Abstract
Chronic obstructive pulmonary disease (COPD) is a common disease and among the top causes of mortality worldwide but can be prevented and treated. This study aims to estimate the awareness of COPD among the Syrian population. A cross-sectional anonymous self-administered online survey was conducted by using Google Forms on Social Media platforms. The questionnaire included demographic, smoke-related and COPD-related questions. This study included 1607 participants with 930 (57.8%) females, 40% aging 21–25 years old, more than 90% being university students/graduates and 67.8% living in cities. Around half were either active smokers or had second-hand smoke exposure. After excluding participants in health-related fields who were 950 participants, only 25.4% of the remaining had ever heard of the term COPD. Knowing about COPD was not associated with reported smoking habits. No significant differences in awareness were seen between city and countryside dwellers, governate groups, genders, or age groups. Being in a health-related field was a major factor of being aware of COPD. COPD awareness in Syria is low, even amongst the well-educated group. Moreover, COPD risk factors of smoking and exposure to indoor and outdoor pollutants are common. Raising awareness is crucial in the Syrian community as COPD is highly prevalence.
Introduction
Chronic obstructive pulmonary disease (COPD) is a common condition that has a high prevalence worldwide but it is preventable and can be managed1. It manifests as a partially reversible airflow limitation due to chronic inflammation that most commonly occurs due to exposure to particles and gases, mostly from cigarettes. It is often associated with symptoms of shortness of breath, mainly on exertion, chronic cough, and chronic sputum production1,2,3. In addition to cigarette smoking, COPD may arise from certain occupational or environmental exposures such as coal mining4. Pulmonary function tests (PFT) are essential to document airflow obstruction and confirm COPD diagnosis. Post bronchodilator airflow obstruction is defined as a ratio of forced expiratory volume in the first second to the forced vital capacity (FEV1/FVC) below 0.71,4.
COPD represents a major health concern and ranks as the 3rd leading cause of mortality globally, killing 3.23 million people in 2019, which was approximately 20% of the total deaths occurred in high-income countries5. COPD prevalence varies from one country to another1. Unfortunately, Syria is estimated to have one of the highest COPD prevalence among the Middle Eastern countries as it reached 17.2% compared to 14.3% in other countries in the Middle East and North Africa, adjusted by age and gender using symptoms of persistent coughing or breathlessness6,7 (Fig. 1). COPD is often underdiagnosed until it reaches moderate or severe stages or when the patient is hospitalized due to disease exacerbation8.
Poor public awareness about COPD and its symptoms is a major concern9. Research papers in numerous countries studied the level of knowledge related to COPD among the population and emphasised on the importance of increasing awareness10,11,12,13, especially to help increase smoking cessation and prevent smoking initiation. This is particularly important as governments around the world spend billions combat COPD and its complications, which is particularly important in low-income countries due to the high burden of COPD6. This study aimed to measure the knowledge related to COPD in Syrian population in light of its high prevalence6 and the high prevalence of tobacco and shisha smoking in Syria14.
Methods
A cross-sectional anonymous self-administered online survey was conducted between 9 and 26 August 2021 among Syrian adults (age ≥ 18) through various social media platforms (WhatsApp and Facebook). It was posted daily and assured confidentiality on all participants. People had access to the link of the survey 24/7 and can access it using any device. The survey’s first page was confidentiality statement, explain the goals of the research and the reasons for the questionnaire.
The survey was originally developed following reviewing relevant literature, designed using the Google forms tool, and consists of 24 questions that were completed within 5 min. The questionnaire was split into several sections which were: demographic characteristics such as age, gender, education level, smoking habits, and basic knowledge about COPD such as its prevalence, definition, symptoms, and diagnostic test.
We confirm that all methods were performed in accordance with the relevant guidelines and regulations and in accordance with the Declaration of Helsinki.
All variables are presented as frequency and percentages. Chi-square test was used to determine statistical significance between proportions and differences were statistically significant when p values were ≤ 0.05. SPSS version 25 was used to analyse the data.
Ethics approval and consent to participate
Online informed consent was taken before proceeding with the survey for participating in the research, and for using and publishing the data. We ensure confidentiality was maintained and asked no questions that might reveal any individual’s identity. No subjects were under the age of 18 years. Our study protocol and ethical aspects were reviewed and approved by Damascus University Faculty of Pharmacy, Damascus, Syria.
Results
Demographic characteristics
A total of 1619 Syrian adults started the survey, 1607 of them completed it fully, with 930 (57.8%) being females, and about 40% were in the age range of 21–25 years. In our study, 950 (59.1%) participants were either health-related field university students or graduates. Overall, 703 (43.7%) were university graduates. A total of 657 (40.9%) of respondents were of non-medical background and 67.8% of the total were living in Syrian cities. Demographics of the participants are shown in (Table 1).
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