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Chronic Obstructive Pulmonary Disease in Rural Areas

The prevalence rate of COPD among the most rural residents was almost double that of the most urban in 2015, with a rate of 8.2% of adults in noncore counties compared to 4.7% of adults in large metropolitan centers. From 1999 to 2014, age-adjusted death rates for COPD have decreased in urban areas and increased in rural areas. A 2015 study using a nationally representative sample found that, in addition to poverty, rural residence was an independent risk factor for COPD.

Risk Factors and Rural Populations

The leading cause of COPD is cigarette smoking. Cigarette use is more prevalent among rural adults (30.3%) than among their large and small metro counterparts (22.0% and 25.8%, respectively). In the Appalachian Region specifically, almost 20% of all adults report being cigarette smokers, a figure higher than the 16.3% reported at the national level.

However, 20-25% of COPD cases are not related to cigarette smoking. Genetic factors, respiratory infections, and long-term exposure to irritants such as air pollutants also play a role. Occupational hazards are estimated to account for nearly 15% of COPD cases. Coal mine dust and crystalline silica exposures are known risk factors for COPD, which are common byproducts of rural industries like coal mining and construction. Other exposures that are common in rural settings are also associated with respiratory illnesses, such as mold spores, nitrogen dioxide, and organic toxic dust. Therefore, efforts to address COPD in rural settings should expand beyond tobacco use to account for occupational lung diseases and other rural exposures.

Prevention, Diagnosis, and Treatment

Since tobacco plays a major role in causing COPD, not smoking is the best way to prevent COPD and its complications; this includes never smoking and quitting smoking. Avoiding secondhand smoke, a lung irritant, is also important. Traditional prevention efforts may find less traction in rural communities where tobacco use is more common, so strategies should be tailored to local context.

COPD cannot be cured, but it can be treated and managed. Individuals with COPD may have better prognoses the earlier they are diagnosed. Early interventions can help slow the progression of COPD to preserve lung function and prevent complications down the line. Rural health initiatives should raise awareness about the signs and symptoms of COPD and promote early screening.

COPD treatment constitutes a combination of various clinical and pharmacologic therapies as well as behavioral changes that strive to slow lung function decline, increase exercise stamina, and reduce exacerbations (acute worsening of symptoms). Inhaled medications, such as bronchodilators delivered through inhalers, can ease short-term exacerbations and help maintain lung function in the long term. In addition, pulmonary rehabilitation and oxygen therapy can help patients that have trouble breathing. However, rural communities may not have the healthcare infrastructure or workforce, such as specialty pulmonary rehabilitation clinics or respiratory therapists, to offer all respiratory services. Among individuals that smoke, quitting smoking is critical to managing COPD.

COPD exacerbations can send patients to the emergency department and require clinical support for transition to the outpatient setting. When COPD is accompanied by other conditions, treatment options and access in rural areas are more complicated. A 2009 study among Medicaid enrollees found that rural residents were among those most likely to have emergency room visits, both for COPD and comorbidities.

Resources to Learn More

Addressing the Burden of Chronic Obstructive Pulmonary Disease (COPD) in Rural America from the NACRHHS
Video/Multimedia
Webinar recording of presentations on the topic of COPD in rural areas featuring speakers from the National Advisory Committee on Rural Health and Human Services (NACRHHS), the National Institutes of Health (NIH), University of North Carolina's School of Public Health, and the Dorney-Koppel Foundation.
Organization(s): Rural Health Information Hub
Date: 3/2019

The COPD National Action Plan and its Impact on Patients in Rural America
Document
An overview of the COPD National Action Plan and how it can be utilized to advocate for improved treatment opportunities, including cost of care and access to care, for rural communities.
Author(s): Denning, B.
Organization(s): COPD Foundation
Date: 4/2018

Occupational Exposure to Vapor-Gas, Dust, and Fumes in a Cohort of Rural Adults in Iowa Compared with a Cohort of Urban Adults
Document
Reports on a study comparing jobs and occupational exposure to vapor-gas, dust, and fumes between rural workers, including farmers and non-farmers, and urban workers.
Organization(s): Centers for Disease Control and Prevention
Date: 11/2017

Urban-Rural Differences in COPD
Website
Data and statistics comparing COPD prevalence, hospitalization, and mortality rates between urban and rural populations in the United States.
Organization(s): Centers for Disease Control and Prevention