Simple screening for common lung disease could relieve millions globally


Date:
January 11, 2022
Source:
University College London
Summary:
The global burden of Chronic Obstructive Pulmonary Disease
(COPD), a group of common lung conditions that affects more than
300 million people, could be significantly reduced with a simple
health assessment, concludes a large-scale international study.



FULL STORY ==========================================================================
The global burden of Chronic Obstructive Pulmonary Disease (COPD),
a group of common lung conditions that affects more than 300* million
people, could be significantly reduced with a simple health assessment, concludes a large-scale international study led by UCL researchers.


==========================================================================
COPD includes serious lung conditions, such as emphysema and chronic bronchitis, and is the world's third leading cause of morbidity with
more than three million deaths a year. The greatest burden on COPD is in
low- and middle- income countries (LMIC), which account for around 90%
of COPD related deaths.

Globally, COPD has also been a major risk factor associated with Covid-19 outcomes.

In high-income countries, COPD is typically caused by smoking tobacco
and is diagnosed using a spirometer, where an individual blows into a
device that measures how much air a person can breathe out in one forced breath. Diagnosis is straightforward and symptoms can be effectively
treated.

However, in LMICs the primary cause of COPD is more varied and includes household air pollution in the form of biomass smoke for cooking and
heating; other causes include impaired lung growth, chronic asthma
and post-tuberculosis lung damage. And diagnosis in LMICs is hindered
as spirometry -- the 'gold- standard' for diagnosing COPD -- is often
not available. There is a shortage of clinicians needed to perform and interpret the tests, therefore rolling these out is costly. As a result,
COPD is commonly undiagnosed in LMICs.

In the new study, published in JAMA, researchers found that people
at high-risk of COPD could be identified in 7-8 minutes using either
a questionnaire on its own or a questionnaire combined with a Peak
Expiratory Flow (PEF) assessment, a low-cost device that tests how fast
a person can exhale.

Explaining the study, Principal Investigator Professor John Hurst (UCL
Division of Medicine) said: "Chronic Obstructive Pulmonary Disease is
one of the world's major public health issues, causing both individual
and economic harm: there is a clear and pressing need to find better
ways to identify people early, in all manner of settings.



========================================================================== "Screening tools for COPD have been shown to have reasonable diagnostic accuracy in high-income countries, but due to better population health and treatment in these settings, this has tended to identify milder disease,
not requiring much intervention.

"Up until now the performance of these screening tools has not been
adequately studied in LMICs; we aimed to test both the diagnostic
accuracy and feasibility of simple screening tools." For the study
researchers assessed three COPD screening tools on populations in three distinct settings: semiurban Bhaktapur, Nepal, urban Lima, Peru and
rural Nakaseke, Uganda.

Two of the screening tools (COLA 6 and CAPTURE) comprised a questionnaire
and Peak Expiratory Flow (PEF). The other screening tool, LFQ, solely
involved a questionnaire. All three screening tools were tested in all
three settings.

To establish diagnostic accuracy of the tools, all participants were
also given a spirometry test.



==========================================================================
In total 10,709 male and female adults aged 40 years or older from the
three communities took part. Participants were recruited irrespective
of symptoms and/or a prior diagnosis of COPD, but needed to be able to
perform spirometry.

Study findings
* Prevalence of COPD varied by site, from 3% in Lima (Peru) to 7% in
Nakaseke (Uganda) and 18% in Bhaktapur (Nepal).

* 49% of COPD cases were clinically significant as defined by
symptoms and
or exacerbation burden, and 16% had severe or very-severe disease
measured on spirometry. 95% of cases were previously undiagnosed.

* The screening instruments performed similarly within each population
setting and were feasible to deliver using trained research staff,
taking an average of 7-8 minutes.

Commenting Professor Hurst said:"Our findings support the accuracy and feasibility of using simple screening tools to identify people affected
by COPD living in diverse low- and middle-income settings.

"It is alarming that a high percentage of screen-identified COPD cases
were clinically important, had severe or very severe changes in lung
function, and that most were unaware of their diagnosis despite the high prevalence of symptoms and lower quality of life.

"In addition, only a minority of people had a history of smoking,
further highlighting the poor conditions, exacerbated by biomass
smoke, that people in low- and middle-income countries are living."
Professor Hurst added: "Action is needed: the global health community has neglected the burden of chronic respiratory diseases for too long. It
is now time for people with chronic respiratory diseases such as COPD
to be promptly identified, informed about their condition and treated -- wherever they live in the world." Sia^n Williams and Noel Baxter, Joint
CEO of the International Primary Care Respiratory Group (IPCRG) added:
"This paper demonstrates that COPD can be feasibly identified in primary
care in low-income settings, which is one of the top 10 questions for
primary care in our respiratory research prioritisation: 'How can we
best educate healthcare professionals to improve early recognition and diagnosis of COPD?' "It also reinforces the findings by colleagues
in other recent studies in middle income countries such as China and
Brazil. This is important if we want communities at risk and primary
care teams to know about COPD, to recognise it as a disease with defined characteristics, and to understand it is a disease with a sizeable impact
on communities' health and wellbeing that can be mitigated through a
range of non-pharmacological and pharmacological primary, secondary and tertiary prevention interventions." Researchers say further studies will
be required to assess if COPD screening can be implemented in routine
LMIC healthcare settings; if screening for COPD is of benefit to those
testing positive, and it is cost-effective, for a given population,
to implement COPD screening in LMIC settings.

The Global Excellence in COPD Outcomes 1 Study was led by researchers
at UCL with collaborators at University of Miami (US), Johns Hopkins
University (US), Makerere University (Uganda), Universidad Peruana
Cayetano Heredia (Peru) and Kathmandu Medical College (Nepal).

========================================================================== Story Source: Materials provided by University_College_London. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Trishul Siddharthan, Suzanne L. Pollard, Shumonta A. Quaderi,
Natalie A.

Rykiel, Adaeze C. Wosu, Patricia Alupo, Julie A. Barber, Maria
Kathia Ca'rdenas, Ram K. Chandyo, Oscar Flores-Flores, Bruce
Kirenga, J. Jaime Miranda, Sakshi Mohan, Federico Ricciardi,
Arun K. Sharma, Santa Kumar Das, Laxman Shrestha, Marta O. Soares,
William Checkley, John R. Hurst, Susan Michie, Zachos Anastasiou,
Shakir Hossen, Nicole Robertson, Robert A Wise, Karbir Nath
Yogi, Denis Mawanda, Faith Nassali, Robert Kalyesubula, Elisa
Romani-Huacani, Adithya Cattamanchi. Discriminative Accuracy of
Chronic Obstructive Pulmonary Disease Screening Instruments in
3 Low- and Middle-Income Country Settings. JAMA, 2022; 327 (2):
151 DOI: 10.1001/jama.2021.23065 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/01/220111111942.htm

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