2002 -- The information below is from a U.S. Centers for Disease
Control and Prevention (CDC) telebriefing conference with Dr. David
Mannino, CDC pulmonary disease expert.
Pulmonary Disease, which is also known as COPD, includes patients who
have chronic bronchitis, emphysema and some people with asthma. COPD
is the fourth leading cause of disease in the United States. Some have
described COPD as an asthma attack that never stops. Tobacco use is a
key risk factor for COPD, although other risk factors include
occupational exposures, infections, air pollution, sensitive airways
and genetic factors. Lung function testing is needed to diagnose COPD.
The report released this month reports on trends and different
measures of COPD in the United States over the past 30 years. In 2000,
for the first time, the number of women in the U.S. dying from COPD
surpassed the number of men. This report also finds that women visit
emergency rooms and are hospitalized more often for COPD than are men.
These data confirm that COPD is now a women's health disease.
The increase in these trends for women probably reflects the increase
in smoking by women in the United States since the 1940s. People with
COPD are twice as likely to report activity limitations as people
without COPD. In addition to taking away years from a person's life,
COPD also takes life away from a person's years.
The good news is that the number of men and women, age 25 to 54, with
mild to moderate COPD has actually decreased over the past quarter
century, suggesting that the increases that we're currently observing
in hospitalizations and deaths may not continue indefinitely. We
believe that this observation is a result of the overall decrease in
smoking in the United States since the 1960s.
The main message from this report for physicians is that they should
consider measuring pulmonary function in order to detect COPD in
current and former smokers, age 45 and over, and anybody with
The main message for members of the general public who have a history
of smoking, asthma or respiratory symptoms is that they should discuss
COPD with their physicians.
Recap of Question and
You can get a full copy of the report by going to our website, which
is www.cdc.gov. And if you select "In the News" on the
left-hand corner of your screen, it will be listed under content. That
will take you to a summary of the surveillance report, and then you
can also obtain the full copy.
much of a difference are we looking at between men and women? Is it
statistically significant, and could it be related to the fact that
there are more, I mean, we're talking older people at this point when
you're talking dying, how related is it to the fact that you have more
older women at that age because of survival?
Many of the measures actually are significantly higher in women.
Prevalence of the number of people who report they have COPD is
significantly higher than women, as are I believe emergency room
visits. I'd have to look at the various specifics of the report, but
it is all in there. Because our measure of deaths actually counts
every death in the country, women have about I think there are 7- or
800 more deaths among women than among men, and that of course is
statistically significant, although both were right around 60,000.
Part of this is related perhaps to women living longer, and the
evidence for this is that if you actually look at the age-adjusted
mortality rates, they are still slightly lower among women than they
are men, although the actual numbers are higher in women.
QUESTION: They're slightly lower among women?
DR. MANNINO: Yes, the mortality rates, although the actual
number of deaths is higher in women.
QUESTION: In the deaths, are we talking about predominantly in
the over 60/over 70 age group?
DR. MANNINO: Yes, COPD deaths predominantly occur in older
people. Again, the specific numbers are all in the report.
QUESTION: Can you just address a little bit about the under
diagnosis of this condition.
We have evidence from other reports that we have published, and
it's briefly addressed in this report, that a substantial proportion
of the population has objective evidence of COPD. In other words, in
some of our national surveys, if you actually go out and measure lung
function, you'll find a certain percentage of the population that has
evidence of COPD. In our report, I think it was somewhere around 14
percent that had either a mild or a moderate COPD.
If you actually then look and ask those people who have been diagnosed
with COPD, it's a relatively small proportion. Generally, it's in
about the 30-percent range.
QUESTION: Just a question about asthma and COPD.
Asthma rates have been increasing in the last decade or so or two, and
I'm wondering whether there's any link between asthma and COPD
DR. MANNINO: Yes, actually, there is. Within the pulmonary
community, one typically sees diagrams of overlapping circles, with
emphysema, chronic bronchitis and asthma. Clearly, the definition of
asthma is variable air flow obstruction and the definition of COPD is
fixed airflow obstruction.
One of the problems that one can see with asthma, particularly if it
exists for a long time, is that some of the variation diminishes over
time, particularly it is thought in people that aren't being
adequately treated. And some evidence we have for this that isn't in
this report, but we have another paper that's coming out shortly is
that if you look at COPD deaths in the country, that somewhere between
15 and 20 percent of these occur in people who have never smoked, and
of those, a history of asthma was one of the most significant risk
factors for having a COPD-related death.
QUESTION: So part of the increase might be due to the increase
DR. MANNINO: That is entirely possible.
elaborate a little bit on the overall trend and diagnosis of COPD. I
understand it's the fourth leading cause of death and that in 2002 10
million adults were diagnosed by doctors.
Has that been stable? Is it going up or down? Can you give us any
DR. MANNINO: Yes, that is in the report. If you actually look
at the report that they've been diagnosed with either chronic
bronchitis or emphysema, that has stayed relatively stable over the 20
years that we report for that measure in this report.
QUESTION: Following up on the question earlier on the 15 to 20
percent of those who have never smoked, is that an increasing trend?
I mean, among those, are you seeing in that giant line that goes up,
an increase in nonsmokers who are dying of COPD?
DR. MANNINO: Unfortunately, with the current mortality data
that we have available, which does not ask specifically about smoking,
we cannot tease that out, and we're currently working on some other
databases where we may be able to get an answer to that; but we simply
can't answer that.
QUESTION: And then looking at the data on your report, it seems
that you almost quadruple the deaths in women from 1980 to 2000.
DR. MANNINO: Yes
QUESTION: And that's purely smoking? You're saying it's mostly
smoking. That would be considered alarming in other places.
DR. MANNINO: I consider, we consider it alarming, and that's
why we're reporting it, and that's what we feel is one of the messages
of this report.
QUESTION: But most of that is smoking.
DR. MANNINO: Yes, we believe most of it is smoking. Generally,
the life history of COPD development, or, actually, if you just look
at cigarette smoking, people start smoking in their teens or early
20s, and they start developing COPD in mild cases, probably in their
40s and 50s, and start dying in their 60s and 70s.
So in that sense I think what we're seeing here is really related to
the uptake of smoking by women in the United States in the 1940s and
'50s, and then that continuing increase that has occurred through
Source: U.S. Centers for Disease Control and