Prevalence, socio-economic burden and pharmacologic treatment of COPD in Kyrgyzstan

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and has significant clinical and economic impact on patients and society. While much research has focused on COPD in high-income countries, it’s burden in low-middle-income counties (LMIC) is largely unknown. In this thesis, the prevalence, socioeconomic burden, and pharmacologic treatment of COPD in LMIC was studied, with a focus on the Central Asian country Kyrgyzstan. Using a population-based study, it was revealed that COPD prevalence was much higher in the highlands (37%) of Kyrgyzstan than in the lowlands (10%) and that household air pollution was established as an independent risk factor for COPD in low-resource highlands where indoor-polluting heaters were frequently being used. A subsequent survey highlighted that chronic lung disease in LMIC also heavily impacts on peoples’ work productivity. To reduce the COPD burden in LMIC, evidence-based yet country-tailored guidelines are needed, as was shown in a scoping review of all national COPD guidelines globally. Regarding the economic burden of COPD, over 50% of the total direct medical costs for COPD in Kyrgyzstan were spent on medication, hospitalization and diagnostics and importantly, most patients had to pay for diagnostics and medication out-of-pocket. Medication availability was worrisome with around half of people indicating their medication was not available at the hospital. Even where available, over two thirds of patients indicated that financial barriers prevented them from being adherent. The FRESH AIR project indicates that targeted preventive actions are required to reduce the burden of COPD in LMIC.