NEW Vermont COPD Program

The Centers for Disease Control and Prevention (CDC) awarded The Vermont Department of Health a grant to implement the NEW Vermont COPD Program as part of CDC’s Building Capacity for Chronic Disease Education and Awareness effort. Together with partners across the state, the Vermont COPD Program will work to:

  • increase public health knowledge of COPD among healthcare providers and the public; 
  • promote earlier detection and diagnosis of COPD;  
  • increase COPD patient and caregiver support, and  
  • reduce COPD-related hospital readmissions.

Strategies will include:

  • establishing a new COPD Advisory Panel to elevate COPD as a topic of focus among leadership and partners; 
  • delivering COPD trainings for health care providers on guideline-based, person-centered care;
  • collecting and disseminating Vermont COPD data; and
  • creating media campaigns to increase awareness of COPD prevention and control best practices.

What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a progressive, persistent airway limitation due to the chronic response of the lungs to irritating particles such as tobacco smoke. COPD is a group of diseases which make breathing difficult (Chronic Obstructive Pulmonary Disease (COPD) | CDC). Permanent damage due to lung remodeling results in irreversible airflow obstruction and decreased lung function, and may be associated with emphysema, chronic bronchitis, certain genetic conditions, and brain and/or spinal column injuries.

Prevalence of COPD

COPD is a leading cause of death in the nation, with rates doubling since 1969 while many other chronic conditions have declined. COPD has been the fourth leading cause of death in Vermont since 2016 with a rate of 55.4 deaths per 100,000 residents (Vermont 2020 Vital Statistics Report). Approximately 7% of Vermonters are currently living with COPD compared to 6% in the U.S. (BRFSS 2021), with a greater burden of COPD among those with less education and lower household incomes. Vermont adults living with a disability are six times more likely to have COPD than those without a disability; in addition, those who are food insecure, American Indian and Alaska Native (AIAN) and those who smoke cigarettes are impacted by even higher rates. 

Causes of COPD

Most COPD cases are preventable since 8 in 10 associated deaths are caused by smoking. Given Vermont also carries disproportionately high smoking rates compared nationally, the importance of taking public health action cannot be overstated. Furthermore, families and individuals are encouraged to support quit attempts with the help of Vermont’s own 802Quits.

Environmental Risk Factors

Although the primary cause of COPD is smoking, an increasing number of studies have reported associations between indoor and outdoor air pollution exposures and COPD, suggesting that environmental exposures could be driving a percentage of COPD cases.5,8, 9 

The most prominent indoor exposures are from smoke from tobacco and the use of biomass fuels, while the most common non-occupational outdoor exposures are particulate matter (PM10 & PM2.5), ozone, and sulfur dioxide from automobiles and industrial sources.10,11 

Studies have also shown significant associations with occupational exposures such as fumes, gases, and both inorganic and organic dusts.9, 12, 13 

In 2003, the American Thoracic Society showed that roughly 19% of all COPD cases were attributable to occupational exposures with 31% in never-smokers.13

Other Risk Factors & Co-Morbidities

COPD is associated with several important comorbidities, with asthma being the most important. It has been estimated that those with active asthma were 10 times more likely to develop chronic bronchitis, and 17 times more likely to develop emphysema compared to those without asthma, after controlling for potential confounders.

Current asthma diagnosis was the most significant risk factor for COPD, even higher than cigarette smoking.8 

Prior respiratory infections has also been identified as a key risk factor for COPD.7

Cardiovascular disease and COPD are strongly associated and frequently both are reported on the death certificate. One study has shown that of 45,000 patients with COPD, heart failure, myocardial infarction, and stroke are the leading causes of death14, while another found that the prevalence of all cardiovascular diseases was higher in patients with COPD resulting in higher risk of an emergency department visit and mortality.15

  1. Hoyert DL, Xu JQ. Deaths: preliminary data for 2011. Natl Vital Stat Rep. 2012;61(6):1-65. Hyattsville, MD: National Center for Health Statistics.2012.
  2. Tsai CL, Clark S, Cydulka RK, Rowe BH, Camargo CA Jr. Factors associated with hospital admission among emergency department patients with chronic obstructive pulmonary disease exacerbation. Acad Emerg Med. 2007 Jan;14(1):6-14. Epub 2006 Nov 21.
  3. Kochanek KD, Xu JQ, Murphy SL, et al. Deaths: Preliminary data for 2009. National vital statistics reports; vol 59 no 4. Hyattsville, MD: National Center for Health Statistics. 2011.
  4. Miniño AM. Death in the United States, 2009. NCHS data brief, no 64. Hyattsville, MD: National Center for Health Statistics. 2011.
  5. Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary disease surveillance--United States, 1971-2000. MMWR Surveill Summ. 2002 Aug 2;51(6):1-16.
  6. Trends in COPD (Chronic Bronchitis and Emphysema): Morbidity and Mortality. American Lung Association February 2010.
  7. Dalal AA, Christensen L, Liu F, Riedel AA. Direct costs of chronic obstructive pulmonary disease among managed care patients. Int J Chron Obstruct Pulmon Dis. 2010 Oct 5;5:341-9.
  8. Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet. 2009 Aug 29;374(9691):733-43.
  9. Harber P, Tashkin DP, Simmons M, Crawford L, Hnizdo E, Connett J; Lung Health Study Group. Am J Respir Crit Care Med. Effect of occupational exposures on decline of lung function in early chronic obstructive pulmonary disease. 2007 Nov 15;176(10):994-1000. Epub 2007 Jul 12.
  10. Ko FW, Tam W, Wong TW, Chan DP, Tung AH, Lai CK, Hui DS.Temporal relationship between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Hong Kong. Thorax. 2007 Sep;62(9):780-5. Epub 2007 Feb 20.
  11. Medina-Ramón M, Zanobetti A, Schwartz J. The effect of ozone and PM10 on hospital admissions for pneumonia and chronic obstructive pulmonary disease: a national multicity study. Am J Epidemiol. 2006 Mar 15;163(6):579-88. Epub 2006 Jan 27.
  12. Hu Y, Chen B, Yin Z, Jia L, Zhou Y, Jin T. Increased risk of chronic obstructive pulmonary diseases in coke oven workers: interaction between occupational exposure and smoking. Thorax. 2006 Apr;61(4):290-5. Epub 2006 Feb 7.
  13. Eduard W, Pearce N, Douwes J. Chronic bronchitis, COPD, and lung function in farmers: the role of biological agents. Chest. 2009 Sep;136(3):716-25. Epub 2009 Mar 24.
  14. Sidney S, Sorel M, Quesenberry CP, DeLuise C, Lanes S, Eisner MD. COPD and incident cardiovascular disease emergency department visits and mortality: Kaiser Permanente Medical Care Program. Chest. 2005;128:2068-2075.
  15. Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring E, She D. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada casridvascular disease in COPD patients. Ann Epidemiol. 2006;16:63-70.
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