A study on clinico social profile of patients attending Katuri Medical College Hospital, Guntur

Background: As COPD is fast emerging like epidemic spread by giving a threat to world with the increased proportion of cigarette smoking in developing countries especially India and China and is expected to become the third leading cause of death in the world by 2020, the present study was taken up to evaluate the clinical social distribution of the disease for the purpose of better understanding. Methodology: The setting of the study was at the Katuri Medical College Hospital, Guntur, Andhra Pradesh. A cross sectional study was conducted by examining 110 COPD patients of both sex at the out-patients department of Pulmonary Medicine. Results: In this study about 70% were males and 30% were females. Maximum about 60.9% were belonged to 40-60 years of age group with the mean age of 58.5 years and M±2SE = 56.86 – 60.14 at 95% CI. Agriculture is the main occupation (31.8%) and 59% were smokers. Conclusions: Among all the COPD patients about 51% were developed emphysema and bronchitis, 8% cardiomegaly with enlarged pulmonary artery. And by Echocardiography it was identified that 4% developed mild PAH, followed by 21% moderate PAH, 9% Severe PAH, 18% RV hypertrophy, 4% Cardiac Arrhythmias and 8% Cardiac failure significantly. Introduction Chronic obstructive pulmonary disease (COPD) is one of the major cause of chronic morbidity & mortality in the world among the adult population and occupies 4 leading cause of deaths in the world [1] and projected to be 3 leading cause of death by 2030 worldwide because of continued exposure to risk factors and aging of the population [2]. According to statistical projections COPD will be 7 leading cause of disability adjusted life years (DALY) lost world wide by 2030. The Global Burden of Disease Study reports a prevalence of 251 million cases of COPD globally in 2016. Globally, it is estimated that 3.17 million deaths were caused by the disease in 2015 (that is, 5% of all deaths globally in that year). More than 90% of COPD deaths occur in low and middle income countries [3]. The primary cause of COPD is exposure to tobacco smoke (either active smoking or second hand smoke [3]. Smoking significantly not only increases incidence and prevalence of disease, but also it causes high morbidity and mortality among these patients and is directly proportional to duration and consumption of number cigarettes per day (Smoking Index) [4]. Besides inflammation caused by smoking and air pollution etc, two other processes are involved in the pathogenesis of COPD that is an imbalance between proteases and anti proteases and between oxidants and antioxidants (Oxidative stress) in the lungs [5,6]. As we all know that COPD is characterized by slowly progressive air flow obstruction, resulting in dyspnoea, exercise limitation and pulmonary arterial hypertension which causes major cardiovascular complications. Right ventricular (RV) dysfunction is also common in COPD patients particularly in those with low oxygen saturation which contributes to overall decrease in functional status and high mortality. So its early recognition and treatment may lead to prolonged survival and improved quality of life. Thus this study was under taken to study the socio clinical profiles of the COPD patients attending our teaching hospital by history taking, clinical examination includes chest X-ray and Echocardiography tests etc, to know their health status and early recognition of cardiac involvement and to plan the management to prolong their life. Materials and Methods The current study was conducted during the period from January 2018 to December 2018 at OP Department of Pulmonary medicine, Katuri Medical College Hospital, Guntur, AP, India. Basing on the hospital census the prevalence of the COPD patients attending chest OP was found to be 50%. So the sample size was calculated buy using Article Info Received: 26th June, 2019 Accepted: 8th August, 2019 Published Online: 18th September, 2019


Introduction
Chronic obstructive pulmonary disease (COPD) is one of the major cause of chronic morbidity & mortality in the world among the adult population and occupies 4 th leading cause of deaths in the world [1] and projected to be 3 rd leading cause of death by 2030 worldwide because of continued exposure to risk factors and aging of the population [2]. According to statistical projections COPD will be 7 th leading cause of disability adjusted life years (DALY) lost world wide by 2030. The Global Burden of Disease Study reports a prevalence of 251 million cases of COPD globally in 2016. Globally, it is estimated that 3.17 million deaths were caused by the disease in 2015 (that is, 5% of all deaths globally in that year). More than 90% of COPD deaths occur in low and middle income countries [3].
The primary cause of COPD is exposure to tobacco smoke (either active smoking or second hand smoke [3]. Smoking significantly not only increases incidence and prevalence of disease, but also it causes high morbidity and mortality among these patients and is directly proportional to duration and consumption of number cigarettes per day (Smoking Index) [4].
Besides inflammation caused by smoking and air pollution etc, two other processes are involved in the pathogenesis of COPD that is an imbalance between proteases and anti proteases and between oxidants and antioxidants (Oxidative stress) in the lungs [5,6].
As we all know that COPD is characterized by slowly progressive air flow obstruction, resulting in dyspnoea, exercise limitation and pulmonary arterial hypertension which causes major cardiovascular complications. Right ventricular (RV) dysfunction is also common in COPD patients particularly in those with low oxygen saturation which contributes to overall decrease in functional status and high mortality. So its early recognition and treatment may lead to prolonged survival and improved quality of life. Thus this study was under taken to study the socio clinical profiles of the COPD patients attending our teaching hospital by history taking, clinical examination includes chest X-ray and Echocardiography tests etc, to know their health status and early recognition of cardiac involvement and to plan the management to prolong their life.

