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Prevalence of Chronic Obstructive Pulmonary Disease

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Prevalence of Chronic Obstructive Pulmonary Disease doi • 10.5578/tt.9582 Tuberk Toraks 2015;63(3):170-177 Geliş Tarihi/Received: 24.02.2014 • Kabul Ediliş Tarihi/Accepted: 10.05.2015 Prevalence of chronic obstructive pulmonary MA Ş disease in Zonguldak province of Turkey K ÇALI İ 1 1 N Tacettin ÖRNEK Department of Chest Diseases, Faculty of Medicine, Bulent Ecevit University, İ 1 Zonguldak, Turkey Meltem TOR 1 KL 2 Bülent Ecevit Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, RESEARCH ARTICLE Sibel KIRAN Zonguldak, Türkiye 1 Figen ATALAY 2 Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara, Turkey 2 Hacettepe Üniversitesi Tıp Fakültesi, Halk Sağlığı Anabilim Dalı, Ankara, Türkiye SUMMARY Prevalence of chronic obstructive pulmonary disease in Zonguldak province of Turkey Introduction: Chronic Obstructive Pulmonary Disease (COPD) is increasingly recognized as a leading cause of global morbidity and mortality. This study is the first spirometry-based, cross-sectional survey of COPD from Western Black Sea Region of Turkey. In this study we aimed to investigate COPD prevalence in Zonguldak province of Turkey. Materials and Methods: Adult population of 71.630 persons living in central Zonguldak were enrolled to the study. They were selected by random sampling methods based on regional inhabitant listings. 611 adult persons were finally enrolled to the study. They were interviewed face to face, and were given a questionnaire. Spirometry and early reversibility testing were also performed. Results were evaluated according to Global Obstrucive Lung Disease (GOLD) criteria. Results: 42.6% of the study population were males. Mean age was 49.2 ± 15.4. The number of inividuals 40 years and older was 447 (73.1%). COPD prevalence was found as 11.1% in the study population and 14.1% in the population 40 years and older. COPD prevalence in males and females 40 years and older were 19.6% and 9.8% respectively. Mean age of the COPD patients (60.06 ± 13.2 years) was higher than the subjects without COPD (47.8 ± 15.1) (p< 0.001). COPD prevalence was increasing with age categories. COPD severity based on GOLD criteria were as follows: Stage 1 (23.5%), Stage 2 (58.8%), Stage 3 (16.2%) and Stage 4 (1.5%). Prevalence of smoking history was 95.3% in male COPD patients, and 56% in female COPD patients. Smoking was the most common risk factor present in 80.9% of COPD cases, followed by biomass exposure (63.2%), occupational exposure (41.2%) and passive smoking (7.3%). Smoking history and occupational exposure were higher statistically in males than females in both study populatian and COPD cases. Conclusion: COPD is prevalent and an important public health problem in central Zonguldak province. Key words: Epidemiology, smoking, spirometry ÖZET Zonguldak il merkezinde kronik obstrüktif akciğer hastalığı Yazışma Adresi (Address for Correspondence) prevalansı Giriş: Günümüzde Kronik Obstrüktif Akciğer Hastalığı (KOAH), Dr. Tacettin ÖRNEK tüm dünya ülkelerinde önemli bir sağlık sorunu haline gelmiştir. Bülent Ecevit Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Diğer hastalıkların mortalite oranlarının yıllar içinde düşmesine Anabilim Dalı, Kozlu, ZONGULDAK - TURKEY karşılık KOAH prevalansı ve mortalitesi giderek artış göstermekte- e-mail: [email protected] 170 Örnek T, Tor M, Kıran S, Atalay F. dir. Bu çalışma Batı Karadeniz Bölgesinde yapılan ilk spirometrik ve kesitsel KOAH prevelans çalışmasıdır. Bu araştırmada Zonguldak il merkezinde KOAH prevelansını belirlemek amaçlanmıştır. Materyal ve Metod: Zonguldak il merkezinde yaşayan 18 yaş ve üzeri 71.630 kişi çalışmanın hedef popülasyonu olarak kabul edildi. Hedef popülasyondan 611 kişiye, mahalle ve sokak temelinde küme ve sistematik örnekleme yöntemleri birlikte kullanılarak ulaşıldı. Araştırmaya katılan bireylere yüz yüze görüşme yöntemiyle anket formu dolduruldu ve solunum fonksiyon testi ile birlikte erken reversibilite testi yapıldı. Sonuçlar Global Obstrucive Lung Disease (GOLD) kriterlerine göre değerlendirildi. Bulgular: Çalışmaya katılan bireylerin %42.6’sı erkek idi. Yaş ortalaması 49.20 ± 15.4 bulundu. Kırk yaş ve üstü birey sayısı 447 (%73.1) idi. KOAH prevalansı çalışma grubunda %11.1, 40 yaş ve üstü bireylerde ise %14.1 olarak saptandı. Kırk yaş ve üstü erkeklerde KOAH prevelansı %19.3, kadınlarda ise %9.8 idi. KOAH saptanan hastaların yaş ortalaması (60.06 ± 13.2) KOAH saptanmayan bireylerin yaş ortalamasından (47.8 ± 15.1) fazlaydı (p< 0.001). Yaş kategorileri arttıkça KOAH prevelansının da arttığı tespit edildi. GOLD spirometrik sınıflandırmasına göre KOAH’lı hastaların %23.5’i Evre 1’de, %58.8’i Evre 2’de %16.2’si Evre 3’de ve %1.5’i Evre 4’te tespit edildi. Sigara içme öyküsü erkek KOAH’lı hastaların %95.3’ünde, kadın