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Tashmetova Gulchekhra Talipovna, researcher of the Department of Pulmonology and Clinical Allergology, Tashkent Institute of Postgraduate Education for Doctors, Republic of Uzbekistan
E-mail: [email protected]
SCREENING OF THE CHRONIC OBSTRUCTIVE PULMONARY DISEASE UNDER THE CONDITIONS OF LARGE INDUSTRIAL CENTER
Abstract. Chronic obstructive pulmonary disease is the fourth cause of mortality in all over the world. The main risk factors for development COPD in young population are registered smoking, bronchial hypersensitivity, frequent respiratory infection in the childhood. There has been performed investigation by program of the modern pulmonological screening of 3000 persons of the age 20-60 years working at the enterprises in Tashkent. This program allowed active identification of individuals with risk factors of COPD and respiratory symptoms even slightly expressed and qualitative performance of spirometry allows for specialist of the primary stage of medical care to diagnose COPD at early stages.
Keywords: chronic obstructive pulmonary disease, screening, risk factors, early diagnosis.
Chronic obstructive pulmonary disease (COPD) at present is one of the most significant diseases taking into account the burden of social problems, which is beard by society connected with progressing of disease and its systemic effects [1].
COPD is the fourth cause of mortality in all over the world, and how it is predicted, in the nearest decay it will be observed increased prevalence and mortality from it.
The main risk factors for development of COPD appeared to be smoking, bronchial hypersensitivity, frequent respiratory infection in the childhood [2]. Hypodiagnosis of COPD is usually characteristic for individuals of young and adult age and often connects with absence or insignificant expressions of respiratory symptoms in them [3].
The formation of disease is developing during many years and manifests in the period when it is impossible to restore the functions of the bronchopulmonary system.
It is known how important the role of early diagnosis of COPD and prescription of timely adequate starting therapy. According to the data of European Respiratory Society only 25% cases of disease is diagnosed in time [4]. COPD is frequently diagnosed missed or remained to be unrecognized. At early stages of COPD the patients frequently have no complaints.
The early diagnosis (stage 1) is possible only in active identification of the patients in the groups of risk with methods of special questionnaire and functional investigation of the lungs.
The complexicity of timely diagnosis of the obstructive pulmonary disease justified to perform this investigation the purpose ofwhich was early diagnosis of COPD.
Materials and methods: According to tasks there was studied morbidity due to COPD, and there was performed examination according to the program of the current pulmonological screening of3000 persons of the organized popula-
tion working at the different enterprises of Tashkent at the age from 20 to 60 years.
Assessment of the system of external respiration was performed with method of computed pneumatachometry on the apparatus "Masterlab" (Erich Jaeger, Germany), providing automatic analysis of the parameters of the structure of the lung volumes (FJEL), momentary maximal volumetric velocities at expiration 25.50/75% (MOC25, MOC50, MOC75), expressed in percents.
Results of research: We tried to study prevalence rate of COPD at various stages of disease. For this purpose there were examined 3000 individuals of the organized population of Tashkent. Females were 1400 persons (46.7%), males - 1600 persons (53.3%). The mass screening examination showed, that prevalence of COPD in the studied population accounted for 8.7%. A number, character of the clinical course of disease provided possibility of the representative analysis of the results of the investigations performed from various positions.
All patients with COPD were divided into 4 groups in relation to severity degree. At distribution there was used system of severity degree proposed by GOLD (2003). The main part of patients comprised of only persons with I and II severity degree, and only insignificant part were on III and IV stage of severity degree. The investigation was performed on the enterprises, so the main part of patients consisted of contingent with working ability, while individuals with III and IV stages appeared to be disabled.
We concider the fact the majority of patients with COPD were revealed for the first time appeared to be very important moment (75.2%). Only small quantity of patients before our examination were under observation in
the therapeutic institutions in Tashkent. It was very important that they were persons with severe and extremely severe stage of disease.
