Many smokers already have early signs of the incapacitating lung condition chronic obstructive pulmonary disease (COPD) without realising they have a serious problem that can benefit from medical treatment, an international survey has revealed.
In the survey – the first of its kind to look at breathlessness among people at risk from the lung disease – one in five smokers over the age of 40 reported that they suffered from breathlessness when walking up a short flight of stairs. Breathlessness is a major symptom of COPD.
Up to a third of the survey respondents did not attribute their breathlessness to smoking in any way, believing it had other causes such as growing older, being unfit or an unrelated illness.
“The problem with COPD is that it has a very slow onset. Many people do not recognise the telltale signs, they just cut back on their activities so that they don’t become breathless,” said David Price, GPIAG Professor of Primary Care Respiratory Medicine at the University of Aberdeen, who developed the survey. “It is not normal to get breathless when you walk up a flight of stairs. This survey gives some idea of just how serious breathlessness is in this population.”
Professor Price said he was surprised at the severity of breathing problems that people in the survey admitted to. More than one in 10 said breathlessness prevented them from coping with everyday tasks, such as dressing and leaving the house.
About a quarter of those said that their breathlessness either completely or frequently dictated their daily activities. Problems caused by the breathlessness included being unable to sleep, panicking when unable to breathe, being embarrassed in public, and having problems taking part in exercise, sport and even sex.
The survey – entitled BREATH (Breathlessness Research: Expectations and Treatment Hopes) – questioned about 2,300 people in the UK, USA, France and Germany who were smokers or ex-smokers and aged over 40.
“Although the survey sampled a relatively small group, I think the findings really do show that a lot of people’s lives are severely affected by breathlessness,” Professor Price said.
COPD, sometimes known as “smoker’s lung”, is a slowly progressive disease that causes irreversible damage to the lungs. Symptoms include shortness of breath, cough and sputum production. Tobacco smoking is the biggest risk factor for the condition, which is the world’s fourth-biggest cause of death, killing about the same number of people per year as HIV/AIDS, according to the World Health Organisation (WHO).
Relieving symptoms such as breathlessness is one of the main COPD treatment goals advocated by guidelines, including the recent Global Initiative on Chronic Obstructive Lung Disease (GOLD) report from the WHO and the US National Health Institutes. Bronchodilators are considered to be first line therapy for the relief of symptoms in COPD.1 Studies have also indicated that some bronchodilators, such as the long-acting beta2-agonist Foradil® (formoterol fumarate), can positively affect daily living and improve quality of life.
In the survey, sufferers also reported mixed success when seeking medical advice. According to the BREATH survey, almost two-thirds of those with breathlessness had consulted a doctor about it, but only about half of those had been given a diagnosis.
“There were large country variations in the diagnosis given, but it is difficult to know whether this is a result of cultural or languages differences in disease terminology or whether some diagnoses were inaccurate,” commented Professor Price.
But the survey did show that those people who had not consulted their doctor were more likely to expect to be told to stop smoking.
Among its other findings, the survey highlighted some interesting national differences:
- Twice as many people in Germany as in the other three countries thought smoking had nothing to do with their breathing problems
- Doctors in the USA gave the largest number of diagnoses of COPD
- The French were the least likely to consult a doctor about their breathing problems
- The British reported the most severe problems with mobility caused by breathlessness.
The BREATH survey was sponsored by an unrestricted educational grant from Swiss-based pharmaceutical group Novartis Pharma AG.