Mortality of patients with COPD

ABSTRACT

Introduction

Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide and 24% of the patients die within 5 years of diagnosis.

Areas Covered

The epidemiology of mortality and the interventions that reduce it are reviewed. The increasing global deaths reflect increases in population sizes, increasing life expectancy and reductions in other causes of death. Strategies to reduce mortality aim to prevent the development of COPD and improve the survival of individuals. Historic changes in mortality give insights: improvements in living conditions and nutrition, and later improvements in air quality led to a large fall in mortality in the early 20^th century. The smoking epidemic temporarily reversed this trend.

Older age, worse lung function and exacerbations are risk factors for death. Single inhaler triple therapy; smoking cessation; pulmonary rehabilitation; oxygen therapy; noninvasive ventilation; and surgery reduce mortality in selected patients.

Expert Opinion

The importance of addressing the global burden of mortality from COPD must be recognized. Steps must be taken to reduce it, by reducing exposure to risk factors, assessing individual patients’ risk of death and using treatments that reduce the risk of death. Mortality rates are falling in countries that have adopted a comprehensive approach to COPD prevention and treatment.

KEYWORDS:

• COPD
• exacerbations
• mortality
• non-invasive ventilation
• oxygen therapy
• pulmonary rehabilitation
• single inhaler triple therapy
• smoking cessation

Article highlights

• Over the last 30 years, the worldwide annual death toll from COPD increased by 30% from 2.5 million in 1990 to 3.3 million in 2019 and COPD is now the third most common cause of death worldwide.

• In England 24% of the patients die within 5 years of diagnosis.

• The number of global deaths reflects changes in population sizes, life expectancy and in other causes of death as well as changes in individual survival rates.

• Improvements in living conditions, nutrition, and air quality led to a large fall in mortality in high-income countries in the early 20^th century. The smoking epidemic temporarily reversed this trend.

• Efforts to reduce mortality from COPD in low- and middle-income countries must include policies to reduce poverty and improve air quality as well as policies to reduce smoking.

• Older age, worse lung function and exacerbations are risk factors for death.

• Single inhaler triple therapy; smoking cessation; pulmonary rehabilitation; oxygen therapy; noninvasive ventilation; and surgery reduce mortality in selected patients.

Declaration of interest

DMG Halpin has received personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Inogen, Pfizer, Novartis, Sanofi and Menarini. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.