In: Airways Disease1 Dec 2014
2.3 Morbidity (How Severe Is CAD?)
There is evidence that CAD places heavy demands on health care services. As reported in this symposium, Higgins estimates that in the USA, 1.3 percent of hospital discharges are from COPD; Holland estimates that, in the United Kingdom, respiratory diseases account for 25 percent of general practitioner consultations; Wojtyniak and Wysocld give evidence that 3.3 percent of hospitalizations in Poland are due to chronic bronchitis, emphysema, and asthma; and Utkin reports that 1.5 percent of outpatients attend clinic because of chronic bronchitis. Population studies conducted in Papua New Guinea (PNG) and in Australia show that up to 30 percent of elderly people in PNG and 10 to 12 percent of adults in Australia have CAL. Because there are very few data available about the prevalence of CAL in other countries, there is a great need to collect this information.
2.4 Prevalence (Who Has CAD? Where Is It?)The MRC questionnaire has been used in many reported studies and there is a large literature available relating to the prevalence of certain specific respiratory symptoms and of chronic bronchitis, much of which is summarized in the Surgeon Generals Report, US Government, 1984.
Data from the literature and from papers reported in these proceedings, which are summarized in Table 2, suggests that the prevalence of CAD, particularly chronic bronchitis, remains a very common problem in many countries. However, evidence was presented that a reduced prevalence has been achieved in some European countries, including Poland, and in other places in the world, the prevalence is declining. in detail
2.5 Bisk Factors (What Causes CAD?)
The papers presented in this symposium all show that chronic bronchitis is more common in men and increases with age in both men and women. In addition, chronic bronchitis may be associated with industrialization and with geographic conditions. Emphysema has a strong relationship with smoking. Strong associations between chronic bronchitis and both tobacco smoking and air pollution have been found in all populations in which studies have been conducted. There is also evidence to suggest that acute respiratory infections in early life, certain occupational exposures, socioeconomic status, and genetic factors may be important in some populations. In China the disease is more common in urban dwellers than in rural workers, suggesting that a social factor may be involved.
Chronic airflow limitation can be the outcome of many different pathologic processes, including asthma, which is a chronic disease of the airways with intermittent episodes of airway narrowing. Thus, asthma is an important risk factor for the development of CAL and, as such, presents a complicating factor in certification of death. In countries where asthma is both common and severe, intervention to reduce asthma is obviously important.
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