ROLE OF PHARMACIST INTERVENTION ON COPD PATIENTS OF SELECTED AREAS IN CHITRADURGA: A KAP STUDY

Background: Chronic obstructive pulmonary disease (COPD) is preventable and treatable disease state characterized by air flow limitation that is not fully reversible. Severity of the symptoms is increased during exacerbations. Objectives: The purpose of the study is to assess and improve the knowledge regarding COPD among study subjects. Materials and Methods: A Cross-sectional interventional study was carried out among the peoples in selected areas of the Chitradurga city for a period of six months. Result: A total 207 subjects enrolled in the study in that 155 male and 52 females. In our study mean score of post test was more (5.87±1.68) when compare to pre-test (2.63±1.46) which show significant increase in their knowledge after educating them (p=0.000). A total of 207 subjects were enrolled into the study. SPSS Software was used to calculate the statistical estimation. Paired t-test was used to detect the association status of different variables. Conclusion: The relatively good level of COPD awareness needs to be maintained to facilitate future prevention and control of the disease. This study had identified that negative illness perceptions should be targeted, so that they will not avoid patients from seeking for COPD treatment and adhere to it.


INTRODUCTION
(COPD) is preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation that is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Prevalence is directly related to the prevalence of tobacco smoking and in low and middle income countries, the use of biomass fuels. Current estimates suggest that 65 million people have moderate to severe COPD 1 .COPD is majorly classified as Chronic Bronchitis and Emphysema, Chronic bronchitis is associated with recurrent excess mucus secretion into the bronchial tree with cough that occurs on most of the days for at least 3 months of the year for at least 2 consecutive years. Emphysema is defined as abnormal, permanent enlargement of air spaces distal to terminal bronchioles, accompanied by destruction of their walls, but without obvious fibrosis. 2 Patients suffering from COPD have an impaired quality of life especially on physical health compared with psychological and social health owing to the frequent experience of symptoms and limitation on their physical activities. 3 The symptoms of COPD ranges from dyspnoea, chronic cough with or without sputum production to poor exercise tolerance. Severity of the symptoms is increased during exacerrbations. 4 The risk factor includes exposure to particles such as occupational exposures, air pollution from extensive use of biomass fuel living in rural communities puts women at increased risk of exposure to indoor air pollution for comparatively long periods of time and heating in poorly ventilated dwellings, low socioeconomic status, and lung disorders are other cited environmental risk factors for the development and the progression of COPD. For patients with COPD, health education focusing on disease and need for long term treatment provided by the clinical pharmacist plays an important role in improving the ability to cope up with illness and health status. It is also effective in accomplishing certain goals, including smoking cessation. Pharmacists are in an ideal position to provide patient education and optimize patient care. Greater understanding about the illness and a change of attitude and practice would in turn results in a better therapeutic outcome. 5 So, from the above maintained statement it is very well clear that a study need to be conducted about "Role of Pharmacist Intervention on COPD Patients of selected areas in Chitradurga: A KAP Study"

MATERIALS AND METHODS
A Cross-sectional interventional study was carried out among the peoples in selected areas of the Chitradurga city for a period of six months. A total of 207 subjects were enrolled into the study. SPSS Software was used to calculate the statistical estimation. Paired ttest was used to detect the association status of different variables. Vide number: SJMCP/IEC/PHARM D/08/2017-18.

Inclusion Criteria
 Subjects of both genders.  Subjects who are willing to participate in the study.

Exclusion Criteria
 Subjects who are below 18 years  Subjects who is having Asthma

STATISTICAL ANALYSIS
After the completion of the study, the data will be entered into Microsoft Excel sheets and further analysis done by student paired "t" test in SPSS 24 version and the study was carried out for 6 months.

RESULTS
A cross sectional study was undertaken to assess the impact of Knowledge, Attitude and Practices of COPD in Chitradurga district. A total of 207 peoples (155 males & 52 females) satisfied the inclusion and exclusion criteria and were included as the study subjects.  According to you what is COPD?   Which part of the body is affected by COPD?   What are the common symptoms of COPD?   How COPD is diagnosed?   How often you smoke?  Figure 5 shows 20 subjects taking daily one packet cigarettes, 51 taking daily 1-3 packets, 17 taking weekly once, 13 taking monthly once and 107 peoples don't smoke. Non-alcoholic 132 124 How often do you drink liquor? Table 6 & Figure 16shows 40 taking daily alcohol, 24 taking weekly alcohol, 20 taking monthly alcohol and 132 are non-alcoholic.  According to you is COPD can be completely cured?   What is the best form to take medications in the COPD?

COMPARISON OF KNOWLEDGE (COMPARISON OF MEAN SCORE)
In our study mean score of post-test was more (5.87±1.68) when compare to pre-test (2.63±1.46) which show significant increase in their knowledge after educating them (p=0.000).

DISCUSSION
The study aimed to create awareness on different aspects of COPD among the local people and thus improve their knowledge on the same by means of the KAP study. It was carried out among the carpenters, dabaworkers, cotton-mill, quarry-workers and housewife of Chitradurga district.
A similar study was conducted by Woodruff PG et al involving 126 current or former smokers and controls who had never smoked and measured their respiratory symptoms using the COPD Assessment Test (CAT; scores range from 0 to 40, with higher scores indicating greater severity of symptoms). 6 In our study it shows that 176 subjects responded to the right answer for the question "Is COPD can be cured" and in the post test about 23 during the pre-test and 31 students responded the wrong answer for the above asked question in the post test which was about 184 during the pretest. A similar study also done by Vestbo j et al was also reported that the COPD cannot be completely cured 8 During the study period we found that a positive attitude could be brought out among the subjects regarding their approach towards the COPD patients which was a very essential element in the society. A similar study also done by Reema T et al by a total of 27 patients with COPD were enrolled, into the three months study.Knowledge, Attitu de and Practice (KAP) of patients regarding CO PD were assessed and recorded at baseline by u sing a suitably designed questionnaire. The bas eline KAP result suggested that patients had a p oor perception of their disease. 9

CONCLUSION
This study had identified that negative illness perceptions should be targeted so that they will not avoid patients from seeking for COPD treatment and adhere to it. The negative illness perceptions and quality of life have an impact on COPD calls for programmers to strengthen COPD information, education and counselling and is carried out by considering the socio-demographic characteristics of the target population. In 207 subjects who were enrolled for the study majority were not aware about the different aspects on COPD, which was changed during the post test. These acts could further enhance the effective COPD control among the Chitradurga population. Context specific causes of poor COPD knowledge and still persisting negative attitudes need to be studied further in order to tailor interventional strategies.

ACKNOWLEDGEMENT(s)
I am highly indebted to my guide Mr. Abubaker Siddiq Asst. Professor, SJM college of pharmacy, Chitradurga, for their continuous support, motivation and guidance throughout the tenure of this work inspite of hectic schedule who truly remain driving spirit and their experience gave me light in this work and helped me in clarifying he abstruse concepts, requiring knowledge and perception, handling critical situations and understanding objective of this work. I am extremely thankful to Dr.Bharathi D R Professor SJM College of pharmacy for unwavering support, towards the accomplishment of the work.