Speak Your Piece: Rural Trend in Lung Disease Heads in the Wrong Direction

While the rate of deaths from chronic obstructive pulmonary disease falls in urban areas, it’s increasing for rural America.

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“COPD” means “Chronic Obstructive Pulmonary Disease”. Those medical terms translate into everyday language as “long term plugged up lungs”. The air passages of the lung are inflamed. The delicate membranes where oxygen moves from the air into the blood are damaged or destroyed. COPD can be treated and managed but not cured. It may lead to complications including heart trouble and depression.

COPD is one of the five most common causes of death in the U.S. The other four are heart disease, cancer, stroke and accidents. Of those five, death rates due to heart disease, cancer and stroke are higher in rural communities than in towns and cities, but are coming down for both rural and urban people. Deaths due to accidents, including drug overdoses, are increasing in both areas. The pattern for COPD is unique. Death rates due to COPD are falling in urban people, but increasing among rural people

(SOURCE: NCHS, National Vital Statistics System, Mortality)

About three quarters of people with COPD are or have been smokers. It’s not known how many of the remaining quarter of patients have been exposed to lots of “second hand” tobacco smoke for years at home or at work.

It’s not clear why more rural people are dying of COPD. Several typical rural jobs expose people to very dusty or dirty air….farm work, mining etc. Even non-agricultural rural workers are much more likely to be exposed on the job to high levels of gases, dust and fumes (27%) than urban workers (15%).

Any explanation needs to recognize that a higher percentage of rural than urban people smoke. Smoking among teen-agers is decreasing but remains considerably higher among rural than urban young people.

Other possible factors include difficulties for rural people getting to basic and specialized medical care. Small rural hospitals may not have the equipment to measure and track changes in a person’s breathing over time. Small hospitals may not have “respiratory therapists,” people trained to teach patients better ways to live with their damaged lungs. It has recently been shown that carefully individualized treatment plans can significantly reduce hospital return admissions of people with COPD.

Several organizations are working together to improve care of people with COPD. Simply type “rural COPD” into your computer’s internet search program and you’ll be directed to a wealth of authoritative information and recommendations from the Centers for Disease Control, the National Institutes of Health, the COPD Foundation, the Federal Office of Rural Health Policy, and others. Pay particular attention to the “COPD National Action Plan” drafted by the NIH and CDC with input from a range of people and organizations.

There is a lot we don’t know, but better use of what we do understand would make a big difference: reduce smoking by children and adults, teach people to live with and care for their COPD once they have it, carefully individualize COPD patients’ medical care, tap into national resources to help organize prevention and treatment. We should be doing better.

Wayne Myers is a retired pediatrician and rural medical educator. He directed the federal Office of Rural Health Policy from 1998 through 2000, and was president of the National Rural Health Association in 2003. He and his wife, JoAnn, farm in rural Maine.

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