Healthy People 2020: COPD - Analysis of a Public Health Initiative

This report analyzes the Healthy People 2020 initiative, specifically focusing on chronic obstructive pulmonary disease (COPD). It begins with an overview of the initiative and defines COPD, highlighting its classification, prevalence, and impact as the third leading cause of death in the United States. The discussion explores the risk factors, including environmental factors like smoke exposure and genetic predispositions, and examines the disease's symptoms, such as excessive mucus production and shortness of breath. The report contrasts COPD with asthma and delves into the challenges of readmission rates within the healthcare system. It presents epidemiological data on COPD, including mortality rates, diagnosis numbers, and associated healthcare costs, as well as the objectives of Healthy People 2020 for respiratory diseases and the methods used for target setting. The report also examines trends in COPD management, such as the use of combination inhalers and alterations in inhaler delivery methods. It further addresses complications associated with COPD and highlights solutions like smoking cessation, vaccination, and patient education. The report concludes by emphasizing the need to address the root causes of risk factors like tobacco and pollutants, advocating for reduced tobacco production and consumption, and proposing restrictions on tobacco purchase and emissions from automobiles. The report references several sources to support the discussion of the topic.

Running Head: HEALTHY PEOPLE 2020
HEALTHY PEOPLE 2020: COPD
Name of the Student
Name of the University
Author’s Note

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Introduction
Healthy People 2020 is an initiative by the government of United States with an agenda
to enhance the quality of health in the people of the nation. It has a statement of national health
objectives that are designed to find out the most preventable health threats and plan national
goals to diminish the health conditions. One of the health problems identified in Healthy People
2020 is chronic obstructive pulmonary disease, which is a respiratory disease
(Healthypeople.gov, 2020). It is a lung disease in which breathing becomes difficult and it is
categorized into two types. The first one is chronic bronchitis, which has the involvement of
mucus and cough, and the second type is emphysema, which is the damage to lungs. COPD is a
progressive disease that is characterized by breathing related problems and airflow blockage. It is
the third leading cause of death in the United States because approximately 142,000 people were
killed due to COPD in 2014. This paper will discuss the Healthy People 2020 initiative for this
COPD and the recent trends and issues to prevent and control this public health threat (US
Department of Health and Human Services, 2014).
Discussion
The major issue with COPD is that it can cause due to the environmental factors, which
cannot be prevented all the time. One of the reason for the prevalence of COPD is exposure to
smoke, which can be due to pollution, smoke or chemical hazards. Tobacco is the most common
risk factor of COPD because according to the statistics in Indiana, 45% of the population is
currently smoking, 33.4% of people were a smoker during their life and 21.6% said that they
never smoked. However, genetic factor is also a reason for the incidence of this disease because
not every smoker is diagnosed with COPD. After quitting cigarettes, it might slow down the

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process of the development of this disease (Salvi, 2014). The vulnerability of this disease is not
targeted towards any gender, but it is seen that most of the women die due to COPD since the
year 2000. In Indiana, 8.3% of adults were diagnosed with COPD when compared to the national
data of 6.3%. In 2011, majority of the females were to be suffering from COPD than males. The
symptoms of this disease include excessive mucous production, wheezing and chest tightness,
shortness of breath and chronic coughing (Jalota & Jain, 2016). The difference between asthma
and COPD is that in asthma, inflammation of airways occur and it is an irritable response to an
allergen, and in COPD, the lung goes through an obstruction and hyperinflation due to the
exposure to certain irritants. The readmission due to COPD is a common scenario in the US
healthcare system because patients between the ages of 40-64 years are prone to getting
readmitted within 30 days of a COPD related hospital admission than patients who are older than
65. The public insurance allows 14.77% in medicare and 16.27% in Medicaid for highest
admission rates. The major cause of morbidity and mortality in US is COPD and the patients
vary in terms of imaging, clinical and biological phenotypes. Acute COPD exacerbation
(AECOPD) is one of the phenotypes and the readmission rate for this after discharge is 10-20%
within 30 days of admission (Ford, 2015). The people who are readmitted have a higher chance
of mortality and poor health outcome than people who are not readmitted. Several interventions
have been identified to reduce the pattern of readmissions but it is not of any help as it is not
reducing mortality. One of the reason might less knowledge to identify patients who are at a
higher risk of readmission and inability to utilize resources for these high risk patients.
The epidemiological data suggests that 100,000 deaths occurs due to COPD annually in
United States. In the year 2010, 15 million people were diagnosed of this disease by their
healthcare providers and around 12 million cases remain undiagnosed who susceptible to this

