The most commonly used definition for chronic obstructive pulmonary disease (COPD) is that used by the global initiative for chronic obstructive lung disease (GOLD) as ‘a preventable and treatable disease…characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases’(GOLD 2008) This definition is rigorous, precise and requires spirometry.
Chronic obstructive pulmonary disease results in high mortality and morbidity worldwide. WHO states that COPD is the fifth and sixth cause of death in high income and low and middle income countries, respectively Lopez et al. (2006a,b). Mortality increases with decreasing lung function, due to acute cardiac events, infective exacerbations and acute respiratory failure (Murray et al. 2005). COPD can cause loss of function in multiple ways, including co-morbidities such as muscle weakness, weight loss, cardiac disease and depression (Murray et al. 2005). However, dyspnoea is the main reason for COPD having the 10th highest morbidity in low and middle income countries (Lopez et al. 2006a,b). The economic burden of COPD is high in developed countries due to healthcare and loss of productivity (Mannino & Buist 2007), but there are very few data available on mortality, morbidity or economic burden in developing countries (Chan Yeung et al. 2004).
Smoking is the main risk factor for COPD and exposure to occupational (Naidoo et al. 2005) or domestic fumes (Kiraz et al. 2003) and previous infection also cause the disease. Smoking levels have increased worldwide except in Europe and the Americas (Chan-Yeung et al. 2004) which may affect COPD prevalence worldwide. There is a high COPD prevalence due to indoor air pollution in middle income countries, particularly among women (Kiraz et al. 2003) which indicates that the COPD burden in Africa may be largely due to equivalent indoor air pollution in African homes (Norman et al. 2007). Rising smoking rates and high levels of tuberculosis infection (Ehrlich et al. 2004) may also increase the disease prevalence. Smoking cessation and avoidance of noxious fumes can prevent COPD onset and progression (Buist et al. 2007). Wealth and education are deemed protective (Ehrlich et al. 2004). Treatments include bronchodilators, corticosteroids, oxygen therapy and finally lung transplants (Murray et al. 2005).
We reviewed the burden of COPD in Africa, focusing in particular on prevalence data and the reliability of current estimates. We also carried out a telephone and e-mail survey of African physicians to estimate the current use of spirometry for the diagnosis of COPD in specialist centres.