Chronic Obstructive Pulmonary Disease (COPD) in population studies in Russia and Norway: comparison of prevalence, awareness and management

Sarah Cook,1– 3 Anne Elise Eggen,1 Laila A Hopstock,1 Sofia Malyutina,4,5 Marina Shapkina,4 Alexander V Kudryavtsev,1,6 Hasse Melbye,1,* Jennifer K Quint3,* 1Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway; 2Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; 3National Heart and Lung Institute, Imperial College London, London, UK; 4Research Institute of Internal and Preventive Medicine, Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russian Federation; 5Novosibirsk State Medical University, Russian Ministry of Health, Novosibirsk, Russian Federation; 6Northern State Medical University, Arkhangelsk, Russian Federation*These authors contributed equally to this workCorrespondence: Sarah Cook Email sarah.cook@lshtm.ac.ukBackground: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Despite a high prevalence of smoking and respiratory symptoms, two recent population-based studies in Russia found a relatively low prevalence of obstructive lung function. Here, we investigated the prevalence of both obstructive lung disease and respiratory symptoms in a population-based study conducted in two Russian cities and compared the findings with a similar study from Norway conducted in the same time period.Methods: The study population was a sub-sample of participants aged 40– 69 years participating in the Know Your Heart (KYH) study in Russia in 2015– 18 (n=1883) and in the 7th survey of the Tromsø Study (n=5271) carried out in Norway in 2015– 16 (Tromsø 7) who participated in spirometry examinations. The main outcome was obstructive lung function (FEV1/FVC ratio< lower limit of normal on pre-bronchodilator spirometry examination) with and without respiratory symptoms (chronic cough and breathlessness). In those with obstructive lung function, awareness (known diagnosis) and management (use of medications, smoking cessation) were compared.Results: The age-standardized prevalence of obstructive lung function was similar among men in both studies (KYH 11.0% vs Tromsø 7 9.8%, p=0.21) and higher in the Norwegian (9.4%) than Russian (6.8%) women (p=0.006). In contrast, the prevalence of obstructive lung function plus respiratory symptoms was higher in Russian men (KYH 8.3% vs Tromsø 7 4.7%, p< 0.001) but similar in women (KYH 5.9% vs Tromsø 7 6.4%, p=0.18). There was a much higher prevalence of respiratory symptoms in Russian than Norwegian participants of both sexes regardless of presence of obstructive lung function.Conclusion: The prevalence of respiratory symptoms was strikingly high among Russian participants but this was not explained by a higher burden of obstructive lung function on spirometry testing in comparison with Norwegian participants. Further work is needed to understand the reasons and health implications of this high prevalence of cough and breathlessness.Keywords: COPD, Russian Federation, Norway, respiratory symptoms