(measures the resistance in the patient’s
airways) can better assess damage to
the lungs.” These, however, are available
in very few hospitals in the country, bar-
ring the premium ones, she adds.
Under-diagnosis, therefore, appears
to be a serious problem when it comes
to COPD, and not only due to problems
in detection methods. Chhabra adds
‘lack of knowledge’ to the list: “Most pa-
tients are treated by physicians and gen-
eral practitioners, who are the first to be
approached. Awareness of COPD among
these doctors is limited. Most patients
(of COPD) are thus never informed
about their disease. COPD begins insidi-
ously and early symptoms are often ig-
nored or attributed to smoking,” he says.
Budhiraja agrees that inadequate train-
ing and knowledge amongst doctors re-
garding COPD is definitely
an issue, but it’s more
with GPs than pulmon-
ologists. “The 2016 Cipla
study supports a majority
of doctors report seeing
and treating more cases
of asthma than of COPD.
This implies that despite
a high prevalence, COPD
patients in India are ei-
ther not approaching
doctors or are not be-
ing diagnosed properly.
Doctors were also seen
to have a bias—that fe-
male patients would have
asthma and not COPD,
thus missing the properCOPD detection. According to a July
2016 study published in the science
journal Nature, the use of the spirom-
etry test went from 20 to 26 per cent
of physicians, 10 to 12 per cent of GPs
and 55 to 72 per cent of chest physi-
cians across India from 2005 to 2013
respectively. But is the test enough?
“COPD can be estimated with high
diagnostic accuracy with the help of
a well-performed spirometry test in
day-to-day clinical practices. But this
test also indicates the possibility of
asthma, which cannot be ruled out
using only spirometry. This diagnostic
uncertainty leads to an overestimation
of asthma (see box). So clinical and
radiological correlation is also needed
for greater accuracy,” explains Budhi-
raja. Salvi agrees—“Spirometry can
detect obstruction in the
airways, which could mean
that the patient has either
asthma or COPD.”
The right method, ac-
cording to the Burden of
Obstructive Lung Disease
Initiative (BOLD) study, is
to repeat the spirometry
test after using a bron-
chodilator. According to
(Dr) Major Monica Barne
(Retd), of CRF, Pune,
“Other advanced lung
function tests such as a
body plethysmograph
(measures the total ca-
pacity of the lungs), or
an impulse oscillometerHealthReadeRsdigest.co.in 71courtesy: rina mukherji
“Advanced lung tests
are essential for better
assessment of damage
to the lungs and correct
diagnosis of COPD.”
(Dr) Major Monica
Barne (Retd),
Chest Research Foundation,
Pune