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Suri TM, Ghosh T, Mittal S, Hadda V, Madan K, Mohan A. Prevalence of chronic obstructive pulmonary disease in Indian nonsmokers: a systematic review & meta-analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 0:reveh-2023-0135. [PMID: 38016010 DOI: 10.1515/reveh-2023-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Nonsmokers with chronic obstructive pulmonary disease (COPD) are neglected despite constituting half of all cases in studies from the developed world. Herein, we systematically reviewed the prevalence of COPD among nonsmokers in India. CONTENT We searched Embase, Scopus, and PubMed databases for studies examining the prevalence of COPD among nonsmokers in India. We used the Joanna Briggs Institute (JBI) checklist to assess included studies' quality. Meta-analysis was performed using random-effects model. SUMMARY Seven studies comprising 6,903 subjects were included. The quality of the studies ranged from 5/9 to 8/9. The prevalence of COPD varied between 1.6 and 26.6 %. Studies differed considerably in demographics and biomass exposure profiles of subjects. Among the four studies that enrolled both middle-aged and elderly Indian nonsmokers not screened based on biomass fuel exposure, the pooled prevalence of COPD was 3 % (95 % CI, 2-3 %; I2=50.52 %, p=0.11). The pooled prevalence of COPD among biomass fuel-exposed individuals was 10 % (95 % CI, 2-18 %; I2=98.8 %, p<0.001). OUTLOOK Limited evidence suggests a sizable burden of COPD among nonsmokers and biomass fuel-exposed individuals in India. More epidemiological studies of COPD in nonsmokers are needed from low and middle-income countries.
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Affiliation(s)
- Tejas M Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Chen P, Li Y, Wu D, Liu F, Cao C. Secondhand Smoke Exposure and the Risk of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis 2023; 18:1067-1076. [PMID: 37309392 PMCID: PMC10257914 DOI: 10.2147/copd.s403158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023] Open
Abstract
Background Many studies have shown that active smoking leads to an increasing incidence of chronic obstructive pulmonary disease (COPD). However, studies interested in the effects of secondhand smoke exposure (SHS exposure) on COPD were less or underappreciated. Methods A systematic review and meta-analysis was conducted to investigate the association between SHS exposure and the risk of COPD. Three databases (PubMed, Embase and Web of Science) were searched to obtain data. After assessing the study quality, stratified analyses were performed according to the region, gender, and duration of exposure. Cochran's Q and I2 were utilized for heterogeneity assessment. To assess publication bias, we used a funnel plot and Egger's test. Results A total of 15 studies (6 cross-sectional studies, 6 case-control studies, and 3 cohort studies) with 25,592 participants were involved in this meta-analysis. This study showed that SHS exposure was associated with an increased risk of COPD (odds ratio (OR): 2.25, 95% CI: 1.40-3.62, I2 = 98%, p < 0.01 for heterogeneity based on a random-effects analysis model), especially in those with a longer time exposure of more than 5 years was 4.38 (95% CI: 1.28-15.00, I2 = 89%, p < 0.01 for heterogeneity based on a random-effects analysis model). In addition, SHS exposure also increases the risk of COPD in women (odds ratio (OR): 2.02, 95% CI: 1.52-2.67, I2 = 0%, p = 0.89 for heterogeneity based on a random-effects analysis model). Conclusion The findings suggest that SHS exposure is associated with the risk of COPD, especially for individuals with a long time exposed. Trial Registry Prospero CRD42022329421.
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Affiliation(s)
- Peixv Chen
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
- Medical College of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Yiting Li
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
- Medical College of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Di Wu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
- Medical College of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Fang Liu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
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Sarno G, Stanisci I, Maio S, Williams S, Ming KE, Diaz SG, Ponte EV, Lan LTT, Soronbaev T, Behera D, Tagliaferro S, Baldacci S, Viegi G. Issue 2 - "Update on adverse respiratory effects of indoor air pollution". Part 2): Indoor air pollution and respiratory diseases: Perspectives from Italy and some other GARD countries. Pulmonology 2023:S2531-0437(23)00083-1. [PMID: 37211526 DOI: 10.1016/j.pulmoe.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVE to synthesize the Italian epidemiological contribution to knowledge on indoor pollution respiratory impact, and to analyze the perspective of some GARD countries on the health effects of indoor air pollution. RESULTS Italian epidemiological analytical studies confirmed a strong relationship between indoor air pollution and health in general population. Environmental tobacco smoke, biomass (wood/coal) fuel for cooking/heating and indoor allergens (house dust mites, cat and dog dander, mold/damp) are the most relevant indoor pollution sources and are related to respiratory and allergic symptoms/diseases in Italy and in other GARD countries such as Mexico, Brazil, Vietnam, India, Nepal and Kyrgyzstan. Community-based global health collaborations are working to improve prevention, diagnosis and care of respiratory diseases around the world, specially in low- and middle-income countries, through research and education. CONCLUSIONS in the last thirty years, the scientific evidence produced on respiratory health effects of indoor air pollution has been extensive, but the necessity to empower the synergies between scientific community and local administrations remains a challenge to address in order to implement effective interventions. Based on abundant evidence of indoor pollution health effect, WHO, scientific societies, patient organizations and other members of the health community should work together to pursue the GARD vision of "a world where all people breathe freely" and encourage policy makers to increase their engagement in advocacy for clean air.
