This COPD Awareness Month, Texas Can Close the Gaps in Lung Care

For many Texans, the first signs of chronic obstructive pulmonary disease,or COPD, are easy to brush off. Moving around the house takes more effort. A cough lingers for months. Carrying groceries or doing chores leaves them winded. Because these changes often come on gradually, COPD frequently goes unrecognized until it has already disrupted daily life.

November is COPD Awareness Month, and the COPD Action Alliance is urging Texans, health care leaders and policymakers to take a closer look at how the Lone Star State identifies and treats this progressive lung disease.

COPD’s toll on Texas

About 1.3 million Texas adults have been diagnosed with COPD, according to survey data from the Centers for Disease Control and Prevention, or CDC. COPD, is the sixth leading cause of death in the state, according to the CDC. The financial burden is also significant. A study led by CDC researchers estimates that COPD treatment costs Texas $2.3 billion a year and that the disease accounts for nearly 1.7 million lost workdays. 

What is COPD?

COPD is a chronic lung disease, most commonly emphysema or chronic bronchitis, that limits airflow and makes it harder to breathe. Symptoms include shortness of breath, wheezing, chest tightness and a chronic cough. Because these symptoms can be mistaken for aging or poor fitness, many people go years without a diagnosis. Nationally, an estimated 30 million Americans have COPD, but only about 17 million have been diagnosed.

Who is most at risk

COPD does not affect every community equally. CDC data show that COPD is more common among women than men, and research shows women are more likely than men to go undiagnosed, even when spirometry, the breathing test used to confirm COPD, supports a diagnosis. Rural residents also carry a heavier burden. A CDC analysis found that COPD prevalence was 8.2 percent among adults in rural counties, compared with 4.7 percent in large metropolitan areas. For Texans who live far from a pulmonologist or pulmonary rehabilitation program, simply getting to an appointment can be a barrier.

Work and income play a role as well. Veterans, firefighters and workers in heavy industry may be exposed to dust, smoke, fumes and other airborne hazards on the job. COPD rates are also higher among adults with lower incomes and less education. Smoking remains the leading cause, but the CDC estimates that one in four adults with COPD have never smoked. For that reason, patients and clinicians should consider workplace and environmental exposures when breathing problems appear.

Barriers to diagnosis and treatment

Earlier diagnosis is the first step. The CDC advises clinicians to use spirometry to diagnose patients who have COPD symptoms, regardless of smoking history. Texans who have a cough that will not go away, or who find themselves short of breath more easily, should talk with a health care provider instead of assuming those changes are a normal part of getting older.

After a diagnosis, people with COPD need timely access to prescribed medications, follow-up care and pulmonary rehabilitation. Insurance requirements such as prior authorization can stand in the way. In a recent COPD Action Alliance survey, nearly one in three patients reported trouble obtaining medications or equipment because of prior authorization or high out-of-pocket costs. For someone who is already struggling to breathe, delays in care can lead to worsening symptoms, flare-ups or a hospital stay.

What Texas can do

Texas policymakers, health plans and health care providers can take practical steps to improve COPD care:

• Support earlier and more accurate diagnosis, including wider use of spirometry.
• Reduce unnecessary delays, including prior authorization hurdles, for treatments a patient’s clinician has prescribed.
• Expand access to pulmonary rehabilitation, including home-based and virtual options where appropriate.
• Strengthen tobacco cessation services and raise awareness of on-the-job and environmental risks to lung health.
• Give women’s lung health the attention it deserves.

Comprehensive care should also account for related risks. People with COPD have a higher risk of lung cancer, so conversations about individual risk and lung cancer screening, when appropriate, belong in routine COPD care.

The path forward

For Texans living with COPD, the next step may be as simple as asking a doctor about a breathing test, pulmonary rehabilitation or whether a current treatment plan is working. For policymakers and health care leaders, the task is to make sure those conversations lead to care that is timely, affordable and available close to home. This COPD Awareness Month, the COPD Action Alliance encourages Texans to learn more about the disease, share their experiences and ask state leaders to make lung health a priority.