A Healthier Future for West Virginia - Healthy People 2010

24 - Respiratory Diseases

Objectives | References

Background

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

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 missed annually.

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 remains high.

The Objectives

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 Center (HSC)

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 in 2000)

Data Source: WVBPH, OEHP, Health Statistics Center (HSC), Behavioral Risk Factor Surveillance System (BRFSS)

FLAGSHIP OBJECTIVE
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:

• Worksites
• Schools
• Public Health Programs
• Networks
• 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
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

References/Resources

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 Resources.

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 1999.

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, March 1999.

For More Information

American Lung Association of WV
P.O. Box 3980
Charleston, WV 25339-3980
Phone: (304) 342-6600; Fax:(304) 342-6096

This page was last updated June 27, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov