Published in News
The global burden of 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 GACD study led by researchers from University College London (UCL).
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.
The Global Alliance for Chronic Diseases (GACD) brings together major international research funding agencies specifically to address the growing burden of NCDs in LMICs and vulnerable populations in high-income countries. In 2015, GACD launched its third call for research proposals focusing on chronic, non-communicable lung diseases including COPD. Projects funded included ‘The Global Excellence in COPD Outcomes 1 Study’ led by Professor John Hurst at University College London.
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.”
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).
Grant funding was received from the Medical Research Council as part of a joint Global Alliance for Chronic Diseases call.
Adapted from a press release provided by University College London.