COPD is the third leading cause of death in the United States, yet it remains relatively unknown and underdiagnosed compared to other major diseases. There are a few key reasons for this: 1) lung function decline from COPD often occurs gradually over many years as lung capacity is lost, so people may not notice symptoms initially; 2) there are no simple blood tests to diagnose COPD like there are for other conditions; 3) family doctors often do not test lung function. While smoking is the primary cause and rates have declined, COPD rates continue to increase as the effects of decades of smoking take their toll on lungs.

1. COPD Is Now The Third
Leading Killer of Americans
– So Why Has No One
Heard of It?
COPD unknown, undiagnosed
Sanjay Gupta, MD, Everyday Health: People
don’t seem to really know about COPD, given
how big a killer it is. They know about lung
cancer. They know about heart disease. Why is
the awareness around COPD so low?
Ronald Crystal, MD, Pulmonary Disease Specialist
at Weill Cornell Medical College: I think there’s a
couple of reasons for that. First, the lung is very
redundant. When you and I were 18, we had 300
million air sacs in our lung, and so we start losing
them as we get older, but that accelerates with
COPD. People don’t realize they’re developing
this disease for a long time until they’ve lost
significant amount of lung function.
Dr. Gupta: What is COPD? How do you define it?
Dr. Crystal: It’s an inability to get the air out. In
contrast to asthma, where you also have an
inability to get the air out but it is reversible. In
COPD, it's not reversible.

2. Dr. Gupta: It's chronic obstructive pulmonary
disease.
Dr. Crystal: That’s correct.
Dr. Gupta: What qualifies chronic? How long do
you have it?
Dr. Crystal: Most of it is caused by cigarette
smoking, probably 85 to 90 percent of patients,
and it creeps up on you. Most patients that you
see it’s probably been going on for quite a while
and they ascribe it to, perhaps, “I am getting out
of shape, I am a little overweight, I am getting
maybe short of breath when I go up a flight of
stairs, I cough a little more – but that’s the
smoking.” But they are actually developing the
disease.
Dr. Gupta: Is it under-diagnosed?
Dr. Crystal: Oh, absolutely. Most family doctors
don't test the lung. We have blood tests for liver
disease, kidney disease, heart disease, and so
on, but we don't have good blood tests for COPD.
Dr. Gupta: Is there a relationship between COPD
and lung cancer?

3. Dr. Crystal: There is. Even when you take away
smoking as the risk factor, COPD itself is a risk
factor for lung cancer.
Dr. Gupta: Smoking rates have gone down,
especially in certain populations. Have you seen
COPD rates going down concordantly?
Dr. Crystal: Absolutely. It’s very interesting, you
know now that heart disease and cancer that
there’s good therapies for it. COPD’s been
increasing in terms of killer. It was the fourth
killer in our country. It’s now the third.
Cigarette smoking has gone down, but it’s
leveling off. Across the country, it’s probably
about 20 percent, 21 percent of adults are
smoking, and it’s leveling off now. And that’s
frightening, because unless we can get it to go
further, not only COPD but the other diseases
associated with smoking are going to continue.
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