Chronic obstructive pulmonary disease – A neglected and underestimated chronic lung disease in India: A large single-center study in India

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is more prevalent chronic respiratory illness with significant morbidity and mortality, underdiagnosed and inadequately treated in India. Our objectives of study were to analyze the disease awareness and knowledge, diagnostic patterns, and treatment trends including rational inhalation treatment in COPD in the rural settings. Materials and Methods: Prospective, observational, questionnaire-based study conducted during July 2013 to January 2020 included 12,000 cases of COPD confirmed by spirometry with chronic respiratory symptoms as cough, sputum production, and shortness of breath. In this study, we assessed disease knowledge, spirometry use, oral or inhalation treatment methods used to all patients before enrollment by applying questionnaire. Statistical analysis was done using the single proportion test. Results: Inhalation treatment use was documented in 58% COPD cases, 31% cases levosalbutamol monotherapy, 18% cases levosalbutamol plus beclometasone, and 9% cases either formoterol plus budesonide or salmeterol plus fluticasone (P < 0.0001). Oral medicines use is documented in 42% COPD cases, 16% cases theophylline, 7% cases salbutamol, and 19% cases oral steroids (P < 0.0001) We have documented that 43% study cases were not accepting the diagnosis and convinced for rational inhalation therapy labeled as “Difficult patients” and 9% patients were taking either formoterol plus budesonide or salmeterol plus fluticasone with or without tiotropium due to cost factor versus 91% are on either oral or other inhalation treatment, labeled as “difficult treatment” and oral medicines were offered in 42% COPD cases by treating doctors over inhalation treatment labeled as “difficult doctor.” We have observed 3% study cases were aware about their illness COPD disease, 54% are not having knowledge about disease, and 43% cases are not accepting the COPD diagnosis (P < 0.0001). Conclusion: COPD is a neglected and underestimated chronic lung disease in India, especially in the rural settings. More awareness is recommended with regard to disease knowledge and rational inhalation treatment and COPD definitely needs frontline place in National Health Mission in coming days to prevent morbidity and mortality.

Keywords

• chronic obstructive pulmonary disease
• difficult doctor
• formoterol budesonide
• inhalation treatment
• spirometry