Pilot study of flutter valve device among COPD patients in India- Part 2

Ashish Rai, M.D.

Chief Resident, North Shore Medical Center

PGY- 4

February 15, 2019

During my visit I was surprised to discover the existing infrastructure and support in a tier-two city with a middle to low income in a developing nation. CRF has an established and functioning spirometry lab, available pulmonary consultants, internist, microbiologist with an equipped microbiology lab and all the required technical and administrative support.  At present the institution maintains a registry of over 2000 patients with COPD from across the city and adjacent rural areas who frequently visit CRF, for their outpatient pulmonary follow up which is provided free of cost and receive subsidized medications and equipment to manage their underlying pulmonary disease.

More than half of the patient population registered at the institution are currently enrolled in a clinical or biomedical research, which are conducted and supervised by the institution with support from the local and national government and interested pharmaceutical companies.

The patients at CRF appeared to be unaware of the harmful effects of smoking and the use of biomass for cooking, and only saw a physician when they were sick and needed to visit the emergency room. 

In majority of the cases the barrier to medical treatment seemed to be not just a lack of medical resource, but also a lack of awareness towards primary and secondary prevention.

An outpatient center dedicated towards pulmonary disease with a goal for primary and secondary prevention, in a country with a population having lower purchasing power and high medical cost appears to be proving the much-needed solution to its patient population.

I also discovered that the population of COPD patients in India and in particularly in rural areas is unique as an estimated 60% of the COPD patient population registered at Chest Research Foundation, had biomass exposure as an etiology, while in the developed countries cigarette smoking is the primary cause, and the world’s leading cause for COPD is biomass exposure and not smoking.

A center like CRF, which has a large registry of 

patients with COPD and asthma and the resources to conduct clinical and biomedical research while providing outpatient care is an excellent example of public-private joint venture which looks to be the solution to the ever-growing health care need in a developing country.

(Research team members at CRF, Pune, India. Left to right: Sandhya (research coordinator), Dr. Vijay (attending internal medicine physician), Dr. Ashish Rai, Dr. Sudeep Salvi (attending pulmonary physician and Chief of CRF) and Dr. Govinda Narke (attending preventive and social medicine physician)