COPD Epidemic Forecasted in Next 15 Years

Barring major advances in prevention, diagnosis, and treatment of chronic obstructive pulmonary disease (COPD)—and even taking into account steadily declining smoking rates—hospitalizations for the disease will increase by more than 150% over the next 15 years in developed countries, a Canadian study predicts.

Amir Khakban, MSc, of the University of British Columbia, Vancouver, Canada, and colleagues predict the greatest growth in numbers of COPD patients will occur in the older age group (75 years and up), in whom the absolute number will increase by 220%. The burden of inpatient care, measured as total annual inpatient days, will grow by 185%, they forecast. The new study was published in the American Journal of Respiratory Critical Care Medicine.

The data-driven forecasting analysis combines forecasts of population growth and aging among the 4.7 million residents of British Columbia, Canada, with health data to make the forecast about COPD incidence, prevalence, deaths, and total length of inpatient stays in hospitals. Data were from the province’s health databases from 2001 to 2010. The researchers predict that COPD hospitalizations are projected to more than double by 2030 in British Columbia. The increase is especially striking for hospital-based care, which already is responsible for the greatest share of the direct cost of COPD, they note. The predicted trend in inpatient care is likely to significantly impact healthcare systems, the authors conclude.

There are 2 competing factors regarding COPD, said coauthor Don D. Sin, MD, MPH. While there is a decrease in smoking, which should drive down the rate of COPD, counterbalancing that is the aging of the population, which is driving rates up because COPD is a disease of aging.

The study also found that:

• COPD cases will increase by an annual growth rate of 4.8% over the next decade and a half. By 2030 approximately 55% of COPD patients in British Columbia will be 75 years of age or older.
• Excess inpatient days will reach 667,497 days in 2030, 182% higher than the number in 2010. Patients over age 75 will represent 60% of the excess inpatient days, and 83% will be patients age 65 and older.

The researchers said their study was designed to illustrate the pending epidemic of COPD hospitalizations in North America and most other industrialized nations, where there is already a high prevalence of COPD and where the population is aging. They said that the province of British Columbia was a good locale to use to predict future trends in COPD hospitalizations because all hospitalizations and healthcare resource utilizations occur within a publicly funded healthcare system and are accurately captured in provincial administrative databases.

Unless something is done soon to modify COPD disease burden, the authors conclude, our hospitals are shortly going to be overwhelmed with COPD patients. They recommend more aggressive strategies to identify the disease early, before patients must be hospitalized. Currently, 40%-50% of COPD patients are not diagnosed until they are hospitalized.

“We can do much better than that,” Sin told MedPage Today. “We need to treat patients early with the right medications and the right supportive care to keep them out of hospitals.”