PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) was the fourth leading cause of death in 2004 worldwide. It was estimated that the prevalence of COPD among the elderly Chinese living in Hong Kong was 25.9%. So far, there is little information on the burden of this disease among the population in Hong Kong.
METHODS: We studied the direct and indirect cost of care for moderate to severe COPD patients in specialist clinic (SC) versus the mild to moderate COPD patients in Government Outpatient Patient Clinic (GOPC). Patients were interviewed by trained interviewers using a questionnaire modified from the American Thoracic Society questionnaire for chronic respiratory disease.
RESULTS: We recruited a total of 423 COPD patients, 317 subjects were from SC of 5 hospitals and 105 subjects from 4 GOPC. The demographic characteristics were comparable in both groups. There were significant differences in smoking habits, less SC patients were current smokers when compare to GOPC (9.8% vs 21.9%, p<0.014). Total number of with solid fuel exposure (29% vs 13.3%, p<0.001), and dust or chemical exposure (28.7% vs 10.5%, p<0.001) were higher in SC. A significant proportion of subjects in SC had wheezing in cold weather (73.8% vs 59%, p<0.007), dyspnoea score >3 (63.1% vs 38.2%, p<0.001) when compared with subjects in GOPC. Most of the patients from SC had concomitant medical problems. There was significantly higher number of acute exacerbations among SC COPD in the previous year (mean ± sem, 3.71 + 5.35 vs 2.03 + 2.9, p<0.001), and results was also higher in emergency ward attendance for patients in SC (1.91 + 3.2 vs 1.25 + 2.16, p<0.001). The yearly drug expenditure of inhalers per patient in SC was significantly higher than that of GOPC (US$/year 793.4 + 1070.5 vs 207.7+ 322.5, p<0.001).
CONCLUSION: COPD is responsible for one of the highest health-care burden in Hong Kong. Primary prevention of COPD lies in tobacco and smoking cessation, which should remain important public health measure.
CLINICAL IMPLICATIONS: Prevention is essential to reduce the disease progression and to avoid complication.
DISCLOSURE: Sheng Ho, No Financial Disclosure Information; No Product/Research Disclosure Information