Title: Prevalence of different categories of COPD in a tertiary care teaching hospital in Kerala
Authors: Dr Balachandran, J, Dr Mathew Ninan
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.11
Abstract
Background: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation. It should be considered in any patient who has dyspnoea, chronic cough or sputum production and/or a history of exposure to risk factors for the disease.
Assessment by ABCD classification in GOLD 2011 is useful in the management of the disease. This study aims to find out the number and percentage of patients in each group of COPD among patients who visited the pulmonary medicine outpatient department of a tertiary care center in South Kerala during a 1 year period.
Methods: 112 COPD patients who attended the outpatient department were grouped into A,B,C and D according to GOLD classification 2011. The percentage in each group was also calculated.
Results: After applying the 'ABCD' classification to the 112 COPD patients, 14 patients were in A group, 26 patients were in B group, 40 patients were in C group and 32 patients were in D group.
Conclusion: The choice of medications in COPD differs for each group. There is relatively low prevalence in group A patients. 35.7% of COPD patients in this study belonged to A or B, in whom inhaled corticosteroids are indicated.
References
1. Global Strategy for Diagnosis, Management and Prevention of COPD - 2016, available at goldcopd.org
2. Tashkin DP, Altose MD, Bleecker ER, et al. The lung health study: airway responsiveness to inhaled methacholine in smokers with mild to moderate airflow limitation. The Lung Health Study Research Group. Am Rev Respir Dis 1992; 145(2 Pt 1): 301-10.
3. Jindal SK, Aggarwal AN, Gupta D A review of population studies from India to estimate national burden of chronic obstructive pulmonary disease and its association with smoking. Indian J Chest Dis Allied Sci. 2001 Jul-Sep; 43(3):139-47
4. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 2007; 370(9589): 741-50.
5. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 1994;272:1497-505.
6. Pauwels RA, Lofdahl CG, Laitinen LA, et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med 1999;340:1948-53.
7. Vestbo J, Sorensen T, Lange P, Brix A, Torre P, Viskum K. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 1999;353:1819-23.
8. Spencer S, Calverley PM, Burge PS, Jones PW. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J 2004;23:698-702.
9. Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007;356:775-89.
10. Calverley P, Pauwels R, Vestbo J, et al. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 2003;361:449-56.
11. Jones PW, Willits LR, Burge PS, Calverley PM. Disease severity and the effect of fluticasone propionate on chronic obstructive pulmonary disease exacerbations. Eur Respir J 2003;21:68-73.
12. Mahler DA, Wire P, Horstman D, et al. Effectiveness of fluticasone propionate and salmeterol combination delivered via the Diskus device in the treatment of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002;166(8):1084-91.
13. Szafranski W, Cukier A, Ramirez A, et al. Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J 2003;21:74-81.
14. Suissa S, et al. Inhaled corticosteroids in COPD and the risk of serious pneumonia Thorax 2013;68:1029–1036. doi:10.1136/thoraxjnl-2012-202872
15. Loke YK, Cavallazzi R, Singh S. Risk of fractures with inhaled corticosteroids in COPD: systematic review and meta-analysis of randomized controlled trials and observational studies. Thorax 2011 Aug;66(8):699-708.
16. BR Celli, W MacNee, A Agusti et al. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS postion paper. European Respiratory Journal 2004 23: 932-946; doi: 10.1183/09031936.04.00014304