Chronic Obstructive Pulmonary Disease and Smoking in India: A Meta-Analysis


  • Rashmi KS Chikkaballapur Institute of Medical Sciences, Chikkaballapur, India
  • Shashikala MD Ramaiah Medical College, Bangalore, India
  • Kruttika Naik Sri Siddhartha Institute of Medical Sciences and Research Centre, T- Begur, India



Risk factors, Chronic Obstructive Pulmonary disease [COPD], Meta-analysis smoking


Introduction: WHO estimates show Chronic obstructive pulmonary disease [COPD] as a growing major global cause of morbidity as well as mortality. An estimated 90% of COPD- related deaths occur in low/middle income countries. India and China together constitutes about one third of the total humanpopulation, accounting for 66% of COPD mortality globally. In the south east Asia region, COPD associated mortality is projected to grow by 160% in the decades ahead. Much of this projection holds pansexual cigarette smoking, improved life expectancy, bulging geriatric population and high levels ofsmall particle pollution, as major causes behind increase in COPD case burden.

Methods: The aim of the meta-analysis was to investigate association between COPD and risk factors by pooled and subgroup analysis. We searched for case control studies and studies which are meeting the inclusion criteria. The publications listed in the NCBI PubMed and Cochrane library were searched using the following combination of the key words “COPD”; “smokers”; “health”; “risk” or “factors”;“diagnostic”; “burden”; “exposure”; “disease” or “prevalence” or “morbidity ” or “mortality”; “tobacco”; “smoking”; “smoke”, “India”. Random effects meta-analysis was applied to generate pooled  SMD by using CMA software.

Results: Data base search identified twenty-nine thousand two hundred twenty-two records and 14 articles made to the cut after implementing the inclusion and exclusion criteria. Main risk factors for COPD were higher age [SMD=0.53, CI= (0.0018-1.05)], total pack years of Smoking [SMD=13.83,CI (10.060-17.616)], FEV1 [SMD=-13.15, CI= (-16.234 to -10.085) and FEV/FVC ratio [SMD=0.915.CI= (0.767-1.063)]. Higher age, smoking, low values of FEV1 and FEV/FVC ratio is directly associated with high risk of COPD.

Discussions: The findings of the study shows evidence of smoking history in terms of pack of years as a major risk factor for COPD prevalence. Further research is needed on COPD prevalence andincidence associated with other chemical exposure, to identify how to effectively reduce risks fromexposure to smoking.


Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis management and prevention of Chronic Ob-structive Pulmonary disease. Updated 2014. Global Initiative for Chronic Obstructive Lung Disease; 2014.

Bousquet J, Khaltaev N. Global surveillance, prevention and control of chronic respiratory diseases. A comprehensive approach. Global alliance against chronic respiratory diseases; Geneva; World Health Organization; 2007; ISBN; 978;92;415;634;68.

Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030; PLoS Med 2006:3:e442. Doi: PMid:17132052 PMCid:PMC1664601 DOI:

Gupta D, Agarwal R, Aggarwal AN, et al. COPD Guidelines Working GroupIndian Chest SocietyNational College of Chest Physicians (In-dia).Guidelines for diagnosis and management of Chronic Obstructive Pulmonary Disease: joint recommendations of IndianChest Society and National College of Chest Physicians (India).Indian J Chest Dis Allied Sci 2014; 56 Spec No:5-54.

Buist AS, McBurnie MA, Vollmer WM, et al. BOLD Collaborative Research Group. International variation in the prevalence of COPD (the BOLD study): a population-based prevalence study. Lancet 2007; 370: 741-50. Doi: DOI:

Chapman KR, Mannino DM, Soriano JB, et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J 2006; 27:188-207. Doi: PMid:16387952 DOI:

British thoracic society (2006) The burden of lung disease. http://www. brit- thoracic. org. uk/ burdenofl ungdisease2. html (ac-cessed 11 June 2018).

Salvi SS, Manap R, Beasley R. Understanding the true burden of COPD: the epidemiological challenges. Prim Care Respir J 2012; 21:249-51. Doi: PMid:22885564 PMCid:PMC6547972 DOI:

World Health Organization. The global burden of disease 2004 update. Geneva: World Health Organization, 2008.

