Prevalence of chronic obstructive pulmonary disease (COPD) among rural population: A national survey in Bangladesh

Background

In Bangladesh, there is a scarcity of nationally representative data on the burden of chronic obstructive pulmonary disease (COPD).

Methods

To estimate the COPD prevalence in rural settings, this cross-sectional, population-based study was conducted in all eight administrative divisions of Bangladesh, and involved adults aged 40 years and above. By using multi-stage random sampling, 2,458 individuals were enrolled. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were used to diagnose COPD based on post-bronchodilator lung function, while additional participant data was gathered through computer-assisted personal interviews.

Results

A 2% COPD prevalence (95% CI: 1.45, 2.55) was found in the study sample with a statistically significant difference between males (2.7%; 95% CI: 1.8, 3.6) and females (1.2%; 95% CI: 0.59, 1.81). Increasing age significantly inflated the odds of having COPD irrespective of sex (OR: 1.03; 95% CI: 1.00, 1.05; P value < 0.05). Furthermore, prevalence of COPD was higher among manual workers, cigarette smokers, and those that used the indoor kitchen and did not have a primary education. Sex-based analysis showed that smokeless tobacco consumption was significantly associated with COPD occurrence among males (OR: 2.14; 95% CI: 1.05, 4.37; P value < 0.05), but not females. Further, using an indoor kitchen increased the odds of developing COPD by 400% among female participants (OR: 4.39; 95% CI: 1.37, 14.10; P value < 0.05).

Conclusion

This study provides a comprehensive sex-based estimation of COPD prevalence among rural population and imparts significant contribution to the growing database on COPD prevalence in Bangladesh.

Global prevalence of chronic obstructive pulmonary disease: systematic review and meta-analysis

Background

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide.

Aims

To synthesize data on the worldwide prevalence and severity of COPD by geographical region, age groups, and smoking status in a systematic review.

Methods

A systematic search was performed following Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. International databases including PubMed, Scopus and Web of Science were searched for population- based studies published between January 2004 and May 2015 that reported the prevalence of COPD anywhere in the world. The prevalence of COPD was calculated based on World Health Organization (WHO) regions and sex and severity stages using metaprop. Meta-regression and subgroup analysis were applied to determine the sources of heterogeneity.

Results

Sixty papers were screened with a combined subject sample size of 127 598. The prevalence of post-bronchodilator COPD was 12.16% (10.91-13.40%). The pooled prevalence of COPD was 15.70% (13.80-18.59%) in men and 9.93% (8.73- 11.13%) in women. Among all WHO regions, the highest prevalence was recorded in the Region of the Americas (14.53%), and the lowest was recorded in the South-East Asia Region/Western Pacific Region (8.80%). Meta-regression model variables were: sample size, WHO region, study quality score, level of gathering data, publication year, and sampling methods that justified 29.82% of heterogeneity detected among COPD prevalence rates worldwide.

Conclusions

Global prevalence of COPD among men is about 5% higher than among women. The most prevalent stage of COPD is stage 1.

A case scenario study for the assessment of physician's behavior in the management of COPD: the WHY study

Purpose

COPD diagnosis is mainly based on clinical judgment of physicians. Physicians do not also refer to COPD guidelines in their daily practice. This study aimed to assess attitudes of physicians regarding COPD diagnosis, treatment, and follow-up and to identify the factors influencing physicians’ decisions in clinical practice.

Patients and methods

Fifty physicians were selected from 12 EuroStat NUTS 2 regions and asked to assess seven fictitious case scenarios. The following five scenarios described patients with COPD: Case Global Initiative for Chronic Obstructive Lung Disease (GOLD) A-smoker and Case GOLD A-nonsmoker were previously undiagnosed patients presenting with dyspnea, Case GOLD D-smoker and GOLD B-exsmoker were COPD patients presenting with exacerbation, Case GOLD B-smoker was a previously diagnosed COPD patient with dyspnea in stable phase, Case asthma–COPD overlap syndrome, and Case obesity hypoventilation syndrome. Patients’ history, physical examination findings, pulmonary function tests, and X-ray images were prepared before the study by an experts’ committee and provided to the physicians upon their request, until they reached a final decision. The physicians completed a questionnaire including information about their clinical practices and institutions.

Results

According to the GOLD 2015 recommendations, of the physicians, 44% performed guideline-concordant diagnosis in the first five scenarios, who were all COPD patients, and 6% performed guideline-concordant diagnosis in all cases. There was a negative correlation between high workload and making a guideline-concordant diagnosis (P=0.038, rho =−0.417). Even when the physicians made a guideline-concordant diagnosis of COPD, only a minority (10%–22%) used the GOLD classification. Logistic regression analysis revealed that working in a tertiary health care center was a significant factor in favor of establishing a guideline-concordant diagnosis of COPD (P=0.029, OR =6.139 [95% CI: 1.20–31.32]).

Conclusion

Management of COPD patients in Turkey does not generally follow the GOLD criteria but is rather based on physicians’ clinical experience. Heavy workload appears to adversely affect the correctness of clinical decisions.

Validity of Questionnaire-Based Diagnosis of Chronic Obstructive Pulmonary Disease in Azar-Cohort Population

BACKGROUND

The clinical diagnosis of chronic obstructive pulmonary disease (COPD) should be considered in any patient who has dyspnea, chronic cough or sputum production, and diagnosis should be confirmed by performing spirometry in presence of airflow limitation. The aim of this study was to assess the validity of a questionnaire used to detect COPD based on spirometry findings.

MATERIALS AND METHODS

The validity of a questionnaire for COPD diagnosis was examined using spirometry based on both Global Initiative for Chronic Obstructive Lung Disease (GOLD) and American Thoracic Society/European Respiratory Society (ATS/ERS) criteria for patients 35 years old and older. In total, 350 questionnaires were completed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio and negative likelihood ratio were calculated to determine the accuracy of the questionnaire.

RESULTS

The sensitivity of the questionnaire in detection of airflow limitation was 8.3% and 6.7% by the GOLD and the ATS/ERS criteria, respectively; whereas, specificity was 96% by both criteria.

CONCLUSION

The high specificity of the questionnaire indicates that the questionnaire is more capable to identify people who do not have airflow limitation; whereas, the low sensitivity of the questionnaire could underestimate the actual prevalence of COPD in the general population.