@2024 Afarand., IRAN

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ISSN: 2383-3483    Journal of Police Medicine 2019;8(2):65-68

Background
Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality in industrialized and developing countries. In 1997, the disease was reported as the fourth leading cause of death in the world after cardiovascular disease, tumors and cerebrovascular events. It is estimated to be the third cause of death worldwide in 2020 [1-3].
Previous Studies
Chronic obstructive pulmonary disease is affected by various risk factors that alone or in combination with exacerbation of the effects of each other cause the disease. Most notably are smoking as the main risk factor, respiratory infections, air pollution and contact with other industrial pollutants in the air and occupational exposure. Police personnel are among the at-risk people who are at high risk because of their occupational conditions. For example, traffic forces that are present in roads and streets throughout the day and exposed to the highest levels of air pollution for long periods of time, which are factors in the development of chronic obstructive pulmonary disease [4]. Today, epidemiological research is of great importance for the organization of disease in the community, assessing the causes and risk factors of the disease as well as the impact of the disease on individuals and society [5].
Aim(s)
The aim of this study was to investigate the epidemiology of patients with chronic obstructive pulmonary disease in an emergency department of one of the university centers.
Research type
This is a cross-sectional study.
Research society, place and time
This study was performed in emergency department of Imam Hossein Hospital in Tehran in the first 6 months of 2017 in patients with dyspnea diagnosed with chronic obstructive pulmonary disease on the basis of clinical and history criteria (chronic dyspnea, cough and sputum with long history of Tobacco and drug use) without any restrictions on age or sex.
Sampling method and number
All patients were enrolled in the census method (unless they were unwilling to participate in the study). Also, patients who had come to the emergency department with the same complaint, but eventually found another diagnosis such as chronic heart failure, pulmonary embolism, asthma, etc., were excluded.
Used devices&materials
To collect data, a checklist was designed by the researchers. This checklist contained questions about age, gender, initial complaint, history of chronic obstructive pulmonary disease, history of drug use, tobacco use, accompanying illnesses, and treatment measures presented in the emergency department. This checklist was completed by medical students at the time of arrival of the patients and after the visit of a specialist in emergency medicine and the initial treatment required to stabilize them. At the end of the follow up, the length of hospital stay was also recorded in the hospital. The research protocol was approved by the ethics committee of Shahid Beheshti University of Medical Sciences. In order to maintain the principles of privacy and confidentiality, all information was analyzed without the names and the results were presented in general. Data were analyzed using SPSS 21 software. Describing quantitative data was done using mean and interquartile indices and describing qualitative data was done using frequency and percentages. Chi-square test was used to compare the qualitative variables between two sexes and the Mann-Whitney test was used for quantitative variables.
Findings by Text
Out of 79345 patients in the emergency department of the hospital under study, 87 (0.01%) patients were diagnosed with chronic obstructive pulmonary disease, of which 62 (71.3%) were male and 25 (28.7%) were female. One (1.1%) patient was in the age group of 20-40 years old, 22 (25.3%) were in the age group of 40-60 years, 47 (54.0%) were in the age group of 60-80 years and 17 (19.5%) patients were more than 80 years old. It should be noted that of these, 11 cases had the history of working in the police force (Table 1).The most common primary complaint in 48 patients (55.2%) was dyspnea. The history of the disease in 59 (67.8%) patients was less than 5 years. Also, 79 patients (90.8%) were treated and used drugs, while 8 (9.2%) of patients did not use any drugs. A total of 25 (28.7%) patients did not have any other disease. Three (3.5%) of the patients smoked less than 10 packs per year, and 35 (40.2%) smoked more than 40 packs per year. The most commonly associated illness was hypertension, which was found in 50 (57.5%) patients. The most commonly used drug in the emergency department was inhaled anticholinergic, which was prescribed in 100% of patients. The sole Inhaled beta-agonist was salbutamol, which was prescribed in 98.9% of patients. Antibiotics, inhaled corticosteroids, injectable corticosteroids, and other drugs were prescribed in 96.6%, 73.6%, 48.3%, and 31.0% of cases, respectively. The minimum hospital stay was 3 days and maximum 14 days. The mean period of hospitalization was 7 days. In women, the mean length of duration of hospitalization was 8 days in range (5-14 days) and it was 6 days in range (5-14 days) in men, The duration of hospitalization was significantly higher in women than men (p = 0.009).
Main comparison to the similar studies
In the study of Manino, who has carried out an epidemiological study of the disease and its risk factors, the results show that the main risk factor for the disease is long-term smoking. Due to the increasing prevalence of smoking in society, even among adolescents and women, the prevalence of the disease in these groups has also increased [6] which is consistent with the results of the present study. In an epidemiological study conducted by Jindel et al in India, the prevalence of the disease was estimated at 4.1% of the 35291 studied population, with a male to female ratio of 1.56 to 1, and with a smokers to non-smokers ratio of about 2.85 to 1. In the current study, although the outbreak was much lower than that reported (0.01%), the outbreak was higher in men than in women [7]. In a research by Young et al., smoking is a major risk factor for the disease, which has a direct correlation with the level of smoking. The results are consistent with the results of this study in terms of the importance of cigarette smoking in increasing the incidence of chronic obstructive pulmonary disease [8]. In 2009, a study was conducted to investigate chronic obstructive pulmonary disease in Spain [9]. In this study, the overall prevalence of this disease in men was about 15.1% and in women it was reported to be 6.5%, which is consistent with the results of the present study. Also, in this study [9], the prevalence of disease was increased with age and smoking, especially in low-educated individuals, that the prevalence of the disease in the subjects between the ages of 40-80 years, was the highest among the other age groups. According to the results of the present study, the prevalence of the disease in the age group of 40-80 years was highest in both genders, that about 70-80% of patients were in this age group and had a direct relationship with smoking, the results of which was in accordance with the results of this study[9].
Suggestions
It is suggested that in the future research, more accurate statistics about the disease in the community, be provided for the researcher.
Limitations
From the research constraints, the diagnosis of chronic obstructive pulmonary disease was based on clinical criteria and biographies that may not allow a significant number of patients to be diagnosed in a timely manner, so using spirometry in early diagnosis of the disease would be helpful.
Conclusions
The prevalence of chronic obstructive pulmonary disease is higher among men than women. As with other chronic diseases, the prevalence of the disease is increased with age in both genders.
Acknowledgments
This research is based on Mr. Siavash Abdul Qaderi's dissertation for obtaining a doctoral degree in general medicine from Shahid Beheshti University of Medical Sciences.
Conflict of interest
There are no conflicts of interest.
Ethical Permissions
The research was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences at IR.SBMU.MSP.REC.1397.354.
Funding Sources
No financial support has been received for this project.

TABLES and CHARTS

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