Pilot Study of Chronic Obstructive Pulmonary Disease in an Industrial Town in India

Global Chronic obstructive pulmonary disease burden attributable to air pollution from 1990 to 2019

BACKGROUND

The disease burden attributable to chronic obstructive pulmonary disease (COPD) is significant worldwide. Some studies have linked exposure to air pollution to COPD, but there has been little research on this.

METHODS

We aimed to assess the COPD-related disease burden attributable to air pollution from multiple epidemiological perspectives. This study conducted a three-stage analysis. Firstly, we reported on the burden of disease worldwide in 2019 by different subgroups including sex, age, region, and country. Secondly, we studied the trends in disease burden from 1990 to 2019. Finally, we explored the association of some national indicators with disease burden to look for risk factors.

RESULTS

In 2019, the death number of COPD associated with air pollution accounted for 2.32% of the total global death, and the number of DALY accounted for 1.12% of the global DALY. From 1990 to 2019, the death number of COPD associated with air pollution increased peaked at 1.41 million in 1993, fluctuated, and then declined. We found the same temporal pattern of DALY. The corresponding age-standardized rates had been falling. At the same time, the burden of COPD associated with air pollution was also affected by some national indicators.

CONCLUSIONS

This study indicated that air pollution-related COPD contributed to a significant global disease burden. We called for health policymakers to take action and interventions targeting vulnerable countries and susceptible populations.

Spatial Epidemiology of COPD in Delhi, India

Introduction Chronic obstructive pulmonary disease (COPD) and bronchial asthma are the most common chronic respiratory illnesses. COPD is one of the three most common causes of death worldwide. The main burden of mortality from COPD is seen in Latin America, sub-Saharan Africa, India, China, and South-East Asia. Absence of true prevalence values and mortality burden hinder planning and operationalization of public health interventions for prevention, control, and treatment of the disease. Further, the aggregated value of prevalence estimates calculated for a whole city or a larger geographical area does not provide the location of patients and presence of locally prevalent risk factors. The objective of this study was to understand the spatial distribution of COPD in a large, highly polluted city of a developing country.

Materials and Methods A cross-sectional community-based study was conducted in the National Capital Territory of Delhi (NCTD). All surveyed households were geocoded. GOLD screening criteria and pulmonary function tests using portable digital spirometer were used for diagnosis of COPD.

Results Results are presented as a series of maps depicting spatial epidemiology. Overall prevalence rate was 9.8/1,000 population. Highest prevalence was seen in industrial area. Most of the spatial hotspots were seen in industrial and slum areas. Similarly, Kernel density was also highest in industrial area.

Conclusion In the city of NCTD, we found the COPD being distributed in all types of habitations but spatial distribution helped us understand clustering of cases and compare prevalence rates in subunits of residential clusters within a metropolitan city.

Prevalence of COPD among population above 30 years in India: A systematic review and meta-analysis

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.