The big bad wolf: COPD and trauma

According to the fable “The Three Little Pigs,” the wolf came upon the homes of the pigs and said, “I’ll huff, and I’ll puff, and I’ll blow your house in.”* Recently, this fable has been referenced in commercials for chronic obstructive pulmonary disease (COPD) treatment as the sounds a patient with this condition may make while trying to breathe.

COPD is a group of diseases causing airflow blockage, along with breathing problems. Included in this disease group are emphysema, chronic bronchitis, and, in some cases, asthma. Tobacco use in the U.S. is the principal factor in the development and the progression of this disease. Other factors do play a role as well, such as exposure to air pollutants in the workplace and home and respiratory infections. In developing parts of the world, indoor air quality is more of a factor in the development and progression of COPD than in the U.S.

A debilitating disease

In 2014, chronic lower respiratory disease, primarily COPD, was the third leading cause of death in the U.S. While close to 16 million Americans have been diagnosed with COPD, the actual number may be higher, as more than half of adults with low pulmonary function were unaware that they had COPD. Individuals most likely to report a diagnosis of COPD are 65 years of age or older, women, unemployed, divorced, current or former smokers, and individuals with less than a high school diploma.

COPD affects more than just the lungs. Patients with COPD may have the following symptoms:

  • Activity limitations
  • Unable to work
  • Require supplemental oxygen
  • Experience increased confusion or memory loss
  • Engage in more emergency room visits or overnight hospital stays
  • Have other chronic diseases (arthritis, congestive heart failure, diabetes, coronary heart disease, stroke, or asthma), depression, or other mental or emotional conditions

To treat COPD for those patients who smoke, smoking cessation is the first step. Avoid tobacco smoke elsewhere and remove air pollutants from the patient’s home and workplace. Symptoms of COPD can be treated but require a careful and thorough evaluation by a physician and patient compliance.

An avoidable comorbidity

To examine the occurrence of COPD in the National Trauma Data Bank® (NTDB®) research admission year 2016, medical records were searched using the comorbid conditions DG-01 field value of 23 (chronic obstructive pulmonary disease). A total of 59,086 records were found, 53,416 of which contained a discharge status, including 24,754 patients discharged to home, 9,017 to acute care/rehab, 15,928 to skilled nursing facilities, 977 to hospice, and 293 to a psychiatric facility; 2,447 died. Of these patients, 52 percent were women, on average 70 years old, had an average hospital length of stay of 6.2 days, an intensive care unit  length of stay of 5.8 days, an average injury severity score of 9.2, and were on the ventilator for an average of 6.8 days (see Figure 1).

Figure 1. Hospital Discharge status

Figure 1. Hospital Discharge status

COPD can be prevented by avoiding inhalation of tobacco smoke, clearing the home and workplace of air pollutants, and preventing the development of respiratory infections. To avoid the big bad wolf, early detection of COPD may change its course and progress. A simple test with a spirometer can measure pulmonary function and detect COPD in anyone with breathing problems.

Throughout the year, we will be highlighting NTDB data through brief monthly reports in the Bulletin. The NTDB Annual Report can be found on the American College of Surgeons website as a PDF. In addition, information is available on the website about how to obtain NTDB data for more detailed study. To submit your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at


Statistical support for this column was provided by Ryan Murphy, Data Analyst, NTDB.

*Halliwell-Phillipps J.O. The Nursery Rhymes of England. London and New York: Frederick Warne and Co.; 1886.

Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease. Available at: Accessed January 28, 2018.


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