Prevalence of chronic bronchitis and chronic respiratory symptoms in adults over the age of 35 years in Isfahan, Iran in 1998

Evaluating the affordability of asthma, chronic obstructive pulmonary disease, and cystic fibrosis medicines in a middle-income country

BACKGROUND

A heavy financial burden is imposed on patients suffering from chronic diseases due to medicine out-of-pocket payments.

OBJECTIVES

This study focuses on assessing the affordability of medications used for chronic respiratory diseases (CRDs) such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) in Iran, specifically on the category R medicines listed in the 2017 Iran drug list (IDL) that are used for the treatment of these diseases, based on the anatomical therapeutic chemical (ATC) drug code.

METHODS

The affordability of medicines in mono and combination therapy approaches was assessed in CRDs using the World Health Organization/Health Action International (WHO/HAI) methodology. Accordingly, if out-of-pocket payment for 30-days of pharmacotherapy exceeds one day for the lowest-paid unskilled government worker (LPGW), it's considered non-affordable.

RESULTS

Based on the monotherapy approach, our finding demonstrates that all generic medicines of category R were affordable. However, branded drugs such as Symbicort®, Pulmicort Respules®, Flusalmex®, Seretide®, Fluticort Plus®, Seroflo®, and Salmeflo® cost between 1.2 and 2.5 days' wage of LPGW and considered unaffordable despite 70% insurance coverage. Moreover, based on the affordability ratio in the combination therapy approach, all medicines used in asthma, COPD, and CF patients with mild respiratory problems are affordable except omalizumab (inj), which is non-affordable due to its high price and no insurance coverage.

CONCLUSION

Results showed that the existing insurance coverage does not protect households from hardship, so more considerations are needed such as different insurance schedules and patient support programs.

Prevalence of Chronic Bronchitis in the Northwest of Iran: Results of the Pilot Phase of the Azar Cohort Study

Background and aims: Although chronic bronchitis is markedly under-diagnosed in the general population, it has a significant impact on the health status and the well-being of patients as well as healthcare resource consumption. This study aimed to determine the prevalence of chronic bronchitis and its correlates in the northwest of Iran. Methods: In 2014, all residents aged 35 and over in Khameneh city, East Azerbaijan, were invited to participate in the pilot phase of the Azar cohort study. The respiratory symptoms questionnaires were filled out by two trained general practitioners. Participants with a cough and phlegm on most days during at least three successive months in the previous two years were classified as chronic bronchitis group. Chi-square test was used to compare the chronic bronchitis and smoking status between males and females. Results: A total of 1036 participants were interviewed, 1006 of whom had completed a respiratory questionnaire, from them 544 (54.1%) were females, and 462 (45.9%) were males. The mean age was 52.5 ± 10.5 years. The prevalence of smoking was 16.2%. According to the chronic bronchitis definition, 24 (2.4%) subjects were classified with chronic bronchitis, and the prevalence was higher in the males (4.1%) than that in the females (0.9%). The prevalence was higher among the active smokers and ex-smokers compared to non- smokers (8.6% and 4.1% vs. 0.8%). The prevalence of cigarette smoking was 16.2% and it was higher in the males than that in the females (33.5% vs. 1.5%). Conclusion: the prevalence of chronic bronchitis in the population of the region under study was relatively low in comparison to the other parts of Iran and its prevalence was higher in the males than that in the females.

Global and regional estimates of COPD prevalence: Systematic review and meta-analysis

Background

The burden of chronic obstructive pulmonary disease (COPD) across many world regions is high. We aim to estimate COPD prevalence and number of disease cases for the years 1990 and 2010 across world regions based on the best available evidence in publicly accessible scientific databases.

Methods

We conducted a systematic search of Medline, EMBASE and Global Health for original, population–based studies providing spirometry–based prevalence rates of COPD across the world from January 1990 to December 2014. Random effects meta–analysis was conducted on extracted crude prevalence rates of COPD, with overall summaries of the meta–estimates (and confidence intervals) reported separately for World Health Organization (WHO) regions, the World Bank's income categories and settings (urban and rural). We developed a meta–regression epidemiological model that we used to estimate the prevalence of COPD in people aged 30 years or more.

