EU’s approach to COPD remains focused on tobacco control

COPD leaves patients unable to breathe freely. [Ruslan Guzov/Shutterstock]

This article is part of our special report The true face of the second leading cause of death.

Despite alarming figures, the European Commission does not plan specific targets or a harmonised approach for the prevention of chronic obstructive pulmonary disease (COPD). Instead, it says it will ensure tobacco control policies are properly implemented in the member states.

The emergence of COPD as the second largest killer in the world has raised concerns among health experts and patient organisations who have called for an EU-wide approach to tackle the situation.

The European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) has been particularly vocal in demanding a better harmonisation of care standards for COPD patients by reinforcing preventive measures. That means including spirometry in general health check-ups and supporting patients’ rehabilitation and quit-smoking programmes across the EU.

EU member states have all committed to cutting mortality from non-communicable diseases or NDCs (including cancers, diabetes, cardiovascular diseases and COPD) by 25% by 2025 under the WHO’s global NCD action plan.

In the EU, however, health is a  national prerogative under the responsibility of member states. The European Commission does not aim to create any new targets for individual diseases such as COPD but to “maximise joint efforts with the member states and stakeholders in reaching these global targets”, a Commission spokesperson told

The EU executive does not intend to set specific targets or strategies to harmonise access to preventive care and rehabilitative treatment for COPD patients, or any other individual disease. The Commission’s main contribution in this area lies in the EU’s tobacco control policy.

In June, the Commission suggested a number of changes to EU tobacco legislation, including plain packaging and mandatory graphic health warnings, a ban on menthol and flavoured cigarettes, safety requirements for e-cigarettes, and the option to ban imports of non-complying tobacco products.

“The work with the member states to ensure that tobacco control policy in the EU is effective will continue,” a Commission spokesperson said.

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Unequal access

Chronic obstructive pulmonary diseases are the second largest killer in the world. With illegal levels of air pollution and smoking rates close to 20%, Europe is among the hardest hit regions – but for patients, access to treatment varies greatly.

COPD is not a single disease but an umbrella term for chronic lung diseases that reduce patients’ breathing capacity. By reducing oxygen flows, COPD affects all other organs and eventually leads to death.

According to the WHO, COPD is the second cause of death worldwide and killed 3 million people in 2015.

In Europe, approximately 1% to 4% of all adults suffer from it. The main known causes are tobacco smoking, but also indoor and outdoor air pollution, as well as occupational dust.

It is not only a major killer but a huge cost as well: the annual costs of healthcare and lost productivity specifically due to COPD are estimated at €48.4 billion.

Yet a survey of 19 EU member states carried out by the patients’ association EFA in 2013 found that prevention, access to care and rehabilitative treatment for patients with COPD varies greatly across member states.

Spirometry – a test of patients’ breathing capacity – can diagnose respiratory diseases like COPD and asthma at an early stage but it is normally only performed by specialist doctors.

General practitioner (GPs) are the first port of call for patients experiencing early symptoms. But they don’t use spirometry, mostly because they don’t receive extra pay for it. In addition, spirometry is not included in regular health check-ups.

Once diagnosed, patients’ access to treatment is also unequal: in all countries surveyed patients suffering from COPD have to pay a small fee for some services, although chronically ill patients are normally exempt.

But in some countries, like Italy and Finland, COPD is not recognised as a chronic disease, and patients may have to pay for treatment.

Chronically ill patients experience a reduction of their breathing capacity and would benefit from pulmonary rehabilitation practices that are scientifically proven to reduce the number of days spent in a hospital and prevent a worsening of their condition. They also help reduce anxiety and depression rates.

But pulmonary rehabilitation and quit-smoking schemes are not widespread, and they are free only in a minority of EU countries.

Health budgets are obviously at stake. But advocates say pulmonary rehabilitation doesn’t need to take up beds in hospitals: it can also be done by patients in the comfort of their home through the internet.

A recent study published by the European Respiratory Journal found that home-based tele-rehabilitation is as effective as in-patient care in reducing the risk of exacerbations and the number of hospitalisations. It also found that patients have a lower risk of being rushed off to the ER when they are treated at home.

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