Specific Population Considerations for Implementing COPD Programs
COPD disproportionately impacts specific populations. Knowing which subpopulations are at higher risk for COPD helps practitioners target the appropriate populations and tailor their programs to high-risk patients.
COPD is characterized by declining lung function, which is often caused or amplified by old age. As individuals grow older, their overall health status tends to decline and their level of physical functioning decreases. In addition, older adults face the cumulative impacts of risk factors. For example, an individual who has smoked cigarettes for 30 years will manifest greater signs of lung damage due to tobacco smoke compared to an individual who has only smoked for five years. It is critical that providers screen older adults for COPD to capture cases as early as possible.
Based on self-reported data from the 2013 Behavioral Risk Factor Surveillance System, age-adjusted prevalence of COPD is higher among women (6.6%) than men (5.4%). Even though age-adjusted mortality rates are declining among U.S. men (57.0 per 100,000 in 1999 and 44.3 per 100,000 in 2014), mortality rates have remained relatively the same among U.S. women during the same time period (35.3 to 35.6).
Women may be more susceptible to developing COPD and may experience more severe symptoms than men. Women diagnosed with COPD report more exacerbations and are more likely to have never smoked. In general, women diagnosed with COPD are younger, smoke less, have a lower body mass index, and are more likely to be of lower socioeconomic status than men diagnosed with COPD.
A 2017 review of the literature highlighted several key differences between COPD in men and women. The authors listed the following key suggestions for improving the management of COPD in women:
- Use a multi-faceted approach, including targeted educational awareness campaigns, that recognize the differences in risk factors for COPD between men and women
- Continue research into the sex differences in both symptoms and presentation of COPD
- Address and reduce bias in diagnosing COPD, including spirometry and succinct history-taking of patients
- Continue research on how interventions may be tailored to fit women's needs, including how to treat their distinct comorbidities
Low Socioeconomic Status
Tobacco use as well as employment in occupations with higher risks of exposures to lung irritants — both risk factors for COPD — are more prevalent among economically disadvantaged populations. Individuals with low-incomes not only face increased exposure to COPD risk factors, but they face more barriers in accessing and affording treatment. COPD management typically requires a multi-pronged approach that includes prescription medications, pulmonary rehabilitation, and regular appointments with providers. It can be expensive to adhere to all treatments to appropriately maintain the disease, and COPD patients with low-incomes may not be able to afford treatment for all of their comorbid conditions. For example, individuals with low incomes who have COPD may need to prioritize paying for hypertension medication or insulin for diabetes instead of their COPD medication.
Industrial and Agricultural Workers
Individuals who work in agriculture and the manufacturing, construction, and mining industries – which are more common in rural areas than urban areas – are regularly exposed to lung irritants that increase risk for COPD. There is no safe level of exposure for most irritants, but lifelong career exposure puts an individual at particularly high risk for COPD. One study found that individuals who were exposed to vapors, gases, dusts, and fumes during the longest job they ever had held had two times higher odds of developing COPD, controlling for cigarette smoking; this trend also occurred among people who had never smoked. When those occupational exposures were combined with past or current smoking, individuals faced a 14 times higher odds of developing COPD compared to people who never smoked and never faced occupational exposures. Interventions to reduce exposure to harmful lung irritants – such as worker education about how to use personal protective equipment (PPE) appropriately and programs to support consistent PPE enforcement – or COPD screening initiatives that target individuals with occupational exposures could be beneficial. COPD is often comorbid with mood disorders like anxiety and depression, so holistic approaches to care for workers in high-stress occupations can help improve overall patient well-being.
People with Disabilities
Beyond barriers to COPD treatment adherence such as a large number of appointments to attend and a lack of transportation, people with disabilities often face unique barriers to accessing care. People with physical disabilities may need additional accommodations to arrive at appointments or face challenges in completing treatment, such as using machines for supplemental oxygen. People with intellectual and developmental disabilities may depend on caregivers to accompany them to appointments, administer treatments, or help manage their care coordination. It is critical that providers are aware of any COPD patients' needed accommodations and that they create an accessible and comfortable environment for all patients.
American Indians and Alaska Natives
In 2013, American Indians and Alaska Natives (AI/AN) had the second highest COPD prevalence among stratified racial and ethnic groups (10.2%), behind individuals who identified as non-Hispanic and multiracial (10.7%). The AI/AN COPD prevalence was nearly twice as high as that of their non-Hispanic white (6.3%), black (6.5%), and Native Hawaiian/Pacific Islander counterparts (6.2%). One reason for this high prevalence is smoking: In 2015, the AI/AN population had the highest adult and adolescent cigarette smoking prevalence in the country (21.9% and 7.5%, respectively).
Resources to Learn More
Faces of Work-Related COPD
A series of videos featuring a pulmonologist and individuals diagnosed with COPD as a result of occupational exposures. Videos discuss the role of work-related exposures, how COPD impacts quality of life, and how workers can minimize their risk for developing COPD.
Organization(s): CDC National Occupational Research Agenda, Respiratory Health Cross-Sector Council
Rural Residence and Poverty Are Independent
Risk Factors for Chronic Obstructive Pulmonary Disease in the United States
Study of a nationally representative sample determining that both rural residence and poverty were independent risk factors for COPD, even among people who never smoked.
Author(s): Raju, S., Keet, C., Paulin, L., Matsui, E., Peng, R., Hansel, N., & McCormack, M.
Citation: American Journal of Respiratory and Critical Care Medicine, 199, 8