High prevalence of COPD symtoms in the Tunisian population contrasting with low awareness of the disease

Introduction: In Tunisia, the estimated prevalence of chronic obstructive pulmonary disease (COPD) was low compared with America and Europe and the disease is certainly under diagnosed. Aims and objectives: We have estimated the prevalence of COPD in the city of Sousse, following the Burden of Obstructive Lung Disease (BOLD) protocol. Methods: we surveyed a representative random sample of 807 adults aged 40 years+ selected from the general population and have collected information on respiratory history and symptoms, risk factors for COPD and health status. Post-bronchodilator spirometry was performed for assessment of COPD. COPD and its stages were defined according to GOLD guidelines. Population weighted prevalence of COPD were computed allowing for survey design. Results: 661 subjects were included in the final analysis. The response rate was 90%. The estimated population prevalence of GOLD Stage 1 and stage 2 or higher COPD were 7.8% and 4.2%, respectively (LLN modified stage 1 and stage 2 or higher COPD prevalence were 5.3% and 3.8%, respectively). COPD was far more common in men, increased with age and exposure to tobacco smoke. Prevalence of stage 1+ COPD was 2.3% in <10 pack years smoked and 16.1% in 20+ pack years smoked. Only 3.5% of participants reported doctor-diagnosed COPD.Conclusions: In this Tunisian population, the prevalence of COPD is higher than reported before and higher than self-reported doctor-diagnosed COPD. The implications for disease diagnosis and management in clinical practices might have a public health impact. In subjects with COPD, age seems to be a much more powerful predictor of lung function than smoking. LLN _ Lower Limit of Normal; BOLD.