Characteristics of Adults Dying with COPD

doi:10.1378/chest.122.6.2003

Chest

Volume 122, Issue 6, December 2002, Pages 2003-2008

https://doi.org/10.1378/chest.122.6.2003 Get rights and content

Study objective

To describe factors associated with COPD deaths in the United States.

Design

Cross-sectional survey.

Participants

A total of 12,803 decedents in the National Mortality Followback Survey, a nationally representative sample of US deaths in 1993.

Methods

We compared the characteristics of adults ≥ 35 years of age who died with COPD (bronchitis, emphysema, chronic airway obstruction) with those dying without COPD listed on their death certificates.

Results

Of the estimated 225,400 adults who died with COPD in 1993, 16.7% had never smoked. People dying with COPD were more likely than those dying without COPD to be current smokers (odds ratio [OR], 6.5; 95% confidence interval [CI], 4.3 to 9.9) or former smokers (OR, 3.7; 95% CI, 2.5 to 5.3), have a history of asthma (OR, 5.0; 95% CI, 3.2 to 7.8), be underweight (OR, 4.5; 95% CI, 2.8 to 7.2), and be of the white race (OR, 3.1; 95% CI, 2.4 to 4.0), after controlling for age group and sex.

Conclusions

A significant proportion of COPD-related deaths occurs in never-smokers. Factors such as a history of asthma and being underweight are associated with COPD mortality and may provide additional opportunities for intervention.

Section snippets

Sample

The 1993 National Mortality Followback Survey,¹¹ which became available in 1998, was initiated by the National Center for Health Statistics to provide information related to the mortality experience of the United States beyond that obtained through the vital registration of deaths. The National Mortality Followback Survey selected deaths from the 1993 Current Mortality Sample, a 10% systematic random sample of death certificates received by the vital statistics offices. Death certificates

Results

Most adult decedents ≥ 35 years of age in 1993 were white (87.7%), ≥ 75 years of age (54.9%), had a high school education or less (77.3%), lived in a metropolitan area (74.4%), had a family income of ≤ $16,499 (54.6%), and had smoked (55.4%) [Table 1]. Approximately 10.6% of these death certificates listed COPD: 42.3% as the underlying cause of death, and 57.7% as a contributing cause of death. A lifetime history of asthma was reported for 6.5% of adult decedents. Among people dying with COPD,

Discussion

This nationally representative study is consistent with other research linking smoking with COPD.¹³^,¹⁴^,¹⁵ However, in addition to the strong association between smoking and dying with COPD, an estimated 37,000 adults died with COPD who had never smoked, including 12,900 for whom COPD was listed as the underlying cause of death. This somewhat surprising finding underscores the need to look beyond smoking to control morbidity and mortality related to COPD.

