Elsevier

Respiratory Medicine

Volume 106, Supplement 2, December 2012, Pages S33-S44
Respiratory Medicine

Management of chronic obstructive pulmonary disease in the Middle East and North Africa: Results of the BREATHE study

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Summary

Chronic obstructive pulmonary disease (COPD) is a potentially severe chronic progressive respiratory condition requiring long-term treatment and frequently involving episodic hospitalisations to manage exacerbations. The objective of this analysis was to document diagnosis, evaluation, treatment and management of COPD-related respiratory symptoms in 1,392 subjects fulfilling an epidemiological definition of COPD identified in a general population sample of 62,086 individuals aged ⩾ 40 years in ten countries in the Middle East and North Africa region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan. 442 subjects (31.8%) claimed to have received a diagnosis of COPD from a physician and 287 (20.6%) had undergone spirometry in the previous year. Use of specific treatments for respiratory symptoms was reported by 218 subjects (15.7%). Use of inhaled long-acting bronchodilators together with corticosteroids (53 subjects; 3.8%) and use of oxygen therapy (31 subjects; 2.3%) was very low. 852 subjects (61.2%) had consulted a physician about their respiratory condition at least once in the previous year, with a mean number of consultations of 3.4±3.6. Moreover, 284 subjects (20.4%) had been hospitalised overnight for their COPD, with a mean of 2.3±3.7 hospitalisations per year. Use of all healthcare resources was significantly higher (p < 0.001) in subjects with CAT scores ⩾10 than in those with scores < 10, and greater in those with exacerbations than in those without. In conclusion, COPD in the region is under-diagnosed, inadequately evaluated and inadequately treated. Nonetheless, COPD symptoms are responsible for considerable healthcare consumption, with high levels of physician consultation and hospitalisation.

Keywords

COPD
Management
Middle East
North Africa
Diagnosis
Treatment

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Conflict of interest statement

MI has received honoraria from GlaxoSmithKline Laboratories for his contribution to the BREATHE study and has received speaking honoraria from AstraZeneca, Novartis, Sanofi, MSD, Pfizer, Actelion and Bayer. M-LK, ST, NS, MP, ABK, AA, GI, AK and AJ have received honoraria from GlaxoSmithKline Laboratories for their contribution to the BREATHE study. NR and AEH are employees of GlaxoSmithKline Laboratories, which funded the BREATHE study and market a number of treatments for COPD.

A

All academic authors contributed equally to the work presented.

B

BREATHE Steering Committee members (in alphabetical order of names): Ashraf Alzaabi, Zayed Military Hospital, Abu Dhabi, UAE; Majed Beji, La Rabta Hospital, Tunis, Tunisia; Ali Ben Kheder, Abderrahmane Mami Hospital, Tunis, Tunisia; Majdy Idrees, Riyadh Military Hospital, Riyadh, Saudi Arabia; Ghali Iraqi, Moulay Youssef Hospital, Rabat, Morocco; Arshad Javed, Lady Reading Hospital, Peshawar, Pakistan; Javaid Ahmed Khan, Aga Khan University Hospital, Karachi, Pakistan; Adel Khattab, Ain Shams University, Cairo, Egypt; Marie Louise Koniski, Lebanese American University, Beirut, Lebanon; Bassam Mahboub, University of Sharjah, Sharjah, UAE; Salim Nafti, Mustapha Bacha Hospital, Algiers, Algeria; Nathir M. Obeidat, University of Jordan, Amman, Jordan; Mehmet Polatli, Adnan Menderes University, Aydin, Turkey; Abdullah Sayiner, Ege University, Izmir, Turkey; Naem Shahrour, Alasaad University Hospital, Damascus, Syria; Mohamed Awad Tageldin, Ain Shams University, Cairo, Egypt; Samya Taright, Bab-El-Oued Hospital, Algiers, Algeria; Esra Uzaslan, Uludag University Medical Faculty, Bursa, Turkey; Siraj Wali, King Abdulaziz University, Jeddah, Saudi Arabia.

BREATHE core team members: Abdelkader El Hasnaoui, GlaxoSmithKline, Dubai, UAE; Nauman Rashid, GlaxoSmithKline, Dubai, UAE; Aïcha Lahlou, MS Health, Rabat, Morocco; Adam Doble, Foxymed, Paris, France, Hocine Salhi, Foxymed, Paris, France and Chakib Nejjari Faculty of Medicine of Fez, Fez, Morocco.