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      A comparative study of COPD burden between urban vs rural communities in northern Thailand

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          COPD prevalence and consequent burden are expected to rapidly increase worldwide. Until now, there has been no community-based study of COPD in Thailand.


          We aimed to compare the prevalence, clinical characteristics, disease severity, previous diagnosis, and management of COPD between urban and rural communities.

          Materials and methods

          A population-based cross-sectional study was designed to compare COPD prevalence and burden in rural and urban communities in Chiang Mai Province, Thailand. The COPD subjects were diagnosed and severity categories assigned using Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The prevalence between the groups was compared using risk regression analysis. Unpaired t-test and chi-square were used to compare differences between the groups.


          There were 574 and 293 enrolled subjects with acceptable spirometry, in rural and urban communities respectively. The prevalence of COPD in general and COPD in females was higher in the rural group (6.8% vs 3.7% and 4.4% vs 0.9%, respectively) across all independent variables. However, after adjustment for age, sex, and smoking status, no significant differences were demonstrated. Although the pulmonary function and disease severity between the two groups were not significantly different, the tendency was more pronounced in the rural group (COPD stage III–IV: 65.0% vs 33.3%). Most of the COPD patients in both groups were underdiagnosed (80.0% vs 77.2%) and undertreated (85.0% vs 81.9%). None of the patients in the study had participated in exercise training programs.


          The prevalence of COPD in general and particularly COPD in females tended to be higher, with more severe disease in the rural community. However, both groups were similarly underdiagnosed and undertreated.

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          Most cited references 20

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          Sampling techniques

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            The European Community Respiratory Health Survey.

            The European Community Respiratory Health Survey (ECRHS) was planned to answer specific questions about the distribution of asthma and health care given for asthma in the European Community. Specifically, the survey is designed to estimate variations in the prevalence of asthma, asthma-like symptoms and airway responsiveness; to estimate variations in exposures to known or suspected risk factors for asthma, and assess to what extent these variations explain the variations in the prevalence of disease; and to estimate differences in the use of medication for asthma. The protocol provides specific instructions on the sampling strategy adopted by the survey teams, as well as providing instructions on the use of questionnaires, the tests for allergy, lung function measurements, tests of airway responsiveness, and blood and urine collection. The principal data collection sheets and questionnaires are provided in the appendices, together with information on coding and quality control. The protocol is published as a reference for those who wish to know more of the methods used in the study, and also to give other groups who wish to collect comparable data access to the detailed methodology.
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              Comorbidities in chronic obstructive pulmonary disease.

              Comorbidities such as cardiac disease, diabetes mellitus, hypertension, osteoporosis, and psychological disorders are commonly reported in patients with chronic obstructive pulmonary disease (COPD) but with great variability in reported prevalence. Tobacco smoking is a risk factor for many of these comorbidities as well as for COPD, making it difficult to draw conclusions about the relationship between COPD and these comorbidities. However, recent large epidemiologic studies have confirmed the independent detrimental effects of these comorbidities on patients with COPD. On the other hand, many of these comorbidities are now considered to be part of the commonly prevalent nonpulmonary sequelae of COPD that are relevant not only to the understanding of the real burden of COPD but also to the development of effective management strategies.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                02 June 2015
                : 10
                : 1035-1042
                Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
                Author notes
                Correspondence: Chaicharn Pothirat, Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthavaroros Road, Sri Phum, Muang Chiang Mai District, Chiang Mai 50200, Thailand, Tel +66 53 946 228, Fax +66 53 895 117, Email cpothira@
                © 2015 Pothirat et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                Respiratory medicine

                chronic obstructive pulmonary disease, spirometry, prevalence


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