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For Media Use Only Chronic Obstructive Pulmonary Disease (COPD) Backgrounder What is COPD? Chronic obstructive pulmonary disease (COPD) is a progressive, life-threatening disease associated with tobacco smoking, air pollution or occupational exposure, which causes obstruction of airflow in the lungs resulting in debilitating bouts of breathlessness. Over time, the disease causes patients to become less active1. What is the prevalence and incidence of COPD? COPD affects 210 million people worldwide2 and is projected to be the third leading cause of death by 20203. More than 12 million people, or 7% of the adult population, are diagnosed with COPD in the United States, while an additional 12 million people probably have the disease but are undiagnosed4. In Europe, 4-10% of adults are estimated to be affected5. According to the World Health Organization (WHO), total deaths from COPD are projected to increase by more than 30% over the next 10 years unless urgent action is taken to reduce the risk factors6. What causes COPD? Smoking is the primary cause of COPD3, with female smokers 13 times and male smokers 12 times more likely to die from COPD than non-smokers7. However, smoking is not the only cause of COPD and in some parts of the world it may not even be the major cause3. Exposure to second-hand smoke or other indoor or outdoor pollutants can increase a person’s chance of developing COPD3. Some people with COPD have worked for many years in places that are very dusty or smoky8, and the American Thoracic Society has concluded that occupational exposure accounts for 10-20% of either symptoms or functional impairment consistent with COPD3. Who is at risk of COPD? COPD used to be more common in men, but now affects men and women equally. This is because of increased tobacco use among women and the higher risk of exposure to indoor air pollution (such as solid fuel used for cooking and heating)6. Some people with COPD have lived in homes filled with fumes from cooking stoves or fumes from heaters used to warm the home. What are the symptoms of COPD? The most common symptoms of COPD are breathlessness, abnormal sputum (a mix of saliva and mucus in the airway), a chronic cough, wheezing and chest tightness. Daily activities, such as walking up a short flight of stairs, can become very difficult as the condition gradually worsens6. How is COPD diagnosed? COPD can be diagnosed by a simple test called spirometry that measures how much air a person can inhale and exhale, and how fast air can be breathed out. Most people with COPD are not diagnosed until the disease is well advanced. Physicians may consider COPD and perform spirometry if any of these indicators are present in someone over the age of 403: Chronic cough Phlegm production Dyspnea (shortness of breath) that worsens over time, is worse with exercise and is present every day History of exposure to tobacco smoke, occupational dusts and chemicals, smoke from home cooking or heating fuels3 Novartis Pharma AG CH-4002 Basel, Switzerland © 2011 Novartis Pharma AG For Media Use Only However, COPD is often under-diagnosed because patients are not properly tested to detect the disease9. Since patients may attribute symptoms to their smoking habit or aging, they do not seek help and remain undiagnosed until they experience serious worsening of their condition. This contributes to the fact that at diagnosis, up to 50% of lung function may already have been lost10. How is COPD treated? There is no cure for COPD, so the primary goal for treatment is to provide relief of symptoms and prevent complications and/or progression of the disease with a minimum of side effects. Bronchodilator medications that relax and open air passages in the lungs are central to the symptomatic management of COPD. Most bronchodilators are taken using an inhaler device. Depending on the severity of the disease, either short-acting or long-acting inhaled bronchodilators may be prescribed. Inhaled short-acting bronchodilators work quickly (within 15 to 20 minutes) and last from four to six hours. They help to decrease shortness of breath and are sometimes described as rescue medications. Inhaled long-acting bronchodilators are used regularly to open the airways and keep them open for 12 hours and in some cases up to 24 hours. There are two main types of long-acting bronchodilator: Long-acting beta2-agonists (LABAs) which act on the beta2-adrenergic receptor, causing smooth muscle relaxation and dilation of the bronchial passages Long-acting muscarinic antagonists (LAMAs) which work by inhibiting muscarinic receptors in the bronchial airways, which leads to muscle relaxation and improved lung function Inhaled corticosteroids are used to treat patients with COPD exacerbations. These medicines may reduce airway inflammation and are prescribed with the aim of helping to relieve breathing problems3. COPD treatments may contain either a single medication or a combination of medications in one inhaler, such as a bronchodilator, a corticosteroid, a combination of bronchodilators, or a combination of bronchodilator