High prevalence of chronic obstructive pulmonary disease in Korea

Article information

Korean J Intern Med. 2016;31(4):651-652

Publication date (electronic) : 2016 July 1

doi : https://doi.org/10.3904/kjim.2016.196

Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

Correspondence to Chin Kook Rhee, M.D. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6067 Fax: +82-2-599-3589 E-mail: chinkook@catholic.ac.kr.

Received 2016 June 22; Accepted 2016 June 24.

See the Original "Smoking habits and nicotine dependence of North Korean male defectors" in Volume 31 on page 685.

See Article on Page [Related article:] 685-693

South Korea has a very high prevalence of chronic obstructive pulmonary disease (COPD). According to data from the Fourth Korean National Health and Nutrition Survey [1], the prevalence of COPD among subjects aged ≥ 40 years is 13.4% (19.4% of males, 7.9% of females). This is considerably higher than in other countries. COPD is a heterogeneous disease [2], the prevalence of which is influenced by diverse factors. Therefore, the high rate in Korea may have several explanations; these are outlined below.

First, Korea has a rate of cigarette smoking considerably higher than that of other countries. In 1995, the rate among Korean adult males was 66.7%. Although it has since decreased, it was 36.2% in 2013, which is the highest of all OECD (The Organisation for Economic Co-operation and Development) countries [3]. Second, a large number of Korean females have been exposed to biomass fuel in previous decades. Third, many in South Korea have tuberculosis (Tb), which might be related to the high rate of COPD. According to data from The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO study) [4], a history of Tb is associated with airflow obstruction. Moreover, a study in Korea [5] reported that 76.8% of patients with Tb-destroyed lungs showed airflow obstruction. Tb is also a risk factor for lung function impairment among Korean non-smokers [6].

The prevalence of COPD in North Korea is unclear due to a dearth of data. Furthermore, collection of such data is hampered by the restrictions placed on society in North Korea. However, its rate there is expected to be very high, because the three abovementioned risk factors for COPD are likely markedly more common there than in South Korea. Indeed, Kim et al. [7] reported that among 272 male North Korean defectors, 84.2% were current smokers and 12.5% were ex-smokers. Such a high rate of smoking will inevitably lead to a high prevalence of COPD. In addition, North Korea is one of the poorest countries in the world and thus smoke inhalation from the burning of wood, charcoal, and other biomass is likely frequent. Furthermore, the country has an extremely high rate of Tb: at 345 cases out of every 100,000 people, it is higher than that in some countries with an epidemic of generalized human immunodeficiency virus [8]. Moreover, the lack of advanced medical facilities and/or anti-Tb medication and the high prevalence of multidrug-resistant Tb in North Korea suggest a high rate of Tb-destroyed lungs.

The high rate of COPD in South Korea and probably considerably higher rate in North Korea represent a huge socioeconomic burden. Screening for early COPD should be performed and adequate treatment should be provided in South Korea. Regarding North Korea, considerable effort will be required post-unification to identify and manage individuals with COPD.

Notes

No potential conflict of interest relevant to this article was reported.

References

1. Yoo KH, Kim YS, Sheen SS, et al. Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008. Respirology 2011;16:659–665.

2. Rhee CK. Phenotype of asthma-chronic obstructive pulmonary disease overlap syndrome. Korean J Intern Med 2015;30:443–449.

3. OECD. Daily smokers: indicator [Internet]. Paris: The Organisation for Economic Co-operation and Development (OECD); c2016. [cited 2016 Jun 28]. Available from: https://data.oecd.org/healthrisk/daily-smokers.htm.

4. Menezes AM, Hallal PC, Perez-Padilla R, et al. Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America. Eur Respir J 2007;30:1180–1185.

5. Rhee CK, Yoo KH, Lee JH, et al. Clinical characteristics of patients with tuberculosis-destroyed lung. Int J Tuberc Lung Dis 2013;17:67–75.

6. Myong JP, Yoon HK, Rhee CK, Kim HR, Koo JW. Risk factors for lung function impairment among the general non-smoking Korean population. Int J Tuberc Lung Dis 2015;19:1019–1026.

7. Kim SW, Lee JM, Ban WH, Park CK, Yoon HK, Lee SH. Smoking habits and nicotine dependence of North Korean male defectors. Korean J Intern Med 2016;31:685–693.

8. Seung KJ, Linton SW. The growing problem of multidrug-resistant tuberculosis in North Korea. PLoS Med 2013;10e1001486.

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