By PAULA SPAN
June 28, 2013, 1:55 pm
You don’t see supermarket products emblazoned with ribbons to help support research on chronic obstructive pulmonary disease. Major corporations don’t sponsor walkathons for thousands of cheering supporters.
This group of respiratory disorders, including emphysema and chronic bronchitis, is the third leading cause of death in the United States and accounts for a fifth of all hospitalizations among people over age 75 — yet we hear surprisingly little about it. Why is that?
“C.O.P.D. has a stigma,” said Dr. Gulshan Sharma, director of pulmonary and critical care medicine at the University of Texas Medical Branch in Galveston. Because smoking accounts for most C.O.P.D. in this country, the prevailing public attitude is, “You did it to yourself,” he said. So the disease, which strikes older people more frequently, remains both underdiagnosed and undertreated.
Yet the research Dr. Sharma and his colleagues recently published in The American Journal of Medicine documents considerable progress. “The number of hospitalizations has been reduced drastically,” he said. “This shows that care of patients with C.O.P.D. has improved.”
C.O.P.D. comprises two illnesses: one, emphysema, destroys air sacs deep in the lungs; the other, chronic bronchitis, causes inflammation, congestion and scarring in the airways. People with C.O.P.D. — their breathing problems frequently compounded by other illnesses, including heart disease, diabetes and osteoporosis — are no strangers to hospitals. Exacerbations can land them there as often as two or three times a year.
But the Texas team, analyzing a decade of Medicare data, looked at the experiences of more than 192,000 patients and found that from 1999 to 2008, hospitalizations declined 18 percent. The number of patients who’d had two or more acute exacerbations requiring hospitalization had dropped 23 percent.
That’s not because fewer people have the disease. Eventually, reduced smoking may also reduce the prevalence of C.O.P.D., but that hasn’t happened yet; according to the Centers for Disease Control and Prevention, for about a decade the proportion of the population affected by the disease has hovered at about 4 percent of men and 6 percent of women, and the figures are much higher among older people. (Yes, there are more women with C.O.P.D. — and because as a group they began smoking more recently, the rates are likely to rise, at least for a while.)
The researchers also found that the proportion of C.O.P.D. patients with more than three accompanying medical conditions grew substantially, which you’d expect to lead to more hospital admissions, not less. It hasn’t.
On the contrary, for every 100 patients followed for a year, there were 131 hospitalizations in 1999. By 2008, there were 107. Given the more than 800,000 hospitalizations for C.O.P.D. each year, “these small numbers can translate into a very large impact,” Dr. Sharma said.
The primary factor keeping people with C.O.P.D. out of hospitals is more effective treatment. “We have better medications now,” Dr. Sharma said, listing a host of examples like long-acting bronchodilators, inhaled steroids and combination drugs introduced in the past decade and being more widely used.
“None of these can reverse the damage, but they help you breathe better and reduce your risk of exacerbation,” he said. “They improve your quality of life.” Redesigned devices, like inhalers, have become easier to use, especially for older patients with less dexterity.
The reduced hospitalization rate probably also reflects improved treatments for the other diseases C.O.P.D. patients often have. “We’re managing their heart disease better,” for instance, Dr. Sharma said. He and his colleagues think that increased use of the flu vaccine and legislation that’s reduced exposure to secondhand smoke have probably helped, too, since either illness or smoke can lead to exacerbations. “A decade ago, two hours in a bar was like smoking a full pack,” he said.
All of which means there’s now good reason to see if your or your parent’s constant coughing, wheezing, shortness of breath (especially when it accompanies physical activity) or frequent respiratory infections might be caused by C.O.P.D.; the diagnostic process includes breathing into an apparatus called a spirometer.
Medical professionals who haven’t kept up with treatment advances may remain more pessimistic than necessary about this disease. A 2008 study of family physicians, nurse practitioners and physician assistants working in primary care, for example, found that many weren’t using appropriate medical guidelines and felt they lacked knowledge and training in C.O.P.D. Very few said they believed treatment would be useful in improving symptoms or reducing exacerbations, despite considerable published data showing it can.
For years, Dr. Sharma said, “we had a nihilistic approach: ‘It’s a done deal; here’s an inhaler.’” Now, there’s more to offer.
The single most important action C.O.P.D. patients can take to stay out of hospitals, of course, is to stop smoking. The single best way to avoid developing C.O.P.D. is not to start. It’s hard to argue with prevention strategies and smoking-cessation efforts; ultimately, fewer smokers will mean less C.O.P.D.
But many older adults who already have C.O.P.D. can still feel better, be more active and spend less time in hospitals. This patient guide from the C.O.P.D. Foundation provides further details.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
http://newoldage.blogs.nytimes.com/2013/06/28/fewer-hospitalizations-for-c-o-p-d-patients/?smid=li-share&goback=%2Egde_84467_member_255605048
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