Chronic Obstructive Pulmonary Disease in India: Factors and Strategies

This report provides a comprehensive analysis of chronic obstructive pulmonary disease (COPD) in India, a significant public health issue. It begins with an introduction highlighting the prevalence, causes, and impact of COPD in the country. The discussion section delves into various factors influencing COPD, including political, economic, and social aspects. Political factors emphasize the need for a national COPD control and prevention program. Economic factors cover the financial burden of treatment and health expenditure. Social factors explore the roles of education, awareness, social class, housing, smoking, ethnicity, and lifestyle in COPD prevalence. The report also addresses the prioritization of COPD as a public health issue, emphasizing the need for increased awareness, improved diagnostic tools, and enhanced healthcare infrastructure, particularly in rural areas. The report concludes by summarizing the key findings and underscoring the importance of comprehensive strategies to mitigate the impact of COPD in India.

Chronic obstructive pulmonary disease 1
CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN INDIA
(Student Name)
(University)

Chronic obstructive pulmonary disease 2
Table of contents
1 Introduction …………………………………………………………………………………...1
2 Discussion ……………………………………………………………………………………...2
2.0 Political factors that influence COPD in India ……………………………………………...3
2.1 Need for the Indian National COPD control and prevention program…………………….3.0
2.2 Economic factors affecting COPD in India………………………………………………….4
2.3 Public health and health expenditure as well as income…………………………………...4.0
2.4 Social factors influencing COPD in India …………………………………………………..5
2.5 Education………………………………………………………………………………......5.0
2.6 Awareness …………………………………………………………………………………5.1
2.7 Social class…………………………………………………………………………………5.2
2.8 Housing ……………………………………………………………………………………5.3
2.9 Smoking …………………………………………………………………………………...5.4
2.9 Ethnicity …………………………………………………………………………………...5.5
2.9.0 Lifestyle ……………………………………………………………………………...5.5.0
2.9.1 Genetic/cultural factors ………………………………………………………………5.5.1
2.10 Prioritization of COPD as a public health issue in India…………………………………...6
3 Conclusion ……………………………………………………………………………………..7
4 Works cited …………………………………………………………………………………….8

Chronic obstructive pulmonary disease 3
Introduction
Chronic obstructive pulmonary disease (COPD) is said to be a communal health problem
in India and is a vital cause of death and morbidity within the country (1). The identification of
COPD is centered on spirometry, symptoms and availability of the COPD risk factors. Smoking
is the significant cause for COPD development, while biomass fuel exposure is the significant
risk factor for COPD development in the female population and the non-smokers in India (2).
COPD is thought to be prevalent in India, in 2005, COPD accounted for about 7 % deaths and
about 3% DALYs (disability-adjusted life-years) in India (3). There are about 12 million Indian
adults with COPD and the predominance of COPD varies with the method applied and the
population (4). The occurrence of COPD ranges between 2.12% - 9.4% in northern India and
between 1.4% - 4.08% in southern India, the predominance in women is constantly lower in
comparison to men (5). Rough estimations suggest that there is about 30 million patient of
COPD in India; India has also contributed greatly to the growing COPD mortality percentage,
which is above 20% (556,000 cases) out of the world’s 2,748,000 cases annually (5).
Worldwide, COPD is the significant cause of mortality and morbidity, the World Health
Organization estimates that 65 million individuals suffer from COPD (5). 3 million individuals
and above died in 2005 of COPD corresponding to about 5% of all the global deaths in that year,
and it is feared to be the 3rd leading death caused by the year 2030 (24). Middle- and low-
income countries have shouldered a great burden of COPD with about 90% of the COPD deaths
occurring in these states (6).
Political factors that influence COPD in India
Need for the Indian National COPD control and prevention program

