Professor Pulmonary Critical Care Sleep Medicine, B.V. Medical College, Pune 411043, India.
J Thorac Dis. 2012 Jun 1;4(3):298-309. doi: 10.3978/j.issn.2072-1439.2012.03.15.
The purpose of this article is to provide an overview of the epidemiology of COPD in India which is one of the most affected countries in the world and contributes significantly to the mortality and morbidity of this disease; to provide insights into the etiological determinants of COPD in India; comment on treatment aspects including drug treatment, adherence to guidelines, treatment of exacerbations and to try to comment on whether it differs significantly from rest of the world. The article reviews published literature on COPD in India; provides insight into comparative methodologies involved; comments on gaps in knowledge and suggests areas of further research such as Prescription Audit. India contributes very significantly to mortality from COPD 102.3/100,000 and 6,740,000 DALYs out of world total of 27,756,000 DALYs; thus significantly affecting health related Quality of Life in the country. COPD is surpassing Malaria, TB even today and the gap would get wider with time in near future. The lack of robust real time nation-wide data does plague India as well, however multiple studies from 1994 to 2010 show increasing trends of COPD morbidity and mortality. Since most inhalational drugs are available in the country there is no reason why mortality should not be comparable to rest of the world but there is poor adherence to treatment guidelines, both national and international. Urban centers in India are comparable to their global counterparts in terms of service quality and facilities and this is also work in progress. However, the rural hinterland is poorly serviced; national GDP spending on health is remarkably low. Some innovation is emerging and that could be the harbinger of a new future if properly nurtured. The article is an overview of COPD in India with emphasis on understanding the multi-dimensional nature of the problem and an attempt of providing insight into possible de-bottlenecking to reduce the pain and suffering of millions of COPD patients in India in future.
本文旨在概述印度 COPD 的流行病学情况，印度是世界上受影响最严重的国家之一，对 COPD 的死亡率和发病率有重大影响；提供印度 COPD 的病因决定因素的深入了解；评论包括药物治疗、遵循指南、治疗恶化等方面的治疗方面，并尝试评论其是否与世界其他地区有显著差异。本文综述了发表在印度 COPD 方面的文献；提供了对比较方法学的深入了解；评论了知识差距，并提出了进一步研究的领域，如处方审核。印度在 COPD 死亡率方面的贡献非常大，占全球 2775.6 万 DALY 总数的 27.756 万 DALY 中的 102.3/100000，6740 万 DALY；因此，对该国的健康相关生活质量产生了重大影响。COPD 甚至在今天已经超过疟疾和结核病，而且随着时间的推移，差距将进一步扩大。缺乏强大的实时全国性数据也困扰着印度，但从 1994 年到 2010 年的多项研究表明，COPD 的发病率和死亡率呈上升趋势。由于该国大多数吸入性药物都有供应，因此没有理由认为其死亡率不应与世界其他地区相媲美，但在国家和国际上，对治疗指南的遵守情况都很差。印度的城市中心在服务质量和设施方面与全球同类城市相当，这也是正在进行的工作。然而，农村腹地的服务水平很差；国家卫生支出占 GDP 的比例非常低。一些创新正在出现，如果得到妥善培育，这可能是未来的一个新起点。本文是对印度 COPD 的概述，重点是了解问题的多维度性质，并试图深入了解可能的解决方案，以减轻未来印度数百万 COPD 患者的痛苦。