Report on causes of death in India (2001-03). 2014 www.censusindia. Vital_ Statistics/ Summary_ Report_ Death_ 01_ 03.pdf (accessed 11 June 2018).

Minion DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet 2007; 370:765-73. Doi: DOI:

Srinath Reddy K, Shah B, Varghese C, et al. Responding to the threat of chronic diseases in India. Lancet 2005; 366:1744-9. Doi: DOI:

Lopez AD, Shibuya K, Rao C, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27:397-412. Doi: PMid:16452599 DOI:

Jindal SK, Aggarwal AN, Gupta D, Agarwal R, Kumar R, Kaur T, Chaudhry K, Shah B. Indian study on epidemiology of asthma, respira-tory symptoms and chronic bronchitis in adults (INSEARCH). Int J Tuberc Lung Dis. 2012 Sep;16(9):1270-7. Doi: PMid:22871327 DOI:

Glass GV. Primary, secondary and Meta analysis of research. Educ Researcher 1976; 10: 3-8. doi: DOI:

Huque MF. Experiences with meta-analysis in NDA submissions. Proceedings of the Biopharmaceutical Section of the American Statistical Association. 1988; 2:28-33.

Celli BR, Decramer M, Wedzicha JA, et al. An Official American Thoracic Society/European Respiratory Society Statement: research questions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2015; 191:e4-e27.

GIfCOL D. Pocket guide to COPD diagnosis, management, and prevention. A Guide for Health Care Professionals. 2017:37. http://goldcopd. Org

World Health Organisation. Fact Sheet No. 310. The Top 10 Causes of Death [updated on May 2014]. Available from:

World Health Organization. The World Health Report 2004: Changing History. Statistical Annex 127-131. Geneva: World Health Organization; 2004.

McKay AJ, Mahesh PA, Fordham PA, Majeed A. Prevalence of COPD in India: a systematic review. Primary Care Respir J. 2012;21:313-321. Doi: PMid:22790612 PMCid:PMC6547954 DOI:

Smith M, Li L, Augustyn M, et al. Prevalence and correlates of airflow obstruction in 317,000 never-smokers in China. Eur Respir J 2014; 44: 66-77. Doi: PMid:24603814 PMCid:PMC4076527 DOI:

Rossiter C E, Weill H. Ethnic differences in lung function: evidence for proportional differences. Int J Epidemiol 1974; 3: 55-61. Doi: PMid:4838716 DOI:

Pauwels R A, Buist A S, Calverley P M A, Jenkins C R, Hurd S S. The GOLD Scientific Committee: global strategy for diagnosis, man-agement, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 163: 1256-1276. Doi: PMid:11316667 DOI:

Masters N, Tutt C. Smoking pack year calculator 2007. Hazlemere, UK: Smoking Pack Years, 2007-2013. http:// Accessed June 2016.

Salvi S, Gogtay J, Aggarwal B. Use of breath-actuated inhalers in patients with asthma and COPD - an advance in inhalational therapy: a systematic review. Expert Rev Respir Med. 2014 Feb;8(1):89-99. doi: 10.1586/17476348.2014.854168. Epub 2013 Dec 10. Doi: PMid:24325614

Akparova A, Abdrakhmanova B, Banerjee N, Bersimbaev R. EPHX1 Y113H polymorphism is associated with increased risk of chronic obstructive pulmonary disease in Kazakhstan population. Mutat Res Genet Toxicol Environ Mutagen. 2017 Apr;816-817:1-6. Doi: PMid:28464990 DOI:

Tripathi PM, Kant S, Yadav RS, Kushwaha RAS, Prakash V, Rizvi SHM, Parveen A, Mahdi AA, Ahmad I. Expression of Toll-like Recep-tor 2 and 4 in Peripheral Blood Neutrophil Cells from Patients with Chronic Obstructive Pulmonary Disease. Oman Med J. 2017 Nov;32(6):477-485. Doi: PMid:29218124 PMCid:PMC5702997 DOI:

