Lung attack: A call to arms

In February the Canadian Thoracic Society published a comprehensive report called The Human and Economic Burden of COPD. The re­port points out that COPD is the most underdiagnosed chronic disease in our society yet is the leading consumer of hospital beds and health care dollars. 

The average admission for an acute exacerbation of COPD lasts 10 days and costs $10000. These are Canadian data and Canadian dollars. Recent research has suggested that up to 10% of Canadians have COPD, which the CTS defines as “a respiratory disorder largely caused by smoking, characterized by progressive, partially revers­ible airway obstruction and lung hy­perinflation, systemic manifestations, and increasing frequency and severity of exacerbations.”

There is a movement in respiratory medicine to call a COPD exacerbation a “lung attack” to call attention to the seriousness of such an event and the implications it has for patient morbidity and mortality. When lung attacks result in hospitalization, they carry the same mortality as a heart attack: 8% die during the hospitalization and 25% die within the following 12 months. 

There is overwhelming data that show decreased hospitalizations from good, comprehensive COPD care, including smoking cessation, pulmonary rehabilitation, and appropriate medications. Yet few patients receive such care due to lack of diagnosis, lack of comprehensive COPD clinics, and lack of recognition of the cost of this disease.

COPD is not difficult or expensive to diagnose. Spirometry done pre- and post-bronchodilators can make the di­ag­nosis in the vast majority of cases—this costs less than $50 and should be available in most hospitals in Canada. It is recommended that any present or ex-smoker over the age of 40 with any respiratory symptom be sent for spir­ometry as a screen for COPD because the sooner a diagnosis is made and appropriate care begun, the better the prognosis.

This report challenges everyone in the health care system—administrators, physicians, and patients—to become more aware of the huge human and economic burden of COPD and to act now.
—LML