1. Respiratory disease
COPD is the most significant risk that we face. There are over 900,000 people in the UK,
diagnosed with COPD and half as many again are thought to be living with undiagnosed
COPD.i The true prevalence of COPD both nationally and locally is unknown, but it has
been estimated at 1-10%.ii Rates are higher in men, although this is now beginning to
equaliseiii as more women reach an age when smoking earlier in life is taking its toll. The
change in smoking habits between the sexes is shown in Whilst COPD starts to affect lung
function from the age of about 40 onwards (which is one reason why younger smokers do
not think that the problem applies to them), death from COPD occurs much later in life.
This is shown in Figure 2, which shows age of death from COPD in Barnet men and
women between 2004 and 2007. With a 30-50-year lag between starting smoking and
dying from COPD, and with an increasing number of women smoking until the mid-1970s,
we can expect more women to die of COPD (if they do not die of another smoking-related
disease first) over the next ten years or so in Barnet whilst the number of men dying from
this unpleasant disease continues to drop.. Women took up smoking in increasing
numbers after the First World War and smoked cigarettes in increasing numbers until the
mid 1970s. In contrast, whilst men smoked more, they started to reduce the amount they
smoked from the beginning of the 1950s, when consumption was near-static for 25 years
and then stated to reduce cigarette smoking sooner and by a greater amount than women.
Whilst COPD starts to affect lung function from the age of about 40 onwards (which is one
reason why younger smokers do not think that the problem applies to them), death from
COPD occurs much later in life. This is shown in Figure 2, which shows age of death from
COPD in Barnet men and women between 2004 and 2007. With a 30-50-year lag between
starting smoking and dying from COPD, and with an increasing number of women smoking
until the mid-1970s, we can expect more women to die of COPD (if they do not die of
another smoking-related disease first) over the next ten years or so in Barnet whilst the
number of men dying from this unpleasant disease continues to drop.
Figure 1: Annual consumption of manufactured cigarettes per person in the UK
Source: Tobacco Advisory Council
4500 virtually no rise in
cigarette consumption
proportionately greater
by men
4000
reduction in cigarette
consumption by men
3500
men
Number of manufactured cigarettes per person
3000
2500
2000
1500 proportionately slower
reduction in cigarette
consumption by women
women
1000
continued substantial rise
in cigarette consumption
500
by women
0
1905 1910 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985

2. In Barnet, death rates from COPD are reducing faster in men than they are in women, as
shown in Figure 2 and we can expect this gender difference to continue for some time.
Figure 2: Trends in age-standardised death rates from COPD in Barnet in men and
women Source: Office for National Statistics
45
Age-standardised death per 100,000
40
Men
Women
35
30
25
20
15
10
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Figure 3 shows the total number of men and women dying from lung cancer in Barnet.
This also indicates that 30-40 years ago, women were more likely to start smoking at an
older age than men. As women now tend to take up smoking in their early teens, as men
used to, we can expect women to die at a younger age from lung cancer than they do now.
Stopping smoking is important whatever the degree of disability someone has because of
COPD. This has two important effects: it prevents the damage getting worse and it
reduces the risk of hospitalisation. Research has shown that stopping smoking more than
halved the likelihood of hospital admission, but merely reducing smoking does not make
any significant difference.iv
The risk of people suffering and dying from other respiratory diseases can also be reduced
by quitting smoking – it increases one’s likelihood of developing acute bronchitis – and, for
those in at-risk groups, of having an annual influenza immunisation.
Asthma is predominantly a cause of intermittent breathing difficulty and a relatively
unusual cause of death. For most people, it can be wholly managed in a primary care
setting with only a small number requiring hospital admission for severe attacks.

3. Figure 3: Total number of deaths from COPD in men and women in Barnet
2004-2007
50
45
40
Men
35
Women
30
25
20
15
10
5
0
40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+
Source: Office for National Statistics
The relationship between diversity and deprivation and respiratory disease
There is a relationship between respiratory disease and deprivation. Figure 4 shows the
hospital admission rate for respiratory disease in 2006/07 for residents in each of Barnet’s
electoral wards ranked in order of deprivation. In most instances, there is a close and
increasing relationship between the two: people living in more deprived areas are more
likely to have respiratory disease that is severe enough to require hospital admission. It is
noteworthy that smoking is more prevalent in more deprived areas.
There are insufficient data currently available to indicate any relationship between ethnicity
or other aspects of diversity and respiratory disease. However, it is likely that different
smoking habits in men and women in different ethnic groups is likely to have an effect on
this.
Figure 4: The relationship between hospital admission for respiratory disease and
deprivation
30
Admission rate per 1000 population
25
20
15
10
5
0
10 12 14 16 18 20 22 24 26 28 30 32 34
Index of Multiple Deprivation 2007
Source: Local hospital admission data
Local targets

4. Currently, there is no formal target to reduce death rates from respiratory disease.
However, reducing deaths from respiratory diseases of all types will contribute to reducing
the all-age, all-cause death rate and, with appropriate targeting of activity, contribute to
reducing health inequalities.
Key things that need to be done
The key activities required are:
continuing to reduce the prevalence of smoking;

continuing to encourage and enable the uptake of influenza immunisation and

pneumococcal immunisation;
the provision of services to manage acute exacerbations of COPD early and to provide

pulmonary rehabilitation services.

5. i
Soriano JB, Maier WC, Eager P, et al. Recent trends in physician diagnosed COPD in women and men in
the UK. Thorax 2000;55:789-94
ii
British Thoracic Society Standards of Care Subcommittee on Pulmonary Rehabilitation. Pulmonary
Rehabilitation. Thorax 2001;56:827-834
iii
Calverley P. COPD: early detection and intervention. Chest 2000; 117:S365-S371
iv
Godtfredsen NS, Vestbo J, Prescott E Risk of hospital admission for COPD following smoking cessation and
reduction: a Danish population study’ Thorax 2002, 57:967-972