Health related quality of life among people with COPD in India

Introduction: There is scarce information on the disease-specific quality-of-life (QoL) among people with chronic obstructive pulmonary disease (COPD) in India. Methods: We conducted a cross-sectional study among 2334 adults ≥40 years to assess the burden of COPD in rural and urban areas of North India. COPD included self-reported physician-diagnosed COPD, emphysema, chronic bronchitis or treatment. Additional case-finding included a sequential screening strategy (administering the Lung Function Questionnaire (LFQ ≤18) followed by pocket spirometry (FEV1/FEV6 <0.70) and COPD confirmation by post-bronchodilation spirometry. Participants were interviewed by trained research staff using the adapted Burden of Obstructive Lung Disease (BOLD) study questionnaire. COPD Assessment Test (CAT) was used to assess the disease-specific QoL. Ordinal logistic regression was conducted to determine associations between disease-specific QoL and key socio-demographic characteristics, risk factors and type of treatment. Results: Mean (±SD) age of the study participants was 55.9 (10.9) years, 45.7% (95% CI: 43.6-47.7) were men. The overall age-standardized COPD prevalence was 8.6% (95% CI: 7.5-9.8) and 39.1% (32.7-45.9) reported taking treatment [inhalational: 37.8% (27.9-48.9); oral: 62.2% (51.1-72.1)]. COPD had a very high impact (CAT score> 30) on the disease specific QoL among 8.0% (95% CI: 3.7-12.3), high impact (CAT score> 20) among 20.4% (95% CI: 1.4-2.6), medium impact (CAT score 10-20) in 35.2% (95% CI: 27.9-42.4) and low impact (CAT score> 10) among 36.4% (95% CI: 29.3-43.6) of individuals with COPD. There were no significant differences in CAT scores according to sex and area of residence. Those taking oral treatment were more likely to have very high impact on their disease specific QoL as compared to those taking inhalational treatment [Odds ratio: 2.9 (1.1-7.7)]. Discussion: People with COPD taking oral treatment have poorer disease-specific QoL, which underlines the urgent need to strengthen the Indian primary health infrastructure to improve the availability and access to inhalational treatment.