Analysis of the data of medical history and results of the functional investigation showed verification of COPD in
Table 1.- The incidence of COPD with rec
263 patients, that accounted for 8.7% of all the interviewed. Among the women COPD was diagnosed in 6.4% of cases (n - 90), among the men COPD was found in 10.8% of cases (n - 173). The incidence of COPD with regard to the stages of disease is presented in (table 1).
h to stages of disease in men and women
Gender n COPD is diagnosed COPD
I ст. II ст. III ст. IV ст.
Men 1600 173 103 38 25 7
100% 10.8 ± 0.8* 6.4 ± 0.6* 2.3 ± 0.3 1.5 ± 0.3** 0.4 ± 0.1
Women 1400 90 37 38 10 5
100% 6.4 ± 0.6 2.6 ± 0.4 2.7 ± 0.4 0.7 ± 0.2 0.3 ± 0.1
Totally 3000 263 140 76 35 12
100 % О 010 4.6 ± 0.3 2.5 ± 0.2 1.2 ± 0.2 0.4 ± 0.1
Note: in the numerator -absolute number; in the denominator -percent;
*difference reliability between men and women p<0,001; ** reliability of differences p < 0.05
Table 1 shows that COPD is reliably more often met (from 6.7% to 18.9%). It was noted that with age increasing among men at the first stage of disease (6.4%), and among women - at the second stage of disease (2.7%).
Analysis of COPD incidence with regard to age (table 2) showed that in women of age above 49 years COPD was noted 2 times more often, than at age of 40-49 and younger. In men the frequency of COPD increases 2.8 times with age growing
both among women and men the specific weight is also increasing in patients with more severe stages of disease. Comparative analysis of the frequency rate of COPD in patients in the age group of50-59 years showed that among the men the frequency ofCOPD was 1.9 times higher than among the women of age 40-49 years - 2.3 times and of age 30-39-1.6 times.
Table 2.- Characteristic of the patients in relation to age and gender
Gender Age groups n = 3000 COPD I st. II st. III st. IV st.
20-29 143 7 5 1 - 1
100% 4.8% 3.4 ± 1.5 0.7 ±0.7 - 0.7 ± 0.7
30-39 247 12 4 4 1 3
100% 4.8% 1.6 ± 0.8 1.6 ± 0.8 0.4 ±0.4 1.2 ±0.7
Women 40-49 488 20 12 7 1 -
100% 4.1% 2.4 ± 0.7 1.4 ± 0.5 0.2 ± 0.2 -
50-59 522 51 16 26 8 1
100% 9.8% 3.0 ± 0.7 5.0 ± 0.9 1.5 ± 0.5 0.2 ± 0.1
Всего 1400 90 37 38 10 5
100% 6.3% 2.6 ± 0.4 2.7 ±_0.4 0.7 ± 0.2 0.3 ± 0.1
20-29 371 25 20 5 - -
100% 6.7% 5.4 ± 1.1 1.3 ± 0.5 - -
30-39 339 26 15 5 4 2
100% 7.7% 4.4 ± 1.1 1.4 ± 0.6 1.8 ±_0.7 0.6 ± 0.4
Men 40-49 483 45 33 4 7 1
100% 9.3% 7.0 ± 1.1 0.8 ±_0.4 0.6 ± 0.3 0.2 ± 0.2
50-59 407 77 35 24 14 4
100% 18.9% 8.6 ± 1.4 5.6 ± 1.1 3.4 ± 0.8 1.2 ± 0.5
Всего 1600 173 103 38 25 7
100% 10.7% 6.5 ± 0.6 2.3 ± 0.3 1.3 ± 0.2 0.7 ± 0.2
Note: in the numerator -absolute number; in the denominator -percent;
It has been seen in (table 3), that diagnosis of COPD was and possible outcomes of disease in 8,4% of men and 4.5% made for the first time that that indicates about hypodiagnosis of women.
Table 3.- Characteristics of studied patients
Gender Diagnosis of COPD has been made Totally
Previously For the first time
Men 38 135 173
n=1600 2.4% NO % 8. 10.8 ± 0.7
Wome 27 63 90
N=1400 1.9% 4.5% 6.4 ± 0.7
Total 65 198 263
n=3000 2.1% 6.6% 8.7 ± 0.5
Comparative data about patients with COPD, being under dispensary observation and revealed for the first time, are presented in table 4, of which it is seen that as among males, so as among females, being earlier under observation, there are
prevailed severe forms of disease, stage III (52.6% and 33.3%) and IV (18.4%), and among the patients with identified for the first time stages I and II of disease in 96.3% of males and to 98,4% of females.
