Currently in the United States, more than 23 million people6, 7 have asthma. Approximately 13.6 million adults have been diagnosed with COPD, and an approximately equal number have not yet been diagnosed.8 The burden of respiratory diseases affects individuals and their families, schools, workplaces, neighborhoods, cities, and states. Because of the cost to the health care system, the burden of respiratory diseases also falls on society; it is paid for with higher health insurance rates, lost productivity, and tax dollars. Annual health care expenditures for asthma alone are estimated at $20.7 billion.

Asthma and chronic obstructive pulmonary disease (COPD) are significant public health burdens. Specific methods of detection, intervention, and treatment exist that may reduce this burden and promote health.

ASTHMA

 

Asthma is a chronic inflammatory disorder of the airways characterized by episodes of reversible breathing problems due to airway narrowing and obstruction. These episodes can range in severity from mild to life threatening. Symptoms of asthma include wheezing, coughing, chest tightness, and shortness of breath. Daily preventive treatment can prevent symptoms and attacks and enable individuals who have asthma to lead active lives.

 

The prevalence of asthma has increased since 1980. However, deaths from asthma have decreased since the mid-1990s. The causes of asthma are an active area of research and involve both genetic and environmental factors.

Risk factors for asthma currently being investigated include:

• Having a parent with asthma
• Sensitization to irritants and allergens
• Respiratory infections in childhood
• Overweight

 

Asthma affects people of every race, sex, and age. However, significant disparities in asthma morbidity and mortality exist, in particular for low-income and minority populations. Populations with higher rates of asthma include:

• Children
• Women (among adults) and boys (among children)
• African Americans
• Puerto Ricans
• People living in the Northeast United States
• People living below the Federal poverty level
• Employees with certain exposures in the workplace

 

While there is not a cure for asthma yet, there are diagnoses and treatment guidelines that are aimed at ensuring that all people with asthma live full and active lives.

COPD

 

COPD is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases (typically from exposure to cigarette smoke). Treatment can lessen symptoms and improve quality of life for those with COPD.

COPD is the fourth leading cause of death in the United States. In 2006, approximately 120,000 individuals died from COPD, a number very close to that reported for lung cancer deaths (approximately 158,600) in the same year.11 In nearly 8 out of 10 cases, COPD is caused by exposure to cigarette smoke. In addition, other environmental exposures (such as those in the workplace) may cause COPD.

Genetic factors strongly influence the development of the disease. For example, not all smokers develop COPD. Quitting smoking may slow the progression of the disease. Women and men are affected equally, yet more women than men have died of COPD since 2000.

Several additional respiratory conditions and respiratory hazards, including infectious agents and occupational and environmental exposures, are covered in other areas of Healthy People 2020. Examples include tuberculosis, lung cancer, acquired immunodeficiency syndrome (AIDS), pneumonia, occupational lung disease, and smoking. Sleep Health is now a separate topic area of Healthy People 2020.

It should be recognized that there are other important respiratory diseases not included in this topic area. Examples include idiopathic pulmonary fibrosis, sarcoidosis, respiratory distress syndromes, and upper airway conditions, such as rhinitis and chronic sinusitis. In some cases, effective preventive interventions do not exist. In others, nationally representative trend data for disease prevalence and/or incidence, causative exposures, and other preventable risk factors are not available for tracking of measurable goals. It is hoped that, as preventive interventions and surveillance for respiratory hazards and diseases continue to improve, future versions of Healthy People will include measurable goals for at least some of these additional respiratory hazards and diseases.

Other emerging issues in the Respiratory Diseases topic area include:

• Assessing the impact of climate change (temperature extremes, the increased geographic span of allergens, and air quality) on asthma causation and exacerbations.
• Increasing importance of indoor air quality as a cause of work-related respiratory symptoms and asthma in a service economy.
• Increasing use of nanotechnology and resulting exposures to engineered nanoparticles.
• Increasing exposures to respiratory hazards such as isocyanates used in “green” building materials.
• Applying knowledge about gene-environment interactions and epigenetics to respiratory disease prevention.
• Using knowledge about primary causes of asthma (determination of distinct asthma phenotypes) in developing effective prevention strategies, such as weight control and allergen avoidance.
• Developing novel treatments to alter the progression of disease severity and, ultimately, to prevent asthma onset.
• Using personalized medicine (tailoring treatment to a patient’s specific phenotype, genetics, and history).
• Identifying new respiratory hazards, as has been done during the last decade for diacetyl and other butter-flavoring chemicals; nylon, rayon, and polypropylene flock; and World Trade Center dust.
• Improving COPD awareness and clinical case-finding in the population at large, and in the health care delivery system at the State and local levels.
• Establishing a surveillance system for COPD.