Updated on 13 June 2013
Dr Sonia Buist, one of the most respected pulmonary researchers in the world, believes that "COPD doesn't get much sympathy or a lot of research funding", largely because as a smoker's problem, it is considered to be "self-inflicted". She studied more than 9,000 people aged over 40 from 12 different countries. Her conclusions were that COPD is the cumulative response of the lungs to the burden of all that is breathed over a lifetime and that COPD varied in prevalence throughout the world. While the overall prevalence was 10.10 percent, the highest prevalence was 22.20 percent in men in Cape Town, South Africa and the lowest being in Hanover, Germany with only 3.70 percent in women. Asian countries were not mentioned. It is to say the least, interesting, to note progress in the global Burden of Obstructive Lung Disease Initiative (BOLD), which is collecting country-specific data on the prevalence, risk factors and social and economic burden of chronic obstructive pulmonary disease. To date, of the 21 sites completed, Asia is represented only by India and the Philippines. Of the 20 sites currently in progress, only Mysore in India and Penang in Malaysia are involved. Clearly Asia has been underrepresented in these important studies.
Recently the Canadian Lung Association along with medical expertise from the Canadian Thoracic Society issued a National Report Card on Chronic Obstructive Pulmonary Disease. The key findings were that there was an alarming increase in mortality and a shockingly low level of awareness. There was a clear deficiency in the way COPD was being managed and while 98 percent of Canadians had awareness of breast cancer, HIV/AIDS and Alzheimer's Disease, only 17 percent had any awareness of COPD.
A regional COPD working group recently tried to estimate the COPD prevalence in 12 Asia-Pacific countries. They concluded that the total number of moderate to severe COPD cases in this region was 56.60 million, assuming the modest prevalence rate of 6.30 percent. Given that the overall worldwide prevalence is thought to be in the 10 percent range, it seems reasonable to speculate that the number of cases of moderate to severe COPD in Asia is, in fact, closer to 100 million.
If level of awareness of COPD in a developed country such as Canada is as low as 17 percent, the awareness levels in the developing markets of Asia are likely to be far worse; surely a suitable issue to be explored in an Asia-specific epidemiological research study in the future. Such a study will possibly be complex: in the developing countries within Asia, the prevalence of tuberculosis is high, so that it is likely that smokers with chronic cough might well have complex lung pathology with co-morbidities. Such patients, if fortunate enough to be correctly diagnosed and treated are of course ineligible for either inhaled or systemic corticosteroids or to be recruited in clinical trials of immune modulating new therapies for COPD.
Attempting to glean Asia-specific information from the Global Initiative for Chronic Lung Disease is challenging as most of the available conclusions come from industrially developed countries. In Asia, with its well recognized ethnic, economic, educational and social diversity, there is a lack of consistency even in the definition of COPD. Hence, attempting to evaluate COPD epidemiology across Asia, using medical records and death certificates makes for scant and unreliable data. Suffice to say, any available prevalence and morbidity data on COPD in Asia are likely to underestimate the total burden. As smoking is the main factor responsible for the development of COPD, and as smoking prevalence is highest in the Western Pacific and China, which is still increasing, the rise in COPD within Asia will undoubtedly be dramatic. One would hope that in the near future, we will have the opportunity to contribute to, and eventually see, an increase in public awareness and educational initiatives about COPD risks in Asia.
COPD management in Asia
The good news about COPD is that it is both preventable and treatable. Furthermore, the Clinical Practice Guidelines are well established and readily available from the Global Initiative for Chronic Lung Disease (GOLD). The bad news is that of the approximately 25 countries that comprise the Asia-Pacific, it is extremely difficult to evaluate the level of compliance with the GOLD guidelines or whether the recommended medicines are available. While there may be cultural differences in medical practice across Asia, the major problems in following the guidelines are resource conflicts and lack of organizational support. In addition, even in the most developed countries, where beta-agonists, anticolinergics, corticosteroids, antibiotics and phosphodiesterase inhibitors are both available and used in compliance with the guidelines, none have been shown to decrease mortality. To date, the only proven strategies to reduce mortality in COPD are smoking cessation and continuous, supplemental oxygen therapy.