24 - Respiratory Diseases
Objectives | References
Lung disease is the fourth leading cause of death of Americans, causing
one in seven deaths in this country. While the rates for heart disease,
cancer, and stroke, the top three causes of death, are dropping, the lung
disease death rate is on the rise. For those living and coping with chronic
lung disease, every day is a struggle to breathe and a struggle to stay
alive. Over 30 million Americans 221,000 of them West Virginians
live with chronic lung disease.
Lung disease is the number one disabler of American workers and one of
the leading causes of restricted activity. Lung disease costs the American
economy about $31.6 billion in direct health-care expenditures every year
plus indirect costs of more than $60 million, according to 1998-99 data
provided by the American Lung Association.
Asthma is a lung disease characterized by chronic inflammation of the
airways, resulting in reduced airflow that causes wheezing, cough, chest
tightness, and difficulty in breathing. It is the sixth-ranking chronic
condition in the country and the leading serious chronic illness among
children. It also is the number one cause of school absences attributed
to chronic conditions, leading to an estimated average 7.3 school days
An estimated 14.9 million Americans suffer from asthma -- 4.8 million
of them children. In West Virginia an estimated 32,000 children and 69,000
adults suffer from asthma. Asthma is unquestionably on the rise, increasing
in prevalence 82% in the last 15 years. Over 500,000 hospitalizations
a year are attributed to asthma along with 5,000 deaths.
Most of the problems caused by asthma are preventable if asthma patients
and their physicians manage the disease according to established guidelines.
Effective management of asthma includes four major components: control
of exposure to factors that trigger exacerbations, adequate pharmacologic
management, continual monitoring of the disease, and patient education.
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is a term used for
two closely related respiratory diseases, chronic bronchitis and emphysema,
that are characterized by the presence of irreversible airflow obstruction.
Between 80% and 90% of COPD is attributable to cigarette smoking. An inherited
version of emphysema caused by a genetic deficiency accounts for less
than 5% of COPD cases.
COPD is predominately a disease of older people. It is estimated that
the prevalence of COPD in North America may be as high as 10% of the population
between the ages of 55 and 85. In West Virginia an estimated 118,000 people
struggle to breathe because of COPD.
Despite the high prevalence and enormous cost to health care and society,
COPD has received little attention in comparison to other respiratory
conditions, probably because COPD is thought of as a self-inflicted disease
that mainly affects the elderly and has few effective treatments.
Obstructive Sleep Apnea
Apnea means "without breath" and occurs during sleep when
the airway to the lung collapses. Obstructive Sleep Apnea (OSA) is one
of the most common sleep disorders and is estimated to affect 18 million
middle-aged and elderly adults in the United States.
The potential consequences of OSA include hypertension, congestive heart
failure, stroke, cognitive impairment, psychiatric problems, sexual dysfunction,
diminished quality of life, and injury due to accidents. OSA also can
increase the seriousness of other lung diseases that decrease airflow,
such as asthma and COPD. Cardiovascular deaths alone attributable to OSA
are estimated at 38,000 annually.
A major factor in the pervasiveness of obstructive sleep apnea's effects
on health and society has been the failure to educate Americans and especially
health care practitioners about the disorder. A wide range of behavioral,
mechanical, and surgical treatments are available to manage OSA symptoms.
Yet, a 1990 survey of U.S. medical schools found that approximately one-third
offered no training in sleep medicine and that another third provided
an average of less than two hours. Absent adequate physician education,
the risk that obstructive sleep apnea will be misdiagnosed and mismanaged
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OBJECTIVE 24.1. Reduce the asthma death rate to no more than 0.8
per 100,000 population 0-64 years of age. (Baseline: 1.0 per 100,000
population aged 0-64 in 1998)
24.1a. Maintain the asthma death rate of 0.3 among persons aged 0-14.
(Baseline: .3 per 100,000 population aged 0-14 in 1998)
24.1b. Maintain the asthma death rate of 0.4 among persons aged 15-34.