and corticosteroid. Additional treatment can include antibiotics, oxygen therapy, pulmonary rehabilitation and surgery. Pneumonia and influenza vaccines should also be given to COPD patients. Overall, COPD patients should live a healthy lifestyle by exercising, avoiding cigarette smoke and other air pollutants. What is the economic and workplace burden of COPD? According to ‘COPD Uncovered: An international survey on the impact of chronic obstructive pulmonary disease (COPD) on a working age population’11, COPD patients lose an average of around USD1,800 of their income each year as a direct result of their disease, equating to an estimated lifetime loss of nearly USD20,000 per individual. In addition, nearly one in five of 45-67 year olds with COPD are forced to retire prematurely due to the condition, thereby incurring increased healthcare utilization costs, reducing their personal tax and pension contributions, and increasing disability allowance costs to governments. How much does the general public know about COPD? An international Social Observational Survey (SOS), conducted by the market research company Opinion Matters on behalf of Novartis12 in August 2011, has revealed the widespread lack of understanding and awareness of COPD among the general public. The survey, involving more than 6,000 people in six countries, found that: 72% of those questioned thought COPD affects only smokers12 Novartis Pharma AG CH-4002 Basel, Switzerland © 2011 Novartis Pharma AG For Media Use Only 65% of those questioned did not realise that COPD can affect those under 65 years old, and 50% did not believe women can be affected12 25% of those surveyed incorrectly thought COPD could be caught through infection12 18% thought that people with COPD are as active as the general population12 When asked to rank 10 diseases as the leading causes of mortality in the US and EU, respondents placed COPD in 8th place12 Although COPD is often considered a disease of the elderly, 50% of patients are estimated to be under the age of 65, and are likely to be at the peak of their earning power and family responsibilities11. Furthermore, COPD used to be more common in men, but now affects men and women equally13. Breathlessness, a key symptom of COPD, affects patients’ daily lives making them less active and productive than the general population, but the survey shows that only a minority of people recognize this. The research involved a random sample of 6,222 members of the general public from Brazil (1,010), China (1,010), Germany (1,010), Turkey (1,008), UK (1,180), and the US (1,004). ### References 1. Pitta F, Troosters T, Spruit MA, et al. Characteristics of Physical Activities in Daily Life. Am J Respir Crit Care Med Vol 171. pp 972–977, 2005. Available at: http://ajrccm.atsjournals.org/cgi/reprint/171/9/972.pdf Last accessed 26 July 2011. 2. Global Alliance Against Chronic Respiratory Diseases (GARD). Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. Available at: http://www.who.int/gard/publications/GARD%20Book%202007.pdf Last accessed 14 July 2011. 3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Updated 2010. http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf . Last accessed 1 August 2011. 4. National Heart, Lung, and Blood Institute. Morbidity & Mortality: 2009 Chart Book on Cardiovascular, Lung, and Blood Diseases. Bethesda, Maryland: US Department of Health and Human Services, NIH, NHLBI. October 2009. 5. European Respiratory Society. European Lung White Book: Huddersfield, European Respiratory Society Journals Ltd, 2003. 6. World Health Organization. Chronic Obstructive Pulmonary Disease Factsheet No. 315, Available at: http://www.who.int/mediacentre/factsheets/fs315/en/index.html. Last accessed 14 July 2011. 7. American Lung Association. Chronic Obstructive Pulmonary Disease Fact Sheet. February 2010. http://www.lungusa.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html. Last accessed 28 July 2011. 8. Global Initiative for Chronic Obstructive Lung Disease. What You Can Do About A Lung Disease Called COPD. http://www.goldcopd.org/uploads/users/files/GOLD_Patient_RevJan10.pdf. Last accessed 28 July 2011. 9. Tinkelman DG, Price D, Nordyke RJ, Halbert RJ. Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over. Journal of Asthma. 2006; 43:1-6. 10. Doherty D, et al. Chronic obstructive pulmonary disease: consensus recommendations for early diagnosis and treatment. Journal of Family Practice. November 2006. http://findarticles.com/p/articles/mi_m0689/is_11_55/ai_n27059405. Last accessed 26 July 2011. 11. Fletcher MJ et al. COPD Uncovered: An International survey on the impact of chronic obstructive pulmonary disease (COPD) on a working age population. BMC Public Health 2011, 11:612. 12. Chronic Obstructive Pulmonary Disease (COPD) Social Observational Survey (SOS). Novartis data on file. 13. The World Health Organization. Chronic obstructive pulmonary disease (COPD). Fact sheet N°315. February 2011. http://www.who.int/mediacentre/factsheets/fs315/en/index.html. Last accessed 22 August 2011. Novartis Pharma AG CH-4002 Basel, Switzerland © 2011 Novartis Pharma AG