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Affiliation(s)
- G Sarno
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - I Stanisci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Maio
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Williams
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - K E Ming
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - S G Diaz
- Universidad Autónoma de Nuevo León, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Av. Dr. José Eleuterio González 235, Mitras Centro, 64460 Monterrey, N.L., Mexico
| | - E V Ponte
- Faculdade de Medicina de Jundiaí - Department of Internal Medicine, R. Francisco Teles, 250, Vila Arens II, Jundiaí SP, 13202-550, Brazil
| | - L T T Lan
- University Medical Center, 217 Hong Bang, dist.5, Ho Chi Minh City 17000, Vietnam
| | - T Soronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Togolok Moldo str., Bishkek 720040, Kyrgyzstan
| | - D Behera
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases (NITRD), Sri Aurobindo Marg Near Qutub Minar, Mehrauli, New Delhi 110030, India
| | - S Tagliaferro
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Baldacci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - G Viegi
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy.
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Agarwal M, Anand S, Patro M, Gothi D. Early versus non-early desaturation during 6MWT in COPD patients: A follow-up study. Lung India 2023; 40:235-241. [PMID: 37148021 PMCID: PMC10298809 DOI: 10.4103/lungindia.lungindia_404_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/26/2022] [Accepted: 01/14/2023] [Indexed: 05/07/2023] Open
Abstract
Introduction Six-minute walk test (6MWT) has a significant prognostic value in chronic obstructive pulmonary disease (COPD). Those who desaturate early during 6MWT are likely to have frequent exacerbations. Aims and Objectives To follow-up and compare exacerbations and hospitalisations of COPD patients having early desaturation versus nonearly desaturation determined during baseline 6MWT. Methods It was a longitudinal follow-up study conducted in a tertiary care institute from November 1, 2018 to May 15, 2020 involving 100 COPD patients. A decrease in SpO2 by ≥4% in baseline 6MWT was considered a significant desaturation. If the desaturation occurred within first minute of the 6MWT, the patient was called early desaturator (ED); if it occurred later, the patient was called nonearly desaturator (NED). If the saturation did not fall, then the patient was called nondesaturator. During the follow-up, 12 patients dropped out and 88 remained. Results Of 88 patients, 55 (62.5%) were desaturators and 33 were nondesaturator. Of 55 desaturators, 16 were ED and 39 were NED. EDs had significantly higher number of severe exacerbations (P <.05), higher hospitalisation (P <.001), and higher BODE index (P <.01) compared to NEDs. The receptor operating characteristic curve and multiple logistic regression analysis showed that previous exacerbations, presence of early desaturation, and distance saturation product during the 6MWT were significant predictors for predicting hospitalizations. Conclusion Early desaturation can be used as a screening tool for assessing the risk of hospitalization in COPD patients.
