RACHEL PRYOR EPID 691 FEBRUARY 25, 2013 Asthma and COPD.

RACHEL PRYOREPID 691

FEBRUARY 25, 2013

Asthma and COPD

What is asthma?

Disorder of the airways causing swelling and narrowing; which leads to wheezing, shortness of breath, chest tightness, and coughing

Most common asthma triggers: dust, animal dander, weather changes, pollution, mold, pollen, respiratory infections, stress, tobacco smoke

There is no cure for asthma. http://www.ncbi.nlm.nih.gov/

pubmedhealth/PMH0001196/

Four categories of asthma

According to the National Heart, Lung, and Blood Institute the four categories are:

1. Intermittent - daytime symptoms that occur less than two times/week and nighttime symptoms occur less than two times/month. Normal pulmonary function tests (PFT).

2. Mild persistent - daytime symptoms occurring two or more times/week and nighttime symptoms occurring two or more times/month. Normal PFT. http://virginiaasthmacoalition.org/

documents/AsthmaPlan.8.30.10.pdf

3. Moderate persistent - daily daytime symptoms and at least one weekly nighttime symptom, and/or PFT reduced to 60 – 80% of normal.

4. Severe persistent - continuous daytime symptoms and frequent night symptoms and PFT that may be less than 60% of normal. National Heart, Lung, and Blood Institute, National Asthma

Education and Prevention Program (2007). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

Asthma: Incidence and Prevalence

18.9 million adults, or 8.2% of the adult population, in the U.S. have asthma

7.1 million children, or 9.5% of children, in the U.S. have asthma http://www.cdc.gov/nchs/fastats/asthma.htm

Incidence of asthma in adults is 3.8/1000 at-risk adults

Incidence of asthma in children is 12.5/1000 at-risk children Among children 0-4 years old, incidence is 23.4/1000 children! Winer, Rachel A., Xiaoting Qin, B.A., Harrington, Theresa, Moorman, Jeanne,

Zahran, Hatice. Asthma Incidence among Children and Adults: Findings from the Behavioral Risk Factor Surveillance System Asthma Call-back Survey—United States, 2006–2008. Asthma, February 2012, Vol. 49, No. 1 , Pages 16-22 (doi:10.3109/02770903.2011.637594).

What is “at-risk”?

Asthma Prevalence by Race/Ethnicity

http://www.cdc.gov/mmwr/preview/mmwrhtml/su6001a18.htm?s_cid=su6001a18_w#tab

Asthma Prevalence by Sex and Race

Asthma Prevalence by SES and Race

More statistics

Number of deaths caused by asthma (in 2010): 3,404 1.1/100,000 of the population

Number of outpatient visits per year with asthma as primary diagnosis (in 2009): 1.2 million

Number of ED visits with asthma as primary diagnosis (in 2009): 2.1 million

Number of hospital discharges with asthma as first-listed diagnosis (in 2009): 479,000 Average length of stay: 4.3 days http://www.cdc.gov/nchs/fastats/asthma.htm

The incidence of asthma is increasing

From 2001 – 2009, the incidence of asthma increased by 4.3 million Rates grew the most (almost a 50% increase!) among

black children Why?

Hygiene hypothesis: we’re “too clean” Sedentary lifestyle: decreases lung strength Obesity: increases overall inflammatory response of the

human body Changes in immune system as we “modernize” http://www.scientificamerican.com/article.cfm?id=why-are-asthma-rates-

soaring

The cost of asthma

Medical expenses per person per year is $3300 on average.

40% of uninsured people could not afford their asthma-related medications, and 11% of insured people could not afford their asthma-related medications between 2002-2007.

Asthma costs in the US in 2002 were approximately $53 billion – in 2007 they were approximately $56 billion.

59% of children and 33% of adults with asthma missed school or work due to asthma in 2008. On average, children

missed 4 days of school and adults missed 5 days of work because of asthma

http://www.cdc.gov/VitalSigns/Asthma/index.html

Asthma and Public Health

There are many public health initiatives in place to reduce asthma exacerbations

Community Preventative Services Task Force’s initiative “Asthma Control: Home Based Multi Trigger, Multicomponent Environmental Interventions” Home visits are conducted by a trained person to

assess home environments and educate families about what can be done to decrease asthma triggers and also how to better self-manage one’s asthma

http://www.thecommunityguide.org/asthma/multicomponent.html

Public Health Initiatives cont.

Healthy People 2020 goal: “Promote respiratory health through better prevention, detection, treatment, and education efforts” Specific objectives:

http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=36 “Increase the number of States, Territories, and the

District of Columbia with a comprehensive asthma surveillance system for tracking asthma cases, illness, and disability at the State level”

No Virginia data on the CDC website!http://www.cdc.gov/asthma/stateprofiles.htm

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=36

In 2008, less than half of the people diagnosed with asthma reported being taught how to avoid triggers.

48% of adults who were taught about trigger avoidance did not follow most of their doctor’s teaching. http://www.cdc.gov/VitalSigns/Asthma/index.html#StateInfo

Asthma in Virginia

In 2010, the Virginia Asthma Coalition released a plan for Virginia

And VDH does track Virginia data (though the last comprehensive report was written in 2007, using data through 2004)

7.3% of adults (412,370 people) in Virginia have asthma

9% of children (152,277 people) in Virginia have asthma

In 2004, total cost of asthma hospitalizations in Virginia was $96 million! (which was a 58% increase from 1999) https://www.vdh.virginia.gov/news/PressKits/Asthma/Overview.pdf

Asthma in Virginia

Current asthma rates in Virginia have slightly increased since 2000 (average in 2000 was 7.1%, in 2008 it was 9.3%)

https://www.vdh.virginia.gov/news/PressKits/Asthma/Overview.pdf

Virginia compared to the US



Virginia Stats


Virginia Stats


Research Needs

According to the EPA, some of the most important areas of research related to asthma include: More information about the induction and

exacerbation of asthma Why the incidence of asthma is increasing What factors make one more susceptible to asthma Risk assessment of environmental pollutants and

asthma http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=54825

What is COPD?