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disease. The total annual cost for COPD in the year 2010 was $49.9 billion and the employment
rate decreased by 8.6% because of disability related to COPD (Sullivan et al., 2018). In the year
of 2014-2015, more than 15.9 million people, which is 5.9% were diagnosed with COPD. The
prevalence noted in the cities were 3.7% in Puerto Rico and Hawaii and 12% in West Virginia. It
was also estimated that 41.5% of people who were diagnosed with COPD were seen by their
physicians before a year for their COPD symptoms. 62.5% of the COPD diagnosed population
complained that their quality of life was affected due to shortness of breath. The hospitalization
rates were also observed and it showed that adults above the age of 25 consisted of 699,000 (age-
adjusted rate of 32.2 per 10,000) cases in 2010 with COPD being the first listed discharge
diagnosis. The emergency department cases were 1,468,000 (age-adjusted rate of 72.0 per
10,000) and the visits to the physician for COPD were done by 10,291,000 (age-adjusted rate of
494.8 per 10,000) people (Ford, 2015).
The solution for reducing the incidence rate of COPD includes cessation of smoking,
vaccination, patient education, disease management and pulmonary rehabilitation. All these
interventions can be used as the initial steps to fight with this issue and improve the public health
of United States. The thesis solution of this paper will be restricting the production of tobacco so
that there is a less supply for the people who are chain smokers, which will eventually lead to the
cessation of smoke. Assistance and promotion will be needed by the government to pass this
implementation as the healthcare system is a huge organization that is getting burdened due to
the increasing cases of COPD (Yakubek et al., 2018). The objective of Healthy People 2020 for
respiratory diseases includes reducing the hospitalization for COPD specifically in adults aged
45 and above, and reducing emergency department visits for COPD, which will be according to
the 2000 standard population. They also have some protocols to reduce COPD such as

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decreasing activity limitations in adults who have COPD, reducing deaths from COPD, lessening
of hospitalizations for COPD patients, reducing emergency department visits for the people who
are diagnosed with COPD. The US preventive services task force developed a target to reduce
the incidence rate to 102.6 deaths per 100,000. The method of target setting is
projection/analysis, which taken from several statistical data such as National Vital Statistics
System Mortality (NVSS-M) and the census (Man et al., 2015).
There are some trends that was identified when the solution for COPD was being
researched such as the use of combination inhaled medications turned out to be game changers.
Combining 2-3 drugs in a single formulation so that it would require people to consume lesser
drug at ones and it would be more affordable to purchase two drugs in one medicine. The
patients have to take 2-3 inhalers for this diseases, so the use of combined inhaler will be cost
cutting and will be easier for them to keep a track of their medications. Combining
bronchodilators and steroids will allow the patient to take it ones a day than using it twice a day.
The second trend is to make alterations in the mode of delivery of these inhalers (Kim et al.,
2016). Few chronically ill COPD patients have difficulty in using an inhaler due to the co-
ordination of pumping and inhaling at the same time. Another type of inhaler is found in the dry
powder form, which is a powder formulation in a capsule or blister packs. This type of packaging
might be difficult for some weak and old patients to handle. Slow mist inhalers are discovered
that has ipratropium bromide and albuterol, which has a long-lasting, slow moving with fine
droplets that will be easier for the patients to handle, and it also goes more deeply into the lungs
(Mahler et al., 2014). The issues that are found in COPD patient is that they are prone to several
types of complications such as respiratory functions because they catch pneumonia, flu and cold

