1. Applied Epidemiology Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) By Chris Callan 23 April 2008

2. What is COPD? COPD is a serious lung disease that over time, makes it hard to breathe – long term condition COPD is sometimes referred to as emphysema or chronic bronchitis Healthy airways and air sacs in the lungs are elastic COPD, the airways and air sacs are partially blocked, which makes it hard to get air in and out

3. Who is at risk? COPD is common >40yrs with a history of smoking (either current or former smokers) Smoking is the most common cause of COPD-it accounts for as many as 9 out of 10 COPD-related deaths Long-term exposure to things that can irritate your lungs, like certain chemicals, dust, or fumes in the workplace. Heavy or long-term exposure to secondhand smoke or other air pollutants may also contribute to COPD COPD is caused by a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency. People with AAT deficiency can get COPD without above exposures

4. What are the symptoms? Constant coughing, sometimes called "smoker's cough" Shortness of breath while doing activities, even basic tasks if COPD is severe Excess sputum production, frequent chest infections Feeling like you can't breathe Not being able to take a deep breath Wheezing COPD develops slowly, and can worsen over time

5. How are you tested for COPD? Test for COPD is called Spirometry Simple, non-invasive breathing test that measures the amount of air a person can blow out of the lungs (volume) and how fast he or she can blow it out (flow) Results will indicate presence of COPD & severity The spirometer measures the total amount exhaled, called the forced vital capacity (FVC), and how much you exhaled in the first second, called the forced expiratory volume in 1 second (FEV 1 ) The guidelines from NICE adopt the following classification:3 50% to 80% predicted FEV1 = mild COPD 30% to 50% predicted FEV1 = moderate COPD Less than 30% predicted FEV1 = severe COPD

6. Preventative care? Quit smoking Avoid exposure to pollutants Visit your doctor regularly Take pre-cautions against flu

7. Treatment options? Medications (such as inhalers, these relax the muscles around the airways) Pulmonary Rehabilitation (learn how to maintain day to day tasks) Physical Activity Training (aimed to make you stronger and the strengthen breathing muscles) Lifestyle Changes (quit smoking) Oxygen Treatment (usually with severe COPD) Surgery (usually with very severe COPD, lung surgery to improve breathing)

8. Epidemiology of COPD – National Prevalence is approx. 1.4% in the UK Adults > 40yrs smoke/ex-smokers Suggestion that problem is under diagnosed 10% for >75yrs Source: NCHOD 2005-06 The disease is progressive and patients deteriorate but the natural history of the disease varies in different people In patients who stop being exposed to cigarette smoke and other noxious substances the disease may continue to progress, but the rate of decline may slow Repeated over exertion may lead to irreversible decline in lung function

9. Epidemiology of COPD - National Significant variation across the country! Source: Yorkshire and Humberside PHO

10. Epidemiology of COPD - International The World Health Organization (WHO) estimates that COPD as a single cause of death shares 4th and 5th places with HIV/AIDS (after coronary heart disease, cerebrovascular disease and acute respiratory infection). The WHO estimates that in 2000, 2.74 million people died of COPD worldwide. According to the WHO, passive smoking carries serious risks, especially for children and those chronically exposed. The WHO estimates that passive smoking is associated with a 10 to 43 percent increase in risk of COPD in adults.

11. Epidemiology of COPD – NSF announced June 06

12. Routine Data Sources for COPD Primary Care – QoF Data (2006/07) South Tyneside PCT split by GP Practice Annual COPD QoF data can be used for Prevalence % confirmed COPD with spirometer % of patients with recorded FEV 1 % of patients on medication / received flu vaccine

13. Routine Data Sources for COPD Accident and Emergency Attendances – SuS Monthly data, not COPD specific but can identify attendances associated with respiratory problems Secondary Care Elective and Non Elective Admissions – SuS (2006/07) Monthly admission data using HRGs Outpatient Attendances – SuS (2006/07) Monthly attendances data by specialty, not COPD specific but can identify attendances associated with respiratory problems

14. Routine Data Sources for COPD NHS Direct – Quarterly Report by PCT Quarterly data, not COPD specific but can identify number of calls associated with respiratory problems NCHOD – Annual data Prevalence and mortality data

15. Data Sources for COPD