Lung disease is a common cause of morbidity and mortality in the United States and the State of Michigan is no exception. Lung disease encompasses a wide range of conditions ranging from obstructive diseases like asthma and COPD to non-obstructive pulmonary diseases that predominantly affect the lung parenchyma like pulmonary fibrosis and interstitial lung disease. COPD and asthma are common diseases and the state of Michigan has some of the highest prevalence rates of both diseases in the United States. Based on 2018 CDC data, an estimated 872,519 people or 11.2% of Michigan adults have asthma. Michigan ranks seventh in the nation overall.
In the Michigan BRFSS health survey, the overall prevalence of COPD in Michigan was 8.9%. A prior study in Michigan found that 28.1% of COPD patients reported having current asthma further supporting the assertion that these diseases overlap significantly. The prevalence of pediatric asthma in Michigan is 17.4% in Black and 6.5% in White children.
It has been increasingly recognized that obstructive lung disease occurs along a continuum and the separation of asthma and COPD is often arbitrary and misdiagnosis is common. Those with severe asthma that begins early in life can progress to chronic obstruction and in some cases emphysema despite the lack of exposure to tobacco smoke and other risk factors for COPD.
During the past two decades, asthma and COPD guidelines have been developed but the implementation of these guidelines is significantly lacking with many patients receiving non-evidence-based therapies. Problems also persist with medication non-adherence, improper inhaler technique, unwillingness to stop smoking, and avoiding environmental triggers. Periods of worsening respiratory symptoms occur in many patients, some leading to exacerbations and treatment with systemic drugs as prednisone, an oral corticosteroid (OCS). These drugs work so well and are much cheaper than inhalers, some patients tend to use them too frequently and often experience side-effects, some quite severe.
The Inspiring Health Advances in Lung Care (INHALE) CQI will address care and outcomes for children and adults with obstructive lung diseases in the State of Michigan by helping to close the gap between guideline-based, patient-focused care and the current state. It will leverage unique data resources to identify asthma and COPD cohorts across the state, including those who are high risk and can be targeted for further interventions. We have the opportunity to radically change the landscape of lung health in the State of Michigan and concurrently reduce the economic burden on patients and other stakeholders.