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Awareness of Chronic Obstructive Pulmonary Disease (COPD) Among Smokers in Saudi Arabia: A Cross-Sectional Study

Faisal Khaled H Alhomayani*, Seham Hassan Almalki, MalakMohammed Alqahtani, Abdullah Hassan Almalki

Medicine Department, Taif University and Nephrology Center, King Abdulaziz Specialist Hospital

Abstract: Background: Knowledge about the COPD disease is a strong shield against suffering from, especially those patients who are acquired from environmental, chemical and habitual factors. Worldwide concepts, smokers are really less aware about the consequences. Objectives: To assess the awareness and level of knowledge about (COPD) among smokersin Saudi Arabia. Subjects and methods: This study was a cross-sectional study carried out in all regions in Saudi Arabia included anyone accepts participation in the questionnaire at any region in Saudi Arabia include Active, Passive and Ex. Smoker. An electronic questionnaire was sent by advanced social contacting to our participants re-analyzed by using SPSS. Results: Weak knowledge was seen in the sector of COPD general knowledge, treatment, relationship with smoking and total knowledge while average knowledge about common symptoms of COPD. The mean and standard deviation of total knowledge was 8.9±5.05. Conclusion: This study showed a low level of awareness about the initiation and progression of the disease and even the linkage between two points (smoking, COPD) is not clear for more than 60% of participants.

Keywords: COPD, Chronic Obstructive Polmunary Disease, Smoking, Smoker, Tobacco, Awareness, Saudi Arabia, KSA

Received October 15, 2019; Revised November 27, 2019; Accepted December 10, 2019

Citation: Faisal Khaled H Alhomayani, Seham Hassan Almalki, MalakMohammed Alqahtani, Abdullah Hassan Almalki, Awareness of Chronic Obstructive Pulmonary Disease (COPD) Among Smokers in Saudi Arabia: A Cross-Sectional Study. American Journal of Medical Sciences and Medicine, 7 (5). 184-189. January 2019. doi:10.12691/ajmsm-7-5-1

1. Introduction

Worldwide death registry regards COPD as the 4th leading cause of death [1]. It is nominated to be the 3rd cause in the beginning of 2020 [2]. World health organization recorded that around 2.75 million deaths are due to COPD, which equals 5% of mortalities worldwide [3]. However, 92% of deaths are due to smoking habits. Patients with history of smoking have high incidence to develop COPD in their life [4]. Despite all biological and molecular theories of COPD disease, lack of awareness is the initial ominous step [5]. The disease is very silent and insidious in onset at first and being aggressive at the final stages when 50% of lung function is being lost. People’s awareness is crucial to prevent developing or aggravating the disease [6,9]. Therefore, it is very important to make people aware about smoking threats and COPD disease linkage. In the future, one can take preventive steps to stop smoking when studying the COPD-smoking relationship [10]. For this reason, we studied awareness and level of knowledge about (COPD) among smokers in Saudi Arabia.

2. Patients and Methods

This study was a cross-sectional study carried out in all regions in Saudi Arabia included anyone accepts participation in the questionnaire at any region in Saudi Arabia include Active, Passive and Ex-Smoker. Passive smoker: is the inhalation of smoke, called second-hand smoke (SHS), or environmental to baccosmoke (ETS), by persons other than the intended "active" smoker. Active smoker is defined as a person who currently smoked at least one cigarette a day. Ex-smoker is defined as a person who had regularly smoked but who had not smoked in the previous month. The sole exclusion criterion is who refuse to share his data in this research.

2.1. Ethical Approval

This study was approved from regional research center and director of primary health care in the institution. Each participant gave a verbal consent prior to recruitment and confidentiality was assured for each situation.

2.2. Study Sample Size Calculation and Method of Sampling

Sample size determination was calculated by a sample calculation website by Clinical Research Training at UCSF. We assume we need 9311 according to confidence level 95% and confidence limit 2%.

The electronic questionnaire was provided to WhatsApp, Facebook, Twitter, and other social media access programs and all smokers were invited to fill it. The questionnaire was developed by the researchers based on intensive literature review and experts' consultations to fulfill the criteria. Study questionnaire was online for at least 5 months and all participants were included consecutively till the end date.

2.3. Data Analysis

Data entry and analysis was conducted using statistical software package SPSS version 25.0. Data were presented using descriptive statistics in the form of frequencies and percentages as all date were of categorized type. Analytic statistics was done using Chi Square tests (χ²) to test for the association and/or the difference between two categorical variables. P-value equal or less than 0.05 was considered statistically significant.

3. Results

3.1. Demographics

The descriptive statistics of our study demographics are plotted in Table 1.

Table 1. Descriptive statistics of demographic distribution

3.2. Smoking History

In Table 2, questions about the smoking history showed that 66% of our participants are Active smokers or Ex-smokers. Ninety-five percent of our participants sit with smoker relatives and/or colleagues. Smoking history was divided into 5,5-10 and more than 10 years. About 40% of our participants smoke for less than 5 years. About 50% of our participants smoke 10-30 cigarettes per day (0.5-1.5 pack/day).

