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Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Vulnerability, beliefs, treatments and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross-sectional study

Authors: Peian Lou, Yanan Zhu, Peipei Chen, Pan Zhang, Jiaxi Yu, Ning Zhang, Na Chen, Lei Zhang, Hongmin Wu, Jing Zhao

Published in: BMC Public Health | Issue 1/2012

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Abstract

Background

The incidence of chronic obstructive pulmonary disease (COPD) in China is very high. This study aimed to assess the vulnerability of COPD patients in rural areas outside Xuzhou City, Jiangsu province, in order to provide helpful guidance for future research and public policies.

Methods

The vulnerability of 8,217 COPD patients was evaluated using a face-to-face questionnaire to obtain information on general characteristics, awareness, beliefs, medication usage, acute exacerbation of the disease, and economic burdens. Direct economic burdens were calculated based on the questionnaire, and indirect economic burdens were estimated using local per capita income and life expectancy in 2008. The years of potential life lost were calculated using loss of life years for each age group and multiplying by the number of deaths in a given age group.

Results

Of the 8,217 patients, 7,921 (96.4%) had not heard of COPD, and 2,638 (32.1%) did not understand that smoking was a risk factor for COPD. No patients had used inhalers, nebulizer drugs or oxygen therapy, either regularly or sporadically. No patients had undergone pulmonary rehabilitation or surgical treatment, while 4,215 (51.3%) took theophylline to relieve dyspnea, and 3,418 (41.6%) used antibiotics to treat exacerbations. A total of 2,925 (35.6%) patients had been admitted to hospital during the past year because of respiratory symptoms. The average direct and indirect economic burdens on COPD patients were 1,090 and 20,605 yuan, respectively.

