CHINESE GENERAL HOSPITAL COLLEGE

First Semester, Academic Year 2020 to 2021

BACHELOR OF SCIENCE IN NURSING

N-113 CHN 2 LEC

COMMUNITY HEALTH NURSING II

RESEARCH JOURNAL

SUBMITTED TO:
Mrs. Vilma P. Albo RM, RN, MAN

SUBMITTED BY:
Cayla Mae M. Carlos
BSN 3-A
a. Title
Prevalence of Chronic Obstructive Pulmonary Disease and its Associated Factors
in Nepal: Findings from a Community-based Household Survey

b. Author
Tara Ballav Adhikari, Pawan Acharya, Marieann Högman, Dinesh Neupane,
Arjun Karki, Arne Drews, Brendan G Cooper, Torben Sigsgaard, and Per
Kallestrup

c. Study Population
The study population is 15, 507, consisting of adults age 40 years old and
above who are full-time residents of the Kaski district in Nepal.This study's sample
size is 1508 that determined by assuming the prevalence of COPD to be 8%, 5%
margin of error, a design effect of 1.5, and a response rate of 90%.

d. Methodology
The researchers used a cross-sectional community-based household survey for
1508 participants conducted in the Kaski district, a semi-urban area of Pokhara
Metropolitan city of western Nepal. They selected households using systematic
random sampling for the Community-based management of non-communicable
disease study in Nepal (COBIN). Using a Kish sampling grid, they randomly chose
one adult per household from the list of adults ≥40 years. The researcher has criteria
for selecting participants for this study: participants should be age ≥40 years, a full-
time resident in the said study area, and consent to the study. They exclude people
with active pulmonary tuberculosis or a current respiratory infection or any
contraindication performing spirometry such as pregnancy, a recent history of eye,
chest, or abdominal surgery, myocardial infarction, hemoptysis, and history of
pneumothorax. Trained enumerators conducted interviews at a participant's home
using a structured questionnaire. To reduce the non-response rate in this study, the
researchers visit the selected individuals for at least three times. The structured
questionnaire included information on sociodemographic information. Lifestyle
variables comprised detailed smoking history, physical activity, exposure to
secondhand smoking, biomass fuel use, chimney in the kitchen, presence of black
smoke mark in the kitchen wall, history of severe childhood lung infection, or
tuberculosis infection, and occupational exposure to dirt and dust as well as other
relevant questions on respiratory symptoms. They also calculated the Pack-years for
all participants with a history of smoking. They also measured the body weight and
height of the participants. The participants used portable diagnostic spirometry after
completion of the questionnaire. They recorded at least three acceptable and
reproducible blows based on the American Thoracic Society (ATS) and European
Respiratory Society (ERS) criteria. Two pulmonologists subsequently over-read the
spirometry. The researchers defined COPD according to the Global Initiative for
Chronic Obstructive Lung Disease (GOLD) criteria as a post-bronchodilator ratio of
forced expiratory volume in 1st second (FEV1) to forced vital capacity (FVC) <0.70
with the presence of symptoms. They also defined COPD by the lower limit of normal
(LLN) threshold – FEV1/FVC < LLN cut-off values with the presence of symptoms.
The researchers applied descriptive statistics and logistic regression analysis in this
study.
e. Summary of the Research

f. Recommendations
The study recommends the significance of population-based screening
insimilar low-resource settings to recognize undiagnosed patients with COPD.
The study also recommends comprehensive actions focused on prevention and
early detection. Reducing exposure to biomass fuels, increasing the use of cleaner
fuels, and reducing direct and indirect exposure to tobacco smoke are proven
strategies to reduce the burden of COPD in Nepal.

g. Nursing Implications
Nurses have a vital role to play in encouraging healthy behavior in patients
with COPD. Nurses help their patients by encouraging smoking cessation because
it slows down the accelerated decline of lung function, promotes proper diet and
exercise, and prevents and manages exacerbations of the disease by
recommending vaccination and teaching patients how to recognize the symptoms
for immediate treatment. Nurses also provide advice and support to patients and
their families. They also educate and encourage patients to manage their disease
proactively. Nurses should assess reactions in terms of enhancing the capacity of
patients to manage their daily lives.