Chronic Obstructive Pulmonary Disease in Florida

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Table of Contents

Introduction
Background of the Disease
Surveillance Methods
Descriptive Epidemiology Analysis
Diagnosis of COPD
Plan for Action
Conclusion
References

Introduction

Chronic obstructive lung disease (COPD) is cited among conditions contributing to pulmonary cancer etiology (Aldrich et al., 2015). Consequently, there has been an urge to intensify research to determine the interrelationships between the two disorders to invent improved strategies for reducing their impact on society. Lung cancer causes the highest number of cancer-related deaths in the United States, while COPD is the third primary cause of general mortality, and the combination of the two creates an immense public health burden, causing significant disability, morbidity, and mortality (Aldrich et al., 2015). The average total annual cost of COPD for the year 2010 was $49.9 billion, and the chances of being employed plunged by 8.6% for those with the COPD linked disability (Doney et al., 2014). The statistics released in 2015 from the Behavioral Risk Factor Surveillance System (BRFSS) indicated a 9.6% countrywide incidence rate for the self-reported COPD cases in grownups aged 40 years or more (Aldrich et al., 2015). It also showed that a regional variation of the disease across the USA with Southern States recording the highest prevalence rates (Aldrich et al., 2015).

Background of the Disease

COPD is a manageable and curable lung disease with some important non-pulmonary effects that may contribute to the severity in individual patients (Reid & Innes, 2014). The pulmonary constituent of the sickness is typified by an almost irreversible breathing limitation that is gradual and accompanied by an unusual allergic reaction of the lungs due to noxious gases and particles (Reid & Innes, 2014). Accompanying diagnoses include chronic bronchitis, chronic obstructive bronchitis, and emphysema. Chronic bronchitis is characterized by the persistent copious mucus production into the bronchioles with the presence of a cough most of the time for no less than three consecutive months in two successive years (Holt et al., 2015). In contrast, emphysema is the permanent hyperinflation of the alveoli at the end of the terminal bronchioles accompanied by damage to the alveolar walls without obvious fibrosis (Reid & Innes, 2014).

The stimulation of the inflammatory cells (neutrophils, macrophages, and CD+ lymphocytes) by exposure to noxious particles and gas causes the cells to release several chemical mediators –tumor necrosis factor α, interleukin 8, and leukotriene B4 – that bring about the irritation (Reid & Innes, 2014). In addition, the impairment of the alveoli may be due to the overproduction of proteases, and oxidants activity. These conditions result in difficult breathing (dyspnea), wheezing, cough, sputum production, airway obstruction, decreased blood O₂concentration, and high blood CO₂ levels (Doney et al., 2014). Also, this blend of weakened pulmonary function and repeated exacerbations promotes a medical condition characterized by reduced endurance to exercise and physical activity, and deconditioning; factors that translate into disease progression, poor quality of life, disability, and eventually premature death.

COPD takes 120,000 American lives every year (Srivastava, Thakur, Sharma, & Punekar, 2015). However, the 2014 statistics indicated a reduction in age-adjusted death rates from 1999’s 57 per 100,000 for men and 35.3 per 100,000 persons for women to 44.3 and 35.4 respectively (Holt et al., 2015). The death toll from COPD in Florida in 2014 was estimated at 34.7-38.7 per 100,000 people. The state prevalence rate was 6.5 – 7.6%. The 2014 average prevalence rates for counties in Florida were 3.3 – 17.7%, while the congressional district ranges were 3.4-14.0% (Holt et al., 2015).

Table 1: Prevalence rates of COPD in several subpopulations of Duval County and Florida State (Holt et al., 2015).

Surveillance Methods

To evaluate the state-level and national prevalence of COPD, the impact on the population’s value of life, and the use of health care resources by patients, the CDC and the State Department of Health use data from the BRFSS (Holt et al., 2015). For instance, the Florida Department of Health uses the Florida BRFSS State Data to obtain the state-specific, population-grounded estimates of COPD prevalence and associated risk behaviors among the residents (Holt et al., 2015). The data are useful for ascertaining issues of health of primary importance and pinpointing populations at risk of ailments, disability, and death (Holt et al., 2015). The information also supports the development and evaluation of prevention programs, community, and policymaker training about disease prevention, and the reinforcement of community policies that encourage health and prevent disease (Holt et al., 2015).

