Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India.
Central Research and Publication Unit, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India.
PLoS One. 2024 Sep 5;19(9):e0308210. doi: 10.1371/journal.pone.0308210. eCollection 2024.
COPD is the second leading cause of death in India. The guidelines for early detection of COPD were released by the Government of India in 2019. However, due to the COVID-19 pandemic, its implementation could not be optimal. Diagnosis of COPD is based on the presence of respiratory symptoms, the presence of exposure to risk factors, and the presence of poorly reversible airflow obstruction as assessed using a spirometer. Spirometers are currently available only at a few district hospitals. The existing guidelines expect the patient to visit the Rural hospital/ Community Health Centre, which does not have a spirometer or a pulmonary medicine specialist. Also, it is not feasible or accessible for patients to visit the district hospital to get diagnosed. The current study will be implemented to determine the prevalence, annual incidence of COPD and asthma, quality of life, and nutritional status of COPD and asthma patients. The novelty of this implementation research, which will be conducted in collaboration with Zilla Parishad (i.e., Government), Pune district, is the empowerment of an Accredited Social Health Activist (ASHA), a peripheral health worker to screen all individuals using a peak flow meter and confirmation of the diagnosis at health and wellness center (HWC). An accredited Social Health Activist (ASHA) will take relevant history to suspect COPD and asthma in 30+-year-old adults, and she will refer the suspected cases to the Community Health Officer (CHO) at the Health and Wellness Center. The CHO/ Medical officer of PHC will initiate the appropriate treatment after confirming the diagnosis using a portable spirometer. The difficult-to-diagnose patients with comorbidity and acute exacerbations will be referred to the nearest higher center, i.e., Primary Health Centre (PHC) or Community Health Centre (CHC), where a primary care physician is available. The ASHA workers will provide two follow-ups to these patients in a year, depending on the severity, to ensure compliance with the treatment. Thus, early diagnosis and appropriate treatment of COPD and asthma at the community level may help to reduce the episodes of acute exacerbations.
COPD 是印度的第二大死亡原因。印度政府于 2019 年发布了 COPD 早期检测指南。然而，由于 COVID-19 大流行，其实施效果并不理想。COPD 的诊断基于呼吸症状的存在、接触危险因素的存在以及使用肺活量计评估的气流受限的不可逆转性。肺活量计目前仅在少数地区医院提供。现有的指南要求患者前往农村医院/社区卫生中心就诊，而这些医院没有肺活量计或肺病专家。此外，患者去地区医院进行诊断既不可行也不方便。目前的研究将确定 COPD 和哮喘的患病率、年发病率、生活质量以及 COPD 和哮喘患者的营养状况。这项实施研究的新颖之处在于，它将与 Zilla Parishad（即政府）合作进行，浦那区将授权认证的社会卫生活动家（ASHA），即基层卫生工作者，使用峰值流量计对所有个体进行筛查，并在健康和健康中心（HWC）确认诊断。认证的社会卫生活动家（ASHA）将通过询问相关病史来怀疑 30 岁以上成年人是否患有 COPD 和哮喘，她将把疑似病例转介给健康和健康中心的社区卫生官员（CHO）。CHO/PHC 医务人员将在使用便携式肺活量计确认诊断后启动适当的治疗。患有合并症和急性加重的难以诊断的患者将被转介到最近的更高一级中心，即初级保健中心（PHC）或社区卫生中心（CHC），那里有初级保健医生。根据病情的严重程度，ASHA 工作人员将在一年内对这些患者进行两次随访，以确保治疗的依从性。因此，在社区层面早期诊断和适当治疗 COPD 和哮喘可能有助于减少急性加重发作的次数。
