Sub-Optimal Chronic Obstructive Pulmonary Disease (COPD) Management in India: Findings from a Community-Based Study

Despite the second most common cause of disease burden, there are few studies reporting the prevalence, awareness, and treatment rates of COPD in India.

A community-based cross-sectional study was conducted among people aged ≥40 years residing in rural and urban areas of Sonipat district in North India using a multistage random sampling technique. COPD was defined as self-reported physician diagnosed COPD, emphysema, chronic bronchitis or being on treatment for COPD. Additional cases were detected using a validated sequential screening strategy, ie, administering the Lung Function Questionnaire (LFQ) followed by the pocket spirometry and confirmation by post-bronchodilation spirometry. Awareness was defined as self-reported diagnosed cases of COPD or self-reported treatment. Treatment was defined as self-reported intake of oral or inhalational corticosteroids and/or bronchodilators. Trained Community Health Workers interviewed the study participants using a paper-based validated questionnaire, screened for COPD with the LFQ and conducted the pocket spirometry. Confirmation of COPD using post-bronchodilation gold standard spirometry was conducted by trained physician researchers. Age-standardized estimates were calculated for the prevalence, awareness, and treatment of COPD.

The overall age-standardised prevalence of COPD in our study was 8.6% (95% CI: 7.5-9.8) with higher prevalence in men and rural population. The overall awareness of COPD was 75.1% (95% CI: 68.5-80.7) with lower awareness among people who ever-smoked [33.9% (32.0-35.8)], currently smoked [29.6% (27.8-31.5)] and among those with post-bronchodilator confirmed diagnosis of mild COPD (4.8%). Less than half (45.7%) of participants with COPD reported taking bronchodilators and/or corticosteroids.

The awareness-treatment gap in COPD was high in the study population. There is a need to strengthen the public health system along with systematic training of health care providers to provide appropriate treatment to people with COPD.