COPD and Severe Asthma: Major Risks for Patients and the Healthcare System

Worsening COPD or severe asthma does not merely mean symptoms that are difficult to manage — it can lead to emergency department visits, hospital admissions, sick leave, and significant limitations in daily life. When diagnosis is delayed or the disease is not kept under control, episodes of deterioration can recur, affecting both patients' quality of life and the resources of the healthcare system.

The consequences extend well beyond the consulting room: exacerbations and hospitalisations increase costs for the healthcare system, whilst absences from work, sick leave, and reduced productivity place an additional economic burden on patients, families, and society as a whole.

Early diagnosis, appropriate treatment, and consistent monitoring can alter the course of the disease. A patient identified in time and followed up properly has a greater chance of controlling their condition and avoiding severe deterioration. For the system, better management of chronic respiratory diseases means fewer emergency presentations, fewer hospital admissions, and fewer resources spent on complications.

Major risks and complications of COPD

Worldwide, approximately 392 million people live with COPD, a disease that ranks third among the leading causes of death, accounting for around 3.4 million deaths annually. In Romania, 8.3% of the general population has a diagnosis of COPD. Of the COPD patients registered with hospitals, 74% are retirees — people who often have limited incomes.

The disease brings numerous pulmonary and cardiovascular complications. For many patients, acute episodes of deterioration — exacerbations — profoundly affect their lives and may require hospitalisation.

The effects extend beyond the lungs: in the first five days following a moderate exacerbation, the risk of myocardial infarction doubles. Furthermore, the risk of death increases by 17% after a single moderate exacerbation and by 80% after two moderate exacerbations within a year. More than half of patients hospitalised due to an exacerbation die within the first five years of that hospitalisation.

Early diagnosis and continuous monitoring remain essential for disease control and the prevention of deterioration. Identifying individuals in at-risk groups, making greater use of spirometry, and involving the general practitioner in early detection can shorten the path to diagnosis and accelerate the start of appropriate treatment.

Severe asthma: underdiagnosed and undertreated

In Romania, approximately 1 million people live with asthma, and between 4% and 10% of them have a severe form of the disease. Asthma is one of the fastest-growing respiratory conditions worldwide, and its severe form represents a public health concern, both through the direct and indirect costs it generates.

In Romania, the journey of a patient with severe asthma is often lengthy and difficult: from the lack of an accurate and timely diagnosis, to delayed access to modern therapies, and the excessive use of oral corticosteroids (OCS).

Underdiagnosed and suboptimally treated, asthma represents a significant burden for patients and their families, being associated with increased morbidity across all age groups. Uncontrolled asthma means a lower quality of life, more absences from work, anxiety, and additional pressure on hospitals through repeated admissions and visits.

International guideline recommendations

International treatment guidelines provide clear directions for the management of severe asthma and COPD, from early diagnosis and accurate patient assessment through to the selection of appropriate therapy and ongoing monitoring. In the case of severe asthma, recommendations emphasise clear diagnostic criteria and personalised management, whilst for COPD, guidelines support the use of therapies with proven benefits in reducing exacerbations and mortality in eligible patients.

For patients, adhering to medical advice and taking treatment as prescribed remain essential for disease control and reducing the risk of deterioration. When treatment is no longer sufficiently effective, it is important that the therapeutic plan be reassessed together with the treating physician.