Chronic obstructive pulmonary disease 4
COPD in India is a progressive, chronic, difficult and expensive infection to treat which
currently has no cure in India. There is a great need for secondary and primary prevention
strategies set to ensure reduction of the developing COPD burden in the country (7). The country
has set very few strategies for making its citizens knowledgeable of the various risk aspects
connected to COPD. For effective policy decision making for efficient management of COPD,
there is need to conduct intensive studies within various states in India to produce enough
evidence and knowledge about the disease in the country. A great number of patients with COPD
remain wrongly diagnosed or undiagnosed in the clinical practices because of various reasons
mostly associated with misinterpretation of the facts associated with COPD in India, this has
resulted in the increased occurrence of COPD in the country (8). For this reason, there is the
need for creation of policies that facilitate the programs for raising awareness in the country to
enable the medical practitioners, as well as other individuals, understand the infection, factors
facilitating it and how to manage COPD (9).
There is a very limited number of the centers for pulmonary rehabilitation within India,
this has resulted in higher prevalence rates of COPD in the country, as the needs for the COPD
patients are catered for ineffectively (10). However, strategies are underway to ensure effective
care and management of COPD patients, the scientists and physicians in India are called upon to
carry out research that will lead to creation of better, newer and easier methods of diagnosis of
the disease as well as development of newer inhalation devices and drugs that will help improve
life’s quality and improve symptom detection, and also halt and revert the progress of COPD in
India (11). There is the limited nationwide effort towards cubing COPD in India as some areas
especially the rural areas are neglected, the rural areas have very little knowledge on COPD
diseases and the anti-COPD campaigns fail to reach the individuals in rural areas, therefore,

Chronic obstructive pulmonary disease 5
increased COPD rates in rural Indian regions. For this reason, there is the need for the Indian
National COPD control and prevention program that will focus on every part of India for the
purpose of curbing COPD (12).
The presence of very few pulmonary rehabilitation structures especially in the rural
Indian areas results in the increased chances of COPD occurrence, this calls on for governmental
intervention to ensure the provision of adequate pulmonary rehabilitation centers nationwide
(13). Pulmonary rehabilitation is effective in managing COPD; however, it has been difficult
setting up these programs especially in rural India due to the resource-poor settings (14). Limited
randomized medical trials offered from India, studied that home-based rehabilitation and
exercise teaching options were effective in the resource-poor settings (15). Exercising is essential
for the patient’s health welfare (16). There are very few programs for assessing the nutritional
status by BMI, bio-impendence analysis and skin-fold anthropometry in COPD patients; and this
has increased the occurrence of malnutrition in COPD patients this has raised various debates in
the country regarding nutritional therapy programs for the COPD patients (17). The national
debate concerning nutritional therapy shoots from the point that there are varying benefits with
dietary supplementation within COPD patients (18).
Economic factors affecting COPD in India
Public health and health expenditure as well as income
COPD and related comorbidities treatment require frequent hospitalization and
established resources and this can be very costly to the health center and the patients. The
hospitalization rate is about four times more in the elderly (above 65 years) than in the patients
who are younger. The mean hospital stay lengths range between 4 - 16 days in a standard

Chronic obstructive pulmonary disease 6
intensive care unit (19). In India, the financial and economic burden of COPD treatment is
overwhelming for the common individuals and the amount of the healthcare expenditure that is
out-of-pocket is about 62.41% (20). The Indian social structure does not offer enough protection
to the older individuals and this results in less observance of the treatment process this has
affected the prevalence of COPD in India.
The medical expenditure required in COPD treatment include direct medical, direct non-
medical costs these costs are usually too expensive for most Indian health systems and the COPD
patients (21). The direct medical costs involve the expenditure incurred in hospital, laboratory
finding and medical charges. The burden of costs causes deviation from the current COPD
Indian guidelines (for instance, 70% of the patients were offered a combination of inhaled
corticosteroids and bronchodilator, with only 16.7 of them getting the beta-2 agonist) for the
purpose of cutting on the costs of expenditure this results in more care and management of
COPD in the healthcare systems (22). On the other hand, the direct non-medical costs involve
the total diet and additional (for instance, the traveling expenses) care charges required, these
charges may be too high for some patients a condition that has led to the failure of medical
access by some patients, therefore, the increased prevalence in India (23). The average of total
straight non-medical charges in private medical centers in India is about 528.10 ± 212.72 and
this is higher than in the rural, charitable hospitals which offer free food services (23). To curb
COPD progress in regard to the total direct medical charges, there is the need to support the
COPD patients, particularly the poor for quality healthcare provision (24).
Social factors influencing COPD in India