Table 4.- Comparative data of patients with COPD being under dispensary observation and revealed for the first time in relation to stages
«I» «II» «III» «IV» Totally
Identified for 34 28 1 - 63
the first time 54.0 ± 6.3** 44.4 ± 6.3 1.6 ± 1.6 - 100%
Women Being under the 3 10 9 5 27
observation 11.1 ± 6.0 37.0 ± 9.3 33.3 ± 9.0 18.5 ± 7.4 100%
Totally 37 38 10 5 90
41.1 ± 5.2 42.2 ± 5.2 11.1 ± 3.3 5.6 ± 2.4 100%
Identified for 102 28 5 - 135
the first time 75.6 ± 3.7** 20.7 ± 3.5 3.7 ± 1.6 - 100%
Men Being under 1 10 20 7 38
observation 2.6 ± 2.6 26.3 ± 7.1 52.6 ± 8.1** 18.4 ± 6.2 100%*
Totally 103 38 25 7 173
59.5 ± 3.7 22.0 ± 3.1 14.4 ± 2.6 4.1 ± 1.4 100%
Note: in the numerator -absolute number; in the denominator -percent;
*difference reliability between primary and earlier being under observation *p < 0.05; **p < 0.001
Thus, among all studied population only 65 (2.1%) were under observation in the therapeutic institutions, that accounted for 24.7% out of all revealed patients. For the first time diagnosis of COPD was established in 198 studied patients (6.6%), that accounted for 75.2% out of all revealed patients. The data obtained indicate that majority ofyoung individuals of the both gender having clinical symptoms of disease diagnosis of COPD was not made, and consequently the therapeutic and prophylactic measures were not performed. The patients who were under observation in the institution of public health service, as a rule, have already process of moderate and severe degree. So, only 30% of all women (n -27) and 22% of men (n -38) had established diagnosis of COPD before our investigation, out of them in 51.8% of women and
71.0% of men the disease had severe degree with bright clinical signs.
We conceder it is important that in these persons diagnosis of COPD was established rather lately, however these patients, as a rule, has diagnosis of chronic bronchitis. This moment appeared to be a cause of missed approaches to treatment, and as consequence, enhance development of disease.
We have studied critical role of the various risk factors such as professional harmful conditions: toxic-chemical and dusty, smoking, recurring diseases of the upper respiratory ducts and development of COPD. The research showed that 45.9% (n-1376) of patients had effect on the body of some or other studied factor or their combinations. With regard
to structure of the risk factors it was noted that factor of eases of the upper ducts - to 11.8%, effect of toxic-chemical smoking occurred with frequency to 37.3%, recurring dis- factor - to 17.7%, dusty - to 33.2%.
Table 5. Prevalence of the risk factors among the individuals with or without COPD
Risk factors Totally n = 1376 Presence of COPD diagnosis n = 263 Absence of COPD diagnosis n= 1113
Occupational harmfulness Toxic-chemical 244 72 172
17.7 ± 1.02 27.3 ± 2.7 15.5 ± 1.08*
Dusty 457 2 455
33.2 ± 1.26 0.8 ± 0.5 40.9 ± 1.4**
Smoking 513 156 357
37.3 ± 1.3 59.3 ± 3.02 32.1 ± 1.4*
Recurring diseases of the upper respiratory ducts 162 33 129
11.8 ± 0.8 12.5 ± 2.03 11.6 ± 0.95*
Note: in the numerator -absolute number; in the denominator -percent; reliability (*p < 0.05; **< 0.002) between presence and absence of COPD
On the basis of the results of research it was established that among the individuals with determined diagnosis of COPD the frequency of meeting of some risk factors prevailed reliably the level, than among the persons without diagnosis of COPD: toxic-chemical effect - by 1.8 times, smoking - by 1.8 times, recurring diseases of the upper respiratory diseases - by 1.07 times.
