Chronic Obstructive Pulmonary Disease
Theme: Health and Wellbeing Status
Background Information
Chronic obstructive pulmonary disease (COPD) is the name given to the collection of lung
diseases including chronic bronchitis, emphysema and chronic obstructive airways disease, all of
which can occur together. COPD can also be referred to as chronic obstructive airways disease
(COAD).
COPD is one of the most common respiratory diseases in the UK, and usually affects people
over the age of 40. COPD occurs as a result of damage to the lungs, usually through smoking.
The main symptom of having damaged lungs is difficulty with breathing. Breathing problems
often gradually get worse, resulting in decreased quality of life and even heart failure (a
weakened heart that no longer pumps blood effectively around the body). The symptoms of
COPD can appear to be similar to those of asthma. However, whereas asthma can be
controlled with treatment, COPD causes permanent damage to the lungs. Treatment for COPD
usually consists of relieving the symptoms, for example, by using an inhaler to make breathing
easier (NHS Direct).
Data
The premature mortality data was taken from the National Centre for Health Outcomes
Development and details mortality from COPD and bronchitis and emphysema (directly
standardised rate per 100,000 population) in the under 75 population for the period 2006-08.
DSRs take into account the different age structures of populations so that their mortality
experience can be compared.
The prevalence data consist of the number of people on GP practice disease registers at the end
of March 2008. This data was taken from Quality Management and Analysis System (QMAS).
QMAS is a national system which shows how well each practice is doing, measured against
national Quality and Outcomes Framework achievement targets. Prevalence refers to the
number of cases recorded over a specified period of time (in this instance 2007/08). More
cecent QOF data is available for 2008/09, however this has not been used in order that
meaningful comparisons can be made with the 2007 APHO modelled estimates.
Modelled prevalence estimates are taken from the APHO and give the number of people (aged
16 and over) with COPD for 2007.
Future projections to 2030 for the numbers aged 65 and over predicted to have a longstanding
health condition caused by bronchitis and emphysema were sourced from the Projecting Older
People Population Information (POPPI) System. These predictions are based on prevalence
rates from the 2007 General Household Survey which were applied to ONS population
projections of the 65 and over population to give estimated numbers predicted to have
bronchitis and emphysema.
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1
Mortality
The rate of premature mortality (under 75 years) due to bronchitis and emphysema and other
COPD in Cumbria in 2006-08 for all persons (9.3 per 100,000) was lower than the England
average (10.7 per 100,000) – although the difference was not statistically significant. The rates
for Cumbria were less than those for England for both genders (with neither being statistically
significant) with premature mortality in males being substantially higher compared to the female
population (Figure 1).
Figure 1: 2006-08: Premature Mortality from Bronchitis and Emphysema and other COPD
2006-2008: Premature Mortality (under 75 years) from Bronchitis, Emphysema and other COPD.
Directly Standardised Rate per 100,000. (Source: NCHOD)
14
12
DSR per 100,000
10
8
12.5
6
10.7
10.6
9.3
4
9.0
8.0
2
0
Cumbria
England
Males
Females
All Persons
Within Cumbria, Copeland had the greatest rate of premature mortality (under 75 years) in
2006-08 for all persons with Eden having the lowest rate. This is also true for females. Males
had the highest rate in Barrow-in-Furness and the lowest in South Lakeland (Figure 2).
Figure 2: 2006-08: Premature Mortality from Bronchitis, Emphysema and other COPD by District Council
2006-2008: Premature Mortality (under 75) from Bronchitis, Emphysema and COPD. Directly
Standardised Rate per 100,000 (Source: NCHOD)
30
25
DSR per 100,000
20
15
10
5
14.2 11.2 12.7
14.7 6.9 10.7
12.3 8.6 10.4
12.6 13.6 13.1
Allerdale
Barrow-in-Furness
Carlisle
Copeland
7.0
1.5
4.2
4.1
5.0
4.6
0
01 March 2010
Males
Females
All Persons
Eden
South Lakeland
2
Modelled and Recorded Prevalence
In terms of prevalence, figures from QOF for 2007-08 detail that 9,788 Cumbrian patients were
included on the COPD register (i.e. have been diagnosed with COPD). This accounts for 1.9%
of the Cumbrian GP population compared to the England average of 1.5%. Modelling by the
Association of Public Health Observatories (APHO) suggests that there should be over 5,000
additional COPD patients that do not currently appear on the GP registers in Cumbria (i.e.
undiagnosed).
