COPD is the third leading cause of death worldwide, as of 2019, and was the third leading cause of death in the United States in 2011.[1]Global Initiative for Chronic Obstructive Lung Disease. Global strategy for prevention, diagnosis and management of COPD (2024 report). 2024 [internet publication].
https://goldcopd.org/2024-gold-report
[3]World Health Organization. Global health estimates: Leading causes of death. Cause-specific mortality, 2000–2019 [internet publication].
https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death
The death rate due to COPD increased over 100% between 1970 and 2002.[4]Jemal A, Ward E, Hao Y. Trends in the leading causes of death in the United States, 1970-2002. JAMA. 2005 Sep 14;294(10):1255-9.
https://jamanetwork.com/journals/jama/fullarticle/201494
http://www.ncbi.nlm.nih.gov/pubmed/16160134?tool=bestpractice.com
Globally, COPD has been shown to be responsible for 3.8% of deaths in high-income countries and 4.9% of deaths in low-income countries.[5]Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007 Sep 1;370(9589):765-73.
http://www.ncbi.nlm.nih.gov/pubmed/17765526?tool=bestpractice.com
There is significant variability in the prevalence of COPD between countries.[6]Mannino DM, Doherty DE, Sonia Buist A. Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med. 2006 Jan;100(1):115-22.
http://www.ncbi.nlm.nih.gov/pubmed/15893923?tool=bestpractice.com
[7]Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007 Sep 1;370(9589):741-50.
http://www.ncbi.nlm.nih.gov/pubmed/17765523?tool=bestpractice.com
[8]Menezes AM, Perez-Padilla R, Jardim JR, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. 2005 Nov 26;366(9500):1875-81.
http://www.ncbi.nlm.nih.gov/pubmed/16310554?tool=bestpractice.com
This may be due to differing rates of exposure to tobacco smoke and indoor and occupational pollutants.[5]Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007 Sep 1;370(9589):765-73.
http://www.ncbi.nlm.nih.gov/pubmed/17765526?tool=bestpractice.com
In the past, men have experienced higher rates of disease due to COPD. This difference has been thought to be due primarily to greater exposure to tobacco smoke and occupational pollutants. Surveys have shown that the prevalence of COPD appears to be becoming more equally distributed between men and women.[7]Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007 Sep 1;370(9589):741-50.
http://www.ncbi.nlm.nih.gov/pubmed/17765523?tool=bestpractice.com
[9]de Torres JP, Casanova C, Hernandez C, et al. Gender and COPD in patients attending a pulmonary clinic. Chest. 2005 Oct;128(4):2012-6.
http://www.ncbi.nlm.nih.gov/pubmed/16236849?tool=bestpractice.com
COPD contributes a significant burden of healthcare costs.[6]Mannino DM, Doherty DE, Sonia Buist A. Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med. 2006 Jan;100(1):115-22.
http://www.ncbi.nlm.nih.gov/pubmed/15893923?tool=bestpractice.com
Exacerbations are responsible for much of the morbidity and mortality experienced by people with COPD, and the median number per year ranges between 1 and 3.[10]Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000 May;161(5):1608-13.
http://www.ncbi.nlm.nih.gov/pubmed/10806163?tool=bestpractice.com
[11]Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998 May;157(5 Pt 1):1418-22.
http://www.ncbi.nlm.nih.gov/pubmed/9603117?tool=bestpractice.com
It has been clearly shown that patients with more severe manifestations of COPD have greater rates of mortality over time.[6]Mannino DM, Doherty DE, Sonia Buist A. Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med. 2006 Jan;100(1):115-22.
http://www.ncbi.nlm.nih.gov/pubmed/15893923?tool=bestpractice.com
However, estimates of mortality may be underestimated, as deaths in this population are often attributed to other etiologies such as other respiratory disorders, lung cancer, and cardiovascular disease.[6]Mannino DM, Doherty DE, Sonia Buist A. Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study. Respir Med. 2006 Jan;100(1):115-22.
http://www.ncbi.nlm.nih.gov/pubmed/15893923?tool=bestpractice.com
Acute exacerbations of COPD are commonly triggered by viral or bacterial pathogens, pollutants, GERD, or changes in temperature and humidity, and present with an acute-onset, sustained worsening of the patient's respiratory symptoms, lung function, functional status, and quality of life.[10]Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000 May;161(5):1608-13.
http://www.ncbi.nlm.nih.gov/pubmed/10806163?tool=bestpractice.com
[12]Rodriguez-Roisin R. COPD exacerbations.5: management. Thorax. 2006 Jun;61(6):535-44.
http://www.ncbi.nlm.nih.gov/pubmed/16738044?tool=bestpractice.com
[13]O'Donnell DE, Parker CM. COPD exacerbations. 3: Pathophysiology. Thorax. 2006 Apr;61(4):354-61.
http://www.ncbi.nlm.nih.gov/pubmed/16565268?tool=bestpractice.com
[14]Barberà JA, Roca J, Ferrer A, et al. Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. Eur Respir J. 1997 Jun;10(6):1285-91.
