A global call for policy action – POLITICO

*Speak Up for COPD is supported by a coalition of partners across industry and the non-profit sector to raise awareness and understanding of COPD amongst policymakers and healthcare decision makers by amplifying the voices of patients, the COPD community and the public. All partners contribute time and expertise to the coalition actitivies. Our one critical goal is to establish COPD as a public health priority.

Coalition partners: Global Allergy & Airways Patient Platform (GAAPP), International Federation of Ageing (IFA), COPD Foundation, International Coalition of Respiratory Nurses (ICRN), International Pharmaceutical Federation (FIP), with funding from AstraZeneca, Roche, Sanofi and Regeneron.

Breathing. It’s simple, isn’t it? In. Out. All day. Every day. Without a second thought.

Yet, for the 391 million people around the world living with chronic obstructive pulmonary disease (COPD), breathing is anything but simple.^1,2 Characterized by airflow obstruction, this progressive disease robs individuals of their ability to breathe freely, leading to severe disability, reduced quality of life and even premature death.^2,3

Beyond the profound human cost, COPD casts a long, expensive shadow over health systems and economies, not only in direct healthcare expenses such as hospitalizations but also in lost productivity.^2,4,5 By 2030, it is estimated to incur a global economic burden of $4.8 trillion, including both direct costs associated with treatment and indirect costs associated with lost productivity and income.⁶ To put this in perspective, this exceeds the projected costs of cardiovascular disease and diabetes combined.⁶ Furthermore, a recent Lancet study points to further macroeconomic implications of COPD in both high-income and low- and middle-income countries. The study suggests COPD can lead to educed aggregate savings and investment, with negative consequences for future growth prospects for world economies.⁷

Despite these staggering findings and figures, COPD remains largely under-recognized on policy agendas compared to other noncommunicable diseases (NCDs), necessitating an immediate shift in policy focus and prioritization.^8,9

The urgency for action isn’t confined to disease burden statistics alone; it’s a matter of public sentiment. A recent Ipsos survey, initiated and funded by AstraZeneca, of 14,890 members of the general public in 14 countries reveals that, once informed about the burden of COPD, over 60 percent of the those surveyed believes governments should do more to prevent unnecessary deaths and hospitalizations from this disease.¹⁰

“I’m speaking up for COPD because it is a leading cause of emergency hospital admissions, and yet it remains poorly understood and also under-prioritized.“ Gitta Vanpeborgh, Member of the Federal Parliament of Belgium.

Speak Up for COPD’s efforts in shaping the future of COPD care

The message is clear: COPD must be elevated on global health agendas.

The solution lies in collaboration. That is why we, as the Speak Up for COPD coalition, are dedicated to speaking up for those who can’t — for the millions of people with COPD around the globe who are so often overlooked or presumed to be facing an inevitable reality of declining health and loss of function due to their condition. It does not need to be this way. This is why the Speak Up for COPD coalition was formed — united with the critical goal to raise awareness of COPD and establish it as a public health priority. On World COPD Day in 2022, we issued a Joint Declaration emphasizing the urgent need to address the burden of COPD, underpinned by evidence-based quality standards of care that serve as a roadmap for public policy action.

This Declaration marked a pivotal moment in our coalition’s journey, as many nongovernmental organizations (NGOs), patient organizations and health care professionals voiced their support to prioritize COPD in healthcare systems. This united front led us to recently bring together policymakers, health policy advisers and members of the respiratory community at a workshop with the objective to discuss the path forward for policy change in COPD prevention and management. The event underscored a shared commitment to addressing COPD.

Several key takeaways from this recent workshop align closely with the principles laid out in the Declaration, such as the importance of establishing and implementing national respiratory and COPD strategies. While there are differences across countries and regions, it is imperative to develop these national programs in accordance with global and regional recommendations, such as the Global Quality Standards and the United Nations Sustainable Development Goals (SDGs).

Additionally, discussions underscored the need for coordinated, multidisciplinary efforts across various stakeholders, including policymakers, physicians, nurses, pharmacists, patients, IGOs, NGOs and the industry, for igniting policy change towards COPD prioritization. This collaborative advocacy approach lies at the core of the Speak Up for COPD coalition’s mission.

“I’m speaking up for COPD because COPD is largely preventable and it is treatable.“ Dr. Obianju B. Ozoh, Vice President, Pan African Thoracic Society and Pulmonologist & Senior Lecturer, University of Lagos, Nigeria.

Prioritizing COPD to achieve broader policy goals

National and local policymakers often grapple with a multitude of priorities that extend beyond individual diseases. These priorities encompass diverse objectives, such as health equity, health system resilience, population resilience and environmental impact.

