Sinha B, Singla R, Chowdhury R
Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India.
Department of TB and Respiratory Diseases, National Institute of TB and Respiratory Diseases, New Delhi, India.
J Postgrad Med. 2017 Jan-Mar;63(1):29-35. doi: 10.4103/0022-3859.194200.
Different definitions used for chronic obstructive pulmonary disease (COPD) preclude getting reliable prevalence estimates. Study objective was to find the prevalence of COPD as per standard Global Initiative for Chronic Obstructive Lung Disease definition, risk factors associated, and treatment seeking in adults >30 years.
Community-based cross-sectional study was conducted in Delhi, among 1200 adults, selected by systematic random sampling. Pretested questionnaire was used to interview all subjects and screen for symptoms of COPD. Postbronchodilator spirometry was done to confirm COPD.
Adjusted odds ratio (aOR) was calculated by multivariable analysis to examine the association of risk factors with COPD. Receiver operating characteristic (ROC) curve was developed to assess predictability.
The prevalence of COPD was 10.1% (95% confidence interval [CI] 8.5, 11.9%). Tobacco smoking was the strongest risk factor associated (aOR 9.48; 95% CI 4.22, 14.13) followed by environmental tobacco smoke (ETS), occupational exposure, age, and biomass fuel. Each pack-year of smoking increased 15% risk of COPD. Ex-smokers had 63% lesser risk compared to current smokers. Clinical allergy seems to preclude COPD (aOR 0.06; 95% CI 0.02, 0.37). ROC analysis showed 94.38% of the COPD variability can be assessed by this model (sensitivity 57.4%; positive predictive value 93.3%). Only 48% patients were on treatment. Treatment continuation was impeded by its cost.
COPD prevalence in the region of Delhi, India, is high, and our case-finding population study identified a high rate of patients who were not on any treatment. Our study adds to creating awareness on the importance of smoking cessation, early diagnosis of COPD, and the need for regular treatment.
慢性阻塞性肺疾病（COPD）使用的不同定义妨碍了获得可靠的患病率估计值。研究目的是根据慢性阻塞性肺疾病全球倡议标准定义，找出30岁以上成年人中COPD的患病率、相关危险因素以及寻求治疗的情况。
在德里进行了一项基于社区的横断面研究，通过系统随机抽样从1200名成年人中选取研究对象。使用经过预测试的问卷对所有受试者进行访谈并筛查COPD症状。进行支气管扩张剂后肺功能测定以确诊COPD。
通过多变量分析计算调整后的优势比（aOR），以检验危险因素与COPD的关联。绘制受试者工作特征（ROC）曲线以评估预测能力。
COPD的患病率为10.1%（95%置信区间[CI] 8.5，11.9%）。吸烟是最主要的相关危险因素（aOR 9.48；95% CI 4.22，14.13），其次是环境烟草烟雾（ETS）、职业暴露、年龄和生物质燃料。每吸烟1包年，患COPD的风险增加15%。与当前吸烟者相比，戒烟者的风险降低63%。临床过敏似乎可预防COPD（aOR 0.06；95% CI 0.02，0.37）。ROC分析显示，该模型可评估94.38%的COPD变异性（敏感性57.4%；阳性预测值93.3%）。只有48%的患者正在接受治疗。治疗的持续受到费用的阻碍。
印度德里地区的COPD患病率很高，我们的病例发现人群研究发现未接受任何治疗的患者比例很高。我们的研究有助于提高对戒烟、COPD早期诊断以及定期治疗必要性的认识。