Another factor we found associated with

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2016, Allergology International
Citation Excerpt :
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The characteristics of phenotypes of elderly patients with asthma are unknown. The aim of this study was to classify these phenotypes using lung function tests and images from high-resolution computed tomography (HRCT), and to identify associations between clinical characteristics and phenotypes.
A cross-sectional study was conducted in 165 elderly patients (>65 years of age) who underwent a multidimensional assessment of clinical and functional status and comorbidity. The patients were divided into three phenotypes: (1) asthma-predominant, (2) asthma-obstructive airway disease (OAD) overlap without emphysema, and (3) asthma-OAD overlap with emphysema (asthma-emphysema overlap) based on chest HRCT. A receiver operating characteristic (ROC) curve was constructed to evaluate the cutoff for differentiating between the two OAD phenotypes. Multivariate analysis was also used to distinguish between these two phenotypes.
The phenotypes were asthma-predominant in 48 patients (29%), asthma-OAD without emphysema in 36 (22%), and asthma-emphysema in 81 (49%). Patients with asthma-emphysema were more frequent smokers. In multivariate analysis, smoking status (odds ratio 2.92: 95% CI 1.21–7.00, P = 0.03) and % predicted FEV₁ ≤70% (odds ratio 3.18: 95% CI 1.13–8.92, P = 0.03) differed significantly between the asthma-emphysema and asthma-OAD without emphysema phenotypes.
Half of elderly patients with asthma are characterized by asthma-emphysema overlap. Our results showed that elderly patients with asthma who are smokers and have moderate or severe OAD are also likely to have emphysema.
Factors predictive of airflow obstruction among veterans with presumed empirical diagnosis and treatment of COPD
2015, Chest
Citation Excerpt :
Similar to other studies, we demonstrated that older patients given an empirical diagnosis of COPD are more likely to have AFO.6, 29–31 We also found that predictors expected to increase the risk of AFO, such as tobacco consumption and being underweight, were associated with a higher risk of having AFO.32, 33 Prior studies have shown that patients with more severe COPD (based on FEV1) were less likely to receive an inaccurate COPD diagnosis.34
Despite guideline recommendations, patients suspected of having COPD often are treated empirically instead of undergoing spirometry to confirm airflow obstruction (AFO). Accurate diagnosis and treatment are essential to provide high-quality, value-oriented care. We sought to identify predictors associated with AFO among patients with and treated for COPD prior to performance of confirmatory spirometry.
We identified a cohort of veterans with spirometry performed at Pacific Northwest Department of Veterans Affairs medical centers between 2003 and 2007. We included only patients with empirically diagnosed COPD in the 2 years prior to spirometry who were also taking inhaled medication to treat COPD in the 1 year prior to spirometry. We used relative risk regression analysis to identify predictors of AFO.
Among patients empirically treated for COPD (N = 3, 209), 62% had AFO. Risk factors such as older age, prior smoking status, and underweight status were associated with AFO on spirometry. In contrast, comorbidities often associated with somatic symptoms were associated with absence of AFO and included congestive heart failure, depression, diabetes, obesity, and sleep apnea.
Comorbidities associated with somatic complaints of dyspnea were associated with a lower risk of having airflow limitations, suggesting that empirical diagnosis and treatment of COPD may lead to inappropriate treatment of individuals who do not have AFO.
Asthma and chronic obstructive pulmonary disease: Similarities and differences
2014, Clinics in Chest Medicine
Citation Excerpt :
In addition, patients with the overlap syndrome are more likely frequent exacerbators (ie, >2 exacerbations per year), have more gas trapping on CT, worse quality of life, more respiratory symptoms, more hospitalizations, and consume much more health care resources than pure asthmatics.6,7,14,57–62 Moreover, patients with the overlap phenotype are reported to have higher mortalities,63 especially when peripheral blood eosinophilia is present.64 Hardin and colleagues14 additionally found that subjects with both COPD and asthma combined frequently have rhinitis, although it still remains to be established whether or not this reflects underlying atopy.
Fluticasone furoate is more effective than mometasone furoate in restoring tobacco smoke inhibited SOCS-3 expression in airway epithelial cells
2014, International Immunopharmacology
Fluticasone furoate (FF) and mometasone furoate (MF) are potent glucocorticoids recommended for the treatment of allergic rhinitis and other inflammatory diseases. However, whether these drugs render any anti-inflammatory effects in Chronic Obstructive Pulmonary Disease (COPD) is unclear. Emerging data on suppressors of cytokine signaling-3 (SOCS-3) activation in the lungs during inflammation suggests that SOCS3 can be potential targets for regulating pulmonary inflammatory responses in COPD. In this study, we compared the effect of FF with MF on SOCS-3 expression in tobacco smoke (TS) exposed BAEpCs in vitro and in a mouse model of COPD in vivo. BAEpCs were exposed to TS or room air and later were treated with either FF (1 nmol–100 nmol) or MF (10–500 nmol) inhibitors in the presence and absence of Jak1 and Stat-3 inhibitors. C57BL/6 mice were exposed to TS for 6 months, and treated with either FF, MF for 2 and 4 weeks. FF induced 7 fold increases in SOCS-3 expression in BAEpCs whereas MF induced a three fold increase when compared to control. Jak1 and Stat-3 inhibitors significantly inhibited the FF and MF induced SOCS-3 expression in BAEpCs. In addition, FF and MF restored TS inhibited SOCS-3 expression in the airway epithelium of COPD mice. FF and MF treatments significantly reduced leukocyte infiltration in airways and inhibited lung inflammation. Our study elucidates a novel mechanism for the anti-inflammatory action of FF in COPD. The superior efficacy of FF may be in part due to the increased expression of SOCS-3 in BAEpCs.
Burden of chronic obstructive pulmonary disease in medicare beneficiaries residing in long-term care facilities
2009, American Journal Geriatric Pharmacotherapy
Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD increases health care resource utilization and spending and adversely affects quality of life. Data from the clinical and economic outcomes in Medicare beneficiaries with COPD who reside in long-term care (LTC) facilities are limited.
Objective: The purpose of this study was to investigate the clinical and economic outcomes associated with COPD in Medicare beneficiaries residing in LTC facilities.
Methods: This retrospective cohort study analyzed data from MarketScan Medicaid, a large US administrative claims database containing data on Medicaid programs in 8 states. The study cohort comprised LTC facility residents aged ≥60 years who had a diagnosis of COPD. Eligible patients also had a prescription filled between January 1, 2003, and June 30, 2005, for one of the following COPD treatments: fluticasone propionate + salmeterol xinafoate, tiotropium bromide, ipratropium bromide, or ipratropium bromide + albuterol sulfate. The date of the first prescription fill was considered the index date. Measures of health care resource utilization included COPD-related and all-cause hospitalizations and emergency department (ED) visits. Cost analysis outcomes included COPD-related and all-cause inpatient, outpatient, pharmacy, LTC, and total costs during the 12-month postindex period.
Results: Data from 3037 patients were included (63.0% women; 82.2% white; mean [SD] age, 78.1 [10.0] years). A total of 43.3% of patients had ≥1 hospitalization; 90.0%, ≥1 ED visit. With the exception of age <70 years, age was associated with all-cause hospitalization (age 70–<75 years, hazard ratio [HR] = 1.31 [95% CI, 1.03–1.68]; age 75–<80 years, HR = 1.40 [95% CI, 1.11–1.78]; age ≥80 years, HR = 1.48 [95% CI, 1.19–1.85]). Age was not associated with COPD-related hospitalization, all-cause ED visits, or COPD-related ED visits. The risk for all-cause hospitalization in white patients was significantly lower compared with that in nonwhite patients (HR = 0.79 [95% CI, 0.69–0.91]). Patients with comorbid asthma had a higher risk for a COPD-related ED visit (HR = 1.34 [95% CI, 1.08–1.66]) than did patients without asthma. Preindex all-cause hospitalization was associated with COPD-related hospitalization (HR = 1.78 [95% CI, 1.49–2.14]) and all-cause hospitalization (HR = 2.05 [95% CI, 1.932.19]). Twelve-month COPD-related and all-cause direct expenditures per beneficiary were US $7391 and $48,183. In COPD-related and all-cause estimates, mean (SD) LTC costs were the largest cost components ($5629 [$12,562] and $32,966 [$14,871], respectively), followed by pharmacy costs ($956 [$957] and $5565 [$3873]), inpatient costs ($466 [$3393] and $6436 [$22,603]), and outpatient costs ($341 [$1793] and $3216 [$6458]).
Conclusion: This study found that the utilization of health care resources and economic burden of LTC residents with COPD were primarily due to LTC, pharmacy, and inpatient costs.
Adverse Childhood Experiences and Chronic Obstructive Pulmonary Disease in Adults
2008, American Journal of Preventive Medicine
Citation Excerpt :
Because of the secular decrease in the prevalence of smoking that has occurred over the past several decades,41 in the future the proportion of cases of COPD that are attributable to smoking will also necessarily decline. In fact, a 1993 study estimated that 17% of COPD mortality in the U.S. population occurs in never smokers.42 National data indicate that 20% of the estimated 11.5 million adults with low lung-function had never smoked.43
Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality in the U.S. However, little is known about the influence of childhood stressors on its occurrence.
Data were from 15,472 adult HMO members enrolled in the Adverse Childhood Experiences (ACE) Study from 1995 to 1997 and eligible for the prospective phase. Eight ACEs were assessed: abuse (emotional, physical, sexual); witnessing domestic violence; growing up with substance-abusing, mentally ill, or criminal household members; and parental separation or divorce. The number of ACEs (ACE Score) was used to examine the relationship of childhood stressors to the risk of COPD. Three methods of case ascertainment were used to define COPD: baseline reports of prevalent COPD, incident hospitalizations with COPD as a discharge diagnosis, and rates of prescription medications to treat COPD during follow-up. Follow-up data were available through 2004.
The ACE Score had a graded relationship to each of three measures of the occurrence of COPD. Compared to people with an ACE Score of 0, those with an ACE Score of ≥5 had 2.6 times the risk of prevalent COPD, 2.0 times the risk of incident hospitalizations, and 1.6 times the rates of prescriptions (p<0.01 for all comparisons). These associations were only modestly reduced by adjustment for smoking. The mean age at hospitalization decreased as the ACE Score increased (p<0.01).
Decades after they occur, adverse childhood experiences increase the risk of COPD. Because this increased risk is only partially mediated by cigarette smoking, other mechanisms by which ACEs may contribute to the occurrence of COPD merit consideration.

