Is early diagnosis of chronic obstructive airway disease using spirometry in asymptomatic smokers an effect tool for smoking cessation in the Indian population? A study from Central India

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in smokers worldwide. A chronic smoker remains asymptomatic for a long time with underlying deteriorating lung function which manifests in later life as COPD. Although there is no screening for the disease, a spirometric evaluation of chronic smokers to detect the early asymptomatic disease and counseling for smoking cessation may slow down further progression of disease. India has a large population of smokers including a sizable number in the defense forces who need to be fighting fit at all times. The data with this regard from Indian scenario are scanty. The present study was carried out with an aim to detect early COPD in chronic smokers and further counsel these individuals to abstain from smoking. This cross-sectional study was done in Air Force Hospital Gorakhpur, India, from August 2014, and 2974 individuals were evaluated and followed. Methods: The individuals were standardized on the basis of personal history including age, number of cigarettes smoking per day, and duration of smoking. The diagnosis of COPD in such individuals was based on the spirometric evaluation which included forced expiratory volume in one sec (FEV1), forced vital capacity (FVC), and FEV1/FVC which were measured at rest and postbronchodilators. The individuals were diagnosed as COPD as per GOLD criteria (Gr C) and nonCOPD (Gr N). Both groups were followed up for 1 year with motivational counseling to stop smoking and spirometry repeated in those who quit smoking completely or partially. Results: COPD was observed in 187 (18.7%) asymptomatic smokers and among these 1.8% having severe COPD. 26% of these patients completely abstained from smoking after diagnosis and counseling and these patients had the least drop in FEV1 after 1 year as compared to partial and nonquitters of smoking. Conclusion: Spirometer for early diagnosis of COPD in asymptomatic nonsmoker is an effective tool. The detection of COPD early paves a way for effective counseling in pursuit for smoking cessation in young adults.