Social and economic burdens affecting patients with COPD provide significant obstacles to optimizing care.
Jeffrey D. Dunn, PharmD, MBA: Mike, I’m going to give you a tougher question because there are indirect and direct costs. Can you summarize the economic burden of COPD [chronic obstructive pulmonary disease] in the United States?
Mike Hess, MPH, RRT, RPFT: Economically, COPD takes about $50 billion out of the economy every year. About two-thirds of that is direct costs—things like the medications, admissions, and hospital expenses—and the remainder are the indirect costs that you mentioned, such as absenteeism or presenteeism. COPD is a huge driver of people not being at work. We figure we miss about 16.4 million workdays because of COPD symptoms, exacerbations, and the rest.
The other thing is those costs are likely higher because we see a significant amount of underdiagnosis in the COPD world. Only about half the people who have symptoms and theoretically have COPD are diagnosed. We have a bunch of people wandering around short of breath with symptoms and missing work, and we aren’t accounting for those millions.
Jeffrey D. Dunn, PharmD, MBA: The social burden is high in COPD. A lot of stakeholders, including payers, have a hard time contextualizing and valuing the social burden, for lack of a better description. It’s the second leading cause of reduced disability-adjusted life years, and it’s behind only ischemic heart disease. What disease aspects contribute to this high social burden of disease?
Mike Hess, MPH, RRT, RPFT: In respiratory therapy, we have this saying: “If you aren’t breathing, you probably aren’t doing much of anything else.” Breathing affects every moment of your day, waking or not. When we have this burden, if you’re out of breath from going to check your mail or use your restroom, then you probably aren’t going to do a lot of things that engage you in your community. You may become withdrawn from your family. You may leave the workforce earlier or have absenteeism. You aren’t going to be involved in church or spiritual events. You aren’t going to be involved in community things. We start to see this downward spiral.
Staying active can stave off some of the comorbidities. We see folks fall into the flip side, where they are withdrawn and inactive and become increasingly depressed. That spikes all the other comorbidities. It’s very good to point that out in addition to the financial costs. There are some tremendous social costs that go along with this. On top of that, there’s the psychological burden. People often feel guilty because they’ve been told for many years that this is a thing they’ve done to themselves through smoking and not being strong enough to be able to quit and so on. This contributes to mental health comorbidities, which in turn contribute to the physical health comorbidities.
Jeffrey D. Dunn, PharmD, MBA: From a different perspective, what’s the effect of COPD on quality of life?
Reynold Panettieri Jr, MD: Mike and Courtney touched on some of this. It has a profound effect on quality of life and functional status. Functional status is your activities of daily living, the things you want to do or wish you could do but can’t because of breathlessness and breathing discomfort. The quality-of-life measures are objective ways of characterizing the impact of the disease on the patient. In COPD, we have several tools available. One is the COPD Assessment Tool. It’s a fantastic tool. It’s valid, reliable, and in a number of languages. It allows us to longitudinally follow a patient along with a score. This score then can be compared from visit to visit so patients get a sense [of their progress] and think, “You’ve improved my score, which means the therapy is working,” or “My score is lower than the last time, so we need to change the intervention.” It’s important.
I want to come back to a couple of items Courtney [Crim] mentioned. The difference between asthma and COPD is that COPD is a systemic disease that affects virtually every organ, whereas asthma affects only the airways. There’s some comorbidity with nasal polyps and things, but they’re minor compared with the systemic consequences of COPD affecting almost every organ system, which impacts quality of life.
Jeffrey D. Dunn, PharmD, MBA: It’s important to understand that here because—I’m going to play the role of payer for a bit here—it’s hard for us to fully understand, use, and value the subjective parts of these disease states, so we focus on things like FEV [forced expiratory volume] and exacerbations. This is an important outcome. It’s especially important to the patient and the provider, so we need to do a better job of correlating that with outcomes.
Reynold Panettieri Jr, MD: Sometimes people get confused and think that if you use an inhaler, that disease is the same across the board, and that an inhaler treats everything. That’s wrong. As Courtney mentioned, COPD is a different disease entity from asthma. You can have irreversible airflow obstruction in asthma, but it isn’t tobacco driven. We need to be [clear] in understanding and differentiating these diseases and their consequences.
Jeffrey D. Dunn, PharmD, MBA: Excellent. Perfect.
Transcript edited for clarity.