New Delhi: Despite Chronic Obstructive Pulmonary Disease (COPD) cases rising, Pulmonary Function Tests (PFTs) are not being done routinely in the country. According to the 2016 Global Burden of Diseases study, India ranks second in terms of the number of cases of COPD and first in terms of deaths due to COPD across the globe. COPD or chronic obstructive pulmonary disease is a disease that is the end-result of exposure of the lung to harmful stimuli such as tobacco smoke, biomass fuels, air pollution, and occupational exposures. It is a disease that affects both the airways (tubes) of the lung as well as the parenchyma (tissues). People with COPD tend to be breathless, can wheeze, and can have a chronic cough with mucus. The disease tends to progress as a person gets older.

Dr Lancelot Pinto, consultant Pulmonologist, PD Hinduja Hospital & MRC told The Sunday Guardian: “PFTs are considered the test of choice to diagnose COPD. However, we recently presented our study at the European Respiratory Society Annual Congress that suggested that a low dose CT scan of the lungs could detect the disease at an early stage. Conventional spirometers are expensive, and COPD, despite being the third leading cause of death in India, is underappreciated when it comes to resource allocation. Doctors often find the interpretation of PFTs intimidating, as not enough emphasis is placed on PFTs in medical training, as opposed to ECGs or chest X-rays, which are considered more important to understand.”

Dr Pinto also said that PFTs are effort-dependent tests, which means that the performance of an individual depends on the effort put in by the individual.

Dr Navneet Sood, Pulmonary Consultant, Dharamshila Narayana Superspecialty Hospital, told The Sunday Guardian: “First of all COPD cannot be recognized with apparent symptoms, as they may lead to the suspicion of other diseases also. For the same reason and due to lack of awareness many people report when the problem gets severe and then during procedure COPD is diagnosed. Also, it doesn’t show up instantly rather develops gradually. Now as far as the PFT tests are concerned, there is still a lack of awareness in this regard and many people report when the risk gets high. Also, for some sections, cost issue may be one of the many reasons which may add to this problem.”

Several studies point out that there is a lack of spirometry which is a Global Initiative for Chronic Obstructive Lung Disease (GOLD) standard for diagnosis of COPD at the primary-level and consequently, a large number of cases remain undiagnosed leading to worsening conditions. Chest Radiology which is more frequently employed for monitoring misrepresents the state of the disease and the findings of hyperinflation and early emphysema are frequently missed on plain radiographs.

Dr Vivek Anand Padegal, Director of Pulmonology Department, Fortis Hospital, Bangalore, told The Sunday Guardian: “There is a variety of reason why PFT is not available across the country. First of all, there are not a lot of pulmonologists. The specialty of Pulmonology until very recently was almost non-existent in India. Now there are a lot of pulmonologists but as compared to other specialties we are still less. Secondly, you need a technician who is trained to do this and you need a good setup. Now to overcome this, some of the people in India have spirometer and it is easier to do. Despite many efforts to educate people, awareness about COPD is still low. The chest X-rays can give you a hint about COPD but it is not at all a reliable tool. However, CT scans can be used to diagnose certain aspects of COPD. But it’s not like we can CT Scan everybody. Such use should for special cases. PFT is important. Primary Care Specialists need to be more aware of the diagnosis of COPD.”

Despite, guidelines for the management of COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) are available for different levels of healthcare in the country, there is still a lack of “guideline-directed strategy”. Several studies point out that respiratory rehabilitation and domiciliary care are non-existent.