Feasibility of using Spirometry for COPD Diagnosis in Humanitarian Settings

Aim: To evaluate the feasibility of using spirometry to diagnose Chronic Obstructive Pulmonary Disease (COPD) to support pulmonary rehabilitation in humanitarian settings. Context: COPD presents unique challenges and remains under-addressed in humanitarian settings, with limited evidence on its diagnosis and management. To bridge this gap, we assessed the feasibility of diagnosing COPD using spirometry in a humanitarian context. Method: The RESPIRE study introduced spirometry-based COPD diagnostics at five centers in Cox’s Bazar, Bangladesh. Research team workers were trained in spirometry use and interpretation, with COPD diagnosed by a post-bronchodilator FEV₁/FVC ratio <70% and relevant exposure history to risk factors like smoking, biomass, occupational exposure. Data were collected from July to November 2024, with consecutive patient recruitment. Descriptive analysis focused on confirmed COPD diagnoses and high-quality spirometry per GOLD criteria. Results: Of the 175 participants recruited, 87 (50.6%) were female, and 101 (58.7%) were aged 60 years or younger. Among them, 27 (15.5%) were Forcibly Displaced Myanmar Nationals (FDMN). Education levels ranged from 84 (48%) illiterate, 53 (30.3%) literate, 19 (10.9%) primary, 4 (2.3%) secondary, to 6 (3.4%) with higher secondary education. Smoking prevalence was noted in 56 (32%) of participants. Severe breathlessness was reported by 76 (43.7%) individuals, and spirometry confirmed COPD in 71 (40.6%) participants. Over 90% of spirometry tests were of high quality, with 166 (94.9%) pre-bronchodilator and 158 (90.3%) post-bronchodilator FEV₁ assessments achieving a grade 'A.' Impact: Spirometry enabled a secure COPD diagnosis which gave healthcare workers the confidence to manage respiratory conditions. Several challenges, including limited access to reliable equipment, language barriers, trust and patient anxiety, open settings with inadequate space allocation, advocacy difficulties, and issues with performing maneuvers, were among the many obstacles encountered. Lessons Learned: Spirometry is feasible for early COPD diagnosis in humanitarian settings but requires trained operators and improved logistics for scaling.