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Affiliation(s)
- Mohit Agarwal
- Department of Pulmonary Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Shweta Anand
- Department of Pulmonary Medicine, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Mahismita Patro
- Department of Pulmonary Medicine, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Dipti Gothi
- Department of Pulmonary Medicine, ESI-PGIMSR, Basaidarapur, New Delhi, India
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Roy MP. Indoor air pollution and chronic respiratory diseases. J Family Med Prim Care 2022; 11:6608. [PMID: 36618153 PMCID: PMC9810864 DOI: 10.4103/jfmpc.jfmpc_633_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/30/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Manas Pratim Roy
- Ministry of Health and Family Welfare, New Delhi, India,Address for correspondence: Dr. Manas Pratim Roy, Ministry of Health and Family Welfare, New Delhi, India. E-mail:
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Daniel RA, Aggarwal P, Kalaivani M, Gupta SK. Prevalence of chronic obstructive pulmonary disease in India: A systematic review and meta-analysis. Lung India 2021; 38:506-513. [PMID: 34747730 PMCID: PMC8614617 DOI: 10.4103/lungindia.lungindia_159_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Objective: The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide. There is a lack of national-level estimates on the magnitude of COPD in India. Hence, we estimated the prevalence of COPD among adults in India. Methods: We searched PubMed, Embase, Cochrane Library, Google Scholar, and Scopus and included community-based cross-sectional studies reporting data on the prevalence of COPD among adults based on spirometry. A random-effects model was used to estimate the pooled prevalence of COPD. Results: In the eight identified studies, (pooled sample of 8,569 individuals), the estimated prevalence was 7.4% (95% confidence interval: 5.0%–9.8%), I2 = 95.4% (P < 0.001). The prevalence was higher among males, in the urban area, and the northern region. Conclusion: Adequate training and resources should be provided to diagnose COPD at primary health care level for early management. A nationwide population-based survey is indicated to provide reliable estimates of the burden to inform evidence-based community-based interventions.
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Affiliation(s)
- Roy Arokiam Daniel
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Verma A, Gudi N, Yadav UN, Roy MP, Mahmood A, Nagaraja R, Nayak P. Prevalence of COPD among population above 30 years in India: A systematic review and meta-analysis. J Glob Health 2021; 11:04038. [PMID: 34484706 PMCID: PMC8397327 DOI: 10.7189/jogh.11.04038] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background By 2030, Sustainable Development Goal 3.4 aims to reduce the premature mortality caused by non-communicable diseases through prevention and treatment. Chronic obstructive pulmonary disease is the second leading cause of mortality and disability-adjusted life years in India. This review was conducted to estimate the prevalence of COPD using systematic review and meta-analysis technique. Method Search was conducted using six databases for studies on COPD among population above 30 years in India between years 2000 to 2020. Cross-sectional and cohort studies reporting prevalence of COPD and associated risk factors were included in the present review. Screening and data extraction was done by two authors independently. Studies were appraised for quality using the modified New Castle Ottawa scale and reporting quality was assessed using STROBE guidelines. Result Our search returned 8973 records, from which 23 records fulfilled the eligibility criteria. Overall, the prevalence of COPD among population aged 30 years and above in India was 7%. Risk factors like active and passive smoking, biomass fuel exposure, environmental tobacco smoke, occupational exposure to dust, indoor and outdoor pollution, and increasing age were reported to have a significant association with COPD among Indian population. Conclusion Our findings suggest the need for a multicentric national-level research study to understand COPD burden and its contributing risk factors. The findings also suggest the need for COPD sensitive health literacy program focused on early screening and primary prevention of risk factors for COPD, which may help early initiation of self-management practices, that are crucial for better quality of life.
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Affiliation(s)
- Ashwani Verma
- Evidence Synthesis Specialist, Campbell South Asia, New Delhi, India.,DIT University, Dehradun, Uttarakhand, India
| | - Nachiket Gudi
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, India
| | - Uday N Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.,Center for Research, Policy, and Implementation, Biratnagar, Nepal.,Department of Public Health, Torrens University, Sydney, Australia
| | - Manas Pratim Roy
- Deputy Assistant Director General, Directorate General of Health Services, Nirman Bhawan, New Delhi, India
| | - Amreen Mahmood
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Ravishankar Nagaraja
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Gudi N, Mahmood A, Roy MP, Ravishankar, Nayak P, Verma A. Burden of COPD among population above 30 years in India: protocol for a systematic review and proposed meta-analysis. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2021; 57:14-17. [PMID: 33542948 PMCID: PMC7850165 DOI: 10.29390/cjrt-2020-040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The Sustainable Development Goals and the National Health Policy of India aim to reduce premature mortality from noncommunicable diseases (NCD) by one-third in the next decade and by 25% by 2025, respectively. Among NCDs globally, chronic obstructive pulmonary disease (COPD) is a major contributor to death and disability. This underscores the need to understand the burden of COPD at the national level by synthesizing evidence and collating the state-wise COPD data to estimate the prevalence of COPD and to highlight the associated risk factors to inform policymakers. METHOD The systematic literature search will be carried out in PubMed, Cochrane, Scopus, Web of Science, CINAHL, and ProQuest databases with restrictions for studies published between 2000 and 2020 and available in English. Cross-sectional or cohort studies conducted in and among the Indian population aged 30 years and above will be included. Case reports, randomized trials, meta-analysis, commentaries, and qualitative studies will be excluded from the review. Quality assessment of the included studies will be performed using New Castle Ottawa scale and adherence to reporting standards will be checked using STROBE checklist for Observational Cohort and Cross-Sectional Studies. DISCUSSION Prevalence of COPD in the population aged 30 years and above, diagnosed through spirometry and nonspirometry, will be compared and reported and a meta-analysis will be performed to obtain pooled prevalence rates of COPD and the risk factors associated with COPD.
