New study identifies ways to detect COPD in low- and middle-income countries

How to better detect chronic obstructive pulmonary disease (COPD) in low- and middle-income countries is a question that has long plagued the global medical community.

A new study led by Trishul Siddharthan, M.D., assistant professor of Pulmonary and Critical Care Medicine at University of Miami Miller School of Medicine, and conducted in Nepal, Peru and Uganda is the first step in identifying solutions.

The study, published online January 11, in the Journal of the American Medical Association (JAMA), demonstrates that lay workers in low- and middle-income countries can feasibly administer simple COPD screening instruments to help diagnose the often debilitating lung disease.

Chronic obstructive pulmonary disease is a disorder of the small airways in the lungs, is the third leading cause of death globally. It is well recognized in high income settings, but more than 90% of morbidity and mortality related to COPD occur in low- and middle-income settings.”

Dr. Trishul Siddharthan, M.D., assistant professor of Pulmonary and Critical Care Medicine at University of Miami Miller School of Medicine

This includes countries like Uganda, Nepal and Peru that do not have adequate access to diagnostic equipment and lack skilled healthcare workers needed to treat the disease, as well as treatment modalities such as inhalers, Dr. Siddharthan said.

“It is important from a public health perspective to identify new ways to diagnose and treat COPD in resource limited settings.”

Dr. Siddharthan worked with investigators from Johns Hopkins University, University College London, Makerere University in Uganda, Institute of Medicine Tribhuvan University in Nepal, Universidad Peruana Cayetano Heredia in Peru, and others.

The authors conducted a population-based study of more than 10,700 adults in the three countries who were recruited from regions with different degrees of urbanization, COPD risk and economic development. Field workers were trained to conduct assessments with screening instruments and administer bronchodilator spirometry for comparison.

“We found that screening instruments are easy to deliver and have reasonable sensitivity in ruling out the disease. The screenings can be feasibly delivered in low- and middle-income settings by lay community workers,” Dr. Siddharthan said.

The authors reported COPD prevalence varied by site, with more than 18% of those studied in Nepal having COPD , compared to 2.7% in Peru and 7.4% in Uganda.

More than one-third of those studied were not smokers. In low- and middle-income settings another important risk factor for COPD is exposure to biomass fuel, or daily cooking over wood and charcoal.

“Twenty percent of the global population with symptomatic COPD has never touched a cigarette in their lives,” Dr. Siddharthan said.

The next step in this research is to look at health and cost implications to health systems from identifying cases and triaging them to appropriate health facilities for treatment.

This work reflects the Miller School’s global mission, according to Dr. Siddharthan.

“The University of Miami Miller School of Medicine is a global force in Central and South America, where we see patients who present with similar disease types, which makes this work important to our clinical mission,” he said.

Dr. Siddharthan and colleagues hope to create awareness among consumers and health care providers about COPD symptoms, early diagnosis and treatment.

There is a lack of awareness about what COPD is, as well as how to detect and treat it early, even in high-income countries, according to Dr. Siddharthan.

“Many of the patients we see in the clinic come with end-stage disease. They have bounced around with primary care physicians and outpatient providers complaining about cough and shortness of breath and by the time they see me they have advanced disease,” he said. “We hope to help change that globally.”

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