Factors in COPD and the role of the patient’s environment and employment

Smoking remains the leading cause of chronic obstructive pulmonary disease (COPD), but environmental factors and occupational hazards are also important, says Meilin Young, MD, pulmonary and critical care specialist at the Allegheny Health Network.

Traditionally, COPD was predominant in men, who were more likely to chain smoke or work in jobs that exposed them to pollutants and other caustic agents that cause respiratory diseases. However, women are also more exposed to these risks, and the prevalence of COPD is increasing in this group, but is often underestimated until later in the disease.

Given the role of environment and occupation, preventing COPD can be a challenge, Young said in an interview with The American Journal of Managed Care® (AJMC®). It’s not realistic to ask someone to move or change jobs.

AJMC®: The prevalence of COPD in women is increasing and their outcomes are worse. Why do you think this is the case?

Young: It has a lot to do with smoking and exposure to biofuels. So mostly it was always the men who were the chain smokers. These are the workers. Thus, they are exposed to many pollutants and other caustic agents which will cause a great deal of respiratory diseases, especially with chain smoking. But in recent decades, women have started to smoke a lot more. We have noticed that it is now almost equivocal in terms of diagnosing COPD in women, just because they are starting to smoke a little more.

For some reason, we notice that when women come into the office and show off, they have a bit more advanced disease. But I think that’s just because it was underestimated for a while until we started noticing a trend where women are doing as much as men in terms of exposure and development of sickness.

AJMC®: Does COPD present the same way in women and men?

Young: Relatively similar overall. You will have them with shortness of breath as the main complaint. The women, they noticed it was a little different. Women, in terms of activity levels, change relative to men. Men in the labor market, if they lift heavy things, it is a little more difficult for them to perform certain tasks at work. Whereas women, if they are doing general chores, for example, babysitting or whatever profession they have, they might not exercise as much until they get to the point where it is so deep that it impinges on their ability to enjoy the normal life of things, like raising their kids, chasing their grandkids, going to the gym, or anything else like that. Then they start to become more aware that “Hey, I can’t do what I used to do anymore, there’s something different.”

I feel like for women, we try to let things go a little longer, until eventually it starts to get unbearable, and then we start trying to figure out what’s going on.

AJMC®: What kind of racial disparities do you see with COPD and emphysema?

Young: It will all depend on the locations, but most importantly, we still see the typical populations that are still underrepresented in most regions. Thus, African Americans will always be diagnosed somewhat later in life due to access to medical care. Many urban populations are less diagnosed due to global access. People who live in the suburbs have more access to doctors. Potentially, they have more access to care. Finances also play a role.

Much of the limitation of what we see in many other disease entities and many other problems is simply down to our socioeconomic status. And that goes hand in hand with the racial disparities that we see, because predominantly African American populations live in urban areas, and the suburbs are going to be a more Caucasian and affluent population. We see the differences because of socio-economic background.

AJMC®: What can be done to increase pulmonary rehabilitation for COPD?

Young: A lot of it is about access and awareness. Most of the time if it is a diagnosis of COPD. The recommended guideline is that all patients be engaged in pulmonary rehabilitation. And a big part is diagnosis and recognition. In order to be a candidate for pulmonary rehab for Medicare and CMS, you must have a qualifying diagnosis. So you must have confirmed COPD or emphysema to be a candidate for pulmonary rehabilitation. Then you also need to let the provider know that “hey, patients can go to pulmonary rehab” and discuss, “it’s different than just going to the gym”. It’s a different program. It’s a different expectation. globally. And they are different individuals. When patients are aware that it is another resource, and because it is covered by insurance according to their diagnosis. it is a very low cost. It’s honestly access and awareness once again.

For us, we have providers who have ordered the pulmonary rehab referral, but after that it’s all up to the patient to try and get to the pulmonary rehab sessions and sometimes the times don’t fit into their daily schedule. But if you have a coordinator or some kind of task force in place to help bridge that gap – transportation, finances or some kind of assistance for that – and just seeing the benefits that pulmonary rehab could bring, patients are more willing to then participate and actually continue.

AJMC®: Given that you practice in western Pennsylvania, what types of occupational hazards do you see playing a role in the development of COPD, and is there anything that can be done to prevent the disease from occurring? develop ?

Young: The number one factor we always see is smoking, but that also depends on what parts of Pittsburgh you live in. My practice is based a bit south in the Jefferson area, so Clairton factories and coal workers. Any kind of particulate inhalation also puts you at risk of developing COPD and smoking on top of that is like a doubled risk. But we have a lot of patients because of passive smoking, where did they grow up and just this environment, and air quality plays a big part in it.

Prevention is difficult, because again, industrialization is an important aspect. The region itself depends on a lot of different things like steel mill, coal mining etc. We can’t just tell patients to just quit their jobs or move somewhere else, because that’s just not practical. A lot of that is to make sure they’re wearing the proper respirators. That businesses and industries use the appropriate equipment to protect patients, in general. Also, make sure they don’t do other things that will hasten the rate of lung decline. If they smoke, tell them to quit. If there are certain chemicals that they know are also caustic, try to avoid them or anything like that.

But it’s just that it’s an uphill battle, because again, you can’t tell patients to just stop what they’re doing, because it’s their livelihood, or quit there. where they live, because that’s where they come from.

AJMC®: What is the impact of emphysema on the patient’s quality of life?

Young: For emphysema, the best way to describe it, your lungs are literally filled with air. Hot air that you simply do not participate in gas exchange at all. The air becomes, essentially, trapped. If you imagine, people with COPD or just sensitive lungs, in general, it’s hard to get air in. And then once you finally get the air in or out, it doesn’t contribute at all to what you need for day to day function or just for oxygenation and ventilation.

For patients with emphysema, it’s a little more difficult because not only are they clogged up because they can’t get the air out, but the air they get in only gets worse and worse. add to it, because these lung units are not used. at all. They basically waste lung units. This only contributes more to the patient’s shortness of breath as he essentially fills up with more air which does nothing for him.

Comments are closed.