Burden of chronic obstructive pulmonary disease: healthcare costs and beyond

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory condition that leads to significant burden, both medically and financially. It affects millions of people worldwide and causes significant morbidity and mortality. Most detailed information related to its prevalence, morbidity, and mortality comes from high-income countries, but 90% of COPD-related deaths occur in low- and middle-income countries. Cigarette smoking is the main risk factor for developing COPD, but other risk factors do exist and need to be recognized. A majority of morbidity and mortality as well as health care costs occur from acute exacerbations of COPD with a known phenotype of patients being "frequent exacerbators." Health care costs for COPD are not only from treatment of exacerbations, such as hospitalization, but also medication costs for maintenance therapy and outpatient treatment. COPD has been linked with many comorbidities leading to significant burden of disease. The goal of this review is to evaluate the overall burden of disease including prevalence, morbidity, mortality, health care costs, and economic costs.

Figure 1.

Cessation of smoking in patients with COPD reduces the mortality risk if achieved by age 40. This representation is one of multiple Fletcher-Peto curves that was reprinted by permission from Ref.

Figure 2.

GOLD grading of severity of airflow limitation in COPD based on 2007 guidelines. All patients had FEV₁/FVC (forced vital capacity) less than 0.70.

Figure 3.

GOLD stratification of COPD guidelines for 2011 using symptoms scores, airflow limitation, and number of exacerbations. Symptom scores use either modified Medical Research Council (mMRC) or COPD Assessment Test (CAT).