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Chest

Clinical Investigations: COPDCharacteristics of Adults Dying with COPD

Study objective

Design

Participants

Methods

Results

Conclusions

Section snippets

Sample

Results

Discussion

Med Clin North Am

Nutrition

Chest

J Allergy Clin Immunol

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease: a summary of definitions, epidemiology, pathophysiology, and diagnosis in staging (COPD) in the complete management

Am J Respir Crit Care Med

Direct medical costs of chronic obstructive pulmonary disease chronic bronchitis and emphysema

Respir Med

Deaths: final data for 1998

National Vital Statistics Reports

Definitions and methodology in chronic obstructive pulmonary disease research

Long-term survival of a cohort of community residents with asthma

N Engl J Med

Socioeconomic status and chronic obstructive pulmonary disease

Thorax

Prognostic value of nutritional status in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Chronic obstructive pulmonary disease in lifelong non-smokers: results from NHANES

Am J Public Health

Molecular epidemiology: a key to better understanding of chronic obstructive lung disease

Monaldi Arch Chest Dis

National Mortality Followback Survey: public use date file documentation (machine-readable data file and documentation)

Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, based on the recommendations of the Ninth Revision Conference, 1975

The epidemiology of cigarette smoking and its impact on chronic obstructive pulmonary disease

Am Rev Respir Dis

The epidemiology of chronic respiratory disease

Prev Med

Smoking and health: report of the Advisory Committee to the Surgeon General of the Public Health Service

Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Asthma attacks with eosinophilia predict mortality from chronic obstructive pulmonary disease in a general population

Am J Respir Crit Care Med

Clinical Investigations: COPD
Characteristics of Adults Dying with COPD