Respiratory questionnaire‐based analysis of awareness of COPD in a large multicenter rural population‐based study in India

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a more prevalent chronic lung disease with a significant health burden, and the majority of these cases receive inadequate treatment. Methods: Prospective, observational, interview (questionnaire) based complete workup COPD study, screened 12,000 cases with chronic respiratory symptoms with cough, sputum production, and shortness of breath. A total of 6000 COPD cases were enrolled after the spirometry test. COPD cases were assessed as disease knowledge and methods of treatment offered by applying questionnaires to patients and treating physicians.Results: In the present study, 3% of study cases were aware of their COPD illness, 54% were not having knowledge about the disease, and 43% cases were not accepting the COPD diagnosis (p < 0.0001). A total of 58% of cases received inhalation treatment as levosalbutamol monotherapy in 31% cases, levosalbutamol plus beclometasone in 18% cases, and formoterol plus budesonide or salmeterol plus fluticasone only in 9% of COPD cases (p < 0.0001). Total 42% cases received oral treatment as theophylline in 16% cases, salbutamol in 7% cases, oral steroids in 19% cases (p < 0.0001). Conclusion: "Doctor-patient-drug trio" discordance clubbed as "difficult doctor, difficult patient, and difficult treatment" is a very crucial issue observed during diagnosis and management of COPD in peripheral settings in India. K E Y W O R D S chronic obstructive pulmonary disease, difficult doctor, inhalation treatment, salmeterol fluticasone, spirometry Research HighlightsCOPD is an underestimated chronic lung disease and is halfheartedly treated in rural settings in India. In the present study, we observed that 43% of cases were difficult to accept COPD diagnosis, 91% of cases did not receive rational inhalation treatment, and 42% of cases were treated with oral medicines over rational inhalation treatment.

A nationwide survey of public COPD knowledge and awareness in Saudi Arabia: A population-based survey of 15,000 adults

“…More than half of the respondents were unaware that COPD is a common disease and nearly 60% of the participants did not know that COPD increases mortality, despite COPD being ranked as the third leading cause for mortality globally [ 11 ]. Although lower COPD acceptance rates were also reported in Australia [ 43 ] and India [ 44 ], this poor level of beliefs and perception is particularly higher in Saudi Arabia possibly due to social pressure since most Saudi youths socialize mostly in indoors and areas with high exposure to passive smoking [ 8 ]. Therefore, there is a paramount necessity to provide valid information to the Saudi public regarding the nature, prevalence, risk factors, and the long-term consequences of COPD including the alarming reduction in disability-adjusted life years (DALYs) [ 45 ].…”

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“…Various Chronic respiratory diseases are common in India including COPD, asthma, bronchiectasis, interstitial lung diseases and post-tuberculosis obstructive airways diseases. Authors have observed 43% cases were difficult to accept COPD diagnosis, 91% cases did not receive rational inhalation treatment and 42% cases were treated with oral medicines over rational inhalation treatment in their study in rural settings in India [2].…”

“…Globally, Inhalation treatment method is the preferred route of administration of drug for treatment of COPD and considered as 'lung targeted therapy' and evidence-based medicine has observed significant improvement in symptom control and lesser systemic side effects due to smaller volume of drug used as compared to oral or intravenous route of administration [13]. Authors have mentioned high cost of long-acting or rational inhalation treatments and improper drug selection by family physicians was the reason for least preference to inhalation medicines over oral medicines [2]. Similarly, various studies [14][15] have mentioned COPD management remains suboptimal due to lack of knowledge or unawareness regarding current guidelines by treating physicians, and poor adherence by patients to prescribed medicines regarding usefulness of rational inhalation treatment.…”

“…COPD awareness has positive impact on disease diagnosis and rational treatment due to heterogeneous trends of practices in country as varieties of therapies (Allopathy, Homeopathy, Ayurveda, Unani and others) are involved in treatment of these conditions and nearly two third cases are still undiagnosed, only one fifth are getting rational inhalation treatment [2]. Spirometry has a vital role in diagnosis of COPD including other obstructive airway diseases, including asthma, help in assessing severity of illness, predicting prognosis, help in guiding rational inhalation treatment and is recommended by GOLD [5].…”