Trends of chronic obstructive pulmonary disease diagnosis and treatment in rural setting in India: A large, two-center, prospective, observational study of 6000 cases in tertiary care setting in India

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality due to chronic respiratory illness in India. More than half of COPD patients were not getting adequate rationale inhalation treatment in primary to tertiary care setting. Materials and Methods: A prospective, observational, interview (questionnaire)-based complete workup COPD study conducted during June 2016 to June 2019 in the Department of Pulmonary Medicine, Venkatesh Chest Hospital, and MIMSR Medical College, Latur, screened 12,000 cases with chronic respiratory symptoms with cough, sputum production, and shortness of breath, and all cases were undergone spirometry and 6000 COPD cases were enrolled. In this study, we assessed disease knowledge and the methods of treatment offered to all patients before enrollment by applying questionnaire. Statistical analysis was done using single proportion test (Chi-square test). Observation and Analysis: We have observed that 3% of study cases were aware of their illness “COPD disease,” 54% are not knowing the disease or not counseled for COPD disease ever before, and 43% are not convinced as they are having COPD (categorized as “difficult patient”) (P < 0.0001). Inhalation treatment was offered in only 58% of COPD cases, levosalbutamol monotherapy in 31% of cases, levosalbutamol plus beclometasone in 18% of cases, and formoterol plus budesonide or salmeterol plus fluticasone only in 9% of COPD cases (P < 0.0001), latter being categorized as “difficult treatment” being costlier than former ones. We also observed irrational and exuberant use of oral medicines in 42% of COPD cases, theophylline in 16%, salbutamol in 7%, and oral steroids in 19%, and these medicines were preferred by treating doctors over inhalation treatment in spite of knowledge of inhalation treatment and categorized as “difficult doctor” (P < 0.0001). Conclusion: COPD is less efficiently evaluated and halfheartedly treated in rural setting, and more emphasis should be given to spirometry training for proper diagnosis and awareness regarding advantages of inhalation treatment over oral medicines.

Keywords

• chronic obstructive pulmonary disease
• difficult doctor
• inhalation treatment
• salmeterol fluticasone
• spirometry