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World COPD Day 2008
Campaign Resources Top Tips Resources in Greek 3-Question COPD Survey

World COPD Day 2008World COPD Day 2008

Breathless not helpless is the theme of World COPD day on 19 November 2008.  It marks a day of global action to encourage effective care for chronic obstructive pulmonary disease (COPD)

The International Primary Care Respiratory Group (IPCRG) is supporting the day, in conjunction with the Global Initiative for Chronic Obstructive Lung Disease (GOLD), in order to raise awareness of the central role of primary care physicians in diagnosing and treating COPD and improving the quality of patients' lives.

Primary care physicians are uniquely placed to tackle COPD. Some of the challenges that they face in doing this include: significant restrictions, in some countries, on access to suitable diagnostic tests, common misconceptions amongst professional colleagues about treatment of COPD, and finally, low patient perception of symptoms of COPD especially in the mild to moderate stages, and overall lack of awareness.

As a result, COPD remains massively under-diagnosed throughout the world, with devastating consequences for millions of sufferers. Over 10% of men in Greece suffer from COPD and it is estimated that two thirds of people suffering from COPD remain undiagnosed. In the UK it is estimated that 2.8 million people remain undiagnosed and 30,000 people die each year from the disease.

However, the burden of the disease is high all over the world, with 210 million people suffering from COPD and deaths expected to rise by 30% over the next ten years unless urgent intervention can cut risks, such as smoking1.  The IPCRG has developed a package of resources for our members to support primary care physicians to identify and begin to address some of these challenges.

Early diagnosis and effective treatment can have a significant impact on symptoms. (See the IPCRG guidelines on the management of COPD). However, a survey conducted by IPCRG amongst its members reveals enormous variability across countries in access to diagnostic tests and treatments for COPD (See the survey results)2.

In some countries, such as Romania, primary care is not permitted to undertake diagnostic tests or to prescribe without recommendation from a specialist. In Norway, reimbursement is linked to undertaking spirometry in order to provide an incentive for doctors to diagnose accurately. In others, where access to spirometry testing is available, there is concern that maintenance of the spirometer and quality of the tests are far from excellent. In addition, costs of treatment can vary considerably across countries and in some countries pharmacological treatments are not accessible to everyone suffering from the disease. Despite evidence of their effectiveness3, rehabilitation programmes for COPD are not usually accessible for patients with moderate and mild COPD, and limited provision means that even patients with severe disease have considerable problems getting onto programmes.

These issues are exacerbated by some common misconceptions amongst the profession. Perceptions persist that COPD is a pulmonologist's disease, despite the majority of patients diagnosed with COPD being seen regularly in primary care. Also COPD is thought of as a 'geriatric' disease and yet a significant proportion of COPD sufferers are young smokers. Furthermore, there is a sense of therapeutic nihilism amongst the profession even though evidence shows a reduction in mortality with available pharmacological treatment.

The resources in this package show how effective a primary care intervention in COPD can be, despite these limitations. They also address some of the common misconceptions that create unnecessary barriers for physicians who could otherwise do much to alleviate the suffering of people with COPD.

The focus of World COPD day this year is on breathlessness. The lack of obvious symptoms, especially during the earlier stages of COPD, means that exacerbations, such as increasing breathlessness, often lead patients to a starting point for proactive COPD management. Raising awareness amongst patients of the symptomatic indicators of the disease is an effective first step in getting them on board for behaviour change such as smoking cessation.

Smoking is the single biggest risk factor for COPD. Female and male smokers are nearly 13 and 12 times more likely, respectively, to die from COPD as women and men who have never smoked. Stopping smoking therefore is the single most effective step that patients can take on the road to rehabilitation. Regardless of age, stopping smoking can halt the progression of the disease and has a major impact on life expectancy. It is estimated that complete smoking cessation and stopping solid fuel use in China by 2033, for example, could avoid the deaths of 26 million people. Intermediate level interventions would cause over a 600% reduction in deaths from COPD4.

Primary care teams must be at the forefront of the fight against smoking. Our Top tips for helping your patients tackle COPD show that just one minute spent talking to smokers about stopping has a significant impact on quit attempts. The tips also guide you through steps to encourage patients to stop. We have included tips, taken from our Tackling the Smoking Epidemic web-based guidance on recognising the position of patients in the process of change cycle in relation to smoking cessation so that advice can be better targeted.

The latest peer-reviewed IPCRG Consensus statement: Tackling the smoking epidemic - practical guidance for primary care, highlights the many opportunities within primary care to reduce levels of smoking. By working with medical and non-medical staff, using a range of techniques and resources, the chances of patients quitting smoking can be greatly enhanced and their risk of COPD reduced.

To complete the COPD package of resources, the following are available:
  1. Opinion Sheet on Spirometry 
    • Click here for Turkish version.
    • Click here for Greek version.

  2. Opinion Sheet on Palliative Care
    • Click here for Greek version.

  3. IPCRG Guidelines on the Management of Chronic Obstructive Pulmonary Disease
    • Click here for Turkish version.

References
1World Health Organisation, Chronic Obstructive Pulmonary Disease Fact Sheet, No 315, May 2008.

2E Angullo & M Román Rodriguez, IPCRG survey of members, 4th IPCRG Conference, Seville, May 2008.

3Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003793. DOI: 10.1002/14651858.CD003793.pub2.

4Lin H, Murray M, Cohen T, Colijn C, Ezzati M, 'Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: a time-based, multiple risk factor, modelling study', The Lancet, DOI:10.1016/S0140-6736(08)61345-8

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