Taking action on COPD gives policymakers an unparalleled opportunity to support these broader goals while improving the lives of millions of people of all ages, including older people, and their active participation in society and the economy. For example, by ensuring that optimal COPD care is available across multiple healthcare settings, policymakers can contribute to reducing health inequalities.^11-13 Additionally, optimizing COPD diagnosis and management, encouraging adherence to care guidelines, and early targeting of individuals at high-risk for COPD would not only improve outcomes but also lead to cost savings.^14-16

Furthermore, these measures also align with environmental sustainability goals. UK data reveals a 50 percent increase in emissions for each year of follow-up in patients with severe COPD exacerbations. Therefore, early intervention, particularly for COPD patients with an exacerbation history, can help lower greenhouse gas emissions and reduce COPD-related resource use generated by hospitalizations, primary care, outpatient care, emergency room visits and intensive care stays.^17-19

As agreed during our recent workshop, essential systemic change can be delivered by prioritizing the following areas where policy actions can have the biggest impact:

1. Preventing COPD by limiting exposure to risk factors: Reduce poor indoor and outdoor air quality with better environmental protection measures, such as urban planning, cleaner fuels, and improved cooking stoves and heaters; and further implement the World Health Organization (WHO) Framework Convention on Tobacco Control at a national level.²⁰
2. Improving early detection and diagnosis to optimize outcomes: Drive earlier diagnosis and timely, affordable access to care through i) public awareness campaigns focusing on the key symptoms of COPD, ii) consistent use of guideline-recommended diagnostics tools such as spirometry, including at the primary care level (where possible), and iii) integrated lung function tests as part of existing screening programs for better patient outcomes and reduced healthcare utilization costs.^21-23
3. Improving care and disease management for better quality of life: Provide holistic COPD care delivered by multidisciplinary teams, together with support for family and caregivers, to address COPD and the other diseases often present alongside it, including cardiovascular disease; and integrate routine patient follow-up into the COPD care pathway to deliver better clinical outcomes and reduce lung attacks (or ‘exacerbations’) which may cause irreversible lung damage.^24,25

“I’m speaking up for COPD because we are at a moment where we have a unique opportunity to prevent many future cases of COPD.“ Dr. Ricardo Baptista Leite, Former Member of the Portuguese National Parliament.

The time is NOW

With COPD, we are facing a perfect storm. Without immediate action, the burden of COPD will only intensify alongside the rapid aging of the global population, increased global prevalence of NCDs globally and exposure to risk factures such as air pollution and socioeconomic disparities.²⁰

Prioritizing COPD on the policy agenda today offers a unique opportunity to create healthier, more equitable societies while addressing pressing issues such as healthcare sustainability, population resilience and environmental impact. It has never been more important to make COPD a global health priority.

We, as the Speak Up for COPD coalition, pledge to continue collaborating with policymakers, NGOs, health care professionals and patient organizations to amplify these efforts. Our first-ever policy workshop was just the beginning.

If you’re a government policymaker, health system decision-maker, member of a patient advocacy group or an NGO, researcher, healthcare professional, or someone who wants to lend their support, visit www.speakupforcopd.com to lend your voice. Together, we can amplify the impact of our efforts. It’s time to #SpeakUpforCOPD and transform this global health crisis into a story of resilience and action.

“We know exactly what to do now. We just need to take action.“ Gitta Vanpeborgh, Member of the Federal Parliament of Belgium.

“We need to address COPD as a serious matter and we can do better.“ Dr. Ricardo Baptista Leite, Former Member of the Portuguese National Parliament.

Veeva ID: Z4-58323

Date of Preparation: October 2023 

References

1. Adeloye D, Song P, Zhu Y, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. (2022) Vol 10(5); 447-458 

2. WHO. Fact Sheet: Chronic obstructive pulmonary disease (COPD). Available here: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd) [last accessed September 2023]

3. Global Allergy & Airways Patient Platform. What is COPD? Available at: https://gaapp.org/copd/what-is-copd/ [last accessed October 2023]

4. May, S. and Li, J. Burden of chronic obstructive pulmonary disease: Healthcare costs and beyond. Allergy and Asthma Proceedings (Jan-Feb 2015), Vol. 36, No.1  

5. J F M van Boven, S Vegter, T van der Molen, M J Postma. COPD in the working age population: the economic impact on both patients and government. COPD: Journal of Chronic Obstructive Pulmonary Disease, 10:6, 629-639. DOI: 10.3109/15412555.2013.813446   

6. Bloom DE, et al. The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum; 2011. Available at: https://world-heart-federation.org/wp-content/uploads/2017/05/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf. [Last accessed: October 2023]. 

7. Chen S, et al. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020-50: a health-augmented macroeconomic modelling study. Lancet Glob Health. 2023 Aug;11(8):e1183-e1193. doi: 10.1016/S2214-109X(23)00217-6. PMID: 37474226; PMCID: PMC10369014. 

