The facts about chronic obstructive pulmonary disease (COPD) aren’t pretty. COPD is not one but a group of diseases that impact airflow and breathing. Included in the group are emphysema and chronic bronchitis. (These diseases are grouped together because they are commonly diagnosed together.) COPD is the third leading cause of death. In 2010, it was the cause of death of 135,000 Americans. Every year, COPD results in millions of visits to the doctor’s office or emergency room and hundreds of thousands of hospitalizations, which last an average of almost five days.
All that medical care doesn’t come cheap. COPD is the fifth most expensive disease in the US, with $32.1 billion in direct medical costs. (In addition, billions of dollars are attributed to absenteeism and mortality costs as a result of COPD.) An additional concern is that many COPD sufferers are rehospitalized soon after release. COPD is the third most common cause of 30-day rehospitalization. Under the Hospital Readmissions Reduction Program (HRRP), penalties or loss of benefits are applied to hospitals with greater than average rehospitalization. The penalty for readmission of COPD patients beyond average is $33,000. Of US hospitals, 44.5% received readmissions penalty in 2013.
Because there is no cure for COPD, limiting rehospitalizations primarily involves ensuring appropriate treatment to limit symptoms, and exacerbations, which account for 50-75% of medical costs. However, there are actions that can slow the progression of COPD. By diagramming the cause-and-effect relationships resulting in progression of COPD in a Cause Map, we can visually show how solutions act on these causes. As discussed above, impacts to goals associated with COPD include patient safety (deaths), environmental (exposure to air pollutants), compliance (potential for penalties/ loss of benefits), patient services (high levels of rehospitalization), operations (absenteeism) and property/labor (direct medical costs). These impacts are primarily caused by exacerbation of COPD.
Exacerbation of COPD results from the progression of the disease and delayed treatment. COPD develops due to exposure to air pollutants (primarily tobacco smoke or industrial chemicals), genetic factors (which are just beginning to be understood), and respiratory infections or untreated asthma. Because there is no cure for COPD, time without treatment is the primary way that symptoms increase. (82% of COPD sufferers are over age 65.) Inadequate treatment typically results from the underdiagnosis of COPD (experts predict 10-12 million sufferers have not yet been diagnosed) and insufficient adherence to a medication regime. Based on self-reported values and pharmacy claims, adherence to prescribed medication regime is 32-50%, meaning less than half of COPD sufferers are following doctor’s orders with regards to their COPD, even though studies have also found that optimized medications can reduce exacerbations of COPD by 20%.
Along with underdiagnosis, a cause of exacerbations is delayed treatment. Part of this is also caused by insufficient adherence to a prescribed medication regime, but also to delayed reporting. Symptoms of an exacerbation generally occur about a week prior to a discernible reduction in lung function, but all too often that week is spent without medical care because patients tend to delay reporting symptoms until their lung function is affected.
To reduce the impact of COPD as well as the potential for rehospitalization, the following is recommended: First, the biggest impact an individual can have on COPD is to stop smoking. Individuals should also reduce their exposure to air pollutants, including cigarette smoke and industrial chemicals (whether at the work place or in home cleaning products). Those experiencing an exacerbation of symptoms should report it immediately and should follow all medication guidelines given by their doctor. For doctors, guidelines for the use of spirometry (a breathing test to measure lung function) can provide a more accurate diagnosis of COPD. Presenting information to patients about the importance of the above measures can also help reduce COPD exacerbations and potential for rehospitalization.
To view a one-page PDF with an overview of the cause-and-effect relationships, and recommended solutions for minimizing the impact of COPD, please click “Download PDF” above. Or, visit the COPD Foundation to learn more. You can also view a Cause Map of America’s Smoking Epidemic, here.