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Affiliation(s)
- Nachiket Gudi
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Amreen Mahmood
- Department of Physiotherapy. Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Manas Pratim Roy
- Deputy Assistant Director General (NCD), Directorate General of Health Services, Nirman Bhawan, New Delhi, India
| | - Ravishankar
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka
| | - Ashwani Verma
- Evidence Synthesis Specialist, Campbell South Asia, Global Development Network, 2nd Floor, West Wing, ISID Complex, Plot No4, Vasant Kunj Institutional Area, Vasant Kunj, New Delhi, Delhi 110070, India; PhD Research Scholar, DIT University, Dehradun, Uttarakhand, India
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Roy M. Chronic obstructive pulmonary disease mortality in India: Variations and associated factors. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_27_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Blanc PD, Annesi-Maesano I, Balmes JR, Cummings KJ, Fishwick D, Miedinger D, Murgia N, Naidoo RN, Reynolds CJ, Sigsgaard T, Torén K, Vinnikov D, Redlich CA. The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement. Am J Respir Crit Care Med 2020; 199:1312-1334. [PMID: 31149852 PMCID: PMC6543721 DOI: 10.1164/rccm.201904-0717st] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.
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Arjun P, Nair S, Jilisha G, Anand J, Babu V, Moosan H, Kumari AK. Assessing health-seeking behavior among Asthma and COPD patients in urban South India. J Family Med Prim Care 2019; 8:2714-2719. [PMID: 31548962 PMCID: PMC6753802 DOI: 10.4103/jfmpc.jfmpc_485_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 01/09/2023] Open
Abstract
CONTEXT Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) and asthma and the diagnosis told to them by doctors before they reach tertiary care is not well documented. AIMS This study aimed at describing the health-seeking behavior of asthma and COPD patients before they present to a tertiary care hospital in Trivandrum in South India. METHODS AND MATERIALS The hospital-based cross-sectional study was done at one government and one private tertiary care hospital in Trivandrum, Kerala, including diagnosed COPD and asthma patients. Data were collected using a pretested semistructured questionnaire paired with the results of clinical evaluation and spirometry. RESULTS Among the studied population, about half (53%) of the patients in this study sought initial treatment from government facilities and most patients continued the same pattern of government care or private providers till the final level. Most of them (91%) were likely to have a history of first care from modern medicine system. High proportion of patients (89%) did not have a diagnosis known after the initial consultations, among patients with asthma only 3.4% were given a correct diagnosis and only one person was given a correct diagnosis of COPD out of 129 patients with COPD as the final diagnosis. Out of 739 patients, only 135 patients had done pulmonary functtion test as investigation. CONCLUSIONS High proportions of patients do not know the diagnosis of their disease when they reached tertiary care. Patients tended to follow the same sector of health care (private/government) where they sought initial care.