Conclusions

The vulnerability of patients in rural Xuzhou to COPD was high. Their awareness of COPD was poor, their treatment during both the stable and acute exacerbation stages did not meet standards, and the economic burdens were large. Interventions are therefore needed to improve the prevention and management of COPD in this population. Further studies are required to verify these findings.
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Literature
2.
go back to reference Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, Schmid V, Buist S: Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006, 27 (2): 397-412. 10.1183/09031936.06.00025805.CrossRefPubMed Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, Schmid V, Buist S: Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006, 27 (2): 397-412. 10.1183/09031936.06.00025805.CrossRefPubMed
3.
go back to reference Mathers CD, Loncar D: Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006, 3 (11): e442-10.1371/journal.pmed.0030442.CrossRefPubMedPubMedCentral Mathers CD, Loncar D: Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006, 3 (11): e442-10.1371/journal.pmed.0030442.CrossRefPubMedPubMedCentral
4.
go back to reference World Health Organization: World Health Statistics 2008. Geneva: World Health Organization 2008. World Health Organization: World Health Statistics 2008. Geneva: World Health Organization 2008.
5.
go back to reference Chan-Yeung M, Aït-Khaled N, White N, Ip MS, Tan WC: The burden and impact of COPD in Asia and Africa. Int J Tuberc Lung Dis. 2004, 8 (1): 2-14.PubMed Chan-Yeung M, Aït-Khaled N, White N, Ip MS, Tan WC: The burden and impact of COPD in Asia and Africa. Int J Tuberc Lung Dis. 2004, 8 (1): 2-14.PubMed
6.
go back to reference Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, Chen B, Wang C, Ni D, Zhou Y, Liu S, Wang X, Wang D, Lu J, Zheng J, Ran P: Prevalence of chronic obstructive pulmonary disease in China—a large population based spirometry based cross-sectional survey. Am J Respir Crit Care Med. 2007, 176 (8): 753-760. 10.1164/rccm.200612-1749OC.CrossRefPubMed Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, Chen B, Wang C, Ni D, Zhou Y, Liu S, Wang X, Wang D, Lu J, Zheng J, Ran P: Prevalence of chronic obstructive pulmonary disease in China—a large population based spirometry based cross-sectional survey. Am J Respir Crit Care Med. 2007, 176 (8): 753-760. 10.1164/rccm.200612-1749OC.CrossRefPubMed
7.
go back to reference Fang XC, Wang XD, Bai CX: Burden and importance of proper management about chronic obstructive pulmonary disease in China. Int J Respir. 2011, 31 (7): 493-497. Fang XC, Wang XD, Bai CX: Burden and importance of proper management about chronic obstructive pulmonary disease in China. Int J Respir. 2011, 31 (7): 493-497.
8.
go back to reference Bakerly ND, Davies C, Dyer M, Dhillon P: Cost analysis of an integrated care model in the management of acute exacerbations of chronic obstructive pulmonary disease. Chron Respir Dis. 2009, 6 (4): 201-208.PubMed Bakerly ND, Davies C, Dyer M, Dhillon P: Cost analysis of an integrated care model in the management of acute exacerbations of chronic obstructive pulmonary disease. Chron Respir Dis. 2009, 6 (4): 201-208.PubMed
9.
go back to reference Celli BR, MacNee W: Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004, 23 (6): 932-946. 10.1183/09031936.04.00014304.CrossRefPubMed Celli BR, MacNee W: Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004, 23 (6): 932-946. 10.1183/09031936.04.00014304.CrossRefPubMed
10.
go back to reference National Collaborating Centre for Chronic Conditions: Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004, 59 (Suppl 1): 1-232. National Collaborating Centre for Chronic Conditions: Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004, 59 (Suppl 1): 1-232.
11.
go back to reference Kessler R, Stahl E, Vogelmeier C, Haughney J, Trudeau E, Lofdahl CG, Partridge MR: Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study. Chest. 2006, 130 (1): 133-142. 10.1378/chest.130.1.133.CrossRefPubMed Kessler R, Stahl E, Vogelmeier C, Haughney J, Trudeau E, Lofdahl CG, Partridge MR: Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study. Chest. 2006, 130 (1): 133-142. 10.1378/chest.130.1.133.CrossRefPubMed