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more often, pulmonary distress can also lead to pulmonary hypertension, lung cancer, diabetes,
osteoporosis, cardiovascular diseases and mental disorders such as depression.
The solutions and objectives that have been utilized for reducing the incidence of COPD
is useful and it is showing a difference in the current scenario. The Healthy People 2020
initiative has planned and implemented several activities for many age groups who are
vulnerable to COPD. One of the plan is known as Action Plans with Brief Patient Education for
Exacerbations in Chronic Obstructive Pulmonary Disease and Chronic Obstructive Pulmonary
Disease: Screening in Adults. The motive included increased screening of adults with COPD and
by spirometer (Schauer et al., 2016). The diagnosis and management of this disease was found to
be more common in healthcare systems and this improved the condition of patients in US. The
incidence rate also decreased in the current years when compared to the data of the previous
years. Women have a higher rate of death when compared to men and it shows with 37%
increase in deaths related to COPD (Mamary et al., 2018). Healthy People 2020 has a goal to
promote respiratory health with the help of better detection, prevention and treatment including
patient education. This helped in targeting the health disparities that was caused due to the
prevalence of COPD in all age groups specifically people above the age of 45.
The approach that is missing in these interventions is that it should also focus on the root
cause of the risk factors such as tobacco and pollutants that act as an allergen and an irritant for
the airways. The production and consumption of tobacco should be reduced and an age limitation
should be given. The restriction of purchase and implementation of taxes should be increased in
tobacco products, which will help in reducing the intake of tobacco and eventually leading to less
emission of smoke. The emission from automobiles should also be reduced by implementing

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limits to the fuel purchase and the type of fuel should be administered (López Campos, Tan &‐
Soriano, 2016).
Conclusion
As a conclusion to this paper, it is important to suggest that COPD is one of the most
severe condition of the respiratory system. The mortality rate is higher all around the world
including the United States. The Healthy People 2020 has identified this a threat to the public
health and they have been making objectives to reduce the incidence of this issue. Many trends
and issues are being utilized for the betterment in the management of this disease because it is
the third leading cause of death in US.

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References
Ford, E. S. (2015). Hospital discharges, readmissions, and ED visits for COPD or bronchiectasis
among US adults. Chest, 147(4), 989-998.
Ford, E. S. (2015). Trends in mortality from COPD among adults in the United
States. Chest, 148(4), 962-970.
Healthypeople.gov. (2020). Respiratory Diseases | Healthy People 2020. Retrieved 16 April
2020, from https://www.healthypeople.gov/2020/topics-objectives/topic/respiratory-
diseases
Jalota, L., & Jain, V. V. (2016). Action plans for COPD: strategies to manage exacerbations and
improve outcomes. International journal of chronic obstructive pulmonary disease, 11,
1179.
Kim, M., Ren, J., Tillis, W., Asche, C. V., Kim, I. K., & Kirkness, C. S. (2016). Explaining the
link between access-to-care factors and health care resource utilization among individuals
with COPD. International journal of chronic obstructive pulmonary disease, 11, 357.
López Campos, J. L., Tan, W., & Soriano, J. B. (2016). Global burden of‐
COPD. Respirology, 21(1), 14-23.
Mahler, D. A., Waterman, L. A., Ward, J., & Gifford, A. H. (2014). Comparison of dry powder
versus nebulized beta-agonist in patients with COPD who have suboptimal peak
inspiratory flow rate. Journal of aerosol medicine and pulmonary drug delivery, 27(2),
103-109.

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Mamary, A. J., Stewart, J. I., Kinney, G. L., Hokanson, J. E., Shenoy, K., Dransfield, M. T., ... &
COPDGene® Investigators. (2018). Race and gender disparities are evident in COPD
underdiagnoses across all severities of measured airflow obstruction. Chronic
Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 5(3), 177.
Man, W. D., Puhan, M. A., Harrison, S. L., Jordan, R. E., Quint, J. K., & Singh, S. J. (2015).
Pulmonary rehabilitation and severe exacerbations of COPD: solution or white
elephant?. ERJ open research, 1(2).
Salvi, S. (2014). Tobacco smoking and environmental risk factors for chronic obstructive
pulmonary disease. Clinics in chest medicine, 35(1), 17-27.
Schauer, G. L., Wheaton, A. G., Malarcher, A. M., & Croft, J. B. (2016). Health-care provider
screening and advice for smoking cessation among smokers with and without COPD:
2009-2010 National Adult Tobacco Survey. Chest, 149(3), 676-684.
Sullivan, J., Pravosud, V., Mannino, D. M., Siegel, K., Choate, R., & Sullivan, T. (2018).
National and state estimates of COPD morbidity and mortality—United States, 2014-
2015. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 5(4),
324.
US Department of Health and Human Services, & Office of Disease Prevention and Health
Promotion. (2014). Healthy People 2020. Washington, DC.
Yakubek, G. A., Curtis, G. L., Sodhi, N., Faour, M., Klika, A. K., Mont, M. A., ... & Higuera, C.
A. (2018). Chronic obstructive pulmonary disease is associated with short-term
complications following total hip arthroplasty. The Journal of arthroplasty, 33(6), 1926-
1929.

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