Patterns and management of chronic obstructive pulmonary disease in urban and rural China: a community-based survey of 25 000 adults across 10 regions

Om P Kurmi, Kourtney J Davis, Kin Bong Hubert Lam, Yu Guo, Julien Vaucher, Derrick Bennett, Jenny Wang, Zheng Bian, Huaidong Du, Liming Li, Robert Clarke, Zhengming Chen, Om P Kurmi, Kourtney J Davis, Kin Bong Hubert Lam, Yu Guo, Julien Vaucher, Derrick Bennett, Jenny Wang, Zheng Bian, Huaidong Du, Liming Li, Robert Clarke, Zhengming Chen

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with COPD deaths in China accounting for one-third of all such deaths. However, there is limited available evidence on the management of COPD in China.

Methods: A random sample of 25 011 participants in the China Kadoorie Biobank, aged 38-87 years, from 10 regions in China was surveyed in 2013-2014. Data were collected using interviewer-administered questionnaires on the diagnosis ('doctor-diagnosed' or 'symptoms-based') and management of COPD (including use of medication and other healthcare resources), awareness of diagnosis and severity of symptoms in COPD cases.

Results: Overall, 6.3% of the study population were identified as COPD cases (doctor-diagnosed cases: 4.8% and symptom-based cases: 2.4%). The proportion having COPD was higher in men than in women (7.9% vs 5.3%) and varied by about threefold (3.7%-10.0%) across the 10 regions. Among those with COPD, 54% sought medical advice during the last 12 months, but <10% reported having received treatment for COPD. The rates of hospitalisation for COPD, use of oxygen therapy at home and influenza or pneumococcal vaccinations in the previous year were 15%, 3% and 4%, respectively. Of those with COPD, half had moderate or severe respiratory symptoms, and over 80% had limited understanding of their disease and need for treatment.

Conclusion: Despite a high prevalence of COPD in China and its substantial impact on activities of daily living, knowledge about COPD and its management were limited.

Keywords: COPD; China; management; respiratory.

Conflict of interest statement

Competing interests: KD is a full-time employee of and owns shares in GlaxoSmithKline.

Figures

Figure 1
Figure 1
Flow diagram of participants included in the survey. aResponse rate. bActual response rate (participants included in the analysis and had completed all sections that comprised questionnaire, physical measurements and tests during the second resurvey). cChronic obstructive pulmonary disease (COPD) defined by history of doctor diagnosis of COPD=COPD and/or chronic bronchitis and/or emphysema. dSymptom-based COPD are those with self-reported chronic cough, that is, productive cough for at least 3 months for 2 consecutive years.
Figure 2
Figure 2
Prevalence of chronic obstructive pulmonary disease (COPD) defined by different criteria by age, and place of residence. The dark grey bar represents ‘rural’ participants and white bar represents ‘urban’ participants.
Figure 3
Figure 3
Prevalence of chronic obstructive pulmonary disease (COPD) defined by different criteria by region. The dark grey bar represents ‘symptom-based COPD’, grey bar represents ‘doctor-diagnosed COPD’ and the white bar represents ‘symptom-based or doctor-diagnosed COPD’ participants.
Figure 4
Figure 4
Use of medication among chronic obstructive pulmonary disease (COPD) cases by age and place of residence among 1586 COPD cases. The dark grey bar represents ‘rural’ and the white bar represents ‘urban’ participants. Medications include antibiotics or oral steroids or injectable steroids.

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Source: PubMed

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