COPD: How Tennessee Employers Can Mitigate the Costs

by John W. Walsh

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that affects 24 million Americans – with nearly 70 percent of this population being under the age of 65. Its symptoms include increased breathlessness, frequent coughing, wheezing, tightness in the chest, and constant clearing of the throat, all of which are frequently dismissed as signs of aging, allergies or bad colds. While smoking is the primary risk factor for COPD, exposure to second-hand smoke or pollutants and genetic factors also play a role.

For HR directors, it’s important to know that COPD affects individuals at the peak of their earning and spending power – and triples employers’ health costs compared to employees without COPD. A symptomatic, undiagnosed employee may result in higher claims costs and significant productivity losses compared to an employee who has been diagnosed and is properly managing the condition.

COPD causes almost as much disability as stroke, and more disability than diseases such as cancer and heart disease. For a misdiagnosed employee, what begins as an occasional sick day caused by frequent colds and respiratory infections may evolve into weeks of dealing with greater disability, leading to reduced productivity and higher medical costs due to long-term chronic illness. In 2010 the U.S. spent $29.5 billion in direct healthcare expenditures, with additional costs not captured in claims due to under-diagnosis and misdiagnosis.

Helping Tennessee Breathe Easier

The rate of prevalence of COPD in Tennessee is 8.7 percent – the third highest in the country. Kentucky has the highest rate at 9.3 percent, while the lowest in the contiguous 48 states are Minnesota and Washington, both at 3.9 percent.

Currently, the disease affects women at almost two times the rate of men (11.6 percent vs. 6.7 percent). Also, the lower a person’s income, the more likely they are to have COPD. The rate of prevalence for those making under $15,000 per year is over 19 percent, more than double the average rate of prevalence for Tennessee

The Behavioral Risk Factor Surveillance System (BRFSS) data for Tennessee showed that:

  • Less than 70 percent of adults with diagnosed COPD had received spirometry, a simple breathing test that is the gold standard for COPD diagnosis.
  • Over 60 percent of adults with any stage of diagnosed COPD said it negatively affected the quality of their lives.
  • 11.7 percent of adults, more than 57,000 people, with COPD were hospitalized or had an emergency room (ER) visit at least once in the last 12 months. Most of those ER visits could have been prevented with early diagnosis and proper treatment and management regimens.

Other significant data included:

  • In 2011 there were over 20,000 hospital discharges for COPD. These hospital stays had an average length of 4.2 days and average costs of over $20,000 per stay for principal diagnosis. Costs for hospital stays among people 45-64 were higher than people over 65.
  • Almost 50 percent of people in Tennessee currently smoke or have a history of smoking.
  • Workers in mining, auto production, and farming – some of Tennessee’s major industries – have shown an increased risk for developing COPD.

How to Avoid Productivity Losses and Higher Healthcare Costs

COPD is causing avoidable losses of productivity and higher than necessary healthcare costs.

HR directors are well positioned to help mitigate financial costs and improve the quality of life for employees living with COPD. To begin, it’s important to consider COPD-related education and incentives, develop strategies for leveraging current health plans, engage at-risk employees and facilitate behavioral change.


Learn about COPD by accessing tools to better understand the full impact and implications of the disease in the workplace. The COPD Foundation has created an employer toolkit ( with a calculator that employers can use to estimate how much COPD costs them and the potential savings that could result from better management.

Disease education can teach patients how to prevent or lessen the frequency and severity of acute exacerbations of COPD (a flare-up), thereby decreasing sick days and increasing productivity while at work. Individuals who fail to seek treatment for their flare-ups from their primary care physicians are more likely to be admitted to the hospital. Also, incomplete recovery from flare-ups may be one of the main reasons for faster lung function decline, which may speed up the pace of declining productivity, and lead to premature retirement.


Advocate a benefit plan with employee incentives – a lower cost premium share and lower out-of-pocket costs – for tests, treatments and prescriptions in exchange for following COPD preventive care and taking medication as indicated.


Determine if the employee health plan includes coverage for COPD-related care, such as pulmonary rehabilitation services, spirometry and disease management programs. Spirometry is important for avoiding a misdiagnosis and understanding the severity of the disease.

Encourage employers to capitalize on health plan data that pinpoints gaps in care, and establish goals for continued improvement of the plan’s existing support services, including its ability to identify members who would benefit from coaching or self-management tools. Plans should also adopt and test strategies that improve uptake and effectiveness, such as communications through social media.


Support and engage employees by providing information about COPD and its management. For example, provide a COPD Information Line postcard to connect them to support and education resources, and observe COPD Awareness Month every November, using resources such as those developed by the COPD Foundation and the National Heart Lung and Blood Institute.

Identifying employees at risk for COPD is an important step in managing healthcare costs.  Employees can answer five easy questions online to see if they are at risk at More than 2.7 million Americans have assessed their risk for COPD this way. Also, an on-site COPD screening day enables employees to receive peak flow and spirometry screening.

Many adults who have COPD are misdiagnosed with asthma. Therefore, getting the right diagnosis and the appropriate treatment is critical. HR directors can play a key role in encouraging employees to identify COPD symptoms and seek the medical care they need.


The company should consider offering tobacco cessation programs, which have a high 25 percent success rate. Asking participants in a workplace tobacco cessation program if they have COPD provides the counselor with information they can use to individualize the quit approach. Furthermore, stopping smoking is the only proven method that slows the rapid rate of lung function decline.

Smoke-free policies, such as limiting smoking to an area away from the building or prohibiting smoking on the worksite, protect employees from the harmful effects of second-hand smoke.

Improving Care is an Imperative

COPD patients nationwide often don’t receive the care they need. A study in the journal Chest reports that COPD patients receive recommended care only about half of the time. Worse, delivery of proper care that could prevent hospitalization is severely lacking. The same study found that recommended care was provided at a higher rate for disease exacerbations than for routine care.

As with chronic diseases like diabetes, when COPD patients receive poor quality care there is a corollary increase in complications related to their disease. Increased complication rates have a direct relationship to increased cost of care. Given that the average COPD patient only receives half of the care that is recommended, there is a huge opportunity to improve the quality of COPD care delivered. Such improvements can reduce the overall number of COPD complications and in turn reduce the costs associated with COPD.

Going Forward

To begin the process of reducing COPD’s economic burden, HR directors must access COPD-related resources and expertise, which is critical for analyzing the status of the company wellness programs relative to COPD outcomes, facilitating the integration of tailored screening and education strategies, and helping define measurable health outcome goals to increase productivity and lower costs.

Fortunately, COPD is treatable after diagnosis, and individuals with the disease can lead full and productive lives. So, companies have everything to gain by offering wellness programs that encourage early screening to facilitate earlier diagnosis. Education and health management can lessen the frequency and severity of COPD flare-ups, resulting in fewer workdays missed, reductions in hospital claims, and increased productivity at work.