COPD is Chronic Obstructive Pulmonary Disease and is characterized by diseases that cause airflow blockage and problems related to breathing.

It includes emphysema, chronic bronchitis, and asthma (in some cases).

COPD is caused by: Tobacco exposure Asthma Air pollutants Genetic factors Respiratory infections

http://www.cdc.gov/copd/

Chronic bronchitis vs. emphysema

Chronic bronchitis is characterized by a long-term cough with mucous production

Emphysema is characterized by destruction of the lungs overtime

COPD: Prevalence

There is a vast under-diagnosis of COPD.6.3% of American adults (approximately 15

million people) have been diagnosed with COPD.In adults aged 18-44, 3.2% of the population has

been diagnosed with COPD.In adults ages 65 and older, 11.6% have been

diagnosed with COPD.White adults have the highest rate of COPD

(6.3%).6.1% of black adults and 4.3% of Hispanic adults

have COPD.9.5% of those with COPD did not have a high

school diploma http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6146a2.htm#fig

• In 2008, 9.8 million adults were diagnosed with chronic bronchitis.

• In 2008, 3.8 million adults reported having ever been diagnosed with emphysema.

• Surprisingly (to me), more women than men suffer from these diseases.

• http://www.lung.org/assets/documents/publications/solddc-chapters/copd.pdf

Age-adjusted prevalence of COPD among adults

COPD in Virginia

Chronic bronchitis is the second leading hospital discharge diagnosis in Virginia.

Emphysema is the seventh leading hospital diagnosis in Virginia. http://www.vapremier.com/index.php?page=copd-management-program

Respiratory Disease Deaths in Virginia

Morbidity and mortality

The estimated cost of COPD in 2010 was $49.9 billion. $29.5 billion related to direct hospital costs, $8 billion

on indirect morbidity costs, and $12.4 billion on indirect mortality costs

COPD is the third leading cause of death in the USA, claiming 124,477 lives in 2007.

672,000 hospitalizations in 2006 were due to COPD. http://www.lung.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html

Disparities and COPD

More Caucasians than African Americans have chronic bronchitis (50.8 per 1000 vs. 38.6 per 1000). Rate among

Hispanics only 20.6 per 1000.

The same is true of emphysema (21.1 per 1000 Caucasians vs. 8.1 per 1000 African Americans vs. 6.3 per 1000 Hispanics)

Among the uninsured, African Americans were significantly less likely than Caucasians to receive a lung transplant (61 vs 68%)

50.5 per 100,000 White men died from COPD in 2006

Death rate for White women was 39.1 per 100,000

Death rate for Black men was 37.7 per 100,000

Death rate for Black women was 18.9 per 100,000 http://www.lung.org/assets/

documents/publications/solddc-chapters/copd.pdf

Public Health Research and COPD

Access to healthcare is a huge obstacle for Hispanics who suffer from COPD Studies who that they are twice as likely as

Caucasians to utilize the ER for management of their COPD

Words such as wheeze and dyspnea do not translate well into Spanish

Hispanics are often grouped all together, rather than being treated as people from various countries

More research needs to be done to define subgroups of Hispanics and their relationship to the healthcare system in the United States

http://www.lung.org/assets/documents/publications/solddc-chapters/copd.pdf

Public Health Research and COPD

Very limited information has been collected about Asian Americans, Native Americans, and Native Pacific Islanders and the prevalence of COPD among these groups http://www.lung.org/assets/documents/publications/solddc-chapters/copd.pdf

Healthy People 2020 and COPD

Reduce activity limitations among adults with chronic obstructive pulmonary disease (COPD)

Reduce deaths from chronic obstructive pulmonary disease (COPD) among adults

Reduce hospitalizations for chronic obstructive pulmonary disease (COPD)

Reduce emergency department (ED) visits for chronic obstructive pulmonary disease (COPD)

Increase the proportion of adults with abnormal lung function whose underlying obstructive disease has been diagnosed http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?

topicId=36

COPDCOPD AsthmaAsthma

Rarely occurs before age 45

Rarely occurs in a non-smoker

Little can be done to improve sx. of COPD once patients experience them

COPD patients rarely go a day without experiencing sx.

Lung function never returns to normal

Can occur with asthma

Can occur at any ageCan occur in a smoker or

non-smokerRemoving environmental

triggers can greatly improve asthmatic sx.

Asthmatics can go great lengths of time in between experiencing sx.

Lung function returns to normal between attacks

Asthma vs. COPD COPD is often misdiagnosed as asthma, which leads to ineffective treatment

and management. (http://copd.about.com/od/fa1/a/asthmaorcopd.htm)

SMOKING CESSATION IS KEY!

85 to 90% of COPD deaths are caused by smoking.

Smokers are 12% (in men) and 13% (in women) more likely to die from COPD than non-smokers. http://www.lung.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html

Smokers likelihood of developing COPD is 50%.Risk of COPD decreased by 50% after quitting

smoking. Laniado-Laborín, Rafael . Smoking and Chronic Obstructive Pulmonary Disease (COPD):

Parallel Epidemics of the 21st Century. International Journal of Environmental Research and Public Health, 2009, 6, 209-224; doi:10.3390/ijerph6010209.

Questions?

RACHEL PRYOR EPID 691 FEBRUARY 25, 2013 Asthma and COPD.

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