Chronic obstructive pulmonary disease (COPD) is a broad term that refers to various health complications resulting in breathing-related and airflow blockage issues. Among the diseases bracketed under COPD constitute chronic bronchitis and emphysema, and sometimes, asthma is included in the classic triad (CDC, 2020). Globally, COPD is the third leading cause of death in the U.S. alone; it is estimated to affect 16 million individuals (CDC, 2020). In 2016, COPD was responsible for an estimated million deaths worldwide. Most people who suffer from the disease remain undiagnosed and not under treatment. COPD exacerbations are associated with the most substantial burden that the condition places on the healthcare sector. In the U.S., for example, the number of COPD exacerbations has been linked to an annual increase in management costs, which include COPD treatment pharmacy claims (Hurst et al., 2020). The number is six times higher, $4361, for patients who experience frequent exacerbations, two times or more annually, compared to those without, $644 (Hurst et al., 2020). However, physicians can treat the condition despite the absence of a COPD cure.
Since COPD is an umbrella term for emphysema, chronic bronchitis, and refractory asthma, it becomes equally important to understand the conditions. Emphysema is a lung condition responsible for breath shortness. For victims of the condition, their air sacks are damaged, and over time, the inner walls of their air sacks rupture or weaken, resulting in larger air spaces instead of several small spaces (Borné et al., 2019). While the air sacks might still absorb oxygen, they no longer supply sufficient oxygen to the blood. That causes the lungs to lose their springiness and stretch out (Borné et al., 2019). Due to the damaged air sacks, the air gets trapped within the lungs, and the victims cannot breathe it out, which makes them feel shortness of breath.
Chronic bronchitis is a long-term bronchi inflammation that is common among smokers. Due to acute bronchitis episodes, the condition’s victims quickly get lung infections. The health condition is linked to lingering mucus, shortness of breath, and coughing for at least three to two years (Hurst et al., 2020). Cilia, hair-like fibers that line the bronchial tubes and are responsible for moving mucus out are lost when an individual has chronic bronchitis (Hurst et al., 2020). With this, the victims have difficulty getting rid of their mucus, resulting in increased coughs enabling the mucus to develop. Refractory asthma patients experience persistent asthma attacks, frequent symptoms, or low lung function despite using their medication (Lowe et al., 2018). Some of these patients take oral steroids like prednisone to help them manage their condition (Lowe et al., 2018). Despite making a small number of asthma patients, they require frequent and significant medical costs and healthcare visits, which reduces their life quality.
COPD is a chronic disorder where the subset of patients may have any of the three conditions or a combination of two or three. The outcome of COPD is obstructed, hardly reversible airflow. COPD exacerbation prevalence is high, with more than 50 percent of the patients experiencing multiple exacerbations in long-term studies that lasted at least three years (Hurst et al., 2020). Moreover, patients can experience several COPD exacerbations annually. For example, Hoogendoorn et al. (2017) show that 23 percent of COPD victims, especially those with a spirometry-confirmed diagnosis, experience at least two exacerbations annually, which might be moderate or severe. Another 14 percent of the victims experienced at least three exacerbations annually (Hoogendoorn et al., 2017). Further, hospitalization and exacerbations resulting from the latter were outcomes of COPD patients who considered the condition most significant. Clinicians should give special attention to COPD exacerbations within their practice.
In vulnerable settings, COPD becomes a challenge for healthcare facilities due to a combination of factors contributing to the prevalence of the condition, especially in rural areas. Recently, the percentage of COPD-diagnosed patients in rural areas has doubled compared to that in urban areas (CDC, 2020). According to CDC (2020), a 2015 study revealed that rural residents experienced increased COPD Medicare-covered hospitalization and deaths compared to their urban counterparts. CDC attributed the increased COPD prevalence in vulnerable rural settings to more people smoking. Further, challenges with accessing smoking cessation programs and secondhand smoking habits were associated factors that led to increased COPD prevalence in rural settings (CDC, 2020). The unlikelihood of being uninsured alongside elevated poverty levels in rural areas contributes to limited access to early COPD diagnosis and treatment.
Healthcare facilities have the burden of adding more effort to their approach when dealing with COPD in vulnerable settings. Clinicians must minimize and prevent risk factors while overcoming early diagnosis barriers in rural areas. Further, they must overcome appropriate management and treatment challenges of handling the condition in rural settings. While treatment can improve life quality and minimize hospital readmissions by enhancing healthcare access, it remains challenging for clinicians and the healthcare sector to handle COPD in vulnerable settings (CDC, 2020). Without effective countermeasures implemented and maintained in vulnerable settings, COPD prevalence will continue to rise. Among such countermeasures are highlighting the significance of continued smoking cessation policies and programs to prevent the poor from getting COPD and improving their pulmonary function in adults.
