Prevalence and Determinants of Chronic Respiratory Diseases at community settings in Bangladesh: Evidence from the analysis of 4CCORD-CRD Bangladesh Study

Background: The importance of Chronic respiratory diseases (CRDs) is underappreciated, partly due to the paucity of available evidence on the association of actionable determinants in resource-poor settings. We assessed the determinants associated with CRDs in a community setting in Bangladesh to inform policy decision-making to reduce the disease burden from CRDs. Methods: We collected respiratory health-related data using 4CCORD-study validated questionnaires and performed spirometry on people aged ≥18 years. Different CRDs were defined using standardised definitions followed in the 4CCORD study. Multivariable logistic regression was used to understand the association of determinants, including sociodemographic characteristics, body mass index (BMI), smoking, occupational exposure to dusty jobs, comorbidities, and cooking fuel with CRDs. Result: 889 participants (81.3%) were enrolled from a random sample of 1093 participants aged ≥18. 272 participants (30.6%, 95%CI: 27.6%-33.7%) identified with one of the CRDs. Among them, 74 (8.3%, 95%CI:6.6%-10.4%) had restrictive spirometry, 45 (5.1%, 95 CI: 3.7%-6.7%) were diagnosed with Chronic Obstructive Pulmonary Disease, and 13 (1.5%, 95%CI: 0.8%-2.5%) were diagnosed with asthma. 140 (15.8%, 95%CI: 13.4%-18.3%) participants were identified as having asthma symptoms with normal spirometry values. Ever smoking [aOR=1.84 (95%CI:1.29-3.95) and ≥1 comorbidity [aOR=3.31 (95%CI: 2.42-4.53)] were found to be independent determinants for CRDs. Discussion: The high prevalence of various CRDs is essential to understanding their importance at the community level. However, identifying and diagnosing different conditions like asthma is complicated because most cases will be normal when conducting spirometry, and restrictive spirometry is often challenging to interpret. Important determinants identified were ever smoking and ≥ 1 co-morbidities to be strongly associated with CRDs. Greater emphasis on CRD assessment for those who smoke or have any co-morbidities and further research on their period of exposure and the subsequent impact on CRDs are needed for garnering appropriate policy decisions to reduce the CRD burden in Bangladesh.