COPD is a progressive disease but its advanced stages can be averted if noxious agents are removed early. Often, patients seek advice when they become dyspneic, but by then half of their ventilation is irreparably lost. By far smoking cessation is most rewarding intervention in prevention of COPD. If harnessed adequately for control of COPD, it would prevent alarming future predictions. COPD currently ranks 6th in global impact scale and is predicted to number 3 by 2020. Recent studies indicate that COPD could be detected early by spirometry. High prevalence, morbidity and cost involved prompt early identification of such cases to obviate progression. So far no such study has been conducted in India. Present study evaluated role of spirometric screening in early detection of COPD in smokers.
Study was conducted at Medical College Hospital since 2003 to 2005. Initially for 3 months, a COPD awareness campaign was enacted through mass media viz. articles in papers, radio and television interviews, posters in hospital etc. Thus, smokers with smoking index [SI] above 100 were motivated for spirometry. Finally, 307 subjects were enrolled. Spirometry performed comprised estimation of FVC, FEV1 and FEV1 / FVC ratio. COPD was diagnosed and staged as per GOLD guidelines. Non- COPD pulmonary cases were excluded through clinical examination and investigations.
Of 60 asymptomatic smokers 12% had COPD while 47% of 240 symptomatic subjects suffered COPD. Incidence of COPD in subjects with SI of 100-200, 200-400, and above 400 was 33, 38 and 42 % respectively. Incidence of severe disease i.e. stage III and IV was higher [14%] in subjects with SI above 400 than the incidence [9%] in subjects with SI below 400, [P<0.01].
COPD detected in 40% of all smokers and 12% of asymptomatic smokers. Positive association existed between amount of smoking with incidence and severity of COPD, [P<0.01].
The preliminary data thus generated will make useful contribution towards concept of spirometric screening for early detection and prevention of COPD in country.
Ashok Janmeja, None.