Chronic obstructive pulmonary disease (COPD), a group of diseases that cause airflow blockage and breathing-related problems, is the world’s third leading cause of death, surpassed only by ischaemic heart disease and stroke. An estimated 90% of COPD-related deaths occur in low and middle-income countries (LMICs), where spirometry, considered the gold standard for diagnosing COPD, is often not available. A study published this month, however, found that implementing a set of low-cost screening tools could greatly improve COPD diagnosis in LMICs. If such screening methods are widely deployed, GlobalData epidemiologists expect that the diagnosed prevalent cases of COPD will increase in the 16 major pharmaceutical markets (16MM, namely the US, France, Germany, Italy, Spain, UK, Japan, Australia, Brazil, Canada, China, India, Mexico, Russia, South Africa and South Korea) as more people are diagnosed with COPD. 

The study, conducted by Siddharthan and colleagues and published in JAMA, compared the accuracy of three questionnaires, sometimes coupled with a peak expiratory flow (PEF) assessment to test how fast a person can exhale, with the gold standard of spirometry to diagnose COPD. More than 10,700 adults living in Nepal, Peru and Uganda were screened using these tools. The authors found that COPD could be identified within eight minutes using any of the three questionnaires, with or without a PEF assessment. In addition, 95% of cases in the study were previously undiagnosed with COPD.

In the 16MM, GlobalData epidemiologists expect diagnosed prevalent cases of COPD in men and women to surpass 141.5 million by 2028 (as shown in Figure 1). But if these simple, low-cost screening tools, including questionnaires and PEF, are widely implemented in LMIC, increased COPD case identification could lead to diagnosed prevalent cases exceeding those currently forecast.

In high-income countries such as the US, long-term cigarette smoking causes the lung damage that eventually leads to COPD. But exposure to household biomass smoke, produced during the combustion of wood and coal used for cooking and heating, is a major cause of COPD in low- and middle-income countries. Expanded screening in these countries is the first step to bringing relief to the many people suffering from the symptoms of COPD who do not have an official diagnosis. Additional work will be needed to determine if COPD screening can be feasibly carried out in routine LMIC healthcare settings.