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      Understanding perception of chronic obstructive pulmonary disease among general practitioners, physicians, and pulmonologists in India: Results from a face-to-face survey

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          Abstract

          Background:

          Challenges exist in the diagnosis, management and follow-up of patients with chronic obstructive pulmonary disease (COPD) in India. Lack of awareness of the disease, its symptoms and its implications may significantly contribute in preventing individuals with symptoms from seeking advice from their primary care physicians or eliminating risk factors. This cross-sectional survey aimed to explore the attitudes, beliefs, and knowledge of doctors (general practitioners [GPs], physicians and pulmonologists) related to COPD recognition, diagnosis, and treatment in India.

          Methods:

          Data was collated from 91 randomly selected GPs, physicians and pulmonologists through a questionnaire and face-to-face interviews, in 8 cities of India.

          Results:

          The response rate to the survey was 68% (61 out of 91). Majority of the doctors (90% of GPs-physicians and 82% of pulmonologists) reported that patients with COPD visit them at moderate to severe stages of the disease. 44% of the GPs and physicians reported that they had never performed spirometry to make a diagnosis of COPD. About 35% of doctors reported that COPD occurred only in smokers. The most common reported barriers to the treatment of COPD were difficulty in explaining COPD to the patients, poor patient compliance to the prescribed treatment and the inability of patients to give up smoking. Most doctors agreed that compliance with treatment is a major concern in patients with COPD due to an ageing population, existence of limited therapeutic options and presence of comorbidities.

          Conclusion:

          The results of this cross-sectional survey of doctors in India, highlighted the need for increasing the awareness about COPD at both doctor and patients level to overcome the prevalent under-diagnosis and under-treatment in COPD.

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          Most cited references14

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          Chronic obstructive pulmonary disease in non-smokers.

          Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor, but emerging evidence suggests that other risk factors are important, especially in developing countries. An estimated 25-45% of patients with COPD have never smoked; the burden of non-smoking COPD is therefore much higher than previously believed. About 3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1.01 billion people who smoke tobacco, which suggests that exposure to biomass smoke might be the biggest risk factor for COPD globally. We review the evidence for the association of COPD with biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.
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            New inhaler devices - the good, the bad and the ugly.

            Drug delivery to the lungs is an effective way of targeting inhaled therapeutic aerosols and treating obstructive airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD). In the past 10 years, several new drugs for the management of asthma and COPD have been marketed and more are under development. These new therapeutic respiratory drugs have been furthered by innovations in all categories of pulmonary drug delivery systems to ensure optimal aerosolisation performance, consistency in efficacy and satisfactory patient adherence. In this review, we discuss the technological advances and innovations in recent inhaler devices and the evolving roles of pressurised metered-dose inhalers, dry powder inhalers and nebulisers, as well as their impact on patient adherence to treatment.
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              The risk of osteoporosis in Caucasian men and women with obstructive airways disease.

              Because patients with obstructive airways disease may be susceptible to osteoporosis, we sought to determine the association between airflow obstruction and osteoporosis. We analyzed data from Caucasian participants (n = 9502) in the Third National Health and Nutrition Examination Survey, conducted in the United States between 1988 and 1994. We used data from dual-energy x-ray absorptiometry measurements of the total femur to determine whether a study participant had osteoporosis (defined as total bone mineral density values < or =2.5 SD below the corresponding mean values from young, healthy participants). We calculated the odds ratio (OR) for osteoporosis in four lung function categories: none, mild, moderate, and severe airflow obstruction. Overall, airflow obstruction was associated with increased odds of osteoporosis compared with without airflow obstruction (OR = 1.9; 95% confidence interval [CI]: 1.4 to 2.5). Participants with severe airflow obstruction were at especially increased risk (OR = 2.4; 95% CI: 1.3 to 4.4). Moderate but not mild airflow obstruction was also associated with osteoporosis. Airflow obstruction was an important risk factor for osteoporosis in the study population. These data highlight the importance of measuring bone mineral density in those with moderate-to-severe airflow obstruction for the detection and prevention of osteoporosis-related morbidity.
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                Author and article information

                Journal
                Perspect Clin Res
                Perspect Clin Res
                PCR
                Perspectives in Clinical Research
                Medknow Publications & Media Pvt Ltd (India )
                2229-3485
                2229-5488
                Apr-Jun 2016
                : 7
                : 2
                : 100-105
                Affiliations
                [1] Department of Medical Services, Cipla Limited, Mumbai, Maharashtra, India
                Author notes
                Address for correspondence: Dr. Bhumika Aggarwal, C/o Medical Services, Cipla Limited, Mumbai Central, Mumbai - 400 008, Maharashtra, India. E-mail: bhumikaaggarwal@ 123456gmail.com
                Article
                PCR-7-100
                10.4103/2229-3485.179438
                4840790
                27141477
                19dcf35f-2d59-4c14-ad17-bbe439b68b08
                Copyright: © Perspectives in Clinical Research

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Medicine
                chronic obstructive pulmonary disease treatment,diagnosis,general practitioners,management,pulmonologists,spirometry

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