Comments on: Taking a stab at lung disease: whose numbers do you believe?

By: Talon A

Talon A — Thu, 01 Jan 1970 10:00:00 +0000

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By: Margo

Margo — Thu, 01 Jan 1970 10:00:00 +0000

‘Whose numbers’ indeed. The ABC stories (12 Nov.) on the Access Econ report talk about a direct annual $900 million burden on the health care system, with an estimated annual overall cost to the economy at almost $9 billion. The Canberra Times story of the same day reported that COPD will cost Australia almost $100billion this year.

By: David Christie

David Christie — Thu, 01 Jan 1970 10:00:00 +0000

I claim no particular expertise here except perhaps that of primacy cf MJA (1971) 1: 21–23. The Access Report indicates either an extraordinary lack of common sense or an ulterior motive. Could the latter relate to the inhalation drug “Spiriva” which seems quite good in modifying the bronchospasm associated with prior smoking and if prescribed for all ex–smokers with some ventilatory function impairment would make a motza for the drug firm concerned. Incidentally, apropos Steve’s comment I would take any cause–specific mortality data before say 1960 with a very large grain of salt indeed. BTW why are no names or University Depts on Access Report?

By: steve martin

steve martin — Thu, 01 Jan 1970 10:00:00 +0000

I understand Professor Chapman’s point about COPD being at it’s lowest point since the 1950s since the successful anti-smoking campaign began in the 1960s the death rate has plummeted. But prior to the 1950s just about every male smoked, so why was the death rate so low prior to the 1950s. Was it just misdiagnosis,surely unlikely, or was it just that the immediate cause, rather than the underlying cause appears on the death certificate?

By: Heather Allan

Heather Allan — Thu, 01 Jan 1970 10:00:00 +0000

The ALF commissioned this report to raise awareness of the rising toll of COPD and advocate for interventions that can improve the lives of those with COPD and are cost-effective. So what does the report say and what are Chapman’s issues?

COPD is prevalent in those over 40 who have smoked
The Access Report based prevalence figures on the Sydney BOLD study. This study adopted an international protocol with rigorous attention to quality lung function testing. The data produced are as reliable as any produced so far in Australia.

COPD is deadly
Chapman questions the number of COPD deaths in the Report (16,000). Access arrived at this figure by multiplying the relative risk of mortality by prevalence. The lower 2003 AIHW figures are based on death certificates where COPD is listed as the primary cause of death (5,000). He dismisses over 7,000 deaths where COPD is listed as an associated cause of death. A 2007 report done for the Vic Govt by the Centre for Health Policy at University of Melbourne, found that using AIHW data, 39,070 deaths between 1997 and 2003 were attributable to COPD as the underlying cause and 87,403 deaths were attributable to COPD as one of multiple underlying causes. In total 126,473 deaths were attributed to COPD. Taking the upper and lower bounds of deaths from COPD, there are 6,500-21,080 per annum. The Access estimate of 16,000 sits in the middle of this range.

COPD is under-diagnosed
Studies show 40-80% of those with spirometry-confirmed COPD are unaware they have COPD.

Early intervention can lengthen and improve life
Smoking cessation is crucial, but there are other interventions that lengthen life and reduce symptoms. Chapman seems ignorant of recent advances in COPD management. Chapman should speak to a patient whose life has been transformed by rehabilitation to understand the benefits of early diagnosis and proper management. The ALF will continue to advocate on behalf of patients who struggle for breath.

By: Dianne

Dianne — Thu, 01 Jan 1970 10:00:00 +0000

David Christie commented that pharmaceutical companies would stand to benefit big time if ex-smokers with ventilatory impairment all went on medication. The Australian Lung Foundation’s website ( annual report for 2007) shows a formidible list of drug companies support the Foundation. So, in the interests of transparency, will the ALF declare whether it received any direct support from such a company to pay for this Access report, which I assume didn’t come cheap. Or was the cost paid for by ALF’s general funds, which would seem to be also largely supplied by the drug industry? I’m fully supportive of people with COPD receiving treatment which we would hope would bring them some benefit. But when Access’ estimates of the size of the problem are so much larger than major government agencies and Australia’s leading burden of disease expertise have put it before, such information is relevant. It would be difficult to imagine the companies being disappointed with Access’s estimates.