COPD IN THE UK. Peter Barnes FRS, FMedSci National Heart & Lung Institute Imperial College London, UK

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1 COPD IN THE UK Peter Barnes FRS, FMedSci National Heart & Lung Institute Imperial College London, UK MRC-ICMR Workshop on Chronic Diseases Delhi November 2009 Imperial College Royal Brompton Hospital

2 Ischaemic heart disease Cerebrovascular disease Lower respiratory infection Diarrhoeal disease Perinatal disorders COPD Tuberculosis Measles Road traffic accidents Lung cancer FUTURE GLOBAL MORTALITY th rd Stomach cancer HIV Murray & Lopez: WHO/World Bank Global Predictions Nat Med 1998 Suicide

3 COPD MORTALITY IN USA Proportion of 1965 Rate Coronary Heart Disease Stroke Other CVD COPD All Other Causes 59% 64% 35% +163% 7%

4 FUTURE BURDEN OF DISEASE Lower respiratory infections 2. Diarrhoeal diseases 3. Perinatal conditions 4. Unipolar major depression 5. Ischaemic heart disease 6. Cerebrovascular disease 7. Tuberculosis 8. Measles 9. Road traffic accidents 10. Congenital anomalies 11. Malaria 12. COPD DALY: disabilityadjusted life-years Murray & Lopez: WHO/World Bank Global Predictions Nat Med 1998

5 Data from BOLD (Lancet 2007), PLATINO (Lancet 2005) GLOBAL PREVALENCE OF COPD Overall prevalence: 11.8% for men 8.5% for women

6 FEV 1 (% predicted at age 25y) ANNUAL DECLINE IN LUNG FUNCTION Susceptible smoker (~20%) Symptoms Disability Death Hoogendoorn M et al: Respir Med 2006 Fletcher C, Peto R: BMJ 1977 Mild (GOLD I) General Practice V severe (2%) 20% Moderate (GOLD II) Severe (GOLD III) Very severe (GOLD IV) Age (years) Severe 18% Non smoker Non-susceptible smoker Mild 30% Moderate (52%) Stopped smoking aged 50 yr Stopped smoking aged 60 yr

7 SYSTEMIC EFFECTS & COMORBIDITIES OF COPD Lung inflammation Oxidative stress Liver CRP IL-6 Systemic inflammation IL-6, TNF-α,, IL-1β CRP, AAP Lung cancer Other inflammatory diseases Depression Osteoporosis Osteopenia Ischaemic heart disease Heart failure Muscle wasting Cachexia Metabolic diseases Diabetes Metabolic syndrome Obesity

8 COPD IN UK Prevalence ~10% over 40 yrs; M=F ~50% undiagnosed (the missing millions) High mortality 30,000 deaths/yr (4 th commonest cause) More women now die of COPD than breast cancer! High morbidity Commonest cause of hospital admission (acute exacerbations) >1 million bed-days/year days/year >24 million working days lost/year High costs > 1 1 billion in NHS costs Costs related to severity

9 CAUSES OF COPD IN UK Cigarette smoking 70-80% Related to pack-years ~20% smokers develop COPD (but probably greater) Non-smoking causes/risks (20-30%) Other inhaled irritants, air pollutants Occupation Poverty: rich-poor gradient x13 (lung cancer x3) Asthma Autoimmune disease? Lung infection, including TB Genetic: α 1 -antitrypsin deficiency (PiZZ( PiZZ) ) <1% Salvi S, Barnes PJ: Non-smoking COPD, Lancet 2009

10 Garcia-Rodriguez LA et al: J COPD 2009 COPD IN GENERAL PRACTICE: RISK FACTORS UK General Practice Research Database New Δ COPD (1927) vs age- sex-matched controls (16,546) Incidence of COPD: 2.6/1,000 person-years yr Risk factors OR 95% CI Current smokers: Ex-smokers: Age Weight: BMI < BMI > Paracetamol Statin use:

11 National Clinical Strategy for COPD CMOs report (2005): highlighted burden of COPD Healthcare Commission Report (2006): high prevalence, underdiagnosis,, variation in access to resources National Clinical Strategy: Department of Health April 2010? Increase awareness of COPD Improve support for patients and carers Spirometry in general practice Screening high risk patients: identify undiagnosed patients Pulmonary rehabilitation

12 IMVAC STUDY A COLLABORATIVE RESEARCH PROJECT BETWEEN: Chest Research Foundation IMPERIAL PERIAL COLLEGE, LONDON Pune, India VADU DU RURAL HEALTH PROGRAM, Director: KEM Dr Sundeep HOSPITAL, Salvi PUNE CHEST HEST RESEARCH FOUNDATION, PUNE STUDY OF PREVALENCE OF COPD AND PHENOTYPIC CHARACTERIZATION OF SMOKING AND NON-SMOKING COPD IN A RURAL SETTING IN INDIA Initial funding: NHLI Foundation Study started: June 2008

13 IMVAC STUDY Phase I: Epidemiology Phase IIA: Phenotyping patients Phase IIB: Trial of corticosteroids theophylline

14 CONCLUSIONS COPD is a major global epidemic Important in developed and developing countries Underdiagnosis a major problem Non-smoking causes of COPD now recognised in developed and esp developing countries Recognition of systemic effects and comorbidities Enormous opportunities for collaborative research between UK and India e.g. IMVAC study

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