12.
go back to reference Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J: Impact of COPD in North America and Europe in 2000:subjects’perspective of confronting COPD international survey. Eur Respir J. 2002, 20 (4): 799-805. 10.1183/09031936.02.03242002.CrossRefPubMed Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J: Impact of COPD in North America and Europe in 2000:subjects’perspective of confronting COPD international survey. Eur Respir J. 2002, 20 (4): 799-805. 10.1183/09031936.02.03242002.CrossRefPubMed
13.
go back to reference Wilkinson TM, Donaldson GC, Hurst JR, Seemungal TA, Wedzicha JA: Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004, 169 (12): 1298-1303. 10.1164/rccm.200310-1443OC.CrossRefPubMed Wilkinson TM, Donaldson GC, Hurst JR, Seemungal TA, Wedzicha JA: Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004, 169 (12): 1298-1303. 10.1164/rccm.200310-1443OC.CrossRefPubMed
14.
go back to reference Ulrik CS, Hansen EF, Jensen MS, Rasmussen FV, Dollerup J, Hansen G, Andersen KK, KVASIMODO II study group: Management of COPD in general practice in Denmark – participating in an educational program substantially improves adherence to guidelines. Int J Chron Obstruct Pulmon Dis. 2010, 5: 73-79.CrossRefPubMedPubMedCentral Ulrik CS, Hansen EF, Jensen MS, Rasmussen FV, Dollerup J, Hansen G, Andersen KK, KVASIMODO II study group: Management of COPD in general practice in Denmark – participating in an educational program substantially improves adherence to guidelines. Int J Chron Obstruct Pulmon Dis. 2010, 5: 73-79.CrossRefPubMedPubMedCentral
15.
go back to reference Chen YH, Yao WZ, Kang J, Cai BQ, Zhou X, Liu Z, Chen P, Sun DJ, Zheng JP, Wang GY, Feng YL, Xu YJ, Jia Y, Lu M, Chang C, Wang XH: Attitudes and actions of chronic obstructive pulmonary disease patients on treatment:a national multi-center investigative study. Chin J Tubec Respir Dis. 2010, 33 (10): 750-753. Chen YH, Yao WZ, Kang J, Cai BQ, Zhou X, Liu Z, Chen P, Sun DJ, Zheng JP, Wang GY, Feng YL, Xu YJ, Jia Y, Lu M, Chang C, Wang XH: Attitudes and actions of chronic obstructive pulmonary disease patients on treatment:a national multi-center investigative study. Chin J Tubec Respir Dis. 2010, 33 (10): 750-753.
16.
go back to reference Chai JJ, Liu T, Cai BQ: Evaluation of clinical significance of chronic obstructive pulmonary disease assessment test. Chin J Tubec Respir Dis. 2011, 34 (4): 256-258. Chai JJ, Liu T, Cai BQ: Evaluation of clinical significance of chronic obstructive pulmonary disease assessment test. Chin J Tubec Respir Dis. 2011, 34 (4): 256-258.
17.
go back to reference Fan CF, Yang YF, Cao GW: Application of vulnerability appraising in constructing theoretical model for early warning of emergent public health event. Acad J Sec Mil Med Univ. 2007, 28 (10): 116-119. Fan CF, Yang YF, Cao GW: Application of vulnerability appraising in constructing theoretical model for early warning of emergent public health event. Acad J Sec Mil Med Univ. 2007, 28 (10): 116-119.
18.
go back to reference Chen JC, Wang AM, Wang F: Public Health Emergency Response Mechanism and Assessment System. [J] China Inspection and Quarantine. 2007, 20 (02): 25-26. Chen JC, Wang AM, Wang F: Public Health Emergency Response Mechanism and Assessment System. [J] China Inspection and Quarantine. 2007, 20 (02): 25-26.
19.
go back to reference Chinese Society of Respiratory Disease, chronic obstructive pulmonary disease group: Diagnosis and treatment guidelines of chronic obstructive pulmonary disease(revised edition in 2007). Chin J Intern Med. 2007, 46: 254-261. Chinese Society of Respiratory Disease, chronic obstructive pulmonary disease group: Diagnosis and treatment guidelines of chronic obstructive pulmonary disease(revised edition in 2007). Chin J Intern Med. 2007, 46: 254-261.
20.
go back to reference Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Grit Care Med. 2001, 163 (5): 1256-1276.CrossRef Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Grit Care Med. 2001, 163 (5): 1256-1276.CrossRef
