Abstract
While chronic lung disease causes substantial global morbidity and mortality, global estimates have primarily been based on broad assumptions. Specific country data from low-income countries such as Nepal are limited. This review assessed primary evidence on chronic respiratory disease burden among adults in Nepal. A systematic search was performed in June 2019 (updated May 2020) for studies through nine databases. High levels of heterogeneity deemed a narrative synthesis appropriate. Among 27 eligible studies identified, most were low-moderate quality with cross-sectional and retrospective study design. Chronic lung diseases identified were chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis and restrictive lung diseases. Studies were categorised as: (i) community-based, (ii) hospital-based and (iii) comorbidity-related and disease burden. Reported disease prevalence varied widely (COPD, 1.67–14.3%; asthma, 4.2–8.9%). The prevalence of airflow obstruction was higher among rural dwellers (15.8%) and those exposed to household air pollution from domestic biomass burning as opposed to liquid petroleum gas users (Odds Ratio: 2.06). Several comorbidities, including hypertension and diabetes mellitus added to the disease burden. The review shows limited literature on lung disease burden in Nepal. Publications varied in terms of overall quality. Good quality research studies with prospective cohorts related to respiratory conditions are required.
Highlights
The burden of chronic lung disease worldwide is huge, both in terms of morbidity and mortality
This study has identified and synthesised the available evidence on the prevalence of chronic respiratory diseases, symptoms, lung function, comorbidities and the overall burden of lung disease in Nepal
As with chronic obstructive pulmonary disease (COPD), asthma prevalence figures for Nepal varied widely depending on the population, rendering it difficult to interpret alongside World Health Surveys and findings from other low to middleincome countries (LMICs) where prevalence of diagnosed asthma have been estimated at 4.3%60 and 2.9% respectively.[59]
Summary
The burden of chronic lung disease worldwide is huge, both in terms of morbidity and mortality. It is increasing and the current COVID-19 pandemic is likely to add further. Just one lung non-communicable disease (NCD), chronic obstructive pulmonary disease (COPD), causes >3 million deaths per year globally, >90% of these occurring in low to middleincome countries (LMICs).[1,2] Globally identified risk factors in LMICs include tobacco smoke, household and ambient air pollution, and occupational exposure.[3,4,5,6,7,8] Ontario, Canada.
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