COPD Prevalance Study

Title: Study of prevalence of chronic obstructive pulmonary disease (COPD) and phenotypic characterization of smoking and non-smoking COPD in a rural population in the region of Pune district, India

Duration: 2 years

Collaborators:

     Imperial College, London, UK
     Chest Research Foundation, Pune, India
     Vadu Rural Health Program, KEM Hospital Research Centre Pune, India

Sponsor: Imperial College, London

Investigator:

            Prof. Peter Barnes
            Dr. Sundeep Salvi
            Dr. Sanjay Juvekar

Rationale:

Chronic Obstructive Pulmonary disease is one of the leading causes of death worldwide. In developing countries, exposure to biomass combustion is likely to be the most common cause of COPD. It is estimated that 50% households worldwide use biomass and coal as their main source of energy for cooking, heating and other household needs. In India, as per 2001 census, nearly 75% of the households use biomass fuel for cooking and heating purpose. Biomass fuels have higher emission factors for particulate matter and other pollutants, especially during incomplete combustion at lower temperatures, which generates indoor airborne particles at much higher levels than those for cleaner fuels or outdoors, as well as above levels in most polluted cities (levels which are over 10-times the safety limits set by the World Health Organization). Studies performed in various regions of the developing world, have shown a link between biomass fuel cooking and development of COPD in women.

Aims and objectives:

Phase-IA
Primary Objectives

  • To study the prevalence of COPD and its risk factors (smoking and non-smoking causes) in a rural setting in India 
  • To estimate the burden of COPD in terms of its impact on quality of life, activity limitation, respiratory symptoms, and use of health care services.

Secondary Objectives:

  • To compare the impact of COPD prevalence of using various definitions of COPD, including those proposed by the American Thoracic Society, the European Respiratory Society, and GOLD.
  • Describe the distribution of COPD according to age, sex, smoking history and exposure to biomass fuel.
  • Describe the main clinical symptoms reported by subjects diagnosed with COPD.


Phase 1B

  • To measure the levels of ambient (outdoor) gaseous and particulate matter air pollutants and indoor gaseous and particulate matter air pollutants in the rural setting, and study its association with COPD and respiratory health effects.
  • To study the elemental composition of particulate matter from indoor air of homes using different types of cooking fuel (liquefied petroleum gas, kerosene, wood, coal, dung, etc.) and study its association with COPD and respiratory health effects.

Phase II
To compare the different phenotypes of COPD using physiological parameters, radiological parameters and cellular and inflammatory mediator parameters in the airway and blood compartments.


Methodology:

  1. Phase IA :
    The study participants were randomly selected from the 22 villages and the BOLD questionnaire was administered and Spirometry was performed.
  2. Phase IB:
    The Air Samplers were placed in households of the study participants within the 22 villages. The ambient air pollution monitors were placed in four villages of Vadu HDSS namely, Sanaswadi, Dongargaon, Fulgaon and Vadu.
  3. Phase II:
    Enrolled 64 subjects showing symptoms of chronic airflow obstruction and fulfilled the lung function criteria as set out by the NLHI/WHO Global Initiative for Chronic Obstructive Lung Disease. The subjects were classified into different phenotypes based on the exposure to risk factors, particularly   cigarette smoking, tobacco smoking and biomass fuel usage. Following tests have been performed on the subjects: ECG to rule out cardiovascular disorder, Blood and Urine collection, Impulse Osscilomety to measure airway resistance, proximal airway resistance, small airway resistance, airway reactance and airway admittance, Bodyplethesmography to assess Total Lung Capacity, Intrathoracic Gas Volume, Residual   Volume, Specific Airway Resistance, Specific Airway Conductance, Inspiartory Capacity and Lung Compliance, DLCO to measure diffusing capacity of the lungs, Spirometry to assess lung volumes, Sputum induction and underwent HRCT of thorax.

Study population / sample size: Phase 1A & B- 3582
          Phase II- 64

Outcome - some results / links to publication if applicable: Nil

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