Seattle - Globally, there are twice as many people with bronchial asthma than chronic obstructive pulmonary disease (COPD), but mortality from COPD is eight times higher. This came out in an inventory in Lancet Respiratory Medicine (2017; doi:).
COPD and asthma are the two most common chronic respiratory diseases. It is difficult to determine how many people worldwide have it, since diagnosis today requires test of lung function, for which instruments are lacking in many poorer countries around the world. In addition, the diagnostic criteria have changed. The global inventory that the “GBD 2015 Chronic Respiratory Disease Collaborators” led by Theo Vos from the Institute for Health Metrics and Evaluation in Seattle is therefore no more than an approximation.
It showed that around 348 million people worldwide suffered from asthma in 2015 compared to 174 million people with COPD . In both cases, this represents an increase in numbers since 1990 when the World Health Organization (WHO) carried out similar inventory. However, the increase is primarily result of the increased world population. The age-standardized prevalence of COPD has decreased by 14.7 percent since 1990, while Vos determined decrease of 17.7 percent for asthma.
Since COPD is an incurable disease that slowly leads to death, while if asthma is not necessarily progressive, deaths from COPD are more common. Vos identified 3.2 million deaths from COPD and 0.40 million deaths from asthma. Here, too, an increase in the total number is offset by decrease in the age-adjusted mortality rate.
In most cases, both diseases are the result of air pollutants or allergens inhaled over the years. The most important risk factors for COPD are smoking and fine dust / airborne dust (ambient particulate matter), followed by air pollution in the home, dust exposure at the workplace, as well as ozone and passive smoking. According to Vos' calculations, these factors explain 73.3 percent of all years of life lost due to COPD in good quality of life (DALY). The connection is less easy to establish in asthma. According to Vos, smoking and “asthma-related” pollutants in the workplace account for 16.5 percent of asthma-related DALY.
The burden of disease of COPD and asthma varies widely around the world. Most of the DALY from COPD is in Papua New Guinea, India, Lesotho and Nepal. Asthma is highest in Afghanistan, the Central African Republic, Fiji, Kiribati, Lesotho, Papua New Guinea, and Swaziland in particular. Poverty, smoking and the need to use fossil fuels in the home and for local energy production are likely to play an important role here.
The disease burden from COPD is lowest in high-income countries in Asia-Pacific, Central Europe, North Africa and the Middle East, the Caribbean, Western Europe and the Andean countries of Latin America. Asthma is least common in Eastern and Central Europe, as well as China, Italy, and Japan.
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