Abstract
BackgroundOur previous scoping review revealed limitations and inconsistencies in population surveys of chronic respiratory disease. Informed by this review, we piloted a cross-sectional survey of adults in four South/South-East Asian low-and middle-income countries (LMICs) to assess survey feasibility and identify variables that predicted asthma or chronic obstructive pulmonary disease (COPD).MethodsWe administered relevant translations of the BOLD-1 questionnaire with additional questions from ECRHS-II, performed spirometry and arranged specialist clinical review for a sub-group to confirm the diagnosis. Using random sampling, we piloted a community-based survey at five sites in four LMICs and noted any practical barriers to conducting the survey. Three clinicians independently used information from questionnaires, spirometry and specialist reviews, and reached consensus on a clinical diagnosis. We used lasso regression to identify variables that predicted the clinical diagnoses and attempted to develop an algorithm for detecting asthma and COPD.ResultsOf 508 participants, 55.9% reported one or more chronic respiratory symptoms. The prevalence of asthma was 16.3%; COPD 4.5%; and ‘other chronic respiratory disease’ 3.0%. Based on consensus categorisation (n = 483 complete records), “Wheezing in last 12 months” and “Waking up with a feeling of tightness” were the strongest predictors for asthma. For COPD, age and spirometry results were the strongest predictors. Practical challenges included logistics (participant recruitment; researcher safety); misinterpretation of questions due to local dialects; and assuring quality spirometry in the field.ConclusionDetecting asthma in population surveys relies on symptoms and history. In contrast, spirometry and age were the best predictors of COPD. Logistical, language and spirometry-related challenges need to be addressed.
Highlights
Our previous scoping review revealed limitations and inconsistencies in population surveys of chronic respiratory disease
283/508 (55.7%) reported one or more chronic respiratory symptoms, most commonly breathlessness on walking uphill (25%) or wheezing (21%). 33 (6.5%) reported breathing problems that interfered with daily activities
Based on a consensus categorisation, we estimated the prevalence of asthma as 16.3%; chronic obstructive pulmonary disease (COPD) 4.5%; restrictive spirometry 21.6%; and ‘other Chronic Respiratory Diseases (CRD)’ 3.0%. 5.5% were considered to have non-respiratory causes for their symptoms
Summary
Our previous scoping review revealed limitations and inconsistencies in population surveys of chronic respiratory disease. Chronic Respiratory Diseases (CRD), most commonly asthma and chronic obstructive pulmonary disease (COPD), and post-tuberculosis (TB) lung disease, bronchiectasis, interstitial lung disease and lung cancer, are common public health problems, with high prevalence and mortality rates globally, especially in low- and middle-income countries (LMICs) [1,2,3,4]. Symptoms such as cough, phlegm, shortness of breath, chest tightness and wheeze, are disabling features of CRD that contribute to poor health-related quality of life [5], impact on family, work and societal roles, as well as using healthcare resources. The impact of CRD on the quality of life of individuals, or their social and healthcare burden were rarely reported
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