Chronic Obstructive Pulmonary Disease prevalence, diagnosis and relation to tobacco dependence in a nationally representative population sample

Lion Shahab ^1*, Martin Jarvis ¹, John Britton ² and Robert West ¹

¹ University College London, United Kingdom
² University of Nottingham, United Kingdom

^* To whom correspondence should be addressed. E-mail: lion.shahab{at}ucl.ac.uk.

Accepted 25 August 2006

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is the fourth most common cause of death worldwide. It is caused primarily by cigarette smoking. Given its importance it is remarkable that reliable national prevalence data are lacking for most countries. This study provides estimates of the national prevalence of COPD in England, the extent of under-detection of the disorder, and patterns of cigarette smoking, dependence, and motivation to stop smoking in those with the disease.

Methods: Data from 8215 adults over the age of 35 who participated in the Health Survey for England were analysed. Information was obtained on self-reported and cotinine-validated smoking status, cigarette dependence, motivation to stop smoking, COPD defined through spirometry using joint American Thoracic Society and European Respiratory Society criteria, and self-reports of diagnosis with respiratory disorders.

Results: Spirometry-defined COPD was present in 13.3% (95%CI 12.6 to 14.0%) of participants, over 80% of whom reported no respiratory diagnosis. Even among people with severe or very severe COPD by spirometric assessment, only 46.8% (95%CI 39.1 to 54.6%) reported any diagnosed respiratory disease. A total of 34.9% (95% CI 32.1 to 37.8%) of people with spirometry-defined COPD were smokers, compared with 22.4% (95%CI 21.4 to 23.4%) of those without, and smoking prevalence increased with disease severity. Smokers with spirometry-defined COPD were more cigarette dependent but had no greater desire to quit than other smokers.

Conclusion: COPD is common among adults in England and is predominantly undiagnosed. In smokers it is associated with higher degrees of cigarette dependence but not greater motivation to stop smoking.

Keywords: COPD Epidemiology, COPD Prevalence, Smoking Cessation, Spirometry-defined COPD, Tobacco Dependence

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