Date of Award

4-2023

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Grace Shayo

Second Supervisor/Advisor

Mandela Makakala

Third Supervisor/Advisor

Tumbwene Mwansisya

Department

Internal Medicine (East Africa)

Abstract

Background

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable non communicable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development. It is associated with a lot of risk factors such as smoking, biomass fuel use for cooking and air pollutants in general.

Objectives

The primary objective of this research was to determine the functional status of patients with COPD. The secondary objectives were to determine the factors influencing the functional status of patients with COPD.

Methods

The study was a cross sectional study which enrolled one hundred and twenty participants with COPD attending tertiary hospitals in Dar es salaam, of which majority were enrolled via telephonic interview after being identified from the outpatient registry of patients with COPD attending the tertiary hospitals, and others via face to face interview for those who were directly recruited from the outpatient clinics. The mMRC was used as an estimate of the functional status of the enrolled COPD patients. The redefined GOLD criteria (A, B, C, D) was used to assess disease severity.

Results

A total of 120 participants were enrolled into with COPD attending the tertiary hospitals with a mean age of 68.18 (±12.372), and 55% of them were males. Majority of the participants were married 76.7%. Majority (45.8%) of the participants engaged in agricultural activities and 12.5% were office employees . Whereas industrial/mine workers made up 5.8%, and 11.7% were retired, entrepreneurs were 9.2%, and others were 19.4%. In terms of education, most of the participants had a primary level of education, which made up 53.3%, secondary school 14.2%, college/university 17.5% and 15% were without any formal education. Cigarette smoking (35%) was found to be the most prevalent risk factor followed by firewood use (34.2%). However, in 11.7% of the participants no obvious risk factor could be identified. Occupational risk factor and previous TB infection each contributed to 11.7% and 7.5% respectively, of the risk factors. Majority of participants had an mMrc score of less than 2 (51.7%), and a CAT score of ≥10 (70.8%). The severity distribution of patients was mostly in class D with 44.2%, followed by class B (25.8%), class A (19.2%), and class C (10.8%) in decreasing order of prevalence. Most of the patients were on combination inhaler medications mostly consisting of long-acting beta agonists and inhaled corticosteroids (58.3%). Only the CAT score showed a significant association with the functional status outcome when the Chi square cross tabulation was done, with a p-value of 0.000. Thereafter a binary logistic regression was done which showed that participants with a CAT score of less than ten were less likely to have a poor function status with an odds ratio of 0.101 with a confidence interval of 95% (0.035-0.286).

Conclusion

Nearly half of participants with COPD had poor functional status and they had a score of equal or more than two on the mMRC score. However, only the CAT score was found to be statistically significant as a predictor of the functional status outcome.

Recommendation

Because a significant number of participants in our study had poor function status, further studies must be done in this group of patients to evaluate what interventions can improve their functional status in our setting. The use of mMRC in conjunction with CAT tool can be used as a quick way of assessing patients at high risks and taking appropriate measures. Moreover, more studies are required in this field involving multiple centers and using spirometry to better understand the characteristics of COPD patients in our setting.

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