In my teens, I watched my grandmother slowly change and wither away. I can still remember the feel of her bones under my arms as I advanced through my teen years as her already slim frame became slimmer. I watched as her breathing became more labored, there were more trips to the hospital, and she eventually became tethered to oxygen at ever-increasing flow rates. The sound of the portable concentrator she eventually became reliant on still echoes in my ears. I watched as her activity level slowly dwindled to the bare minimum. First, she stopped cooking, something she enjoyed and did throughout my childhood. Then as the oxygen became a tether, she began going out less to shop or to bingo, which were her favorite things to do. I saw her change; she smiled less, and even a simple conversation would leave her struggling to breathe. I saw the person I knew as a young child change into someone I barely recognized. She would succumb to lung cancer in my early twenties. My grandmother was a long-time smoker and had COPD. This was before I was ever interested in medicine, so I did not understand that the changes I was seeing were the result of the disease. Today, as a family medicine physician and women’s health advocate, I understand the impact that COPD had not only on my grandmother, but also on the women under my care.
COPD is a very serious and progressive lung disease that includes both chronic bronchitis and emphysema. This disease affects millions of Americans, estimated to affect 30 million Americans. However, this disease often remains undiagnosed, with only 17 million Americans being diagnosed. Many patients do not receive their diagnosis until their disease has significantly progressed. Since COPD was originally thought of as a “man’s” disease, women have historically been underdiagnosed. However, in recent years, this is changing, and there has been an increase in diagnosis among women. It is also important to recognize that COPD is a leading cause of illness, disability, and death. The death rate for COPD has doubled since 1969 while the rate for other chronic conditions has declined, and it is currently the fifth leading cause of death. Costs attributable to COPD continue to rise, with an expected cost in 2029 to be $60.5 billion, which is nearly double that of the cost in 2019 of $31.3 billion.
As physicians, we also know earlier diagnosis and recognition can make a difference in the lives of our patients. Raising awareness of the symptoms (including persistent cough, shortness of breath, wheezing, and a reduced ability to participate in everyday activities) can help to make an earlier diagnosis. This increased awareness can also lead to education in reducing exposure to tobacco smoke and other lung irritants, receiving appropriate vaccinations, and access to appropriate treatments and pulmonary rehabilitation. For physicians, it is important to remember that about 25 percent of people diagnosed with COPD have never smoked, and continual awareness of other symptoms should raise our suspicion for a COPD diagnosis. Despite the known benefit of pulmonary rehab after hospitalization, it is estimated that only 2 percent of patients receive this potentially lifesaving intervention.
COPD remains an important women’s health issue, with millions of women living in the U.S. today with this diagnosis. Women may also experience a substantial burden from the disease and experience the disease differently than their male counterparts. Women are more likely to have more severe shortness of breath at similar lung functions compared to men. Women also have more frequent exacerbations leading to a higher health care cost. Women with the disease have higher rates of anxiety and depression, but this often remains underdiagnosed and underrecognized. If there is a smoking history, women require less cumulative tobacco exposure compared to men leading to the development of this disease. Women will also have an overall worse quality of life compared to men as a result of this disease. Raising awareness of COPD among patients, families, health care professionals, and communities is an important step toward improving prevention, earlier recognition, and access to care.
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Statistics may describe the scope of COPD, but they do not reflect living with it. Personal stories fill that gap. They show what the disease takes away: the meals no longer cooked, the outings given up, the conversations cut short by breathlessness. When patients and their families share their experiences, they put a face on a disease that is often overlooked. Clinicians have a responsibility to help amplify those voices. We see the toll of this disease every day, and that gives us credibility and an obligation to speak up. When clinicians and the people we care for speak together, awareness becomes action.
The American Medical Women’s Association (AMWA) has worked for more than a century to advance the health care of women and improve the health of communities. During COPD awareness month, we join patients, caregivers, clinicians, public health leaders, and organizations across the country in increasing awareness of COPD. We also encourage people experiencing symptoms or who are at increased risk to speak with their health care provider. AMWA is proud to be a member of the COPD Action Alliance to continue to improve care, awareness, and public policy for people living with COPD.
Through my work with AMWA, I am proud to have Kentucky proclaim November COPD awareness month on behalf not only of the patients I see in the office every day, but also in memory of my grandmother. I have seen firsthand the effects of this disease on people and families. I am dedicated to promoting recognition of this disease and betterment of health for my patients so that no family watches their loved one wither away in front of them due to a delayed diagnosis. I encourage my fellow physicians, regardless of specialty, to listen to their patients and watch for those subtle signs that would enable earlier COPD diagnosis and treatments. I am proud to partner with AMWA to raise awareness of this life-changing disease.
Rebekah Costello, DO, is a family medicine physician, an assistant professor at the University of Louisville Family Medicine Residency Program in Owensboro, and the Kentucky state director of the American Medical Women’s Association.
The American Medical Women’s Association (AMWA) is the oldest multispecialty organization dedicated to advancing women physicians and improving the health of women. For more than a century, AMWA has been the vision and voice of women in medicine, pursuing its mission through leadership, advocacy, education, mentorship, and strategic partnerships.
AMWA has a long publishing history. Its members produced a series of consumer health references in the 1990s, including The Women’s Complete Health Book (Delacorte Press, 1995), the AMWA Guide to Pregnancy and Childbirth (1996), the AMWA Guide to Cardiovascular Health (1997), and The Complete Family Health Book (1999). The association’s flagship scholarly publication, the Journal of the American Medical Women’s Association (JAMWA), ran from 1946 to 2005 and grew out of earlier titles that trace back to the Bulletin of the Medical Women’s National Association, first published in 1922.
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