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ChiesiPro | Kongress | European Respiratory Society | Global burden of COPD

Global burden of COPD

COPD is an increasingly important cause of morbidity, disability and mortality worldwide. Environmental risk factors are important to address for future lung health.

ChiesiPro | Kongress | European Respiratory Society | Global burden of COPD
2025_ ERS satellite online
ERS

An update from the Global Burden of Disease 

Speaker: Prof Wisia Wedzicha, Imperial college London (UK)

In summary: The presentation focused on the risk factors and the burden of disease associated particularly with environmental COPD etiotypes, namely cigarette smoking COPD (COPD-C) and biomass and pollution exposure COPD (COPD-P). Strong public health policies are needed to address environmental etiotypes, and continued efforts to reduce rate of undiagnosed COPD are also required to reduce the burden of disease.

Burden of disease is expected to increase

COPD is associated with significant health and economic burden worldwide. Global COPD prevalence was projected to approach 600 million cases worldwide by 2050, which represents a relative growth of 23% in the number of individuals with COPD compared to 2020. The largest growth is projected to occur among females and within low and middle-income income countries and regions1.

COPD risk factors

Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity, disability, and mortality worldwide. Old age, male sex, smoking (>10 pack years), body-mass index of less than 18.5 kg/m2, biomass exposure, and occupational exposure to dust or smoke have been recognized as substantial risk factors for COPD2. Also, lower respiratory tract infection during early childhood (age < 2 years) has been associated with almost a two-fold risk of premature adult death from respiratory disease3.

Smoking cessation: the earlier the better

Understanding normal lung development and aging in health and disease, both in men and in women, is essential to interpreting any therapeutic intervention. An analysis4 described lung function changes in healthy, never-smoking males and females, from adolescence to old age, and determined the effects of smoking and those derived from quitting. The findings showed that:

  • Healthy never-smoker females achieve full lung growth earlier than males, and their rate of decline with age was slightly lower.
  • Smoking increases the rate of lung function decline, both in males and in females.
  • There is a range of susceptibility to the effects of smoking. The presence of respiratory symptoms at baseline and/or a respiratory diagnosis during follow-up appears to identify a group of susceptible smokers; and
  • Quitting smoking has a beneficial effect at any age, but it is more pronounced in earlier quitters. Lung function changes from adolescence to old age differ in males and females, smoking has similar deleterious effects in both sexes.

Among middle-aged smokers, chronic mucus hypersecretion (CMH), represents an early developmental phase of COPD. Although this is improved when they quit smoking, a longer duration is associated with a greater loss of FEV1, suggesting that CMH may reflect underlying airway disease activity across adult life.5

Focus on spirometry and early detection

Undiagnosed COPD despite respiratory symptoms remains an issue. As noted in a cohort of individuals in lung cancer screening (LCS) study also exploring COPD comorbidity6, half of those with undiagnosed COPD had respiratory symptoms but only two thirds had emphysema. Airflow limitation was a stronger predictor for respiratory symptoms than emphysema. This emphasizes the importance and value of spirometry at LCS over and above detecting emphysema on low-dose computed tomography6.

Lung abnormalities can be identified early in the disease history, as shown in a large prospective cohort study (BEACON).7 In young smokers, radiological abnormalities on CT were already established with relatively short exposure to tobacco smoking and was linked to loss of FEV1, independent of symptoms, long before smokers typically receive diagnoses of COPD.

Air pollution

Approximately 8% of global COPD deaths may be caused by air pollution, making it a major risk factor worldwide.  The impact of ambient air pollution on respiratory health in patients living with COPD is described in GOLD’s 2023 committee report8, stating that:

  • There are no safe levels of ambient air pollution.
  • Climate change, i.e. wildfires and extreme weather conditions such as heat waves are major threats to COPD patients and increase their risk of morbidity and mortality.
  • The number of persons dying from air pollution is expected to increase by 100-300% over the next 30 years, due to climate change.
  • Air pollution exposure is associated with increased risk of COPD and accelerated decline in lung function. It worsens the symptoms and may increase the risk to respiratory infections. The risk is amplified in patients with small airways abnormalities, in females and concurrent smokers.

Strong public health policies around the world are recommended to reduce ambient air pollution and for implementation of public warning systems to alert patients of excessive levels of air pollution.

Pekka Ojasala
Medical Advisor, Chiesi Nordic

References

  1. Boers E et al. Global Burden of Chronic Obstructive Pulmonary Disease Through 2050. JAMA Network Open. 2023;6(12):e2346598.doi:10.1001/jamanetworkopen.2023.46598
  2. Davies a et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med 2022; 10: 447–58
  3. Allinson et al. Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study. Lancet 2023; 401: 1183–93. Doi.org/10.1016/ S0140-6736(23)00131-9
  4. Kohansai et al. The Natural History of Chronic AirflowObstruction Revisited. An Analysis of the Framingham Offspring Cohort. Am J Respir Crit Care Med Vol 180. pp 3–10, 2009. DOI: 10.1164/rccm.200901-0047OC on April 2, 2009.
  5. Allinson JP et al. The Presence of Chronic Mucus Hypersecretion across Adult Life in Relation to Chronic Obstructive Pulmonary Disease Development. Am J Respir Crit Care Med Vol 193, Iss 6, pp 662–672, Mar 15, 2016. DOI: 10.1164/rccm.201511-2210OC
  6. Ruparel et al. Prevalence, Symptom Burden, and Underdiagnosis of Chronic Obstructive Pulmonary Disease in a Lung Cancer Screening Cohort. Ann Am Thorac Soc Vol 17, No 7, pp 869–878, Jul 2020.
  7. Ritchie A et al. Structural Predictors of Lung Function Decline in Young Smokers with Normal Spirometry. Am J Respir Crit Care Med Vol 209, Iss 10, pp 1208–1218, May 15, 2024. DOI: 10.1164/rccm.202307-1203OC on January 4, 2024.
  8. Sin DD et al. Air pollution and COPD: GOLD 2023 committee report. Eur Respir J 2023 May 11;61(5):2202469. doi: 10.1183/13993003.02469-2022

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