Take A Deep Breath: COPD And Its Effect On Life Underwriting

Breathing for most of us comes easy, and we proceed through each day without a thought about how critical this bodily function could be when compromised.

When Chronic Obstructive Pulmonary Disease (COPD) is present, however, the picture changes. Advisors need to be aware of this disease and of the underwriting implications for life insurance.

COPD includes 2 main lung disorders–chronic bronchitis and chronic emphysema. Both conditions develop gradually over many years, entail obstruction of airflow which inhibits normal breathing, and are linked to tobacco use.

COPD is the fourth leading cause of death in the United States, claiming over 120,000 lives in 2004, and approximately 41.5 deaths per 100,000 in the U.S. population. About 13 million people in the U.S. live with this disease. (See National Center for Health Statistics, Report of Morbidity Statistics 2005 and Report of Mortality Statistics 2004.)

Chronic bronchitis, one of the associated disorders, is characterized by a frequent and persisting cough that produces sputum (saliva mixed with mucus). It causes mucus glands in the lungs to increase in number and size, resulting in mucus buildup that leads to airway obstruction. Though there are many causes, cigarette smoking is the most common.

This condition is often neglected until it advances to chronic obstructive bronchitis. In this stage, symptoms include dyspnea (difficulty breathing). The resulting weakness makes the lungs more susceptible to viral and bacterial infections.

The other disease associated with COPD, chronic emphysema, obstructs the airways by destroying the alveoli or air sacs in the lungs. When these air sacs are destroyed, the lungs are unable to move oxygen freely to the bloodstream, causing shortness of breath.

Other symptoms may include rapid breathing or wheezing which can be heard through a stethoscope. There may also be cyanosis (causes a bluish discoloration of the skin), which results from inadequate oxygen in the blood and is associated with lung diseases and heart failure.

A history of cigarette smoking is also strongly associated with this disease. Other risk factors include pollution and occupational pollutants. Individuals at risk for occupational pollutants are coal workers, construction and metal workers. A genetic predisposition, history of childhood respiratory infections and second hand smoke may be relevant factors as well.

As with chronic bronchitis, emphysema does not occur suddenly. It develops gradually with years of exposure to irritating pollutants and cigarette smoke.

Individuals suffering from COPD are usually diagnosed by symptoms, smoking history, and physical examination. No single test is absolutely definitive; however, lung or pulmonary function is determined by using a “spirograph.” This is an instrument that measures breathing movements into and out of the lungs by calculating the volume and speed that air can be inhaled and exhaled.

COPD’s severity is most often categorized as mild, moderate or severe. The results of the spirograph or spirometry test can provide an indicator of this severity. So can the timed vital capacity (TVC) test, which indicates the presence of obstructive and restrictive breathing defects. (Here, the individual inhales as much air as possible and exhales into a tube with a measuring device that records the forced expiratory volume.)

COPD, including chronic bronchitis and chronic emphysema, cannot be reversed or cured. The damage it causes to the airways and lungs is permanent.