COPD kills more than lung and breast cancer combined. It's time to change that

Chronic Obstructive Pulmonary Disease (COPD) is a critical public healthcare crisis that is under-prioritized, underfunded and under treated. It kills more people every year than lung and breast cancer combined and is the third leading cause of death worldwide (excluding COVID-19). The disease burden is significant, affecting an estimated 391 million people, with associated costs predicted to reach a staggering $4.3 trillion between 2020 and 2050. Additionally, the personal cost is substantial, as around 40% of people with COPD must reduce or stop working altogether. Despite all of this, the disease is not being prioritized by governments or healthcare systems compared to other non-communicable diseases (NCDs).

COPD also disproportionately affects those in low- and middle-income countries (LMICs), where socioeconomic disadvantages, healthcare access – which is often limited – and low disease awareness aggravates the problem. The World Health Organization estimates that nearly 90% of COPD deaths among people under 70 occur in LMICs, while almost half of COPD patients in LMICs suffer from exacerbations, or symptom flare ups which require treatment or even hospitalization. COPD exacerbations can cause permanent, irreversible lung damage and increase the risk of death, so it is essential this is addressed.

There remains a lack of disease understanding among policy-makers which also contributes to the underdiagnosis and undertreatment of COPD and we need an urgent shift in priorities to tackle this burden.

COPD is a progressive condition characterized by persistent symptoms including chronic coughing and shortness of breath. It is a complex disease influenced by various known risk factors, including smoking, air pollution both outside and inside the home, and occupational hazards such as airborne pollutants and chemicals. These factors can vary significantly depending on geography.

In high-income countries, smoking accounts for over 70% of COPD cases. However, in LMICs we see a very different picture, where smoking contributes to only 30-40% of cases, with household air pollution being the other major risk factor, caused mainly by the burning of solid fuel for cooking or heating. Over 2 billion people worldwide use solid fuels, especially in rural areas in LMICs, presenting a serious challenge in tackling the issue.

However, innovative policy reforms have the power to influence health outcomes. India’s government is tackling household air pollution by providing people below the poverty line with liquefied petroleum gas (LPG) for cooking in place of solid fuels. In a study of the impact of this policy change on non-smoking women from rural Maharashtra, those who cooked using LPG had a lower prevalence of obstructive airway disease, including COPD (1.3%) compared with the group that used solid fuels (7.6%). This is a visionary policy shift which not only addresses air pollution but the known associated health implications and has already demonstrated a tangible impact in health outcomes.

Despite understanding the risk factors and witnessing the devasting effects COPD has on patients and the economy, the disease still does not receive the needed level of prioritization in clinical care and healthcare policy across most LMICs, resulting in patients being diagnosed late and when the severity of the disease has increased. When there is a delay in diagnosis, patients are at an increased risk of comorbidities while there is a greater economic cost when compared with early diagnosis, further highlighting the need for accurate and timely diagnosis.

It is estimated that every hour, COPD claims 425 lives, a bleak reminder of the urgency required in addressing a public health crisis that has been low on the global health agenda for too long. This is of particular importance in LMICs, where the burden is greatest, healthcare resources are already severely stretched, and the economic impact is considerable.

One crucial aspect involves aligning and including COPD advocacy with broader health initiatives. Many countries have established frameworks for addressing NCDs, but these too often lack important COPD inclusion and national respiratory strategies focused on mortality reduction. China, for example, has demonstrated what is possible in advancing COPD care when integration happens on a national level. Recognizing the immense burden as the country accounts for almost a third of all COPD cases globally, a successful nationwide strategy has been implemented, including enhanced screening, lung function tests at a primary care level and comprehensive training for 140,000 primary healthcare workers. Through a combination of initiatives, 1.5 million people have been screened in two years, leading to a notable increase in early COPD diagnosis.

In addition to integrated healthcare policies like these, we need to work to break down the barriers of low disease awareness and education, along with pervasive stigma, which would play a pivotal role in demystifying the disease and encouraging people to speak to their healthcare provider. If we can drive greater understanding, we truly can transform patient outcomes.

At AstraZeneca, we are dedicated to supporting a shift in the COPD landscape through Speak Up for COPD, a coalition of partners across the healthcare ecosystem and non-profit sector to raise awareness and understanding among decision makers and ensure the voice of COPD patients is heard. Only by working in partnership can we make the difference that patients need – to prioritize prevention, early detection, and proactive comprehensive disease management so no one with COPD is left behind.

Through education, collaboration, and strategic action, we can significantly reduce the burden of COPD on people, their families, society, and the planet.