BRFSS is a “state-run random-digit-dialed phone assessment of the non-institutionalized, US civilian grownups aged 18 years and above” that is conducted yearly by the CDC health divisions at the state level in homes accessible via phone calls (Holt et al., 2015, p. 8). The response rate for BRFSS is computed using specific criteria or response formula and is the proportion of the number of people who complete the survey to that of the eligible persons (Holt et al., 2015).

Descriptive Epidemiology Analysis

Disease prevalence is related to multiple health and socioeconomic factors. It has been approximated that 10 -16 million persons in the US have been diagnosed with COPD and that 14-16 million more cases go undiagnosed (Doney et al., 2014). That is due to under-reporting or under-diagnosis, predominantly those cases with mild to moderate disease. In addition, self-reports of the disease may be inaccurate, making it difficult to ascertain the actual prevalence of COPD in the state (Aldrich et al., 2015). The incidence, morbidity, and mortality of this disease are increasing with the aging of the US population (Doney et al., 2014). Risk factors for acquiring COPD include tobacco smoking (>95% of cases), biomass fuels use, occupational (coal mining or prolonged contact with cadmium), and air pollution (Reid & Innes, 2014). Other factors that predispose individuals to COPD include repeated infections and diseases such as adenovirus and HIV, low socioeconomic status, cannabis smoking, poor nutrition, genetic factors like α1-antiproteinase deficiency, and the respiratory system hyperactivity (Reid & Innes, 2014). Children with pulmonary growth and functional impairment due to low birth weight and childhood or maternal infections are at higher risk of suffering from the disease. Apparently, smoking cessation can halt the progress of COPD.

From the state data in table 1 above, it is evident that the Hispanics are less prone to COPD than the non-Hispanic Whites and the non-Hispanic blacks (3.7% compared with 9.7% and 5% respectively). Women have a higher incidence of COPD than men (8.8% compared to 6.4%). Persons below the high school level of education often report higher disease incidences than those at advanced levels of training (13.2% in comparison to 8.3% for high school and 5.8% for college). Also, unmarried couples are more susceptible to COPD than married people (8.8% to 6.5%). Similarly, employment status correlates with reported COPD cases. Disease incidences are prevalent among the physically impaired, unemployed, or retired than among the students, house makers, and the employed. Verified COPD cases drop with growing household income from 11.5% among those with an annual family income <$25, 000 to 3.7% for those with annual income ≥ $50,000. Persons who have been smoking for a longer duration have a higher incidence rate for COPD than former smokers and non-smokers, The asthmatic patients are also likely to suffer from the disease as compared to the non-asthmatic persons.

Exacerbations and disease severity of COPD are accompanied by health-related quality of life and economic drain. Other critical parameters connected with increased burden are increasing age, female gender, and the presence of co-morbidities. The impact on population outcomes can be estimated by observing the overall health condition, psychological well-being, functional status, fatigue, and life quality (Srivastava et al., 2015). Drainage of economic resources occurs when patients seek treatments. Therapy is by the use of bronchodilator drugs. Further, patients with COPD often require prolonged oxygen therapy, and antibiotics are frequently used to treat exacerbations caused by bacterial infections (Reid & Innes, 2014).

Diagnosis of COPD

Diagnosis is based on medical history, physical examination, and the results from the pulmonary function tests. However, differential diagnosis is essential to discriminate COPD from diseases such as chronic asthma, tuberculosis, bronchiectasis, and congestive heart failure (Reid & Innes, 2014). The patients exhibit atypical pulmonary function test values, e.g., a lower FEV₁ (Reid & Innes, 2014). The maximum volume of air that can be inhaled forcefully per second (FEV₁) and FVC are essential prognostic indicators in a patient, with the average rate of FEV₁ decline being an important objective measure to assess the COPD progression (Reid & Innes, 2014). FEV₁ is excessively reduced in airflow obstruction conditions, leading to FEV₁/FVC ratios of less than 70% (Reid & Innes, 2014). The average rate of decrease of FEV₁in healthy, nonsmoking persons due to aging is 25-30mL annually (Reid & Innes, 2014). For smokers, the rate of decline is higher, being steepest in heavy smokers.