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Affiliation(s)
| | - Sanjeev Nair
- Health Action by People and Department of Pulmonary Medicine, Medical College, Trivandrum, India
| | - G Jilisha
- Health Action by People, Trivandrum, India
| | | | - Veena Babu
- Health Action by People, Trivandrum, India
| | | | - Anitha K Kumari
- Department of Pulmonary Medicine, Medical College, Trivandrum, India
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Faizan MA, Thakur R. Measuring the impact of household energy consumption on respiratory diseases in India. Glob Health Res Policy 2019; 4:10. [PMID: 31020047 PMCID: PMC6472035 DOI: 10.1186/s41256-019-0101-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/01/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most households in developing countries like India are not able to afford to get the services of efficient energy for cooking and lighting. Therefore, they rely mostly on solid fuels (firewood, dung cakes, crop residue, coal/coke/lignite). Such fuels cause respiratory diseases like tuberculosis, asthma respiratory cancer. Hence, this study aims to estimate the association between different types of energy used and the prevalence of respiratory diseases in India where more than 50% of the population relies on solid fuels for cooking. METHODS The study is based on 117,752 respondents who were diagnosed with various chronic diseases such as diabetes, chronic heart diseases, leprosy, chronic renal diseases, tuberculosis, asthma etc. from District Level Household Survey (DLHS-4) which was conducted in 2012-13. Individuals who were diagnosed with a chronic illness after a proper medical examination have been considered as a dependent variable. Exposure to the type of cooking fuel is the main exposure variable, which recognises the dependence on energy. Logistic regression has been utilized to understand the association between the use of solid fuels for cooking and the prevalence of respiratory diseases. RESULTS The dependence on solid fuels is very high in rural areas (72.22%) as compared to urban areas (21.43%). Among different castes, the reliance on solid fuels for cooking is highest among Scheduled Castes (61.79%) and Scheduled Tribes (70.46%). Individuals living in households where crop residue and coal/lignite is used for cooking suffer from asthma/chronic respiratory failure in the higher proportion as compared to others. Results further revealed that the use of solid fuels for cooking has a strong association with respiratory diseases. Individuals living in households where solid fuels like firewood [OR: 1.27 (0.001); C.I.: 1.19-1.35], crop residue [OR: 1.33 (0.001); C.I.:1.19-1.48], and coal [OR: 1.60 (0.001); C.I.:1.32-1.93] are used as primary fuel for cooking are 17 to 60% more likely to suffer from respiratory diseases. CONCLUSION Use of solid fuels is associated with respiratory diseases like asthma, tuberculosis and cancer of the respiratory system. Assuming these associations are causal, therefore, about 17 to 60% of the respiratory diseases in India could be prevented by providing access to clean cooking fuel to the individuals.
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Affiliation(s)
- Mohammad Ahmad Faizan
- School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Kamand Campus, Himachal Pradesh 175075 India
| | - Ramna Thakur
- School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Kamand Campus, Himachal Pradesh 175075 India
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Sharma AK, Baliyan P, Kumar P. Air pollution and public health: the challenges for Delhi, India. REVIEWS ON ENVIRONMENTAL HEALTH 2018; 33:77-86. [PMID: 29267177 DOI: 10.1515/reveh-2017-0032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/11/2017] [Indexed: 06/07/2023]
Abstract
Mitigating the impact of pollution on human health worldwide is important to limit the morbidity and mortality arising from exposure to its effect. The level and type of pollutants vary in different urban and rural settings. Here, we explored the extent of air pollution and its impacts on human health in the megacity of Delhi (India) through a review of the published literature. The study aims at describing the extent of air pollution in Delhi, the magnitude of health problems due to air pollution and the risk relationship between air pollution and associated health effects. We found 234 published articles in the PubMed search. The search showed that the extent of air pollution in Delhi has been described by various researchers from about 1986 onwards. We synthesized the findings and discuss them at length with respect to reported values, their possible interpretations and any limitations of the methodology. The chemical composition of ambient air pollution is also discussed. Further, we discuss the magnitude of health problem with respect to chronic obstructive pulmonary diseases (COPD), bronchial asthma and other illnesses. The results of the literature search showed that data has been collected in last 28 years on ambient air quality in Delhi, though it lacks a scientific continuity, consistency of locations and variations in parameters chosen for reporting. As a result, it is difficult to construct a spatiotemporal picture of the air pollution status in Delhi over time. The number of sites from where data have been collected varied widely across studies and methods used for data collection is also non-uniform. Even the parameters studied are varied, as some studies focused on particulate matter ≤10 μm in aerodynamic diameter (PM10) and those ≤2.5 μm in aerodynamic diameter (PM2.5), and others on suspended particulate matter (SPM) and respirable suspended particulate matter (RSPM). Similarly, the locations of data collection have varied widely. Some of the sites were at busy traffic intersections, some on the terraces of offices and residential houses and others in university campuses or airports. As a result, the key question of the extent of pollution and its distribution across various parts of the city could be inferred. None of the studies or a combination of them could present a complete picture of the burden of diseases like COPD, bronchial asthma and other allergic conditions attributable to pollution in Delhi. Neither could it be established what fraction of the burden of the above diseases is attributable to ambient air pollution, given that other factors like tobacco smoke and indoor air pollution are also contributors to the causation of such diseases. In our discussion, we highlight the knowledge gaps and in the conclusion, we suggested what research can be undertaken to fill the these research gaps.