https://erj.ersjournals.com/content/erj/10/6/1285.full.pdf
http://www.ncbi.nlm.nih.gov/pubmed/9192930?tool=bestpractice.com
[15]Cote CG, Dordelly LJ, Celli BR. Impact of COPD exacerbations on patient-centered outcomes. Chest. 2007 Mar;131(3):696-704.
http://www.ncbi.nlm.nih.gov/pubmed/17356082?tool=bestpractice.com
[16]Spencer S, Jones PW; GLOBE Study Group. Time course of recovery of health status following an infective exacerbation of chronic bronchitis. Thorax. 2003 Jul;58(7):589-93.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746751/?tool=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/12832673?tool=bestpractice.com
[17]Xu W, Collet JP, Shapiro S, et al. Negative impacts of unreported COPD exacerbations on health-related quality of life at 1 year. Eur Respir J. 2010 May;35(5):1022-30.[18]Terada K, Muro S, Sato S, et al. Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation. Thorax. 2008 Nov;63(11):951-5.
http://www.ncbi.nlm.nih.gov/pubmed/18535116?tool=bestpractice.com
[19]Terada K, Muro S, Ohara T, et al. Abnormal swallowing reflex and COPD exacerbations. Chest. 2010 Feb;137(2):326-32.
http://www.ncbi.nlm.nih.gov/pubmed/19783670?tool=bestpractice.com
[20]Ingebrigtsen TS, Marott JL, Vestbo J, et al. Gastro-esophageal reflux disease and exacerbations in chronic obstructive pulmonary disease. Respirology. 2015 Jan;20(1):101-7.
https://onlinelibrary.wiley.com/doi/full/10.1111/resp.12420
http://www.ncbi.nlm.nih.gov/pubmed/25297724?tool=bestpractice.com
[21]Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010 Sep 16;363(12):1128-38.
http://www.nejm.org/doi/full/10.1056/NEJMoa0909883#t=article
http://www.ncbi.nlm.nih.gov/pubmed/20843247?tool=bestpractice.com
[22]Martinez CH, Okajima Y, Murray S, et al. Impact of self-reported gastroesophageal reflux disease in subjects from COPDGene cohort. Respir Res. 2014 Jun 3;15(1):62.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049804
http://www.ncbi.nlm.nih.gov/pubmed/24894541?tool=bestpractice.com
Exacerbation rates and all-cause mortality tend to be higher during winter months.[23]Rabe KF, Fabbri LM, Vogelmeier C, et al. Seasonal distribution of COPD exacerbations in the Prevention of Exacerbations with Tiotropium in COPD trial. Chest. 2013 Mar;143(3):711-9.
http://www.ncbi.nlm.nih.gov/pubmed/23188489?tool=bestpractice.com
Acute exacerbations of COPD, particularly those that are moderate to severe, have significant public health impact, with increased healthcare utilization and healthcare costs and increased mortality.[24]Sutherland ER, Cherniack RM. Management of chronic obstructive pulmonary disease. N Engl J Med. 2004 Jun 24;350(26):2689-97.
http://www.ncbi.nlm.nih.gov/pubmed/15215485?tool=bestpractice.com
[25]Ai-Ping C, Lee KH, Lim TK. In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: a retrospective study. Chest. 2005 Aug;128(2):518-24.
http://www.ncbi.nlm.nih.gov/pubmed/16100133?tool=bestpractice.com
[26]Donaldson GC, Wedzicha JA. COPD exacerbations .1: Epidemiology. Thorax. 2002 Oct;57(10):847-52.
http://www.ncbi.nlm.nih.gov/pubmed/16443707?tool=bestpractice.com
[27]Seneff MG, Wagner DP, Wagner RP, et al. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA. 1995 Dec 20;274(23):1852-7.
http://www.ncbi.nlm.nih.gov/pubmed/7500534?tool=bestpractice.com
[28]Soler N, Agusti C, Angrill J, et al. Bronchoscopic validation of the significance of sputum purulence in severe exacerbations of chronic obstructive pulmonary disease. Thorax. 2005 Nov;60(11):925-31.
http://www.ncbi.nlm.nih.gov/pubmed/16928715?tool=bestpractice.com
Early deaths among patients hospitalized with severe COPD exacerbation are often caused by concurrent problems such as pulmonary embolus, pneumonia, or congestive heart failure.[29]Zvezdin B, Milutinov S, Kojicic M, et al. A postmortem analysis of major causes of early death in patients hospitalized with COPD exacerbation. Chest. 2009 Aug;136(2):376-80.
http://www.ncbi.nlm.nih.gov/pubmed/19318666?tool=bestpractice.com
Patients may also be at risk of myocardial infarction and stroke in the post-exacerbation period.[30]Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest. 2010 May;137(5):1091-7.
http://www.ncbi.nlm.nih.gov/pubmed/20022970?tool=bestpractice.com