22.
go back to reference Partridge MR, van der Molen T, Myrseth SE, Busse WW: Attitudes and actions of asthma patients on regular maintenance therapy:the INSPIRE study. BMC Pulm Med. 2006, 6: 13-10.1186/1471-2466-6-13.CrossRefPubMedPubMedCentral Partridge MR, van der Molen T, Myrseth SE, Busse WW: Attitudes and actions of asthma patients on regular maintenance therapy:the INSPIRE study. BMC Pulm Med. 2006, 6: 13-10.1186/1471-2466-6-13.CrossRefPubMedPubMedCentral
23.
go back to reference Cai YY, Li ZZ, Fang ZJ: Living quality evaluation of the patients of Chronic obstructive pulmonary disease. Chin J Gen Pract. 2004, 3 (4): 225-227. Cai YY, Li ZZ, Fang ZJ: Living quality evaluation of the patients of Chronic obstructive pulmonary disease. Chin J Gen Pract. 2004, 3 (4): 225-227.
24.
go back to reference CDC: Year of potential life lost before ages 65 and 85,United States,1989-1990. MMWR. 1992, 18: 313- CDC: Year of potential life lost before ages 65 and 85,United States,1989-1990. MMWR. 1992, 18: 313-
25.
go back to reference Kunik ME, Veazey C, Cully JA, Souchek J, Graham DP, Hopko D, Carter R, Sharafkhaneh A, Goepfert EJ, Wray N, Stanley MA: COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial. Psychol Med. 2008, 38 (3): 385-396.CrossRefPubMed Kunik ME, Veazey C, Cully JA, Souchek J, Graham DP, Hopko D, Carter R, Sharafkhaneh A, Goepfert EJ, Wray N, Stanley MA: COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial. Psychol Med. 2008, 38 (3): 385-396.CrossRefPubMed
26.
go back to reference Walker SL, Saltman DL, Colucci R, Martin L: Awareness of risk factors among persons at risk for lung cancer, chronic obstructive pulmonary disease and sleep apnea: A Canadian population-based study. Can Respir J. 2010, 17 (6): 287-294.CrossRefPubMedPubMedCentral Walker SL, Saltman DL, Colucci R, Martin L: Awareness of risk factors among persons at risk for lung cancer, chronic obstructive pulmonary disease and sleep apnea: A Canadian population-based study. Can Respir J. 2010, 17 (6): 287-294.CrossRefPubMedPubMedCentral
27.
go back to reference Ning S, Wanzhen Y, Hong Z: Patient's perspective of chronic obstructive pulmonary disease in Yanqing County of Beijing. Chin J Tuberc Respir Dis. 2008, 31 (3): 206-208. Ning S, Wanzhen Y, Hong Z: Patient's perspective of chronic obstructive pulmonary disease in Yanqing County of Beijing. Chin J Tuberc Respir Dis. 2008, 31 (3): 206-208.
28.
go back to reference Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, Van-Wel C, Zielinski J: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007, 176 (6): 532-555. 10.1164/rccm.200703-456SO.CrossRefPubMed Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, Van-Wel C, Zielinski J: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007, 176 (6): 532-555. 10.1164/rccm.200703-456SO.CrossRefPubMed
29.
go back to reference Zhou Y, Hu G, Wang D, Wang S, Wang Y, Liu Z, Hu J, Shi Z, Peng G, Liu S, Lu J, Zheng J, Wang J, Zhong N, Ran P: Community based integrated intervention for prevention and management of chronic obstructive pulmonary disease(COPD)in Guangdong. China:cluster randomised controlled trial. BJM. 2010, 341: c6387-10.1136/bmj.c6387.CrossRef Zhou Y, Hu G, Wang D, Wang S, Wang Y, Liu Z, Hu J, Shi Z, Peng G, Liu S, Lu J, Zheng J, Wang J, Zhong N, Ran P: Community based integrated intervention for prevention and management of chronic obstructive pulmonary disease(COPD)in Guangdong. China:cluster randomised controlled trial. BJM. 2010, 341: c6387-10.1136/bmj.c6387.CrossRef
30.
go back to reference Tashkin DP: Long-acting anticholinergic use in chronic obstructive pulmonary disease:efficacy and safety. Curr Opin Pulm Med. 2010, 16 (2): 97-105. 10.1097/MCP.0b013e328335df1e.CrossRefPubMed Tashkin DP: Long-acting anticholinergic use in chronic obstructive pulmonary disease:efficacy and safety. Curr Opin Pulm Med. 2010, 16 (2): 97-105. 10.1097/MCP.0b013e328335df1e.CrossRefPubMed
31.
go back to reference Miravitlles M: Prevention of exacerbations of COPD with pharmacotherapy. Eur Respir Rev. 2010, 19 (116): l19-l126.CrossRef Miravitlles M: Prevention of exacerbations of COPD with pharmacotherapy. Eur Respir Rev. 2010, 19 (116): l19-l126.CrossRef
