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Chronic Respiratory Infections

Since 2008, the third leading cause of death is due to a collection of lung diseases (asthma, chronic bronchitis, and emphysema) referred to as lower respiratory infections. Chronic bronchitis and emphysema are grouped together into chronic obstructive pulmonary disease (COPD), which accounts for the largest portion of lower respiratory infections.8 These are progressive conditions that limit oxygen exchange intake and leave patients with high levels of disability. Despite the severity of COPD, accurate data on its prevalence are not kept by all 50 states. The CDC’s best estimate is that 6.3% of American adults are living with chronic bronchitis or emphysema.41 That is approximately 15 million people who report having been diagnosed. An additional 12 million potentially have COPD but have not yet been diagnosed.42

Incidence of diabetes in the United States since 1980. (Reprinted with permission from Centers for Disease Control and Prevention. Diabetes report card 2012. Published 2012. Accessed October 14, 2015.)

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Exposure to airborne irritants, such as tobacco smoke, chemical fumes, or dust from manufacturing, are the main risk factors for developing COPD. Prevalence is higher in those older than 55 years, which indicates that long-term exposure is a key aspect of the disease.41 Initially, symptoms, such as coughing with mucus and shortness of breath with physical activity, are mild. Over time, they become more pronounced, and wheezing or rapid breathing occur. COPD reduces lung volume. In chronic bronchitis, the lining of the bronchioles is inflamed and mucus is produced, which narrows the passageways for air. The smaller diameter of the bronchioles increases the resistance to air flow, making it harder for someone to take a full breath. In emphysema, damage from fumes and irritants has caused some of the alveoli, or air sacks at the end of the bronchioles, to deflate. Without functioning alveoli, there are fewer places for oxygen and carbon dioxide to be exchanged, which results in lower oxygen content in the blood.33

A common comorbidity of COPD is hypertension and CVD. A comorbidity is a disease that occurs with another disease.1 Because the lungs are less efficient at moving air and exchanging oxygen for carbon dioxide, the body compensates by increasing heart rate and blood pressure so that the oxygen needs of the cells are met. Those with severe COPD find even light physical activity to be difficult because of the poor oxygenation of their blood. Once diagnosed, it is important for those with mild to moderate cases of COPD to stay physically active. Lung volumes, inflammation, and mucus buildup are improved by regular physical activity, such as walking or household chores. Patients who reported at least some physical activity had a lower risk of death and less likelihood of hospitalization for their symptoms.43

Some disparities exist between gender, ethnic, economic groups, and by geographic region. Women have higher rates of COPD than men until age 75, when both genders are nearly equal in prevalence.44 Women aged 65 to 71 years have the highest prevalence at 10.4%, whereas 8.3% of similar aged men are living with COPD. Puerto Rican and White Americans account for more cases of COPD than Black or Hispanic Americans (Figure 1-8). Prevalence44 and disability45 are also inversely related to income. This is likely due to the environmental hazards found in less well-paying jobs and the greater number of smokers in low-income populations.46 States in the central south (Kentucky, Tennessee, Alabama, and Mississippi) have the highest rate of COPD at 7.5%, whereas the Pacific Coast states (Washington, Oregon, California, and Hawaii) have the lowest rate at 3.9%.44 Although more women are diagnosed with COPD, men die from the disease at

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