8. Quaderi, S. A., & Hurst, J. R. (2018). The unmet global burden of COPD. Global health, epidemiology and genomics, 3, e4. 

9. Ballreich et al. Allocation of National Institutes of Health Funding by Disease Category in 2008 and 2019. JAMA Network Open. 2021; 4(1): e2034890. 

10. Act on COPD. Common, Preventable, Treatable: Has COPD been underprioritised? (2022) Accessible at: https://qrcgcustomers.s3-eu-west-1.amazonaws.com/account21372441/30986798_2.pdf?0.16088484869497655 [last accessed October 2023]

11. Williams, P. J., Cumella, A., Philip, K. E. J., Laverty, A. A., & Hopkinson, N. S. (2022). Smoking and socioeconomic factors linked to acute exacerbations of COPD: analysis from an Asthma + Lung UK survey. BMJ Open Respiratory Research, 9(1), e001290. https://doi.org/10.1136/bmjresp-2022-001290 [last accessed October 2023]

12. Hegewald, M. J., & Crapo, R. O. (2007). Socioeconomic Status and Lung Function. Chest, 132(5), 1608–1614. https://doi.org/10.1378/chest.07-1405

13. Gershon, A. S., Dolmage, T. E., Stephenson, A., & Jackson, B. (2012). Chronic Obstructive Pulmonary Disease and SocioEconomic Status: a Systematic Review. COPD: Journal of Chronic Obstructive Pulmonary Disease, 9(3), 216–226. https://doi.org/10.3109/15412555.2011.648030

14. Patel, J., Dalal, A., & Nagar, S. (2014). Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States. International Journal of Chronic Obstructive Pulmonary Disease, 289. https://doi.org/10.2147/copd.s57157

15. Jansen EM, van de Hei SJ, Dierick BJH, Kerstjens HAM, Kocks JWH, van Boven JFM. Global burden of medication non-adherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers. J Thorac Dis. 2021 Jun;13(6):3846-3864. doi: 10.21037/jtd-20-2360. PMID: 34277075; PMCID: PMC8264677.

16. Scarffe, A.D., Licskai, C.J., Ferrone, M. et al. (2022). Cost-effectiveness of integrated disease management for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease in a primary care setting. Cost Eff Resour Alloc 20, 39 https://doi.org/10.1186/s12962-022-00377-w [last accessed October 2023]

17. Kampa, M., & Castanas, E. (2008). Human Health Effects of Air Pollution. Environmental Pollution, 151(2), 362–367. https://doi.org/10.1016/j.envpol.2007.06.012 [last accessed October 2023]

18. Lenzen, M., Malik, A., Li, M., Fry, J., Weisz, H., Pichler, P.-P., Chaves, L. S. M., Capon, A., & Pencheon, D. (2020). The environmental footprint of health care: a global assessment. The Lancet Planetary Health, 4(7), e271–e279. https://doi.org/10.1016/s2542-5196(20)30121-2 [last accessed October 2023]

19. Künzli, N., Kaiser, R., Medina, S., Studnicka, M., Chanel, O., Filliger, P., Herry, M., Horak, F., Puybonnieux-Texier, V., Quénel, P., Schneider, J., Seethaler, R., Vergnaud, J-C., & Sommer, H. (2000). Public-health impact of outdoor and traffic-related air pollution: a European assessment. The Lancet, 356(9232), 795–801. https://doi.org/10.1016/s0140-6736(00)02653-2 [last accessed October 2023]

20. Stolz, D., Mkorombindo, T., Schumann, D., Agusti, Alvar., Ash, Samuel, Bafadhel, M., et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. The Lancet Commissions. Vol.400 Issue 10356 (Sept. 2022); pp.921-972.  

21. Tkacz, J., Evans, K., Touchette, D. R., Portillo, E., Strange, C., Staresinic, A. G., Feigler, N., Patel, S., & Pollack, M. (2022). PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation. Volume 17, 329–342. https://doi.org/10.2147/copd.s347735 [last accessed October 2023]

22. Fromer, L. (2011). Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes. International Journal of Chronic Obstructive Pulmonary Disease, 6, 605. https://doi.org/10.2147/copd.s24692 [last accessed October 2023]  

23. GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023. [Online]. Available at: https://goldcopd.org/2023-gold-report-2/. [Last accessed: October 2023]. 

24. Gavish, R., Levy, A., Dekel, O. K., Karp, E., & Maimon, N. (2015). The Association Between Hospital Readmission and Pulmonologist Follow-up Visits in Patients With COPD. Chest, 148(2), 375–381.

25. Miravitlles, M., Bhutani, M., Hurst, J.R. et al. (2023). Implementing an Evidence-Based COPD Hospital Discharge Protocol: A Narrative Review and Expert Recommendations. Advances in Therapy. 2023;40(10):4236-4263