Chronic Obstructive Pulmonary Disease

Theme: Health and Wellbeing Status

Background Information

Chronic obstructive pulmonary disease (COPD) is the name given to the collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease, all of which can occur together. COPD can also be referred to as chronic obstructive airways disease (COAD).

COPD is one of the most common respiratory diseases in the UK, and usually affects people over the age of 40. COPD occurs as a result of damage to the lungs, usually through smoking. The main symptom of having damaged lungs is difficulty with breathing. Breathing problems often gradually get worse, resulting in decreased quality of life and even heart failure (a weakened heart that no longer pumps blood effectively around the body). The symptoms of COPD can appear to be similar to those of asthma. However, whereas asthma can be controlled with treatment, COPD causes permanent damage to the lungs. Treatment for COPD usually consists of relieving the symptoms, for example, by using an inhaler to make breathing easier (NHS Direct).

Data

The premature mortality data was taken from the National Centre for Health Outcomes Development and details mortality from COPD and bronchitis and emphysema (directly standardised rate per 100,000 population) in the under 75 population for the period 2006-08. DSRs take into account the different age structures of populations so that their mortality experience can be compared.

The prevalence data consist of the number of people on GP practice disease registers at the end of March 2008. This data was taken from Quality Management and Analysis System (QMAS). QMAS is a national system which shows how well each practice is doing, measured against national Quality and Outcomes Framework achievement targets. Prevalence refers to the number of cases recorded over a specified period of time (in this instance 2007/08). More cecent QOF data is available for 2008/09, however this has not been used in order that meaningful comparisons can be made with the 2007 APHO modelled estimates.

Modelled prevalence estimates are taken from the APHO and give the number of people (aged 16 and over) with COPD for 2007.

Future projections to 2030 for the numbers aged 65 and over predicted to have a longstanding health condition caused by bronchitis and emphysema were sourced from the Projecting Older People Population Information (POPPI) System. These predictions are based on prevalence rates from the 2007 General Household Survey which were applied to ONS population projections of the 65 and over population to give estimated numbers predicted to have bronchitis and emphysema.

Mortality

The rate of premature mortality (under 75 years) due to bronchitis and emphysema and other COPD in Cumbria in 2006-08 for all persons (9.3 per 100,000) was lower than the England average (10.7 per 100,000) – although the difference was not statistically significant. The rates for Cumbria were less than those for England for both genders (with neither being statistically significant) with premature mortality in males being substantially higher compared to the female population (Figure 1).

Figure 1: 2006-08: Premature Mortality from Bronchitis and Emphysema and other COPD

Within Cumbria, Copeland had the greatest rate of premature mortality (under 75 years) in 2006-08 for all persons with Eden having the lowest rate. This is also true for females. Males had the highest rate in Barrow-in-Furness and the lowest in South Lakeland (Figure 2).

Figure 2: 2006-08: Premature Mortality from Bronchitis, Emphysema and other COPD by District Council

Modelled and Recorded Prevalence

In terms of prevalence, figures from QOF for 2007-08 detail that 9,788 Cumbrian patients were included on the COPD register (i.e. have been diagnosed with COPD). This accounts for 1.9% of the Cumbrian GP population compared to the England average of 1.5%. Modelling by the Association of Public Health Observatories (APHO) suggests that there should be over 5,000 additional COPD patients that do not currently appear on the GP registers in Cumbria (i.e. undiagnosed).

The number of people on GP practice disease registers was greatest in Copeland with a prevalence of 2.3% whilst Eden and South Lakeland had the lowest with 1.6% (Table 1). All district councils had a prevalence rate above the national average.

Table 1 also shows the estimated prevalence of COPD (diagnosed and undiagnosed) in Cumbria and by district council compared to the observed prevalence from the local QOF register. The data show that 35% of people with COPD in Cumbria are not included on the QOF registers. This has health implications with undiagnosed and unmanaged COPD resulting in a decreased quality of life and possible heart failure.

Table 1: Recorded and expected prevalence of COPD by district council (Source: QMAS and APHO)

Recorded (QMAS) / Modelled (APHO) / Difference
Number on GP practice disease register / Prevalence / Number / Prevalence / Number / Percentage Undiagnosed
Allerdale / 2,076 / 2.1% / 2,906 / 3.7% / 830 / 28.6%
Barrow-in-Furness / 1,582 / 2.0% / 2,101 / 3.6% / 519 / 24.7%
Carlisle / 2,004 / 1.9% / 3,245 / 3.8% / 1,241 / 38.2%
Copeland / 1,623 / 2.3% / 2,134 / 3.7% / 511 / 23.9%
Eden / 871 / 1.6% / 1,432 / 3.3% / 561 / 39.2%
South Lakeland / 1,632 / 1.6% / 2,486 / 2.8% / 854 / 34.4%
Cumbria PCT / 9,788 / 1.9% / 15,060 / 3.7% / 5,272 / 35.0%

Projections

Figure 3 shows projections for the number of people in Cumbria who may be left with a longstanding health condition as a result of bronchitis and emphysema from 2009 to 2030. The number aged 65 and over is projected to rise (reflecting increasing survival rates), increasing from 1,689 in 2009 to 2,754 in 2030: an increase of 64%. All age groups and genders are expected to experience an increase in numbers although the greatest percentage increase is predicted for males aged 75 and over (108% increase).

Figure 3: 2009-30: People aged 65 and over predicted to have a longstanding health condition caused by bronchitis and emphysema

Projections by district council also show an increase in all people aged 65 and over expected to have a longstanding health condition as a result of a heart attack (Figure 4). The greatest numbers are predicted to be in South Lakeland but the largest percentage increase is expected for Eden (77%).

Figure 4: 2009-30: People aged 65 and over predicted to have a longstanding health condition caused by bronchitis and emphysema by district council

Inequalities in Cumbria

In terms of prevalence, there appears to be a strong relationship between COPD and deprivation according to data from the primary care registers (QOF) (Figure 5). This can be largely ascribed to the higher smoking rates (and therefore associated higher COPD prevalence) found in deprived areas.

Figure 5: COPD prevalence by deprivation quintile

5

01 March 2010