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Chronic Lung Obstruction Now a Woman's Disease

Death rate for women with COPD has tripled in last 20 years, government report finds

THURSDAY, Aug. 1, 2002 (HealthDayNews) -- The death rate from chronic lung obstruction has tripled among American women in the last two decades, according to a new government report that also shows the disease in general is vastly under-diagnosed.

As many as 24 million Americans suffer symptoms of chronic obstructive pulmonary disease (COPD), mostly due to smoking, the report says. But 14 million of them aren't properly diagnosed with these health problems, which include chronic bronchitis and emphysema, it adds.

Not only is the prevalence of COPD about 2.4 times higher than physicians formally determine, but women are now more likely than men to die from the disorder, according to the new figures.

"COPD is now a woman's disease," says Dr. David Mannino, a lung expert at the U.S. Centers for Disease Control and Prevention and lead author of the surveillance report. Mannino blames the "alarming" increase on the rise in smoking among women after World War II.

In the year 2000 alone, COPD caused 8 million doctor and outpatient visits, 1.5 million trips to the emergency room and 726,000 hospitalizations in this country, on its way to killing almost 120,000 people, the CDC says. It is the nation's fourth leading cause of death, generally afflicting the elderly.

The rate of death from the disease among women tripled between 1980 and 2000, from 20 per 100,000 to 57 per 100,000. It rose much more modestly among men, from 73 to 82 per 100,000, during that period.

But in the year 2000, government officials say, there were 59,936 female deaths from COPD in 2000 vs. 59,118 male deaths.

Smoking is believed to account for 80 to 85 percent of COPD cases in the United States, with the rest attributed to various other causes such as pollution and on-the-job dust, Mannino says. In developing countries, the disease's origins are somewhat broader, and include coal burned during cooking and heating.

COPD is irreversible, and the treatments that exist can only soothe symptoms. However, quitting smoking can slow the progression of the disease, says Dr. Gail Weinmann, of the National Heart, Lung, and Blood Institute. "It's never too late to stop smoking and it's always too early to start," Weinmann says.

Some research has suggested that women may be more vulnerable than men to lung damage from tobacco, Weinmann says. But it's hard for scientists to separate this effect from that of gender differences in lung and airway size.

The good news in the report, officials say, is that the share of Americans under age 55 with mild or moderate COPD dropped between 1971 and 1994, implying that it will become less common as the population ages. Fewer people between the ages 25 and 54 are smoking, Mannino says, likely explaining the decline in prevalence.

Still, experts call for building awareness of the disease among patients and doctors. In 1993, it led to an estimated $23.9 billion in direct and indirect costs.

"We're very pleased with the report because it will give some data to the magnitude of the problem," says Suzanne Hurd, coordinator of the US COPD Coalition.

Hurd's group wants doctors to take a more active role in screening their patients, particularly smokers, for evidence of lung impairment. That includes using a device called a spriometer that measures airway function, and not simply relying on self-reported complaints.

Indeed, one reason the CDC report revealed such a dramatic undercount in the prevalence of COPD was that it relied on spirometer evidence, in addition to patient surveys and medical records. Mannino says 13.5 percent of American adults show signs of mild-to-moderate lung impairment when tested with the device, but only 30 percent of those are diagnosed with the disease.

As a result, some experts recommend that every current or former smoker age 45 and up have an occasional lung function test. The same applies for those with breathing trouble or a history of asthma.

What To Do

The USCOPD Coalition wants to make November National COPD Awareness Month, and Nov. 20 World COPD Day. For more information, check the group's web site. The American Lung Association also has more on the disease.

SOURCES: David Mannino, M.D., Centers for Disease Control and Prevention, Atlanta; Gail Weinmann, M.D., medical officer, National Heart, Lung, and Blood Institute, Bethesda, Md.; Suzanne Hurd, Ph.D., coordinator, U.S. COPD Coalition; U.S. Centers for Disease Control and Prevention, Surveillance Report, Aug. 2, 2002
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