32.
go back to reference Barr RG, Celli BR, Mannino DM, Petty T, Rennard SI, Sciurba FC, Stoller JK, Thomashow BM, Turino GM: Comorbidities, patient knowledge, and disease management in a national sample of patients with COPD. Am J Med. 2009, 122 (4): 348-355. 10.1016/j.amjmed.2008.09.042.CrossRefPubMedPubMedCentral Barr RG, Celli BR, Mannino DM, Petty T, Rennard SI, Sciurba FC, Stoller JK, Thomashow BM, Turino GM: Comorbidities, patient knowledge, and disease management in a national sample of patients with COPD. Am J Med. 2009, 122 (4): 348-355. 10.1016/j.amjmed.2008.09.042.CrossRefPubMedPubMedCentral
33.
go back to reference Restrepo RD, Alvarez MT, Wittnebel LD, Sorenson H, Wettstein R, Vines DL, Sikkema-Ortiz J, Gardner DD, Wilkins RL: Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008, 3 (3): 371-384.PubMedPubMedCentral Restrepo RD, Alvarez MT, Wittnebel LD, Sorenson H, Wettstein R, Vines DL, Sikkema-Ortiz J, Gardner DD, Wilkins RL: Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008, 3 (3): 371-384.PubMedPubMedCentral
34.
go back to reference Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, Garvey C, Goldstein R, Gosselink R, Lareau S, MacIntyre N, Maltais F, Morgan M, O'Donnell D, Prefault C, Reardon J, Rochester C, Schols A, Singh S, Troosters T: American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006, 173 (12): 1390-1413. 10.1164/rccm.200508-1211ST.CrossRefPubMed Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, Garvey C, Goldstein R, Gosselink R, Lareau S, MacIntyre N, Maltais F, Morgan M, O'Donnell D, Prefault C, Reardon J, Rochester C, Schols A, Singh S, Troosters T: American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006, 173 (12): 1390-1413. 10.1164/rccm.200508-1211ST.CrossRefPubMed
35.
go back to reference Wongsurakiat P, Maranetra KN, Wasi C, Kositanont U, Dejsomritrutai W, Charoenratanakul S: Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: a randomized controlled study. Chest. 2004, 125 (6): 2011-2020. 10.1378/chest.125.6.2011.CrossRefPubMed Wongsurakiat P, Maranetra KN, Wasi C, Kositanont U, Dejsomritrutai W, Charoenratanakul S: Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: a randomized controlled study. Chest. 2004, 125 (6): 2011-2020. 10.1378/chest.125.6.2011.CrossRefPubMed
36.
go back to reference Xu F, Liang YQ, Shen HB, Xu YC: Years of potential life lost of chronic obstructive pulmonary diseases among residents in Nanjing from 1997 to 2005. Chin J Epidemiol. 2007, 28 (2): 203-204. Xu F, Liang YQ, Shen HB, Xu YC: Years of potential life lost of chronic obstructive pulmonary diseases among residents in Nanjing from 1997 to 2005. Chin J Epidemiol. 2007, 28 (2): 203-204.
37.
go back to reference Carrasco-Garrido P, de Miguel-Díez J, Rejas-Gutierrez J, Martín-Centeno A, Gobartt-Vázquez E, Hernandez-Barrera V, de Miguel AG, Jimenez-Garcia R: Characteristics of chronic obstructive pulmonary disease in Spain from a gender perspective. BMC Pulm Med. 2009, 9: 2-10.1186/1471-2466-9-2.CrossRefPubMedPubMedCentral Carrasco-Garrido P, de Miguel-Díez J, Rejas-Gutierrez J, Martín-Centeno A, Gobartt-Vázquez E, Hernandez-Barrera V, de Miguel AG, Jimenez-Garcia R: Characteristics of chronic obstructive pulmonary disease in Spain from a gender perspective. BMC Pulm Med. 2009, 9: 2-10.1186/1471-2466-9-2.CrossRefPubMedPubMedCentral
38.
go back to reference Dalal AA, Christensen L, Liu F, Riedel AA: Direct costs of chronic obstructive pulmonary disease among managed care patients. Int J Chron Obstruct Pulmon Dis. 2010, 5: 341-349.CrossRefPubMedPubMedCentral Dalal AA, Christensen L, Liu F, Riedel AA: Direct costs of chronic obstructive pulmonary disease among managed care patients. Int J Chron Obstruct Pulmon Dis. 2010, 5: 341-349.CrossRefPubMedPubMedCentral
Metadata
Title
Vulnerability, beliefs, treatments and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross-sectional study
Authors
Peian Lou
Yanan Zhu
Peipei Chen
Pan Zhang
Jiaxi Yu
Ning Zhang
Na Chen
Lei Zhang
Hongmin Wu
Jing Zhao
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-287

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