Table 2. Questions about smoking history

3.3. Assessment of Knowledge

In Table 3, there are four sectors of questions about knowledge assessment. Generally speaking, the answers were quietly different with high significance. In the first sector, more than 50% of participants knew about continuous deterioration of COPD, relationship with tobacco smoking and involvement of dust, chemicals and vapors. In the second sectors of questions, assessment of knowledge about the common symptoms revealed that more than 50% of participants knew about common symptoms (chest pain, chronic cough, whistling and fatigue). In the third sector, questioning about the treatment of COPD revealed that most of participants knew about necessity of walking over exercise, stopping exercise in case of acute illness and possibility of deterioration of respiratory function even without superimposed infections. Final sector of questions discussed the relationship of COPD and smoking. Surprisingly, about 70% of patients knew that stop smoking can reduce deterioration in lung function, quitting smoking may reverse lung changes and improving of lung function is done by quitting smoking first.

Weak knowledge was seen in sector of COPD general knowledge, treatment, relationship with smoking and total knowledge while average knowledge about common symptoms of COPD. The mean and standard deviation of total knowledge was 8.9±5.05 as seen Table 4 and Figure 1.

Age, region and number of cigarettes per day were different with statistically significant difference in all four sectors of knowledge. Gender and level of education were found to be statistically significant in knowledge of COPD and treatment. Females were found to be more aware about COPD than males. University attendees had more knowledge than other subgroups. Being a smoker or ex-smoker was associated with significant knowledge in symptoms and relationship of smoking with COPD. Less than 5 years duration of smoking was associated with significant knowledge in COPD disease while those with less than 10 years duration were more aware about symptomatology as seen in Table 5.

Table 3. Assessment of knowledge and awareness about symptoms and fate of COPD patient

Figure 1. Complex Bar chart of Percentages of knowledge among different categories of COPD management

Table 4. Levels of knowledge and percentages among participants with different categories

Table 5. Tabulation of different demographic variables against different types of knowledge

Table 6. Tabulation of demographic factors against total knowledge

In Table 6, all the previously mentioned factors were statistically significant different in case of total knowledge. Age (20-30), female gender, those who were from Qassim and Riyadh, secondary school graduates, ex-smokers or current smokers, smoking for less than 10 years and less than 10 cigarettes where more aware about COPD in the form of total knowledge.

4. Discussion

Our study was conducted on various governorates from our kingdom. This is the first publication done in kingdom to done on awareness of COPD in the population of smokers. Simply, Awareness of COPD in population is weak. Weakness in awareness and knowledge was more in male gender. This is going with same results in Zerifin et al and Suthar et al [11,12].

This study mentioned the prevalence of smoking habits in young populations. This can be attributed to several social factors. A study was conducted by Ljaljevi and coworkers suggesting that up to 100,000 young people start to smoke daily [7]. Most of them are from developing countries.

Certain studies on chemical inhalation due to pollution said that patients were spending hours in polluted spaces with chemicals and dust [10,13]. Prematurity can be attributed to pollution or being in a shared space with a heavy smoker. Our study suggest that, smokers are not aware by their inward and outward hazardous effects as well as progression of COPD [5,8,14].

Smoking have bad impact on the natural course of COPD [15,16]. Despite all these fixed facts, our study population were aware about linkage between smoking and COPD pathophysiology. Male gender and low level of education were the exact prototype of smokers who developed COPD later. This is quite similar to other studies [6,10,17]. This prototype is usually having low level of knowledge about COPD in general and linkage with smoking in particular [5].

In contrast to the nature of progression of the disease and its silent course at the beginning, the results suggest that not even half of the participants aware about it, which means there is a further need for the aware-ness programs in the population who are in the habit of smoking to increase their awareness level.This may reflect an ominous imagination of being questioning early COPD patients with silent insidious start [10,16].

In a study done by Zielinski & Bednarek etal, most of the COPD cases were in the age group of 40-59 years while our maximum age of smoking prevalence was 20-30 years. As per the study, most of the people who have started smokingin their early twenties, have more chances to develop COPD in their forties. However, as per the findings of our study very few participants area ware about it. Regarding similar studies done by Wali and Ghobian on the prevalence and management of COPD in Saudi Arabia, suggesting that kingdom have the appropriate treatment available for the COPD [18,19]. This important information might be known by the population but as per the finding very less people are aware about the treatment options of our kingdom, and very few aware that COPD cannot be cured completely [3,15].

In conclusion, this study showed low level of awareness about initiation and progression of the disease and even the linkage between two points (smoking, COPD) is not clear for more than 60% of participants.

Acknowledgments

We would like to thank Dr. Dalia El-Sayed Desouky Abdellah for her unlimited support. We appreciate the efforts done by data collectors and study subjects for participation in the study.

Conflict of interest

There is no conflict of interest.

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