Chronic Lung Disease in Western NC

Why is chronic lung disease a key health issue in western North Carolina?

The percent of adults  diagnosed with Chronic Obstructive Pulmonary Disease (COPD) is slightly higher in WNC (8.5%) than North Carolina (7.8%) or the United States (6.4%).

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Percent of Adults in WNC with COPD, by Year

Source: WNC Healthy Impact Community Health Survey, 2015-2021

CLRD includes four chronic lung diseases: chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, and asthma.

(Oelsner et al., 2016)

The percent of adults diagnosed with COPD in WNC declined from 13.9% in 2018 to 8.5% in 2021.

(WNCHN – WNC Healthy Impact Community Health Survey, 2018-2021)

Chronic Lower Respiratory Disease (CLRD) mortality rates have steadily risen from 51.3 in 2002-2006 to 53.5 in 2015-2019 per 100,000 population.

(N.C. State Center for Health Statistics, 2020)

What do the numbers say about Chronic Lung Disease?

Western North Carolina (WNC) Data:

Approximately 8.5% of adults in WNC have been diagnosed with Chronic Obstructive Pulmonary Disease (COPD). The following adult populations were significantly more likely to have ever been diagnosed with COPD in 2021:

  • Adults aged 65+ (12.9%)
  • Very low income (18.7%)
  • Those identifying as either AI/AN, Indigenous (16%)
(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Differences in health outcomes across social groups, economic status, and racial/ethnic identity are closely linked with disparities in social determinants of health, which disproportionately burden individuals and communities who experience systemic disadvantage and/or discrimination. See our data story on the social determinants of health to learn more about how the conditions in which people are born, live, work, play, learn, worship, and age can influence their ability to achieve good health for themselves and their families.

This map shows the mortality rate for chronic lower respiratory disease at the census tract level in western North Carolina from 2012 to 2016.

Source: NC SCHS 2012-2016 | Geographic Unit: Census Tract | Map Produced by: NC SCHS

Chronic Lower Respiratory Disease (CLRD) is listed in the top 6 overall causes of death in all 16 counties in western North Carolina for 2014-2018.

CLRD Cause of Death Rank, 2015-2019

Source: N.C. State Center for Health Statistics, 2020

wdt_ID County Year Rank
1 Buncombe 2,019 4
2 Cherokee 2,019 4
3 Clay 2,019 5
4 Graham 2,019 3
5 Haywood 2,019 4
6 Henderson 2,019 5
7 Jackson 2,019 4
8 Macon 2,019 3
9 Madison 2,019 4
10 McDowell 2,019 3
11 Mitchell 2,019 3
12 Polk 2,019 6
13 Rutherford 2,019 3
14 Swain 2,019 3
15 Transylvania 2,019 4
16 Yancey 2,019 3
County Year Rank

More than 16 million Americans are living with a disease caused by smoking – including chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis.

(CDC, 2018)

Percent of Adults in WNC Smoking Cigarettes, by Year

Source: WNC Healthy Impact Community Health Survey, 2012-2021

The percentage of adults who smoke cigarettes in WNC is lower than the percentage of adults who smoke cigarettes in North Carolina and the United States in 2021.

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Percent of Adults in WNC Breathing Smoke at Work, by Year

Source: WNC Healthy Impact Community Health Survey, 2012-2021

Nearly 1 in 10 (9.1%) adults in WNC have breathed someone else’s smoke at work in the past week.

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

State and National Findings:

In 2015, 13.4% of North Carolinians answered “yes” when asked if they had ever been told by a healthcare professional that they had asthma.

(N.C. State Center for Health Statistics, 2016)

The prevalence of COPD is higher in rural areas nationally, with a rate of 8.2% compared to metro incidence of 4.7%.

(CDC, 2018)

In 2010, national medical costs attributable to COPD were estimated at $32.1 billion annually.

(Ford, Murphy, Khavjou, Giles, Holt, & Croft, 2015)

What did the region say is the story behind the chronic lung disease numbers?

Source: WNCHN – Online Key Informant Survey, 2018

The items below are paraphrased themes that emerged from a 2018 regional survey of key informants. These responses do not necessarily:

  • Reflect accurate or scientifically validated information about health determinants, outcomes, and/or strategies for change,
  • Represent an exhaustive list of factors that can help or hurt efforts to address this key regional health issue.

The information in this section should be interpreted and used with care. It should be used only to help local health departments and agencies begin to understand community perceptions about local health issues. Communities are strongly encouraged to collect their own, local-level data to inform local planning and evaluation activities.

What’s Helping?

  • Smoking cessation campaigns
  • Smoke free businesses
  • Case Management for these patients
  • Education to the younger generation on the dangers of smoking

What’s Hurting?

  • Vaping rates on the rise and not enough research to understand the impact
  • Challenge with quitting smoking
  • Lack of education and resources for this disease
  • Expense of medications
  • Poor air quality
  • Lack of healthcare providers in rural communities

What we are hearing:

“Primary care physicians and other professionals are educating patients on this condition and prescribing/treating per evidence-based recommendations.”

“Extremely limited resources, limited education, and very poor access to care.”

How is the region prioritizing this issue?

The western North Carolina region includes 17 communities: 16 counties and Eastern Band of Cherokee Indians (EBCI)

In the 2021 CHA cycle, none of the 17 communities chose a priority related to chronic lung disease.

5 communities prioritized chronic disease.

What is already happening regionally?

The list below represents a sample of what is happening in the region around this key health issue. Visit for more resources.

  • Chronic Disease Self-Management (Healthy Aging NC)
  • The regional dataset (WNC Healthy Impact Community Health Survey and Online Key Informant Survey) is available thanks to contributions from hospitals in the 16-county region of western North Carolina. Thank you!