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March 18, 2020

Managing chronic illnesses like Chronic Obstructive Pulmonary Disease (COPD) a respiratory condition has become high priority among healthcare systems across the world. Governments run wellness and disease management programs to manage chronic patients. However, healthcare organizations are challenged in choosing the right program for their patients given the different approaches. An effective way to manage COPD is with better management of GERD.

COPD is a respiratory condition that is primarily caused by smoking, and is characterized by progressive, airflow obstruction that is partly reversible. According to an article on disease management published by National Health Service (NHS), this condition cannot be cured but can be managed through medical and non-medical interventions. This group of lung diseases affect about 10% of the population above the age of 40 at any given time and estimated prevalence rates range between 12-15%, globally.

COPD is a leading cause of death in the United States and across the world, yet many are not aware of the significance of COPD as a major national health concern. The estimated hospital admission is 4.22 per 1000 people with an estimated cost of $28,612 per admission in the US according to MarketScan Data IBM Watson, 2015. This shows that overall treatment cost of COPD including hospital admission is huge. And it puts a significant stress on the healthcare systems across the world. It impacts the utilization of scarce healthcare resources available with the health authorities, putting much burden on the patients and their care givers in terms of morbidity and mortality.

An individual with COPD experiences inflammation of the lungs, which prevents oxygen from flowing properly from the lungs to the bloodstream. Based on the COPD research by Dr Mannino from Lung Institute in 2007, more than half of those who suffer from severe COPD also experience gastroesophageal reflux disease (GERD), a condition where stomach acids back up from the stomach into the esophagus. While smoking is the major cause of COPD (80% of COPD patients are smokers), it is also observed that only 20% of smokers have COPD. On the other hand, there seems to be a much stronger correlation between COPD and GERD. Almost half of COPD patient have GERD and vice versa based on the findings of the COPD research study.

This indicates that GERD may be the primary driver for COPD while smoking aggravates the condition as a secondary trigger.

Figure 1: Indicative graph showing relationship between COPD, GERD and Smokers population

The graph below depicts a typical journey of a COPD patient. With increase in age and time duration from the onset of the disease, the condition of the patient becomes more severe depicted by the increase in the severity of symptoms. The time duration is shown in four distinct health stages.

Figure 2: Indicative graph showing increasing frequency and severity of symptoms with time           

Healthstage 1

Early stages of the condition. Spikes indicate aggravated symptoms requiring antibiotic or nebulizer treatment. Spikes are normally far apart

Healthstage 2

Symptoms grow aggravation requiring more resources for treatment

Healthstage 3

The dosage is increased and the aggravation (spikes) becoming more frequent. Also, spikes may require frequent hospitalization

Healthstage 4

Spikes become longer with increased duration. Require longer duration of hospitalizations. Nebulizer becoming a regular treatment


In my opinion we can slow down the growth of COPD symptoms through better control on GERD. The graph in figure 2 would be flatter and the duration of each healthstage would be longer if we effectively engage with the patients to manage their GERD symptoms. We can use healthcare analytics to support the governments in identification of target population for health and wellness programs, evaluation of program effectiveness, allocating appropriate budgets to different programs, and getting best value and patient outcomes from these programs.

Although there is clear evidence of COPD and GERD being correlated, the implementation on targeting GERD to cure COPD is at a very early stage right now. The future of healthcare analytics is to provide deeper insights to confirm, revalidate and help governments in efficient implementation of health and wellness programs. I would be delighted to hear from you if you have anything that is associated with COPD or anything that revolves around disease management.

Munish Aggarwal specializes in Life Sciences and Healthcare Analytics with experience of 20 years in the industry. In his 13 years with TCS, he has led programs for clinical statistical analysis, pharma commercial analytics, and healthcare analytics. He holds a master’s degree in management studies from Indian Institute of Science, and a diploma in Population Health Nutrition from Indian Institute of Population Health. Some of the ideas on dealing with COPD come from his own struggle with the condition and successfully managing the symptoms.


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