Prevalence and Determinants of Chronic Obstructive Pulmonary Disease (COPD) in Bangladesh.
BACKGROUND
There is a paucity of population-based data on COPD prevalence and its determinants in Bangladesh.


OBJECTIVE
To measure COPD prevalence and socioeconomic and lifestyle determinants among ≥40 years Bangladeshi adults.


METHODS
In a cross-sectional study, we measured lung function of 3744 randomly selected adults ≥40 years from rural and urban areas in Bangladesh, using a handheld spirometer. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as post-bronchodilator ratio of Forced Expiratory Volume in 1st second (FEV1) to Forced Vital Capacity (FVC) < 0.7. In addition, COPD was also assessed by the lower limit of normal (LLN) threshold defined as lower fifth percentile for the predicted FEV1/FVC.


RESULTS
The prevalence of COPD was 13.5% by GOLD criteria and 10.3% by LLN criteria. Prevalence of COPD was higher among rural than urban residents and in males than females. More than half of the COPD cases were stage II COPD by both criteria. Milder cases (Stages I and II) were over estimated by the GOLD fixed criteria, but more severe cases (Stages III and IV) were similarly classified. In multiple logistic regression analysis, older age, male sex, illiteracy, underweight, history of smoking (both current and former), history of asthma and solid fuel use were significant predictors of COPD.


CONCLUSIONS
COPD is a highly prevalent and grossly underdiagnosed public health problem in Bangladeshi adults aged 40 years or older. Illiteracy, smoking and biomass fuel burning are modifiable determinants of COPD.
a 1 Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Mohakhali , Dhaka , Bangladesh.|b 2 Centre for Global Health Research , Li Ka Shing Knowledge Institute, St. Michael Hospital , Toronto , Ontario , Canada.
Dewan S
DS
Alam
a 1 Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Mohakhali , Dhaka , Bangladesh.
Muhammad Ah
MA
Chowdhury
a 1 Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Mohakhali , Dhaka , Bangladesh.
Ali T
AT
Siddiquee
a 1 Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Mohakhali , Dhaka , Bangladesh.
Shyfuddin
S
Ahmed
a 1 Centre for Control of Chronic Diseases (CCCD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Mohakhali , Dhaka , Bangladesh.
John D
JD
Clemens
D000328:Adult; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors; D013147:Spirometry
Bangladesh; COPD; determinants; prevalence; spirometry