Global burden of chronic obstructive pulmonary disease (COPD), a group of common lung conditions that affects more than 300 * million people, could be dramatically reduced with a simple health assessment, concludes large-scale international study by UCL researchers.
COPD includes serious lung conditions, such as emphysema and chronic bronchitis, and is the third leading cause of morbidity worldwide with more than three million deaths per year. The heaviest burden of COPD is found in low- and middle-income countries (LMICs), which account for about 90% of COPD-related deaths. Globally, COPD has also been a major risk factor associated with Covid-19 outcomes.
In high-income countries, COPD is typically caused by smoking and is diagnosed using a spirometer, where a person blows into a device that measures how much air a person can breathe out in one. forced breathing. The diagnosis is simple and the symptoms can be treated effectively.
However, in LMICs, the root cause of COPD is more varied and includes domestic air pollution in the form of biomass smoke for cooking and heating; other causes include impaired lung growth, chronic asthma, and post-tuberculosis lung damage. And diagnosis in PRFI is hampered because spirometry – the “gold standard” for diagnosing COPD – is often not available. There is a dearth of clinicians needed to perform and interpret the tests, so their deployment is expensive. As a result, COPD is usually not diagnosed in LMICs.
In the new study published in JAMA, the researchers found that people at high risk for COPD could be identified in 7-8 minutes using a questionnaire alone or a questionnaire combined with a peak expiratory flow (PEF) assessment, a device inexpensive that tests how fast a person can breathe out.
Explaining the study, lead researcher Professor John Hurst (UCL Division of Medicine) said, “Chronic obstructive pulmonary disease is one of the major public health problems around the world, causing damage to the body. both individual and economic: there is a clear and urgent need to find better ways to identify people early, in all kinds of contexts.
“COPD screening tools have been shown to have reasonable diagnostic accuracy in high-income countries, but due to better population health and better treatment in these settings, this has tended to be to identify a milder disease that does not require much intervention.
“Until now, the performance of these screening tools has not been sufficiently studied in LMICs; we sought to test both the diagnostic accuracy and the feasibility of simple screening tools. “
For the study, the researchers evaluated three tools to screen for COPD on populations in three distinct settings: semi-urban Bhaktapur, Nepal, urban Lima, Peru and rural Nakaseke, Uganda.
Two of the screening tools (COLA 6 and CAPTURE) included a questionnaire and peak expiratory flow (PEF). The other screening tool, the LFQ, consisted only of a questionnaire. The three screening tools were tested in all three settings.
To establish the diagnostic accuracy of the tools, all participants also underwent a spirometry test.
A total of 10,709 adult men and women aged 40 or over from the three communities participated. Participants were recruited regardless of symptoms and / or a previous diagnosis of COPD, but had to be able to perform spirometry.
- The prevalence of COPD varied by site, from 3% in Lima (Peru) to 7% in Nakaseke (Uganda) and 18% in Bhaktapur (Nepal).
- 49% of COPD cases were clinically significant, as defined by symptoms and / or exacerbation burden, and 16% had severe or very severe disease as measured by spirometry. 95% of cases had not been diagnosed before.
- Screening instruments functioned the same in each population setting and were achievable using trained research personnel, taking an average of 7-8 minutes.
Commenting Professor Hurst said: “Our results confirm the accuracy and feasibility of using simple screening tools to identify people affected by COPD living in various low- and middle-income settings.
“It is alarming that a high percentage of COPD cases identified by screening were clinically important, had severe or very severe changes in lung function, and most were unaware of their diagnosis despite the prevalence high symptoms and a lower quality of life.
“In addition, only a minority of people had a history of smoking, highlighting the poor conditions, exacerbated by biomass smoke, that people in low- and middle-income countries experience.”
Professor Hurst added: “Action is needed: The global health community has neglected the burden of chronic respiratory disease for too long. Now is the time for people with chronic respiratory diseases such as COPD to be quickly identified, informed of their condition and treated – – wherever they live in the world. “
Siân Williams and Noel Baxter, Co-CEO of the International Primary Care Respiratory Group (IPCRG) added: “This article demonstrates that COPD can be identified in primary care in low-income settings, which is the one of the top 10 questions for primary care. in our prioritization of respiratory research: “How can we better train healthcare professionals to improve the early detection and diagnosis of COPD?” “
“It also reinforces the findings of colleagues in other recent studies in middle-income countries such as China and Brazil. This is important if we want at-risk communities and primary care teams to know about COPD, recognize as a disease with defined characteristics, and understand that it is a disease with a significant impact on the health and well-being of communities that can be mitigated through a range of primary prevention interventions, secondary and tertiary non-pharmacological and pharmacological. “
The researchers say more studies will be needed to assess whether screening for COPD can be implemented in routine LMICs health facilities; whether screening for COPD is beneficial for those who test positive, and whether it is cost-effective for a given population to implement COPD screening in low- and middle-income countries.
The Global Excellence in COPD Outcomes 1 study was led by UCL researchers with collaborators from the University of Miami (United States), Johns Hopkins University (United States), University of Makerere (Uganda), Universidad Peruana Cayetano Heredia (Peru) and Kathmandu Medical College (Nepal).