Freedom to Breathe: Inequalities and COPD
Nearly 16 million Americans are living with a diagnosis of chronic obstructive pulmonary disease (COPD). Millions more don’t even know they have it.
The COPD Foundation, a nonprofit organization that promotes research, advocacy and awareness to combat COPD and related diseases, estimates that the number of Americans affected by COPD is as high as 30 million, some of whom are mistakenly diagnosed with other respiratory diseases (such as asthma). be diagnosed).
COPD includes several chronic lung diseases, including emphysema and bronchitis. Shortness of breath is the most common COPD symptom, and those affected may also suffer from constant fatigue and a chronic cough with or without mucus. Other symptoms may include wheezing or noisy breathing, shortness of breath at rest or during physical exertion, and chest pain.
Although most COPD cases are caused by cigarette smoking, COPD’s connection to smoking is one of the reasons the disease is underdiagnosed, said Jean Wright, MD, MBA, CEO of the COPD Foundation.
“There is a misconception that COPD is just a smoking disease or only affects older people,” Wright said. “Younger people can have COPD without knowing it. COPD can be caused by many factors, including environmental factors, childhood infections, exposure to chemicals or dust at work, or genetics. Smoking is the most common cause of COPD, but there are many others.”
Who is most affected by COPD?
Certain groups are at higher risk of developing COPD and experience worse outcomes from the disease. Factors that influence COPD rates include:
Rural/urban environment: Of the nearly 16 million Americans living with a COPD diagnosis, 2 million live in rural areas. Hospitalizations and emergency room visits for COPD are also higher in rural areas.
“These individuals often have limited access to health care and specialized COPD care, such as pulmonary rehabilitation programs,” Wright said. “People living in rural areas often experience greater financial strain, limiting their access to quality health care.”
Racial background: Blacks, American Indians and Alaska Natives have higher rates of COPD than whites, while Asians and Hispanics have lower rates of COPD than their white counterparts, and genetics may play a role in COPD development. High rates of other health conditions, such as diabetes, high blood pressure and asthma, which are more common in certain races, may also contribute to racial disparities in COPD.
Some studies suggest that menthol cigarette smokers with COPD have more severe symptoms than non-menthol cigarette smokers. Research has also shown links to the targeted marketing of menthol-flavored cigarettes in black communities, and 8 in 10 black American smokers consume menthol cigarettes.
Social determinants of health: People without a college degree and with lower incomes have a higher incidence of COPD. Other causes of health disparities may be related to inequities resulting from systemic barriers to health care, jobs, or housing in areas with higher levels of environmental pollutants, which may contribute to higher rates of COPD in certain populations.
Sex/Gender:Women develop COPD more often than men and more women die from COPD than men. This may be due to smaller airways in women, the effects of hormones such as estrogen, the marketing of tobacco to women, and lack of diagnosis because the disease is less recognized in women.
Read: Women and COPD >>
Age: Diagnoses and death rates are higher in older patients. More than 8 out of 10 COPD deaths occur in people over 65 years old.
Sexual Orientation/Gender Identity: Higher rates of COPD are reported among LGBTQ+ people, with studies suggesting a link to higher smoking rates in LGBTQ+ communities.
Living with COPD
Although there is no cure for COPD, treatments are available to improve quality of life. Therefore, it is important to get an accurate diagnosis as quickly as possible.
People who experience the symptoms listed above, especially if they currently smoke or have smoked in the past, can ask their healthcare provider (HCP) for a COPD test. People who have been exposed to significant air pollution over time should also consider getting tested.
HCPs test a patient’s lung function through a spirometry test, which involves breathing into a tube connected to a machine. The machine, known as a spirometer, calculates how much air you blow out in a second and how much you blow out in total. Additional tests may also be needed to confirm a diagnosis, such as an X-ray or CT scan.
Treatments such as steroids, biologics, inhalers, and nebulizers can help minimize COPD symptoms and give patients more freedom to breathe and more energy. Although treatments cannot resolve existing lung damage, they can make it easier for patients to manage their daily activities. Treatments can also help reduce hospital stays and other doctor visits for breathing difficulties or other problems.
COPD patients are also strongly advised to stop smoking or vaping if they have not already done so. Staying current on vaccinations can help patients prevent further respiratory damage from illnesses such as flu or pneumonia.
People with COPD should also consider pulmonary rehabilitation programs that provide comprehensive support in a clinical setting to help them manage the physical and mental aspects of their disease. A program might include exercise, a nutrition plan, psychological counseling, and medication management.
In more severe cases, surgery may be required to remove damaged lung tissue or supplemental oxygen may need to be carried.
“The sooner someone is diagnosed with COPD, the sooner they can receive the care they need,” Wright said. “Treating COPD in its early stages can help slow the progression of the disease. COPD often worsens over time, but with proper treatment the disease can be better managed.”
This educational resource was created in collaboration with the COPD Foundation and with support from Regeneron and Sanofi.
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