Another approach that helps control the challenge of COPD prevalence in low-income settings is highlighting the need for more widespread treatment programs. Such programs include oxygen therapy, pulmonary rehabilitation, and comprehensive chronic disease self-management programs (CDC, 2020). While healthcare providers are duty-bound to help patients, it remains challenging to help adults deal with COPD unless they partner with the community. As such, it becomes difficult to involve adults in COPD awareness participation programs in healthcare interventions (CDC, 2020).
The range of challenges faced with COPD among low-income communities is broad. Lowe et al. (2018) show that exposure to environmental and occupational dust, toxic substances, and fumes also contributes to increased susceptibility to smoking among individuals from low occupational status. Other associated factors that are prone in low-income settings constitute poo nutrition, air pollutants, crowding, intrauterine lung function growth, or increased childhood respiratory infections contribute to COPD prevalence among individuals from vulnerable settings (Lowe et al., 2018). Challenges attributed to poor or less education impede how individuals from low-income societies understand the relationship between smoking and COPD. Moreover, in vulnerable settings, individuals are less likely to have health insurance coverage, and their opportunity to access preventative care from clinicians or doctors decreases.
Access to primary care is critical when dealing with early signs of COPD. However, in vulnerable settings, there is no guarantee of the likelihood of maintaining or even accessing healthcare services, which impacts the double increase in the prevalence among rural adults compared to their urban counterparts. The challenges associated with medical costs mean low-income adults are more likely to skip their medication or medical visits, which helps worsen their health, especially among those with respiratory exposure (Borné et al., 2019). However, the underlying issue in vulnerable settings contributes to the increased COPD prevalence and is poor decision-making to seek care and treatment compliance.
The relationship between COPD and other comorbidities, as attributed to hospitalization costs and length, further contributes to the challenge faced by low-income individuals. Hurst et al. (2020) show that in patients with a single or two severe comorbidity issues, their risk of exacerbation recurrence increases if they have a low-income background. Similarly, physical and mental health comorbidities like chronic heart failure, diabetes, and hypertension are common among COPD exacerbation patients (Hurst et al., 2020). These comorbidity conditions are more prevalent in vulnerable settings compared to high-income settings since patients from the latter are more aware of the significance of healthcare and its contribution to overcoming COPD. As such, any two or three combinations of emphysema, chronic bronchitis, and asthma significantly increase in vulnerable settings, with increased severe exacerbations.
Moreover, while the number of diagnosed COPD patients is high in vulnerable settings, it means that the number of undiagnosed patients is equally high. COPD prevalence in low-income settings is high since adults from such settings do not value the significance of physical activity in improving their respiration system. Anxiety and depression in poor patients are high, which impacts COPD exacerbation. With this, low-income COPD patients encounter more mortality risk, hospitalization, and increased respiratory symptoms.
References
Borné, Y., Ashraf, W., Zaigham, S., & Frantz, S. (2019). Socioeconomic circumstances and incidence of chronic obstructive pulmonary disease (COPD) in an urban population in Sweden. Copd, 16, 1, 51-57.
CDC. (2020). Urban-rural differences in COPD. cdc.gov. Web.
Hoogendoorn, M., Feenstra, T. L., Boland, M., Briggs, A. H., Borg, S., Jansson, S. A., Risebrough, N. A., & Rutten-van Mölken. M. P. (2017). Prediction models for exacerbations in different COPD patient populations: comparing results of five large data sources. International Journal of Copd, 12, 3183-3194.
Hurst, J. R., Skolnik, N., Skolnik, N., Hansen, G. J., Anzueto, A., Donaldson, G. C., Dransfield, M. T., & Varghese, P. (2020). Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. European Journal of Internal Medicine, 73, 1-6.
Lowe, K. E., Make, B. J., Crapo, J. D., Kinney, G. L., Hokanson, J. E., Kim, V., Iyer, A. S., Bhatt, S. P., Hoth, K. F., Holm, K. E., Wise, R., DeMeo, D., Foreman, M. G., Stone, T. J., & Regan, E. A. (2018). Association of low income with pulmonary disease progression in smokers with and without chronic obstructive pulmonary disease. ERJ open research, 4(4), 00069-2018. Web.