(Baseline: .4 per 100,000 in 1998)
24.1c. Reduce the asthma death rate among persons aged 35-64 to 1.35.
(Baseline: 1.71 in 1998)
24.1d. Reduce the asthma death rate among persons aged 65+ to 4.8. (Baseline:
6.1 per 100,000 in 1998)
Data Source: West Virginia Bureau for Public Health (WVBPH),
Office of Epidemiology and Health Promotion (OEHP), Health Statistics
OBJECTIVE 24.2. Reduce overall asthma morbidity as measured by
a reduction in asthma hospitalizations to fewer than 350 annually. (Baseline:
465 in 1997)
Data Source: West Virginia Health Care Authority, Uniform
Billing (UB-92 data)
OBJECTIVE 24.3. (Developmental) Reduce asthma morbidity as measured
by a reduction in the annual rate of emergency department visits by
20%. (Baseline data available in 2001)
Data Source: Public Employees Insurance Agency, ambulatory
care data; Bureau of Medical Services, Medicaid data
OBJECTIVE 24.4. Reduce by 10% the prevalence of West Virginia residents
18 years of age and older with asthma. (Baseline data available
Data Source: WVBPH, OEHP, Health Statistics Center (HSC),
Behavioral Risk Factor Surveillance System (BRFSS)
OBJECTIVE 24.5. Reduce the chronic obstructive pulmonary disease (COPD)
death rate to no more than 50 per 100,000 population. (Baseline:
age-adjusted rate of 54.0 in 1998)
Data Source: WVBPH, OEHP, HSC
Meeting the Objectives
Health Promotion Channels for Achieving Objectives:
- Public Health Programs
- Health Care System
- Higher Education
One of the first means through which
we aim to meet the asthma objectives is to obtain more accurate and detailed
information about the prevalence of asthma in West Virginia. Questions concerning
asthma diagnosis will be added to the Behavioral Risk Factor Survey so that
we can attempt to determine if patients are being accurately diagnosed,
if their physicians are providing an appropriate asthma management plan,
and if the patient is complying with that plan. Asthma patients who are
effectively managing their asthma have fewer acute episodes, fewer hospital
visits, and overall reduced morbidity and mortality.
The COPD objectives are inherently linked to the state's tobacco control
objectives. It is imperative to reduce the prevalence of smoking among
West Virginians if we hope to affect the state's rate of COPD morbidity
and mortality. That can be achieved by conducting a more comprehensive
tobacco prevention, education, and cessation program statewide.
Work Group Members
Sara M. Crickenberger, Work Group Leader, Executive Director,
American Lung Association of West Virginia
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Kimberly S. Collins, RRT, Asthma Coordinator, Thomas Memorial Hospital
Mary Mace, Concerned citizen, Charleston
Guineth Turner, Concerned citizen, St. Albans
Teddie Focht, LRT, RRT, RPFT, Education Coordinator, Respiratory
Care, Charleston Area Medical Center
John L. Szarek, PhD, Department of Pharmacology, Marshall University
School of Medicine
Daniel M. Christy, MPA, Director, Health Statistics Center, WVBPH
American Lung Association. Lung Disease Data 1998-99. New York
City, NY: 2000.
West Virginia Bureau for Public Health. Behavioral Risk Factor Surveillance
System data. Charleston, WV: West Virginia Department of Health and Human
CDC. West Virginia Health Profile 1998. Atlanta, GA: U.S. Department
of Health and Human Services, Public Health Service,1999.
American Lung Association. Estimated Prevalence and Incidence of Lung
Disease by Lung Association Territory. New York City: New York, April
West Virginia Bureau for Public Health. Survey of Medical Schools
on Curriculum Hours. Charleston, WV: West Virginia Department of Health
and Human Resources, 2000.
West Virginia Bureau for Public Health. West Virginia Vital Statistics
1998. Charleston, WV: West Virginia Department of Health and Human Resources,
For More Information
American Lung Association of WV
P.O. Box 3980
Charleston, WV 25339-3980
Phone: (304) 342-6600; Fax:(304) 342-6096