Chest
Volume 117, Issue 5, Supplement 2, May 2000, Pages 326S-331S
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Scope of the COPD Problem in North America: Early Studies of Prevalence and NHANES III Data: Basis for Early Identification and Intervention

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COPD is a common disease that is often not diagnosed in the primary-care setting. This review highlights the findings of studies ranging from the early 1960s to the third National Health and Nutrition Examination Survey (NHANES III) study, undertaken to try and accurately estimate the prevalence of COPD in the US population. Results of the NHANES III indicate that COPD remains frequently underdiagnosed, and that spirometry should be more widely used in the primary-care setting to identify asymptomatic disease. Early intervention, in particular smoking cessation, could alter the course and outcome of disease in patients with COPD.

Section snippets

Earlier Prevalence Studies

Early regional COPD prevalence studies included Berlin, NH5; Tecumseh, MI6; and Glenwood Springs, CO.7 These studies surveyed subjects with somewhat different degrees of airflow obstruction and used dissimilar definitions of COPD. In all studies, an attempt was made to separate COPD from acute intermittent and/or reversible asthma.

In Berlin, NH, the prevalence of a broad designation, chronic nonspecific respiratory diseases, ranged from 15.4 to 39.1% in men, in different locations in the

National Health and Nutrition Examination Survey III

A recent analysis of data from the third National Health and Nutrition Examination Survey (NHANES III) documents the contemporary prevalence of obstructive lung disease (OLD) in large population samples.11 Full details of this study are beyond the scope of this presentation and have previously been reported11; however, there are a number of important findings that should be highlighted. Briefly, this study was limited to adults aged ≥ 17 years, who classified themselves as white or black, had

The Lung Health Study

The Lung Health Study showed that stopping smoking can greatly retard the rate of decline in FEV1 compared to continuing to smoke in a population aged 35 to 60 years. This landmark study forms an additional foundation for the early history of smoking in order to identify abnormality and risk of progressive impairment on the pathway to symptomatic COPD.14 Unfortunately, only a small percentage of subjects were able to stop smoking for the full 5 years of this study; only 22% who received special

Discussion

Early prevalence studies showed that COPD was common and related to smoking in various industrial and nonindustrial communities in the United States. Smoking was more prevalent in the 1960s and 1970s than in the period of the NHANES III study. For example, between 1983 and 1995, overall smoking prevalence among those aged ≥ 18 years declined from 34 to 26% for white men, from 41 to 29% for African-American men, from 30 to 24% among white women, and from 32 to 23% among African-American women.2

Summary

COPD has been known for many years to be a disease of high prevalence, both in industrialized and in nonindustrialized communities. Identification of patients with COPD-related symptoms and spirometric abnormalities identifies a population at risk for premature morbidity and mortality from both respiratory and nonrespiratory causes. The recent NHANES III population analysis sheds additional light on the high prevalence of OLDs, of which COPD is a major component. Since the majority of patients

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