COPD Rises to Third Leading Cause of Death in the United States, 12 Years Earlier Than Projected

November 03, 2011

Reprinted from Managed Care Outlook, November 1, 2011, Volume 24, Number 21, pages 1,7–9 with permission from Aspen Publishers, Wolters Kluwer Law & Business.

The Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS) recently released a report titled “Deaths: Preliminary Data for 2008” in which it confirms that chronic obstructive pulmonary disease (COPD) became the third leading cause of death in the United States for 2008 (the most current data available). Previously, COPD was the fourth leading cause of death — a distinction many, including the COPD Foundation, would argue is a move in the wrong direction.

“It’s unacceptable that COPD has gone from fourth to the third leading cause 12 years sooner than originally projected,” says John W. Walsh, president and co-founder of
the COPD Foundation. “This wake-up call intensifies our declaration of war on COPD and points to the importance of increased awareness, prevention, detection, and treatment to reduce the burden of COPD.”

The CDC report states that the mortality rates are the result of chronic lower respiratory diseases (CLRD) such as chronic bronchitis, emphysema, and bronchiectasis. CLRD increased by 7.8 percent while stroke fell 3.8 percent. The report notes that this increase could be due to a change in rules governing the coding and classifi cation of deaths in 2008. Before the change, many deaths that were previously assigned to COPD/unspecifi ed, pneumonia, and other acute lower respiratory infections are now classified under CLRD.

“There are several issues that come into play when we look at COPD and the increase in the mortality rate for this disease,” says Howard Garber, MD, MPH, and medical director at Johns Hopkins Healthcare. “First of all, even though the statistics show us that fewer people are smoking, the bulk of smokers — including those who have smoked for a long time — are beginning to suffer from and are dying from COPD. There is also concern about pollution in the atmosphere, which contributes to the development of COPD, so it’s not just one factor, and what we are seeing is a sizable number of people who are getting the disease and dying from it. What we need to be asking ourselves is this: are we doing everything we can to make sure people are being treated properly, and what more can be done to detect it earlier and prevent deaths?”

The secret is to be proactive and identify risk factors before the patient develops COPD, notes Garber. “Unfortunately, in many cases, by the time a patient is finally diagnosed with COPD, they have lost nearly 50 percent of their lung function, which is why, at least in part, it has moved to the number three spot in terms of mortality,” he adds.

With a simple test, individuals experiencing the symptoms of COPD (including breathlessness, wheezing, and chronic coughing) can take action to prevent the worsening of symptoms. There are also certain things that are risk factors — like cigarette smoking, secondhand smoke, air pollution, and even genetic factors — that are instrumental in precipitating COPD.

“If people are at risk, our goal is to impress upon them the need to talk to their doctor and get screened,” says Garber. “Even if they aren’t exhibiting any symptoms, they still need to be proactive and take these steps. I cannot stress enough how important early detection is with COPD. The course is significantly different for those diagnosed early. They can avoid that huge loss of lung function, resulting in a much better long-term diagnosis. But they have to be proactive.”

It is important to note the impact that COPD can have in the workplace, says Garber. Whether it’s absenteeism (the employee is actually absent from work) or presenteeism (the employee is at work but cannot perform as well as he or she should), the implications — both direct and indirect — are huge, he adds.

“There was a report released in 2010 called COPD Uncovered that sheds some light on the fact that there is this misconception that COPD is a disease of the Medicare population,” states Walsh. “That’s just not true anymore. It absolutely impacts the workforce; it leads to lost productivity and, in some cases, can even lead to early retirement. It also impacts employer costs and employee costs, so it is felt on many levels.”

The COPD Foundation is currently working on a project (on which Dr. Garber sits on the steering committee) that is creating an employer corporate education and awareness toolkit for COPD. The goal is to educate human resource managers about the burden of COPD in the workplace as well as give them the tools they need to address the disease with their employees. It will include tools that would encourage people who are at risk to get screened, encourage those who smoke to quit, and educate employees who have COPD about obtaining proper treatment, including not only medications but other treatments (e.g., getting the right vaccines, signing up for pulmonary rehab, et cetera) that would allow them to stay healthy and keep working.

“As part of the toolkit, we will be asking employers to integrate a screening process into their health risk assessment; it’s a short five-question screener that will help employees identify if they are at risk for COPD,” explains Walsh. “Again, it’s not meant to diagnose the patient but rather serve as a prompt for the employee to proactively take steps to determine if they are at risk and then talk to their doctor in response to the screener. At the end of the day, we want to provide the support they need on the front end to keep them healthy and keep them out of the hospital later on down the

Additional information about COPD is available by calling the COPD Information Line at 866/316-COPD (2673) or visiting the COPD Foundation’s Web site at The COPD Foundation will also be hosting the COPD7USA Conference, a continuing medical education conference that will feature a track on improving outcomes through care delivery changes on December 3-4, 2011, in Crystal City, VA. Information for the conference is available at