Bajpai J, Prakash V, Kant S, Verma AK, Srivastava A, Bajaj DK, Ahmad MK, Agarwal A. Study of oxidative stress biomarkers in chronic obstructive pulmonary disease and their correlation with disease severity in north Indian population cohort. Lung India. 2017 Jul-Aug;34(4):324-329. doi: PMid:28671162 PMCid:PMC5504888 DOI:

Meshram PL, Shinde SN, Ramraje NN, Hegde RR. Study of inflammatory markers and BODE index in chronic obstructive pulmonary disease. Lung India. 2018 Jan-Feb;35(1):37-40. doi: PMid:29319032 PMCid:PMC5760865 DOI:

Singh A, Kumar S, Mishra AK, Kumar M, Kant S, Verma SK, Kushwaha RA, Garg R. Correlation between clinical characteristics, spi-rometric indices and high resolution computed tomography findings in patients of chronic obstructive pulmonary disease. Lung India. 2016 Jan-Feb;33(1):42-8. Doi: PMid:26933306 PMCid:PMC4748664 DOI:

Arja C, Surapaneni KM, Raya P, Adimoolam C, Balisetty B, Kanala KR. Oxidative stress and antioxidant enzyme activity in South Indi-an male smokers with chronic obstructive pulmonary disease. Respirology. 2013 Oct;18(7):1069-75. doi: PMid:23683270 DOI:

Sarangi R, Varadhan N, Bahinipati J, Dhinakaran A, Anandaraj, and Ravichandran K. Serum Uric Acid in Chronic Obstructive Pulmo-nary Disease: A Hospital Based Case Control Study. J Clin Diagn Res. 2017 Sep;11(9):BC09-BC13. doi: 10.7860/JCDR/2017/29300.10605. Epub 2017 Sep 1. PMID: 29207693; PMCID: PMC5713715.

Salvi S, Gogtay J, Aggarwal B. Use of breath-actuated inhalers in patients with asthma and COPD - an advance in inhalational therapy: a systematic review. Expert Rev Respir Med. 2014 Feb;8(1):89-99. Doi: PMid:24325614 DOI:

Nayyar N, Sood RG, Sarkar M, Tomar A, Thakur V, Bhoil R. Prevalence of osteoporosis and osteopenia in stable patients of chronic obstructive pulmonary disease in Sub-Himalayan region of Himachal Pradesh, India. J Family Med Prim Care. 2017 Jul-Sep;6(3):595-599. doi: PMid:29417015 PMCid:PMC5787962 DOI:

Gupta PP, Sood S, Atreja A, Agarwal D. A comparison of cognitive functions in non-hypoxemic chronic obstructive pulmonary dis-ease (COPD) patients and age-matched healthy volunteers using mini-mental state examination questionnaire and event-related po-tential, P300 analysis. Lung India. 2013 Jan;30(1):5-11. doi: PMid:23661909 PMCid:PMC3644834 DOI:

Mukherjee S, Banerjee G, Das D, Mahapatra ABS. Occurrence of COPD in Patients with Respiratory Allergy: A Clinico-Spirometric Evaluation in a Tertiary Hospital, Kolkata. J Clin Diagn Res. 2017 May; 11(5):CC11-CC13. Doi: PMid:28658755 PMCid:PMC5483657 DOI:

Gupta PP, Govidagoudar MB, Yadav R, Agarwal D. Clinical and pulmonary functions profiling of patients with chronic obstructive pulmonary disease experiencing frequent acute exacerbations. Lung India. 2018 Jan-Feb;35(1):21-26. Doi: PMid:29319029 PMCid:PMC5760862 DOI:

Kumar A, Kunal S, Shah A. Frequency and effect of type 1 hypersensitivity in patients from India with chronic obstructive pulmo-nary disease and associated upper airways symptom




How to Cite

Rashmi KS, Shashikala MD, Naik K. Chronic Obstructive Pulmonary Disease and Smoking in India: A Meta-Analysis. Natl J Community Med [Internet]. 2022 Jul. 31 [cited 2022 Aug. 10];13(07):478-86. Available from:



Systematic Review/ Meta Analysis