Military Tackles COPD Care

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Henderson.jpgWASHINGTON, DC—In 2005, CDC estimates COPD caused an estimated 126,005 deaths in people 25 years and older in the US. This was an 8% increase from 116,494 in the year 2000.

Just as COPD is a concern in the civilian population, it is also a concern for the military. “The typical age group that we see in the military is between 20 and 50, and as age progresses there is a higher incidence,” said Air Force Col Chris Henderson, MD, pulmonary medicine chairman at Wilford Hall Medical Center (WHMC). “It is definitely related to smoking incidence. So people who smoke one pack a day for 10 years have a far higher incidence of having obstructive lung disease by the time they get into their 40s and 50s than those who do not.”

The 2008 DoD Survey of Health Related Behaviors Among Active Duty Military Personnel found that the rate of any past month smoking among DoD services decreased slightly from 34% in 2002 to 31% in 2008. The rate of heavy smoking has decreased from a high of 34% in 1980 to a low of 10% in 2008.

In the US, tobacco use is a key factor in the development and progression of COPD, but asthma, exposure to air pollutants in the home and workplace, genetic factors, and respiratory infections also play a role.

The development of COPD does not necessarily mean the end of a military career. “Once you are in the military and if you develop COPD, your ability to serve is really determined by the severity of your disease and your response to therapy,” he said. “If you respond to simple therapy on an as needed basis, by and large, most services are not limiting much in those patients’ service, including deployment. Once you are on chronic medication, very often there are significant limitations to service.”

COPD Care

While young people may present with asthma, people in the latter half of their careers who are smokers or have had other environmental exposures may present with chronic bronchitis or emphysema. “They will present normally later in their 40s with shortness of breath and we have to tease out, ‘is this because they are out of shape, they have gained some weight, or have some pulmonary disease?’” said Henderson.

The condition is often under-diagnosed because it typically is a progressive disorder and so individuals with it may not initially notice the changes. They may begin to notice that they can no longer climb five flights of stairs, but they do not recognize that their shortness of breathe indicates a problem. “Part of it is just recognizing whether you have had a significant change or not,” said Henderson. “Most people don’t have COPD, but if they have a significant change in their ability over a short period of time in being able to breathe, those are the people who need to be assessed.”

In addition to medications, the most important part of treatment is to avoid risk factors, such as smoking and adverse environmental exposures.

Persuading patients with COPD to stop smoking and encouraging those who are treated for COPD to return to a more normal lifestyle can also be a challenge, Henderson said. At WHMC, pulmonary rehabilitation is used to help patients become more active and to improve quality of life. “Something we do here, and in a few locations in DoD as well, is pulmonary rehabilitation,” he said. “We actually train people that they can regain function by strengthening their body and learning the signs of how to appropriately breathe when you are short of breath, and going through different training regimens to help increase their function.”

COPD research is taking place that will also be important to the field. Research efforts include examining different ways to improve lung function and whether certain genetic factors can increase the risk of COPD in people who smoke, among other research areas.

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