The more severely diminished the FEV₁ at diagnosis, the steeper is the rate of decline. Also, the more the number of years of smoking and the number of cigarettes smoked, the steeper the decreases in lung function. The diagnosis is through spirometry and confirmation is made when the post-bronchodilator FEV₁ is below 80% of the projected figure and that the FEV₁/FVC <70% (Reid & Innes, 2014). If the FEV₁/FVC <70% and FEV₁ is more than 80%, this may be a typical finding in adult patients or an indicator of the mild disease (Reid & Innes, 2014). The seriousness of COPD is defined according to the post-bronchodilator FEV₁ as a proportion of the projected value of the patient’s age (Reid & Innes, 2014). An FEV₁/FVC value of <70% and FEV₁of ≥ 80% would indicate mild disease, while an FEV₁/FVC figure of <70% and FEV₁ of 50-79% would suggest moderate disease (Reid & Innes, 2014). The diagnoses for severe and serious COPD include FEV₁/FVC is <70% and FEV₁ of 30-49% and FEV₁/FVC<70% and FEV₁ <30%, respectively (Reid & Innes, 2014).

Measurement of lung volumes aid in the assessment of hyperinflation and is performed either by the helium dilution technique or body plethysmography (Reid & Innes, 2014). In this case, a low gas transfer factor suggests the presence of emphysema. In addition, exercise tests are essential in the evaluation of exercise tolerance and provide a baseline on which to judge the response to bronchodilator therapy or non-pharmacological treatments (Reid & Innes, 2014). Notably, although there are no reliable radiographic signs that correlate with the gravity of airflow obstruction, a pulmonary x-ray is essential to rule out other diagnoses – cardiac failure, lung cancer, or presence of bullae (Reid & Innes, 2014).

As mentioned above, spirometry is the gold standard test for the diagnosis of this disease. It is a painless breathing test. In some healthcare units, this screening test is administered freely. It is an essential step to ensure an accurate diagnosis and guide medication. The international COPD guidelines – the GOLD criteria – provide recommendations for screening, disease severity classifications, medical treatment, and prescription. Guideline-based care has been shown to improve patient outcomes in COPD (Holt et al., 2015).

Plan for Action

The prospective benefit of epidemiologic knowledge is realized when it is transformed into health policy and later prototyping and implementation of disease control programs. The health planning phase involves the following key steps: assessing disease frequency, identifying the causes, evaluating the efficacy and efficiency of existing treatment, implementing interventions, monitoring activities, and measuring the progress. To determine the outcome of the interventional measures or actions, it is crucial to re-measure burden-of-illness parameters, analyze trends in population groups at risk of disease, and ascertain the acceptance of various interventions after the disease awareness program.

In my case, I plan to promote awareness of GOLD guidelines among GPs through training and underscore the need for adherence to them. Also, I plan to educate, inform, and empower the Florida community by identifying gaps in the current public information about COPD. In addition, I intend to research more on health hazards and risk factors of COPD given the current economic, environmental, and lifestyle dynamics that impose health and psychosocial strain on the people. Further, I purpose to diagnose and investigate COPD in Florida to identify emerging threats and mobilize the public to implement distinct preventive, diagnostic, rehabilitation, and support plans. The outcomes of these endeavors can be measured by the approaches mentioned above.

Conclusion

COPD is an epidemiological disease with serious health implications for the people of Florida. It has both humanistic and economic side effects. Statistics on the disease are obtained through surveys conducted by the Florida BRFSS, etc. Diagnosis and treatment of the disease follow the GOLD guidelines. Treatment for the disease involves both preventive and pharmacotherapy approaches.

References

Aldrich, M. C., Munro, M. M., Mumma, M., Grogan, E. L., Massion, P. P., Blackwell, T. S., & Blot, W. J. (2015). Chronic obstructive pulmonary disease and subsequent overall and lung cancer mortality in low-income adults. PLoS ONE, 10(3), 1-14. Web.

Doney, B., Hnizdo, E., Syamlal, G., Kullman, G., Burchfiel, C., Martin, C. J., & Mujuru, P. (2014). Prevalence of chronic obstructive pulmonary disease among us working adults aged 40 to 70 years. J Occup Environ Med, 56(10), 1088–1093. Web.

Holt, J. B., Huston, S. L., Heidari, K., Schwartz, R., Gollmar C. W., Tran, A.,…Croft, J. B. (2015). Indicators for chronic disease surveillance – United States, 2013. Morbidity and Mortality Weekly Report (MMWR), 64(1), 1 – 250. Web.

Reid P. T., & Innes, J. A. (2014). Obstructive pulmonary disease. In R. N. Colledge et al. (Eds.), Davidson’s principles and practice of medicine (22nd ed.) (pp. 662 -678). Edinburg, UK: Elsevier Limited.

Srivastava, K., Thakur, D., Sharma, S., & Punekar, Y. S. (2015). Systematic review of humanistic and economic burden of symptomatic chronic obstructive pulmonary disease. PharmacoEconomics, 33(1), 467–488. Web.

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