An Epidemiological Overview of Chronic Obstructive Pulmonary Disease: What Can Real-Life Data Tell Us about Disease Management?

Figures & data

Figure 1. Reported prevalence of chronic obstructive pulmonary disease and relative underdiagnosis in selected population studies from various world regions. Reproduced from (3) with permission.

Figure 2. Mean frequency of consults per patient per year. For lower respiratory symptoms (A), for lower respiratory prescriptions (B), chest radiography (C) and outpatient consultations (D). Reproduced from (4) with permission.

Figure 3. A representation of potential endotypes in chronic obstructive pulmonary disease (COPD), indicating the pathognomonic role of infection, inflammation and alpha-1-antitrypsin deficiency. Reproduced from (6) with permission.

Figure 4. Hyperinflated, hyperlucent lungs fields and scattered bronchiectasis evident on chest X-ray in a patient with α1-antitrypsin deficiency-related chronic obstructive pulmonary disease.

Table 1. Case study: COPD with AATD.

History	52-year-old female
	Smoker (currently 1 pack/day); total exposure: 35 pack-years
	Chronic intermittent cough
	Several episodes of pneumonia in past few years treated with outpatient antibiotics
Family history	Father died from complications of pulmonary disease attributed to heavy tobacco use
	Sibling twin died in infancy from liver failure of unknown aetiology
Presentation	Progressive fatigue and easy bruising of skin
	Increased shortness of breath on physical exertion; salbutamol inhaler prn for intermittent respiratory symptoms
Investigations:	Physical examination: scattered ecchymosis along extremities; diffuse wheezing and crackles throughout lung fields, firm liver edge 5 cm below the costal margin; palpable spleen
	Spirometry: severe airflow limitation; FEV1 44% predicted
	Chest X-ray and high-resolution computed tomography: hyperinflated, hyperlucent lung fields; scattered bronchiectasis (Figure 4)
	Liver ultrasound: diffusely coarsened echo texture suggestive of fibrosis and 2 cm focal hypoechoic lesion in right hepatic lobe
	Laboratory assessment: mild elevation in liver transaminases (ALT  =  67 IU/L, AST  =  52 IU/L); decreased albumin (2.9 g/dL), elevated prothrombin time (INR 1.8)
	Genotyping: PiZZ; α1-antitrypsin serum level 31 mg/dL
Diagnosis	COPD with AATD

Soriano JB, Zielinski J, Price D. Screening for and early detection of chronic obstructive pulmonary disease. Lancet 2009; 374(9691):721–732.

 PubMed Web of Science ®Google Scholar

Jones RC, Price D, Ryan D, Sims EJ, von Ziegenweidt J, Mascarenhas L, et al. Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort. Lancet Respir Med 2014; 2(4):267–276.

 PubMed Web of Science ®Google Scholar

Woodruff PG, Agusti A, Roche N, Singh D, Martinez FJ. Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management. Lancet 2015; 385(9979):1789–1798.

 PubMed Web of Science ®Google Scholar