COPD awareness is growing, but information gap persists

Washington -- Awareness of chronic obstructive pulmonary disease is on the rise, but few patients have a good understanding of its origins or of available treatment, according to a new survey.

Although 64% of respondents to the HealthStyles questionnaire mailed early last summer had heard of the disease -- compared with 49% four years earlier -- only half recognized that it is a leading cause of death, and just 44% knew it could be treated.

In addition, while 74% correctly identified shortness of breath as a symptom, only 5% recognized chronic cough as an additional symptom. Although smoking is a major risk factor, most survey respondents were unaware of this fact. And only 22% of current smokers reported recognizing they are at greater risk.

However, COPD typically affects those who are current or former smokers, with most older than 45.

The survey was conducted by the public relations firm Porter Novelli, and the data were analyzed by the National Heart, Lung and Blood Institute. Results were released Nov. 13.

COPD is the fourth leading cause of death in the United States, affecting an estimated 24 million people, with only about half diagnosed.

Despite having recognizable symptoms, such as dyspnea, chronic cough or sputum production, and a decline in level of activity, about 12 million people remain undiagnosed, according to the NHLBI. Although other major causes of death have been declining, COPD mortality continues to climb.

NHLBI launched a campaign last year aimed at increasing awareness and underscoring the benefits of early detection and treatment in slowing the disease. Primary care physicians were identified as lead players in the campaign.

Asking questions of patients suspected of having COPD is a good first step for physicians, said Gail Weinmann, MD, deputy director of the Division of Lung Diseases at NHLBI. "The disease is insidious at the onset, and often patients attribute their symptoms to aging."

Physicians should zero in on how far a patient can walk as a sign of diminished lung capacity and whether the patient has a cough, she advised.

If patients are at risk, whether because of smoking, working in a dusty environment or having a family history of the disease, spirometry is the main diagnostic tool, she added. "There are some accurate, inexpensive devices available."

Uncomplicated COPD can be handled by the primary care physician, said Dr. Weinmann, with bronchodilators and inhaled glucocorticosteroids the most commonly prescribed treatments. Since influenza can present a major health problem for patients with COPD, yearly flu immunization is an important preventive step, she added. Pneumonia vaccine is also appropriate for some patients.

"We are encouraged that people are becoming more aware of the term COPD," said NHLBI Director Elizabeth G. Nabel, MD.

"But the survey also indicates that we, as a public health community, have much more work to do to promote greater understanding of the disease, its symptoms and risk factors, so that we can improve rates of diagnosis and treatment."