Materials and Methods
The current study was conducted during the period from January 2018 to December 2018 at OP Department of Pulmonary medicine, Katuri Medical College Hospital, Guntur, AP, India. Basing on the hospital census the prevalence of the COPD patients attending chest OP was found to be 50%. So the sample size was calculated buy using the formula N= 4PQ/ L 2 where P =50%, Q= 100-P i.e., 50%, L = 10 % absolute error so the N = 100 by adding 10% attrition finally 110 COPD patents were taken into study. An ethical committee approval and written informed consent of study subjects was obtained.
And among all the COPD patients of both sex attending chest OP during the above period, every alternate patient was selected as study subject until the required sample is obtained after receiving the informed consent. They were interviewed by using a pretested Pro-forma including information about their socio-demographic profiles like age, sex, occupation and habits like smoking etc. And they were also examined clinically subjecting them to undergo ECG, Echo cardiography, etc.
The collected data was analysed and presented by using appropriate statistical techniques and methods like measures of central tendency, dispersion, percentages, proportions, standard error of mean and tests of significance etc so as to achieve the prescribed objectives like 1. To know the sociodemographic profiles and 2. To study the clinical pattern of distribution of disease etc with the help of computer software. The study observations were discussed in the light of published material of various authors of relevant studies and accordingly the conclusions and recommendations were made. 1. In this study it was observed that among the total study subjects males were 70% (77) and females were 30% (33). Related to age majority of the study subjects were observed between 51-60 years 47(42.7%) followed by 61-70 years 35(31.8%) and 40-50 years 20(18%). 2. And it is also identified that related to severity of the disease moderate COPD patients were more in number which accounts for 89(81%). 1. Related to occupation majority of the study subjects were confined to agriculture related 49 (44.5%) followed by daily wage workers 35(31.8%) and drivers 14(12.7%). 2. Among the total study group history of smoking was found to be 59%. 1. In this study among the COPD patients mixed findings like emphysema and bronchitis together was observed as 51% followed by chronic bronchitis 27.2%., emphysema 13.6% and cardiomegaly with enlarged pulmonary artery 8.1% in chest X-ray.
Related to occupation majority of the group were belonged to Agriculture related (44.5%) followed by daily wage workers (31.8%) and drivers & others (23.6%). In Rathi et al., study [7] it was (30%) in agriculture related occupation. So common factor noticed in all the above occupations was exposure to smoke, dust and noxious gases etc were implicated as the cause for development of chronic airflow obstruction.
In our present study by studying the chest X-ray it was observed that about 51% of the COPD patients had features suggestive of emphysema and bronchitis Significantly followed by more than 8% Cardiomegaly with enlarged Pulmonary artery and these figure were comparable with the figures of Agarwal et al., study [13], Vikhe et al., study [9].

Conclusions
As the majority of the study subject's occupation was associated with wide explore to noxious gases and variety of dust, it is important to educate them to take specific control & personal protective measures like wearing mouth and face mask, sufficient ventilation at work place during their time of work.
Smoking as a major risk factor concerned to COPD, we need to educate the target population by means of various health education & counselling methods using social, electronic and print media so as to achieve cessation at required levels.
By means of using simple non invasive laboratory investigations like chest X-ray ECG and 2D echocardiography, it is possible to detect easily and early the adverse consequences of COPD like PAH and RV dysfunction etc directing to moderate and Severe and OPD patients will allow us to take early intervention to prolong the life span of the effected individuals.
Source of funding None.

Conflict of interest
None declared