Findings

Our search returned 37 472 publications. A total of 123 studies based on a spirometry–defined prevalence were retained for the review. From the meta–regression epidemiological model, we estimated about 227.3 million COPD cases in the year 1990 among people aged 30 years or more, corresponding to a global prevalence of 10.7% (95% confidence interval (CI) 7.3%–14.0%) in this age group. The number of COPD cases increased to 384 million in 2010, with a global prevalence of 11.7% (8.4%–15.0%). This increase of 68.9% was mainly driven by global demographic changes. Across WHO regions, the highest prevalence was estimated in the Americas (13.3% in 1990 and 15.2% in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in 2010). The percentage increase in COPD cases between 1990 and 2010 was the highest in the Eastern Mediterranean region (118.7%), followed by the African region (102.1%), while the European region recorded the lowest increase (22.5%). In 1990, we estimated about 120.9 million COPD cases among urban dwellers (prevalence of 13.2%) and 106.3 million cases among rural dwellers (prevalence of 8.8%). In 2010, there were more than 230 million COPD cases among urban dwellers (prevalence of 13.6%) and 153.7 million among rural dwellers (prevalence of 9.7%). The overall prevalence in men aged 30 years or more was 14.3% (95% CI 13.3%–15.3%) compared to 7.6% (95% CI 7.0%–8.2%) in women.

Conclusions

Our findings suggest a high and growing prevalence of COPD, both globally and regionally. There is a paucity of studies in Africa, South East Asia and the Eastern Mediterranean region. There is a need for governments, policy makers and international organizations to consider strengthening collaborations to address COPD globally.

Global and regional estimates of COPD prevalence: Systematic review and meta-analysis

BACKGROUND

The burden of chronic obstructive pulmonary disease (COPD) across many world regions is high. We aim to estimate COPD prevalence and number of disease cases for the years 1990 and 2010 across world regions based on the best available evidence in publicly accessible scientific databases.

METHODS

We conducted a systematic search of Medline, EMBASE and Global Health for original, population-based studies providing spirometry-based prevalence rates of COPD across the world from January 1990 to December 2014. Random effects meta-analysis was conducted on extracted crude prevalence rates of COPD, with overall summaries of the meta-estimates (and confidence intervals) reported separately for World Health Organization (WHO) regions, the World Bank's income categories and settings (urban and rural). We developed a meta-regression epidemiological model that we used to estimate the prevalence of COPD in people aged 30 years or more.

FINDINGS

Our search returned 37 472 publications. A total of 123 studies based on a spirometry-defined prevalence were retained for the review. From the meta-regression epidemiological model, we estimated about 227.3 million COPD cases in the year 1990 among people aged 30 years or more, corresponding to a global prevalence of 10.7% (95% confidence interval (CI) 7.3%-14.0%) in this age group. The number of COPD cases increased to 384 million in 2010, with a global prevalence of 11.7% (8.4%-15.0%). This increase of 68.9% was mainly driven by global demographic changes. Across WHO regions, the highest prevalence was estimated in the Americas (13.3% in 1990 and 15.2% in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in 2010). The percentage increase in COPD cases between 1990 and 2010 was the highest in the Eastern Mediterranean region (118.7%), followed by the African region (102.1%), while the European region recorded the lowest increase (22.5%). In 1990, we estimated about 120.9 million COPD cases among urban dwellers (prevalence of 13.2%) and 106.3 million cases among rural dwellers (prevalence of 8.8%). In 2010, there were more than 230 million COPD cases among urban dwellers (prevalence of 13.6%) and 153.7 million among rural dwellers (prevalence of 9.7%). The overall prevalence in men aged 30 years or more was 14.3% (95% CI 13.3%-15.3%) compared to 7.6% (95% CI 7.0%-8.2%) in women.

CONCLUSIONS

Our findings suggest a high and growing prevalence of COPD, both globally and regionally. There is a paucity of studies in Africa, South East Asia and the Eastern Mediterranean region. There is a need for governments, policy makers and international organizations to consider strengthening collaborations to address COPD globally.

Prevalence of self-reported respiratory symptoms in rural areas of Iran in 2000

OBJECTIVES

The aims of the present study were to measure the population prevalence of symptoms of asthma, chronic bronchitis, obstructive lung disease and non-specific respiratory symptoms in randomly selected rural communities in south-west Isfahan, Iran.

METHODOLOGY

Nine hundred and ninety-four subjects from a total of 1127 villagers (88.2% response rate) took part in a medical interview conducted by interns from the Isfahan Medical School.

RESULTS

The mean (+/-SD) age of the population surveyed was 25.21 +/- 17.55 years and the smoking rate was 7.2%. The self-reported prevalence rates for current asthma, chronic bronchitis, non-specific exercise-induced cough and night cough were 6.1, 4.4, 13.3 and 11.3%, respectively.

CONCLUSION

Asthma, chronic bronchitis and other respiratory disorders in rural Isfahan are more prevalent than expected for a young rural population with low smoking rates. The cause of this should be investigated.