Chronic obstructive pulmonary disease 7
Education
There is need to educate the clinicians on the various factors and diagnostic features of
COPD (25). It has been found that; a great number of patients with COPD remain wrongly
diagnosed or undiagnosed in the clinical practices because of various reasons mostly associated
with misinterpretation of the facts associated with COPD in India, this has resulted in increased
occurrence of COPD in the country (26). These misinterpretations include; Spirometry which is a
tool of COPD diagnosis is under-utilized by the clinicians due to absence of knowledge and
limited spirometer availability; COPD is believed to be caused only by smoking tobacco, this
results in under-diagnosis of the condition of COPD in individuals who do not smoke and this
has contributed to about half of the COPD cases in India; there is also the strain in making the
difference between COPD and asthma (27). The cases of poor or under-diagnosis of COPD
results in increased suffering of the patients and therefore, increased worsening of the disease
condition. For this reason, nurses, doctors, and other medical professionals need to be educated
clearly for effective diagnosis, care, and management of COPD within India (28).
Awareness
COPD prevalence, as seen before, has a high prevalence rate in India and this has been
attributed to factors such as poor diagnosis of the infection (28). For this reason, there is the need
for raising awareness among the clinicians to enable effective use of the COPD diagnostic tools
such as spectrometry (29). The program of both postgraduate and undergraduate medical
education needs to be strengthened within India to empower the doctors with effective
knowledge for better management of COPD (30). There is the need for the inhalation therapy
which is made available to every patient suffering from COPD (31).

Chronic obstructive pulmonary disease 8
Social class
The level of occupation and education are closely connected, and some respiratory
disorders are a result of occupational exposure. Women usually have occupations that are less
exposed to fumes and dust that cause respiratory disorders this aspect explains the lower
occurrence of COPD in women than in men in India (32). Therefore the more the exposure to
fumes and dust as a result of a particular occupation the greater the risk of COPD diseases (33).
Education, on the other hand, is an important risk element for the symptoms of COPD after the
modification for occupational disclosure. After amendment for smoking and occupational
exposure, the ratios of COPD in primary against university educated topics is 2.9 (1.3–6.5) and
the matching ratios for spirometry flow of air restriction are 5.2 (2.0–13.4) (34).
The damaging of the small airways and the alveolar tissue is mediated by oxidants,
smoking intensely affects the antioxidant/oxidant balance it also escalates the oxidative stress
and this explains the increased vulnerability towards COPD in relation to the social class, heavy
alcohol intake is also related to airflow restriction (35). Studies indicate that the socioeconomic
incline is slightly affected by the selective access or drift to healthcare. The incline also
originates in education which, contrasting with social class and income, precedes the disease
(36).
Housing
Home dampness and poor housing with increased dust mites of the house and using the
gas stove are all related to decreased lung functioning, lower socioeconomic level, and
respiratory symptoms (37). Household crowding which is very common in India has been
assumed to cause greater respiratory infection instances, therefore, increasing the number of
respiratory conditions (38). Children in homes that use the gas stove for cooking are said to be at

Chronic obstructive pulmonary disease 9
a higher risk of respiratory disorders than those who use electricity for cooking, also adults using
the gas stove for cooking were at an increased threat of reduced ventilator functioning and the
respiratory symptoms among the men but not in women (39). Communal air pollution exposure
is a great aspect that determines COPD prevalence among Indians (40).
Smoking
The most conspicuous cause of lung infections is smoking; children raised in homes with
individuals who smoke are at a greater threat of respiratory diseases than children from homes
that are tobacco-free (41). Tobacco smoking in adolescence and in childhood affects the
development of lung functioning (42). This social aspect is greatly associated with the
occurrence of COPD among the Indian citizens especially the men who are thought to be
exposed to smoking more than the women. And the success rate of quitting is greatly inclined
towards the higher level of the social class (43).
Ethnicity
Ethnicity is the main aspect determining the major socio-economic factors that affect the
occurrence of COPD; it is related to the combination of living in regions growing tobacco,
smoking, and education (44). However, other factors such as genetic or cultural factors and
lifestyle that differ in various ethnic communities indicate the association of ethnicity and COPD
(45).
Lifestyle
There is a significant association between age groups and the quality of living; older
patients with COPD indicate a more compromised lifestyle. And the harshness of the disease
increases due to age-related deterioration of the patient’s physical functioning of the lungs, this
results in the impaired quality living of the patients with COPD (46). There is an association

