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      Signs of progress in the Australian post-2000 COPD experience, but some old problems remain

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          Abstract

          This study aims to describe current trends in Australia regarding chronic obstructive pulmonary disease (COPD) mortality and morbidity rates, and in its treatment and prevention from 2000 to 2010. The study’s purpose is to better define future directions in curbing COPD. People with COPD and their caregivers who attend patient support groups (n = 21), pulmonary rehabilitation group coordinators (n = 27) within Victoria, and the Australian Lung Foundation provided informed feedback. COPD was a leading underlying cause of death in both sexes during these years. Nevertheless, mortality rates declined from 1980 to 2007, with rates for males almost halving. Its prevalence has also substantially declined. Smoking rates have declined in age groups over 40 years old in both sexes. The COPD-X Plan provides evidence-based guidelines for the management of COPD. Many government, professional, and community initiatives have been recently implemented to promote the Plan. Two studies—one conducted before and one conducted after the publication of the COPD-X Plan—report some progress, but there are still very considerable departures from evidence-based practice. The Australian Lung Foundation estimates that only 1% of patients who could benefit from pulmonary rehabilitation programs have suitable access to such programs. A common priority for all informants was that there needed to be greater awareness of—and a more positive orientation to—COPD in both the Australian and health professional communities. The study concluded that substantial reductions in COPD and smoking cessation rates contrast with more limited progress toward adopting other aspects of evidence-based practice. The “good news” story concerning reductions in COPD disease with improving smoking cessation rates could form the basis for suitable media campaigns.

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          Most cited references 32

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          The impact of aging and smoking on the future burden of chronic obstructive pulmonary disease: a model analysis in the Netherlands.

          Chronic obstructive pulmonary disease (COPD) causes extensive disability, primarily among the elderly. On the World Health Organization ranking list of disability-adjusted life years (DALYs), COPD rises from the twelfth to the fifth place from 1990 to 2020. The purpose of this study is to single out the impact of changes in demography and in smoking behavior on COPD morbidity, mortality, and health care costs. A dynamic multistate life table model was used to compute projections for the Netherlands. Changes in the size and composition of the population cause COPD prevalence to increase from 21/1,000 in 1994 to 33/1,000 in 2015 for men, and from 10/ 1,000 to 23/1,000 for women. Changes in smoking behavior reduce the projected prevalence to 29/1,000 for men, but increase it to 25/ 1,000 for women. Total life years lost increase more than 60%, and DALYs lost increase 75%. Costs rise 90%; smokers cause approximately 90% of these costs. The model demonstrates the unavoidable increase in the burden of COPD, an increase that is larger for women than for men. The major causes of this increase are past smoking behavior and the aging of the population; changes in smoking behavior will have only a small effect in the nearby future.
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            Australia’s Health 2014a

            (2014)
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              The burden of chronic obstructive pulmonary disease.

               P Vermeire (2002)
              Chronic obstructive pulmonary disease (COPD) is a disease state characterized by chronic airflow limitation that is not fully reversible, with a precise definition varying between different management guidelines. The burden of COPD is considerable from all relevant viewpoints. From the perspective of society, the mortality is already considerable, and it is likely to increase from the sixth to the third most common cause of death worldwide by 2020. From the patient's perspective, COPD is responsible for disability that restricts many everyday activities, such as walking up stairs. The burden of COPD on physicians includes increasing consultations for the condition. From the perspective of healthcare payers, COPD represents an increasing burden, primarily due to the costs incurred when exacerbations require hospital treatment. Despite this considerable burden, there are many signs that the impact of COPD is not recognized. Research on COPD is currently underfunded in relation to the impact of the disease; patients only present late with symptoms; physicians may fail to diagnose the condition and healthcare payers may be failing to support treatment approaches that could reduce the number of costly hospital exacerbations. Reasons for this overall poor recognition of the burden of COPD include lack of recognition of the disease, difficulties in diagnosis, poor knowledge of COPD and nihilistic attitudes towards the condition and its treatment. Awareness of COPD could be improved with education of the public and healthcare professionals. Long-term epidemiological studies showing the impact on morbidity and mortality of different treatment approaches would also influence the setting of priorities by healthcare payers.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2012
                2012
                07 June 2012
                : 7
                : 357-366
                Affiliations
                [1 ]Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, The University of Melbourne, Parkville, Victoria, Australia
                [2 ]National Ageing Research Institute, Royal Melbourne Hospital, Victoria, Australia
                Author notes
                Correspondence: David Dunt, Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, The University of Melbourne, VIC 3010, Australia, Tel +61 3 8387 2305, Fax +61 3 9387 4030, Email d.dunt@ 123456unimelb.edu.au
                Article
                copd-7-357
                10.2147/COPD.S30003
                3379871
                22745535
                © 2012 Dunt and Doyle, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

                Respiratory medicine

                copd, health services planning, community perceptions, disease trends

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