KOAH’lı hastaların ise %56’sında mevcut idi. KOAH’lı hastalarda en sık görülen risk faktörleri sırasıyla sigara (%80.9), biomass maruziyeti (%63.2), mesleksel maruziyet (%41.2) ve pasif sigara içiciliği idi. Sigara ve mesleksel maruziyet hem çalışma grubunda hem de KOAH’lı hastalarda erkeklerde daha sık görülmekteydi. Sonuç: KOAH Zonguldak il merkezinde çok belirgindir ve önemli bir halk sağlığı sorunudur. Anahtar kelimeler: Epidemiyoloji, sigara, spirometri INTRODUCTION South America and Burden of Obstructive Lung Disease (BOLD) Study used the fixed ratio (FEV /FVC< Chronic Obstructive Lung Disease (COPD) is a disease 1 0.7) as a measure of obstruction and reported a of increasing prevalence, morbidity and mortality, but prevalence of around 20% (5). suffers from underrecognition, underdiagnosis and undertreatment. It has been defined by the Global Mortality data also underestimate COPD as a Initiative for Chronic Obstructive Lung Disease (GOLD) common cause of death, but again COPD is now the as a “preventable and treatable disease with some fourth leading cause of death and will become the significant extrapulmonary effects that may contribute third leading cause of death by 2020 (6,7). to the severity in individual patients. Its pulmonary Despite the increasing trend in the COPD prevalence, component is characterized by airflow limitation that is there are limited data from Turkey. In this study, we not fully reversible. The airflow limitation is usually aimed to measure the prevalence of spirometrically progressive and associated with an abnormal confirmed COPD in a population of adults aged 18 inflammatory response of the lung to noxious particles years or more with at least one risk factor, and to or gases“ (1). evaluate the characteristics and risk factors of the Actual prevalence of COPD worldwide is unknown COPD patients. because of variation due to differences in survey MATERIALS and METHODS methods (doctor diagnosed, spirometry based, symptom based etc), diagnostic criteria and analytic Subjects and Protocol approaches. Worldwide, cigarette smoking is the This study was performed between September and most commonly encountered risk factor for COPD. October 2005 in central township of Zonguldak Air pollution resulting from the burning of wood and province of Turkey, which has a population of 71,630 other biomass fuels, and occupational exposure to adults aged 18 years or more according to National noxious gases and particles have also been identified Institute of Statistics of Turkey (TUIK) at the time of the as other COPD risk factors (2,3). Diagnosed prevalence study. The study protocol was approved by the local and morbidity data underestimate the total burden of Ethics Committee. Informed consent was obtained COPD because the disease is usually not diagnosed from all subjects. The smallest number (n= 382) until it is clinically apparent, and there is considerable which represented this population according to 95% variation in reported prevalence (4). Lowest prevalence confidence interval with a 20% prevalence ± 5 is generally reported from studies based on doctor deviation was calculated by Epi Info/Statcalc software. diagnosis, and higher prevalence is reported from This number was assumed as the number of symptom-based surveys. Spirometry based studies households that should be reached. Central town of report prevalence rates in between and is now accepted Zonguldak province is consisted of 19 districts. Three as the gold standard method in epidemiologic studies hundred and eighty-two households were randomly for COPD. Latin American Project for the Investigation selected from regional inhabitant lists of these of Obstructive Lung Disease (PLATINO) study from Tuberk Toraks 2015;63(3):170-177 171 Prevalence of chronic obstructive pulmonary disease in Zonguldak province of Turkey districts. Neighbouring house was used as refill. Total were exposed to cigarette smoke were considered of 611 subjects from 382 households completed the passive smokers. study. All participants were interviewed face to face, Occupational exposure was defined as working at and a questionnaire which was modified from BOLD least one year in occupations with dusts, fumes or questionnaire was given. The questionnaire included chemical gases. demographic characteristics of the patients, body mass index (BMI), smoking habit, questions related to Biomass exposure was defined as using plants or the presence of symptoms and indoor or outdoor plants-derived materials (wood, coal, etc.) indoor and exposure to irritant gases or fumes. Persons who were outdoor for heating or cooking. unable to answer the questionnaire and/or unable to Statistical Analysis perform spirometric test were excluded. Data analysis was conducted using SPSS v. release Spirometric Examination 11.01 statistical software
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