The number of people on GP practice disease registers was greatest in Copeland with a
prevalence of 2.3% whilst Eden and South Lakeland had the lowest with 1.6% (Table 1). All
district councils had a prevalence rate above the national average.
Table 1 also shows the estimated prevalence of COPD (diagnosed and undiagnosed) in Cumbria
and by district council compared to the observed prevalence from the local QOF register. The
data show that 35% of people with COPD in Cumbria are not included on the QOF registers.
This has health implications with undiagnosed and unmanaged COPD resulting in a decreased
quality of life and possible heart failure.
Table 1: Recorded and expected prevalence of COPD by district council (Source: QMAS and APHO)
Allerdale
Recorded (QMAS)
Number on
Prevalence
GP practice
disease
register
2,076
2.1%
Modelled (APHO)
Number
Prevalence
Difference
Number
Percentage
Undiagnosed
2,906
3.7%
830
28.6%
Barrow-in-Furness
1,582
2.0%
2,101
3.6%
519
24.7%
Carlisle
2,004
1.9%
3,245
3.8%
1,241
38.2%
Copeland
1,623
2.3%
2,134
3.7%
511
23.9%
871
1.6%
1,432
3.3%
561
39.2%
South Lakeland
1,632
1.6%
2,486
2.8%
854
34.4%
Cumbria PCT
9,788
1.9%
15,060
3.7%
5,272
35.0%
Eden
Projections
Figure 3 shows projections for the number of people in Cumbria who may be left with a
longstanding health condition as a result of bronchitis and emphysema from 2009 to 2030. The
number aged 65 and over is projected to rise (reflecting increasing survival rates), increasing
from 1,689 in 2009 to 2,754 in 2030: an increase of 64%. All age groups and genders are
expected to experience an increase in numbers although the greatest percentage increase is
predicted for males aged 75 and over (108% increase).
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Figure 3: 2009-30: People aged 65 and over predicted to have a longstanding health condition caused by bronchitis and
emphysema
Cumbria: People aged 65 and over predicted to have a longstanding health condition caused by
brochitis and emphysema, by gender and age (64-74, 75+), 2009 to 2030 (Source: POPPI)
3000
2500
Number of People
2000
1500
1000
500
0
2009
2015
Males 65-74
2020
Males 75+
2025
Females 65-74
Females 75+
2030
Total 65+
Projections by district council also show an increase in all people aged 65 and over expected to
have a longstanding health condition as a result of a heart attack (Figure 4). The greatest
numbers are predicted to be in South Lakeland but the largest percentage increase is expected
for Eden (77%).
Figure 4: 2009-30: People aged 65 and over predicted to have a longstanding health condition caused by bronchitis and
emphysema by district council
Percentage aged 65 and over predicted to have a longstanding health condition caused by
bronchitis and other emphysema projected to 2030 by district council (Source: POPPI)
800
700
Number of People
600
500
400
300
200
100
0
2009
2015
Allerdale
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Barrow-in-Furness
2020
Carlisle
2025
Copeland
Eden
2030
South Lakeland
4
Inequalities in Cumbria
In terms of prevalence, there appears to be a strong relationship between COPD and
deprivation according to data from the primary care registers (QOF) (Figure 5). This can be
largely ascribed to the higher smoking rates (and therefore associated higher COPD prevalence)
found in deprived areas.
Figure 5: COPD prevalence by deprivation quintile
2007-08: Unadjusted Prevalence Rate for COPD by Deprivation Quintile of GP Practice in Cumbria
(Source: QMAS)
2.5
Cumbria Average
Prevalence (%)
2.0
1.5
2.3
2.2
1.0
1.9
1.6
1.5
4
5 - Least Deprived
0.5
0.0
1 - Most Deprived
2
3
Deprivation Quintile of GP Practice
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5