Abstract
Rationale/Objective: The Behavioral Risk Factor Surveillance System (BRFSS) health survey has been used to describe the epidemiology of chronic obstructive pulmonary disease (COPD) in the US. Through addressing respiratory symptoms and tobacco use, it could also be used to characterize COPD risk. Methods: Four US states added questions to the 2015 BRFSS regarding productive cough, shortness of breath, dyspnea on exertion, and tobacco duration. We determined COPD risk categories: provider-diagnosed COPD as self-report, high-risk for COPD as ≥10 years tobacco smoking and at least one significant respiratory symptom, and low risk was neither diagnosed COPD nor high risk. Disease burden was defined by respiratory symptoms and health impairments. Data were analyzed using multiple logistic regression models with age as a covariate. Results: Among 35,722 adults ≥18 years, the overall prevalence of COPD and high-risk for COPD were 6.6% and 5.1%. Differences among COPD risk groups were evident based on gender, race, age, geography, tobacco use, health impairments, and respiratory symptoms. Risk for disease was seen early where 3.75% of 25–34 years-old met high-risk criteria. Longer tobacco duration was associated with an increased prevalence of COPD, particularly >20 years. Seventy-nine percent of persons ≥45 years-old with frequent shortness of breath (SOB) reported having or being at risk of COPD, reflecting disease burden. Conclusion: These data, representing nearly 18% of US adults, indicates those at high risk for COPD share many, but not all of the characteristics of persons diagnosed with the disease and demonstrates the value of the BRFSS as a tool to define lung health at a population level.
Highlights
Characterizing chronic obstructive pulmonary disease (COPD) at the population level through cross-sectional surveys is important to the overall strategy to target the disease
Respiratory symptom questions employed for this study were derived from multiple questionnaires used to screen for COPD [8,9,10,11], and these characterize the most common pulmonary symptoms associated with COPD—mucus production and dyspnea—as well as the main risk factor for lung disease in the US—prolonged tobacco smoking [14]
Tobacco smoking is the principal risk factor for COPD in the USA—we found that nearly one-half of the study participants were ever-smokers and rates varied among states and with age
Summary
Characterizing COPD at the population level through cross-sectional surveys is important to the overall strategy to target the disease. Both the National Heart Lung and Blood Institute’s (NHLBI). In 2012, we used the BRFSS in one state to better characterize persons with or at risk for COPD through the inclusion of tobacco smoking duration and respiratory symptom questions [5]. To explore this approach in a larger population, we used these same survey questions in 2015 to characterize adults at high-risk of COPD in four states, that collectively represent 17.7% of the US adult population [6]
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