Assessing global COPD awareness with Google Trends

Discussion

COPD is one of the most alarming diseases with rising numbers in terms of incidence, prevalence, morbidity and mortality. However, the disease is largely underdiagnosed and public awareness of the diseases is low. To the best of our knowledge, this is the first report highlighting that the topic “chronic obstructive pulmonary disease” is under-represented in Google search queries compared with other frequent but less preventable diseases. Accordingly, low awareness of COPD in the general population has been reported previously [13–15]. A recent investigation by Seo et al. [16] assessed awareness and understanding of COPD in smokers participating in a smoking cessation programme. The authors showed that only 1% mentioned COPD as an example of a respiratory health problem, although more than two-thirds of the participants presented with COPD-related symptoms. Importantly, the authors observed a significant increase of smoking cessation willingness when awareness of COPD was raised [16].

The disparity between the relative search volume of “chronic obstructive pulmonary disease” and other topics, including “breast cancer” or “diabetes mellitus”, may have its origin in the only recently established awareness campaigns for COPD. In line with this assumption, Wikipedia contains a comprehensive article on “Breast cancer awareness” including almost 30 references, whereas the entry titled “COPD Awareness Month” fills only three sentences [17, 18].

Major efforts to raise awareness and knowledge on breast cancer have been undertaken over the past decades, making breast cancer a role model in terms of awareness promotion [19]. The pink ribbon has emerged as a brand concept for breast cancer and the National Breast Cancer Awareness Month (NBCAM) was founded in 1985 [19, 20]. The impact of the NBCAM on public interest is illustrated by cyclic relative search volume peaks during the month of October. In contrast, the COPD Foundation was established in 2004 by John W. Walsh, almost 20 years after the NBCAM [21]. In 2007, the Learn More Breathe Better programme was initiated to raise awareness for COPD and 10 years later, in 2017, the National Institutes of Health and the Centers for Disease Control and Prevention together with several other federal agencies published the COPD National Action Plan to fight COPD through improvements in public education, diagnosis, treatment and prevention [13, 22]. Importantly, the COPD National Action Plan proposes to evaluate the effectiveness of information campaigns. Accordingly, the herein presented Google Trends analysis may reflect the effectiveness of the COPD Foundation to raise awareness, as our data analysis shows a significant increase of search volumes related to “chronic obstructive pulmonary disease” in November, when the COPD Awareness Month and the World COPD Day are promoted. However, it is alarming that there is no significant trend towards a general increase in the global interest for “chronic obstructive pulmonary disease”, that the awareness for other diseases is growing at a much faster pace and that the relative search volume of the topic “lung cancer”, a disease closely related to COPD and cigarette smoking, is constantly decreasing.

Interestingly, we observed a rise in the relative search volume of “chronic obstructive pulmonary disease” during the winter months, displaying an annual cycle. Similarly, a study by Kumar et al. [23] reported seasonal patterns of online search trends related to cardiovascular health. We hypothesise that our findings reflect higher rates of acute COPD exacerbations during the winter months, closely related to infectious aetiologies such as Streptococcus pneumoniae and respiratory viruses including influenza virus [24, 25]. The fact that Google Trends is a powerful tool to analyse health-seeking behaviour was demonstrated previously by Ginsberg et al. [6], who tracked the geographic spread of influenza-like illness via Google Trends. The authors were able to show a correlation between web queries via Google and the number of physicians being consulted in a certain geographic region. This approach enabled calculation of the current influenza activity levels, which may be of relevance for patients affected by COPD, as similar trends could help to predict more severe exacerbations with the need of additional intensive care and mechanical ventilation therapy.

The topics “breast cancer” and “chronic obstructive pulmonary disease” revealed an awareness month-related relative search volume peak, a finding also described by Schootman et al. [9], who analysed public interest in cancer screening via Google Trends and found a higher relative search volume during particular cancer awareness months. Accordingly, Jellison et al. [26] reported annual relative search volume peaks for “arthritis” during the National and World Arthritis Days.

Although the herein presented data show interesting new aspects related to the 10 most deadly diseases of high-income countries, we have to acknowledge potential limitations of this study as the presented data need to be carefully interpreted in the context of disease awareness. First, the data output is a relative number, therefore an increase of search volumes related to other important topics (politics, general news, technology, etc.) might impact on relative search volumes. Second, there is no information available about the individuals who searched for the analysed terms or topics. A bias related to high numbers of search queries by healthcare professionals, industry or marketing agencies cannot be excluded.

Finally, it is to some extent elusive which search queries are summarised in the topics defined by Google Trends algorithms, as detailed information on how Google generates this data is not provided. The selections of terms/topics might affect the results and conclusions; therefore, we decided to use the topics more accurately representing the top 10 causes of death and provide a detailed description of our data-gathering approach in order to facilitate reproducibility. The importance of accuracy in defining the search queries is exemplified when searching Google Trends for the topic “cough”. Cough is a symptom frequently associated with COPD, although not specifically representing this disease (reported in the supplementary material), thus using the query “cough” may be useful to analyse symptom-related interest but does not sufficiently represent global COPD awareness. Although the number of studies based on Google Trends is increasing, so far no standardised procedure for data collection is known and thus more guidance by Google is warranted in order to assist researchers to establish an optimal search strategy [7].

In conclusion, Google Trends provides an important tool to evaluate public interest related to COPD and associated respiratory diseases. In line with the goals of the COPD National Action Plan, Google Trends helps to collect, analyse, report and disseminate COPD-related health data. Thus, Google Trends may drive change and track progress, and may help to improve programmes to counteract the current lack of public COPD awareness.