Simple lung screening method could save lives

[NAIROBI] Deaths from common lung diseases are on the rise in Sub-Saharan Africa but a simple screening method could significantly reduce their occurrence in the region, a study says.

According to the study by a team of US scientists, chronic obstructive pulmonary disease (COPD) affects more than 300 million people globally, with the highest burden in low- and middle-income countries (LMICs).

COPD is a group of diseases including bronchitis and emphysema that increase airflow blockage and cause breathing-related problems.

Community surveys conducted between 2013 and 2019 found that the burden of COPD varied from 2.4 per cent in Cameroon to 16.2 per cent and 17.5 per cent respectively in Uganda and Tanzania.

The study, published last month in the Journal of the American Medical Association, showed that people at high-risk of COPD could be identified in 7-8 minutes using a questionnaire either alone or in combination with an instrument that measures how fast a person can breathe out air.

“We were motivated by this gap, and desired to design simple tools to increase screening and improve management of COPD patients in LMICs.”

Patricia Alupo, Makerere University’s Lung Institute

The large-scale study was conducted in Nepal, Peru and Uganda from January 2018 to March 2020 among 10,709 men and women aged at least 40 years old. It found that the prevalence of COPD varied from country to country, from three per cent in Lima, Peru, to seven per cent in Nakaseke, Uganda and 18 per cent in Bhaktapur, Nepal.

“COPD is underdiagnosed and yet morbidity and mortality [is] increasing,” says Patricia Alupo, a co-author of the study. “We were motivated by this gap and desired to design simple tools to increase screening and improve management of COPD patients in LMICs where the burden is biggest.”

According to the World Health Organization, COPD caused more than three million deaths in 2019, with about 80 per cent of them occurring in LMICs. Those with COPD are also more likely to get severe COVID-19.

The main causes of COPD in LMICs include household air pollution resulting from biomass smoke for cooking and heating, chronic asthma and lung damage that occur because of tuberculosis.

Alupo, who is an internal medicine physician and a clinical researcher at Makerere University Lung Institute in Uganda, tells SciDev.Net that the “gold-standard” diagnosis of COPD in LMICs is through a method called spirometry, but this is hindered by issues such as a shortage of clinicians who can perform and interpret the tests, and rollout costs.

“The screening tool that we evaluated and found feasible to administer could translate into more screening of COPD, with faster results and thus improved management,” Alupo explains, adding that African health experts should consider it to help address the escalating burden of COPD in the region.

Lydia Atambo, a medical doctor and research fellow based at the Amref International University in Kenya, says that the basic assessment questionnaire could be useful in assessing the severity and duration of exposure to inhaled irritants.

“Simple questions can explore the presence of breathing changes in the patient. The extent of the breathing changes can then determine the extent of the damage. The information can be a very easy and simple guide to assess the severity of the injury,” Atambo tells SciDev.Net.

She adds that the findings confirm that COPD is a serious health burden in Sub-Saharan Africa, and concerted efforts are urgently needed to reduce increased cases and deaths.

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.