Analysis of the risk factors for development of COPD in the males and females is presented in table 6, from which it is seen, that among males the smoking (60.7%) and toxic-chem-
ical effect (33.0%) appeared to be factors of COPD formation, the frequency among which is reliably higher, in comparison with individuals without COPD (p < 0.01). Among women the leading factors for development of disease may be presented by smoking (56.7%) and recurring diseases of the upper respiratory ducts (24.4%). However, while comparing significance of the risk factors among males and females, suffering from COPD, it is necessary to note that factor of smoking and toxic-chemical effects are reliably more frequently registered in males, suffering from COPD.
Table 6.- Frequency of the risk factors for COPD
Risk factors Determined diagnosis of COPD Undetermined diagnosis of COPD
Males n = 173 Females n=90 P Males n = 711 Females n = 402 P
Toxic-chemical 57 15 P < 0.01 104** 68W P < 0.001
33.0 ± 3.5 16.7 ± 3.9 1 14.6 ± 1.3 16.9 ± 1.8
Dusty - 2 289 166ww P < 0.05
- 2.2 ± 1.5 40.6 ± 1.8 41.3 ± 2.4
Smoking 105** 51WW P < 0.01 244 113 P < 0.01
60.7 ± 3.7 56.7 ± 5.2 1 34.3 ± 1.7 28.1 ± 2.2
Recurring diseases of upper respiratory ducts 11 22 ww P < 0.01 74* 55 P < 0.05
6.4 ± 1.8 24.4 ± 4.5 1 10.4 ± 1.1 13.7 ± 1.7
Note: in the numerator -absolute number; in the denominator -percent; P - reliability between males and females with COPD; w - reliability between females with COPD and without COPD; * - reliability between males with COPD and without COPD (**p < 0.001; P < 0.05)
Analyzing the factor of smoking it was noted that out of males - in 51 individuals. The patients smoking previously all studied individuals 22% were males (n-349) and 11.7% included 1.5% of males (n-24) and 0.85% of females (n -12) women (n -164). The frequency of COPD among smok- and frequency of COPD occurred in this group was 13.8% ing males was found in 105 patients, among the smoking fe- and 13.3%, respectively.
Table 7. Effect of smoking into COPD
Smoking Nonestablished COPD n = 2737 Established COPD n = 263
Active smoking people 357 156
100% 43.6%
Smoking in the last time 536 36
100% 6.7%
Not smoking 1844 71
100% 3.8%
Studying of the effect of smoking factor on COPD it was revealed that 43.6% of actively smoking had diagnosis COPD, at the same time among individuals smoking in the last time diagnosis of COPD was determined in 6.7% of cases. Not smoking people had the less risk of the COPD occurrence, because in this group COPD was noted in 3.8% of cases.
Studying the factor of smoking in relation to stage of disease it is necessary to note that at stages of COPD I and II there is met category of individuals not smoking and persons smoking in the last, and at stages III and IV of disease there is found high special weight of actively smoking patients.
Data shows that at the initial stages of disease index of smoking individual accounts for 10-20 years, while at the late stages there is noted index higher than 30 years. Consequently, it may be concluded that with growing index of smoking man the severity of disease increases too and this process has closed interrelation.
In our research the recurring diseases of the upper respiratory ways resulted in COPD among males in 12.8% of cases, and among women in 20.8% of cases. At the compar-
ing of the risk factors of various origins it was clear that the main provocateur of COPD among males is smoking, and among women - the recurring diseases of the upper respiratory ways.
All the patients with verified diagnosis of COPD were registered in the pulmonological center, where they were offered programs of rehabilitation and constant regular observation of the specialist. In the conclusion it is necessary to note that the final purpose for performance of any epidemiological investigation is to introduce clarity into prevalence of this disease in the region, to study the gender-aged characteristics of the epidemiological characteristics. In its turn this will allow to know real parameters of morbidity and help to reduce growth of parameters of morbidity and mortality due to COPD.
Thus, active identification of the individuals with risk factors of COPD and respiratory symptoms even less marked, and qualitative, according to the current requirements, performance of spirometry will open possibility for doctor of the primary level of public health service to diagnose COPD at the early stages.
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