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Affiliation(s)
- Arun Kumar Sharma
- Department of Community Medicine, University College of Medical Sciences, University of Delhi, Dilshad Garden, Delhi 110 095, India
| | - Palak Baliyan
- Department of Environmental Studies, University of Delhi, Delhi, India
| | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
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Pandey KC, De S, Mishra PK. Role of Proteases in Chronic Obstructive Pulmonary Disease. Front Pharmacol 2017; 8:512. [PMID: 28848433 PMCID: PMC5550664 DOI: 10.3389/fphar.2017.00512] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/21/2017] [Indexed: 02/02/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is generally associated with progressive destruction of airways and lung parenchyma. Various factors play an important role in the development and progression of COPD, like imbalance of proteases, environmental and genetic factors and oxidative stress. This review is specifically focused on the role of proteases and their imbalance in COPD. There are three classes (serine, mettalo, and cysteine) of proteases involved in COPD. In serine proteases, neutrophil elastase, cathepsin G, and proteinase-3 are involved in destruction of alveolar tissue. Matrix-mettaloproteinase-9, 12, 13, plays an influential role in severity of COPD. Among cysteine proteases, caspase-3, caspases-8 and caspase-9 play an important role in controlling apoptosis. These proteases activities can be regulated by inhibitors like α-1-antitrypsin, neutrophil elastase inhibitor, and leukocyte protease inhibitor. Studies suggest that neutrophil elastase may be a therapeutic target for COPD, and specific inhibitor against this enzyme has potential role to control the disease. Current study suggests that Dipeptidyl Peptidase IV is a potential marker for COPD. Since the expression of proteases and its inhibitors play an important role in COPD pathogenesis, therefore, it is worth investigating the role of proteases and their regulation. Understanding the biochemical basis of COPD pathogenesis using advanced tools in protease biochemistry and aiming toward translational research from bench-to-bedside will have great impact to deal with this health problem.
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Affiliation(s)
- Kailash C Pandey
- Department of Biochemistry, National Institute for Research in Environmental Health (ICMR)Bhopal, India
| | - Sajal De
- Department of Pulmonary Medicine, National Institute for Research in Environmental Health (ICMR)Bhopal, India
| | - Pradyumna K Mishra
- Department of Molecular Biology, National Institute for Research in Environmental Health (ICMR)Bhopal, India
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Sarkar A, Javia A, Pithadia P, Parmar D. Why do Patients undergoing Chronic Obstructive Pulmonary Disease Treatment Turn Defaulters? A Follow up Study in a Tertiary Care Hospital in Jamnagar, India. J Clin Diagn Res 2017; 11:LC04-LC06. [PMID: 28892934 PMCID: PMC5583815 DOI: 10.7860/jcdr/2017/24883.10251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 06/22/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD), a progressive respiratory illness requiring long-term treatment, is a significant cause of morbidity, mortality and economic burden on the family as well as the country. In the tertiary health care facility where the study was carried out, it was observed that many COPD patients did not come for regular follow up. In these patients, treatment interruption may lead to increased morbidity and mortality. AIM This study aimed to find out the reasons for defaulting follow up and treatment in COPD patients. MATERIALS AND METHODS All patients of COPD, attending TB Chest outpatient department during the study period (September 2012 to February 2013), were classified into Group A, B, C, and D according to latest Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Data was collected on patient's sociodemographic profile, severity of disease and reasons for defaulting follow up and treatment using pre-tested semi-structured questionnaires, patient history and clinical examination. Data obtained were entered in Microsoft Office Excel 2007 and analysed using Chi-square test. RESULTS The mean age of the 200 patients recruited was 59.3 years. A total of 87% patients were male. Patients belonging to Group A, B, C and D were 11%, 25.5%, 41.5% and 22% respectively. Overall, 32% patients were defaulters. Three main reasons for default were non-affordability for treatment expenses (39.07%), resolution of symptoms (26.56%), and too ill to come (18.75%). The associations between default rate and demographic variables like age and gender were found statistically significant. CONCLUSION Default rate among COPD patients is significantly associated with GOLD Group A and D, patient's income and patient literacy level. Main reasons for default were non-affordability of treatment expenses, too ill to come and resolution of symptoms.
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Affiliation(s)
- Amrita Sarkar
- Senior Resident, Department of Community Medicine, NEIGRIHMS, Shillong, Meghalaya, India
| | - Abhay Javia
- Consultant Pulmonologist, Department of Pulmonology, Sterling Hospital, Rajkot, Gujarat, India
| | - Pradeep Pithadia
- Assistant Professor, Department of Community Medicine, Shri MP Shah Govt. Medical College, Jamnagar, Gujarat, India
| | - Dipesh Parmar
- Professor and Head, Department of Community Medicine, Shri MP Shah Govt. Medical College, Jamnagar, Gujarat, India
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