation. Trained technicians can meet quality goals for spirometry tests about 90% of the time.31 Early diagnosis of COPD should affect individual and population outcomes,
Risk factors
There are comprehensive lists of risk factors associated with the development and triggering of COPD exacerbations, available elsewhere.5, 10, 11, 12, 13 Some of them are amenable to modification whereas others are not, and some apply at the individual and/or group level, so that in all likelihood any strategy to limit each burden differs.38 The recent literature is packed with reports aimed at explaining COPD separately from smoking. Risk factors for developing COPD other than smoking tobacco
Spirometry screening
At this early stage, spirometry as a screening tool of disease has been explored in only α1-ATD probands and their relatives, smokers, and those workers with occupational exposures. Apart from marihuana consumers49, 50 and biomass exposure in selected developing countries,51 spirometry is unlikely to be successful for other types of exposures.
Although it is important to recognize that COPD does not exclusively affect smokers, it is the authors’ opinion that the current emphasis on COPD in
Burden of COPD in developing countries
On a global scale, about 50% of all households and about 90% of those in rural areas of developing countries use solid fuels (coal and biomass) as their main source of energy. Thus, one-half of the world’s population (up to 3 billion people) is exposed to the harmful effects of solid-fuel smoke produced by unvented open fires for heating and cooking.60, 61 The use of solid fuels is the most important source of indoor air pollution and is inversely associated with socioeconomic development,
Future
Several investigators,68 societies, and nonprofit international initiatives have elegantly outlined some of the burning pending questions on COPD burden now and in the foreseeable future, with an intention either to help funding agencies to prioritize limited resources in competitive decision making or to streamline alternative routes to reduce its overall massive burden. Publications include documents from the ATS/ERS,10, 69 GARD,6 GOLD,5 IPCRG,70 as well as from independent researchers.68, 71
Acknowledgments
The authors thank Professor Michael Studnicka for his helpful comments on the manuscript.
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Cited by (36)
A review for the anti-inflammatory effects of paeoniflorin in inflammatory disorders
2019, Life SciencesCitation Excerpt :The TGF-β mediated epithelial-mesenchymal transition in alveolar epithelial cells was suppressed by PF treatment. Chronic obstructive pulmonary disease (COPD) is regarded as largely irreversible and progressive airway obstruction caused by smoking, air pollution, and bronchiectasis [43]. Reactive oxygen species (ROS), elastase, and other serine proteinases that originate from inflammatory cells are correlated with the development of COPD.
The BIOMEPOC Project: Personalized Biomarkers and Clinical Profiles in Chronic Obstructive Pulmonary Disease
2019, Archivos de BronconeumologiaMice overexpressing latent matrix metalloproteinase-2 develop lung emphysema after short-term exposure to cigarette smoke extract
2018, Biochemical and Biophysical Research CommunicationsCitation Excerpt :It is one of the leading causes of disability, morbidity and mortality worldwide [1]. Presently, there are about 200 million people suffering from some degree of COPD in the entire world [2]. COPD is now the fourth leading cause of death globally, and it is going to be the third leading cause of death by 2020 [1–3].
Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis
2015, The Lancet Respiratory MedicineCitation Excerpt :As the third leading cause of death worldwide,2 COPD imposes substantial economic and human burdens to both individuals and societies.3,4 Management of the disease is often complicated by the presence of comorbidities,5 which have been widely recognised as an important component of COPD.6 Cardiovascular comorbidities are one of the most frequent systemic manifestations that have the biggest effect in patients with COPD,1,7 contributing substantially to disease progression, clinical outcomes, mortality, and resource use.8–10
A basis for vaccine development: Comparative characterization of Haemophilus influenzae outer membrane vesicles
2015, International Journal of Medical MicrobiologyCitation Excerpt :Although NTHi strains are frequently part of the normal nasopharyngeal flora in most humans, some strains can cause severe infections like otitis media, sinusitis, pneumonia, as well as exacerbations of chronic obstructive pulmonary disease (COPD) (Erwin and Smith, 2007; Johnston and Apicella, 2009; Ulanova and Tsang, 2009; Van Eldere et al., 2014). COPD, in particular, has been a major public health problem and is expected to increase its burden of disease over the next few years to become the third leading cause of death worldwide by 2020 (Soriano and Lamprecht, 2012). Due to the lack of a conserved capsule as well as highly variable phenotypes and genotypes, there is currently no proven efficient vaccine against NTHi available (Poolman et al., 2000; van Alphen et al., 1997; Van Eldere et al., 2014).
Non-typeable Haemophilus influenzae, an under-recognised pathogen
2014, The Lancet Infectious DiseasesCitation Excerpt :Introduction of Prevenar in the USA led to an increase in the proportion of nasopharyngeal NTHi colonisation in children with sinusitis, from 25% in 1997 to 41% in 2005.38 COPD is a leading cause of death worldwide, with disease burden expected to increase significantly.73 NTHi colonisation of the airways is a major cause of airway inflammation and tissue damage, particularly during acute exacerbations.74
Disclosures: There are no relationships with a commercial company that have a direct financial interest in the subject matter or materials discussed in this article or with a company making a competing product.
Conflict of interest statement: There are no conflicts of interest to report regarding the content of this review.