This article is part of our special report The true face of the second leading cause of death.
The idea of a cough being fatal brings up images of coal mining, hollow-cheeked children and Charles Dickens novels. But are we really past the time when a simple cough could kill you?
Unfortunately not. According to the WHO, chronic obstructive pulmonary diseases (COPD) are the second largest cause of death, killing 3.2 million people in 2015 alone. In Europe, between 1 and 4% of all adults suffer from COPD.
Causes range from smoking (including passive smoking), air pollution and occupational dusts and fumes.
The effect is a persistent reduction of patients’ airflow capacity and its symptoms include breathlessness and chronic cough. But these rarely come alone.
COPD patients are also at higher risk of stroke, due to a reduced flow of oxygen, and indeed heart diseases may be the final cause of death. Research also shows that COPD is often the antechamber of type 2 diabetes.
Patients with COP are limited in their daily life activities, and acute episodes of breathlessness can also trigger anxiety and depression. Mental illness in patients with COPD have devastating consequences on patients’ coping strategies, and evidence shows that mental health problems increase reliance on healthcare systems of COPD patients.
Negative feedback loop
On top of reinforcing the negative impacts of co-morbidity, COPD exerts a devastating economic burden as well.
A 2015 study found that breathlessness and airflow obstruction (symptoms of COPD) could predict future job instability. A survey in the UK found that 10% of respondents experiencing airflow obstruction quit their job, switched to part time or reported changing their working hours and activities at work for health reasons.
Not only can COPD put people out of work but also unemployment may have a negative impact on patient health, increasing the risk of co-morbidities and the death toll of COPD, in a negative feedback loop.
Research shows that patients with COPD are more likely to develop co-morbidities, experience more acute episodes and have to be hospitalised more frequently – therefore adding the indirect cost of unemployment to the direct cost of healthcare.
Estimates suggest the EU spends close to €50 billion on COPD alone, due to health costs and loss of productivity.
Keeping patients in employment would slow down the disease, and lead to lower healthcare costs.
The EU does not have a specific strategy on COPD but treats it as part of its action on non-communicable diseases.
Commenting on its action on non-communicable diseases, the EU executive said: “The current joint action on non-communicable disease works on the issue of preventing chronic conditions at the workplace and retention of or re-employment of persons with chronic conditions. Best practices will be selected and a toolkit for employers developed.”
In the first phase of its work on non-communicable disease, the EU worked on a training programme for managers of patients with co-morbidity, and a new care model for co-morbid patients, which it seeks to field-test starting from 2020.
Treatment and prevention
Many cases of COPD are preventable by quitting smoking at an early stage – and even chronic patients can achieve a better quality of life and reduce the risk of death by engaging in active lifestyles.
The majority of COPD cases become apparent after 40 or 50 years of age, and an “active ageing” approach can bring significant improvements by ensuring the patient stays active thus reducing the risk of exacerbation.
Some EU countries (Finland, the Czech Republic and Portugal) have specific, cost-effective COPD programs, and other such as the UK, France, and the Netherlands have developed integrated care pathways (IPS) that outline all steps of treatment to lead to an improved outcome for the patient.
However, a survey of 19 member states by patients association EFA found significant variations in terms of access to treatment and preventive care.
But because health policy is the responsibility of member states, the EU takes only a subsidiary role.
“Taking into account the responsibilities of the member states for the definition of their health policy, the Commission does not intend to shape specific strategies on harmonising access to preventive care and rehabilitative treatment for patients with COPD or any other individual diseases,” a Commission spokesperson said.