Epidemiology

Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive airflow limitation and tissue destruction related to chronic inflammation, manifesting as chronic bronchitis (mucus overproduction and hypersecretion) or emphysema (alveolar destruction).^1,2 COPD is associated with significant morbidity and mortality; however, its prevalence may be underestimated due to under-diagnosis.¹

COPD Rapid Stats

In 2022, 11.7 million people, or 4.6% of adults, reported a diagnosis of COPD (chronic bronchitis or emphysema). Rates were greater among non-Hispanic white individuals compared to other racial and ethnic groups, and women (5.0%) compared to men (4.1%)³
The prevalence of COPD increases with age, with a five-fold increased risk for those aged over 65 years compared with patients aged less than 45 years.⁴
Although both genders have higher COPD prevalence in ages ≥ 65 years, observed rates of chronic bronchitis are higher in women, while men have greater rates of emphysema³
The prevalence of COPD increases with smoking status (by a factor of five), but it needs to be emphasized that COPD prevalence in nonsmokers is 4%, suggesting the existence of other risk factors, such as passive smoking or occupational exposure⁵
Smoking is the most common risk factor worldwide; smoking cessation and avoidance of secondhand smoke exposure, as well as environmental and occupational exposures, are imperative¹
At present, only a severe deficit in α1-antitrypsin, responsible for the PiZZ phenotype, is a proven genetic causal factor. This deficit affects 1%–3% of patients with COPD and is clinically expressed as pan lobular (or panacinar) emphysema⁶
Childhood infections and lung growth may predispose an individual to COPD later in life.⁷ As an adult, the repeated occurrence of exacerbations of viral or bacterial origin could also contribute to lung function decline⁸
Identifying undiagnosed cases of COPD remains a challenge due to delays in patients seeking medical care and failure to recognize underlying disease, and the tendency to overlook risk factors beyond tobacco smoking and advanced age^9,10
Compared to early diagnosis, delayed diagnosis of COPD is associated with a higher risk of exacerbation and increased comorbidities (such as cardiovascular disease, depression, osteoporosis and diabetes) and greater management costs^11,12
It is estimated that approximately two-thirds of patients with COPD have one or more comorbidities. The primary comorbidities include cardiovascular disorders, lung cancer, lung infections, thromboembolic disorders, asthma, hypertension, osteoporosis, gastroduodenal ulcer, depression, and anxiety^13,14

Data from COPDGene (Figure) describe sex differences that translate into higher risk of disease severity, particularly in women in early- and late-age ranges¹⁵

References

Agarwal AK, et al. Chronic Obstructive Pulmonary Disease. Stat Pearls. 2023. Last update 8/7/23. https://www.ncbi.nlm.nih.gov/books/NBK559281/
Widysanto A, Mathew G. Chronic Bronchitis. Stat Pearls. Last update 11/28/22. https://www.ncbi.nlm.nih.gov/books/NBK482437/
American Lung Association (ALA). COPD Trends Brief: Prevalence. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-prevalence
Epidemiology of chronic obstructive pulmonary disease. In: Postma DS, Siafakas N, eds. Management of Chronic Obstructive Pulmonary Disease. Eur Respir Mon. 1998;7:41-73.
Raherison C, Girodet PO. Epidemiology of COPD. Eur Respir Rev 2009;18:114:213-221.
Stoller JK, Aboussouan LS. Alpha1-antitrypsin deficiency. Lancet. 2005;365:2225-2236.
Barker DJ, Godfrey KM, Fall C, et al. Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease. BMJ. 1991;303:671-675.
Donaldson GC, Seemungal TA, Bhowmik A, et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. 2002;57:847-852.
Martinez CH, Mannino DM, Jaimes FA, et al. Undiagnosed obstructive lung disease in the United States. Associated factors and long-term mortality. Ann Am Thorac Soc. 2015;12:1788-1795.
Hangaard S, Kronborg T, Hejlesen OK. Characteristics of subjects with undiagnosed COPD based on post-bronchodilator spirometry data. Respir Care. 2019;64:63-70.
Larsson K, Janson C, Ställberg B, et al. Impact of COPD diagnosis timing on clinical and economic outcomes: The Arctic observational cohort study. Int J Chron Obstruct Pulmon Dis. 2019;14:995-1008.
Kostikas K, Price D, Gutzwiller FS, et al. Clinical impact and healthcare resource utilization associated with early versus late COPD diagnosis in patients from UK CPRD database. Int J Chron Obstruct Pulmon Dis. 2020;15:1729-1738.
Sin DD, Anthonisen NR, Soriano JB, et al. Mortality in COPD: Role of comorbidities. Eur Respir J. 2006;28:1245-1257.
Boutin-Forzano S, Moreau D, Kalaboka S, et al. Reported prevalence and co-morbidity of asthma, chronic bronchitis and emphysema: A pan-European estimation. Int J Tuberc Lung Dis. 2007;11:695-702.
Maselli D, Bhatt S, Anzueto A, et al. Clinical epidemiology of COPD: Insights from 10 years of the COPDGene study. Chest. 2019; 156:228-238.