Chronic obstructive pulmonary disease 10
between the level of education and the quality of life of the patients, the COPD patients who are
more educated tend to live a better lifestyle than the ones with lower educational level (47). The
reason for the quality lifestyle in educated patients has increased COPD awareness, prompt
health-seeking characteristics, and self-care management (48).
Genetic/cultural factors
Poor delivery procedures due to failure to access professional midwives (where most
Indian women prefer to deliver in their homes due to some misleading cultural beliefs) can result
in respiratory diseases during infancy (49). These early respiratory disorders can be as a result of
decreased lung capacities independent of the low delivery weight effects, a situation that can be
reverted by approaching professional midwives during pregnancy and birth (50).
Prioritization of COPD as a public health issue in India
In India, there has been an increase in the burden of the non-communicable diseases,
which have been on an increase from the 1990s. As per 2016, 3 out of 5 leading mortality causes
constituted the non-communicable diseases, and COPD was ranked as the second greatest cause
of mortality in India (51). These results can be ascribed to the increased poverty in India
therefore poor housing conditions, reduced quality of living, increased exposure to fuels and dust
that facilitate increased rates of respiratory disorders, low levels of education and awareness and
inability to access effective medical care as well as insufficient policies regarding management
and control of COPD (52). Different studies indicate the changing COPD prevalence rates in
various states, the predominance ranges from 1.2 to 19% in women and 2 to 22% in men (53).
COPD has become the 4th leading factor of life lose yearly in the EAG (Empowered Action
Group) States comprising Uttarakhand, Madhya Pradesh, Bihar, Chhattisgarh, Jharkhand,

Chronic obstructive pulmonary disease 11
Odisha, Uttar Pradesh and Rajasthan (53). COPD is also ranked 7th cause of death in the State of
the Northern-East including Arunachal Pradesh, Nagaland, Mizoram, Sikkim, Tripura, Manipur,
and Assam (53). In the remaining Indian states, COPD was ranked 4th among all the causes of
life lost years (54). These results indicate the need for increased improvement of strategies meant
to curb COPD prevalence in India (55).
COPD has affected about 5-15% of the grownups in countries that are industrialized, in
1990, COPD was ranked as the 12th global causative factor of a combination of disability and
deaths, and this data is scientifically predicted to rise to the 5th position as one of the factors that
cause mortality globally (56). This inclining gradient of COPD is attributed to the increased
exposure to fuels and dust due to the type of occupation and increased smoking rates especially
in young adults and adolescents in the industrialized countries. For countries that are still
developing, COPD is mainly influenced by the lower socio-economic factors (57).
Conclusion
COPD (Chronic obstructive pulmonary disease) is a condition that is characterized by
reduced respiratory airflow; these features do not usually change significantly over some months.
COPD can be grouped into emphysema and chronic bronchitis. COPD is the core respiratory
infection that affects the quality and length of lives worldwide (58). World Health Organization
describes COPD as a disease of the lungs that is characterized by prolonged lung airflow
obstruction that inhibits the usual breathing and it is not fully adjustable (59).

Chronic obstructive pulmonary disease 12
Works cited
1. Bhome AB. COPD in India: Iceberg or volcano?. Journal of thoracic disease. 2012 Jun
1;4(3):298.
2. Hossain MM, Sultana A, Purohit N. Burden of Chronic Obstructive Pulmonary Disease
in India: Status, Practices and Prevention.
3. Schluger NW, Koppaka R. Lung disease in a global context. A call for public health
action. Annals of the American Thoracic Society. 2014 Mar;11(3):407-16.
4. Hiscock R, Bauld L, Amos A, Fidler JA, Munafò M. Socioeconomic status and smoking:
a review. Annals of the New York Academy of Sciences. 2012 Feb 1;1248(1):107-23.
5. Koul PA, Hakim NA, Malik SA, Khan UH, Patel J, Gnatiuc L, Burney PG. Prevalence of
chronic airflow limitation in Kashmir, North India: results from the BOLD study. The
International Journal of Tuberculosis and Lung Disease. 2016 Oct 1;20(10):1399-404.
6. Schluger NW, Koppaka R. Lung disease in a global context. A call for public health
action. Annals of the American Thoracic Society. 2014 Mar;11(3):407-16.
7. Gupta D, Agarwal R, Aggarwal AN, Maturu VN, Dhooria S, Prasad KT, Sehgal IS,
Yenge LB, Jindal A, Singh N, Ghoshal AG. Guidelines for diagnosis and management of
chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations. Lung
India: official organ of Indian Chest Society. 2013 Jul;30(3):228.
8. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the
diagnosis, management, and prevention of chronic obstructive pulmonary disease:
NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD)