COPD Care in the 21st Century: A Public Health Priority

Abstract

COPD is an underdiagnosed, undertreated, and yet largely preventable disease. COPD affects millions of Americans on a daily basis, accounts for tens of thousands of deaths per year, and costs billions to the United States health-care system annually. Further, it impacts the quality of life for patients living with the disease. COPD care is fragmented in the United States, with a high level of responsibility placed on patients and their primary care physicians. Pulmonary specialists care for a minority of patients with COPD in the United States. Unfortunately, tobacco dependence, which is the leading cause of COPD, remains prevalent. Further, women and those with low socioeconomic status continue to share a relatively greater burden of disease. Exacerbations are experienced frequently by patients and contribute to high rates of emergency department visits and in-patient admissions and readmissions as well as high medical costs to the United States economy. Numerous strategies have been proposed to combat these high rates, including the use of discharge bundles, hospital at-home programs, telemedicine, and tele-rehabilitation, but no single best strategy has emerged. The COPD National Action Plan was introduced in 2017 as part of a multi-stakeholder endeavor to encourage collaboration among various patients, caregivers, physicians, researchers, and policymakers to optimize awareness, diagnosis, and treatment of this disease. It is time to make COPD care a public health priority.

Keywords: COPD; COPD exacerbation; discharge bundle; disparities; economic burden; primary care physician; readmission; tele-rehabilitation; telemedicine; tobacco cessation.

Fig. 1.

Aggregate charges for in-patient stays for COPD or bronchiectasis among patients age ≥18 y, according to the Nationwide Inpatient Sample. Data from Reference .

Fig. 2.

Prevalence of COPD among adults age ≥18 y in the United States from 1998 to 2009. Data from Reference .

Fig. 3.

Locations of 12,392 pulmonologists and quintiles of county estimates of the 15.7 million adults ≥18 y old with diagnosed COPD. From Reference , with permission.

Fig. 4.

United States adults who were current cigarette smokers according to the National Health Interview Survey. Data from Reference .