Chronic Obstructive Pulmonary Disease (COPD) is a major global public health concern and ranks among the leading causes of morbidity and mortality worldwide. In India, COPD represents a substantial healthcare burden, with millions of individuals affected and a significant contribution to overall disease-related mortality. Despite being largely preventable and treatable, the condition remains underdiagnosed and inadequately managed, particularly in low- and middle-income settings.¹

COPD is characterized by persistent respiratory symptoms and irreversible airflow limitation resulting from chronic inflammation of the airways and lung parenchyma, typically following prolonged exposure to noxious particles or gases.² While cigarette smoking remains the most well-recognized risk factor globally, other contributors such as biomass fuel exposure, indoor and outdoor air pollution, occupational hazards, and prior respiratory infections play a crucial role in the Indian context, especially in rural and hilly regions.³

A major challenge in COPD management is the lack of awareness among patients. Early symptoms such as chronic cough and breathlessness are often misinterpreted as normal aging, smoking-related changes, or recurrent respiratory infections, leading to delayed healthcare-seeking behavior and late diagnosis. In addition, poor understanding of disease progression, inadequate knowledge regarding preventive measures, and misconceptions about treatment further compromise effective disease control.⁴

Patient-related factors significantly influence treatment outcomes. Incorrect inhaler techniques, poor adherence to long-term therapy, and continued exposure to risk factors such as tobacco smoke or biomass fuels are commonly observed. These practices are often driven by limited health literacy, socioeconomic constraints, and lack of structured patient education. Consequently, inadequate awareness directly impacts disease progression, frequency of exacerbations, and overall quality of life.⁵

In this context, assessing the knowledge, attitude, and practices (KAP) of COPD patients is essential to identify gaps in awareness and management. Understanding these factors can help in designing targeted educational interventions and improving patient-centered care. Therefore, the present study aims to evaluate the level of knowledge, attitudes, and practices among COPD patients attending a tertiary care hospital in the Garhwal region of Uttarakhand.

Aims & Objectives

1. To assess knowledge about COPD causes and symptoms
2. To evaluate attitude toward disease and treatment
3. To analyze practices such as smoking cessation and inhaler use

A cross-sectional study was conducted at a tertiary care hospital in the Garhwal region of Uttarakhand among patients diagnosed with chronic obstructive pulmonary disease (COPD). Eligible participants were enrolled consecutively during the study period after obtaining informed consent. Data were collected using a pretested structured questionnaire designed to assess knowledge, attitude, and practices related to COPD. The questionnaire included variables pertaining to patients’ knowledge of disease etiology, symptoms, and preventive measures; attitudes toward disease severity and treatment; and practices such as healthcare-seeking behavior, smoking habits, and inhaler use. Relevant demographic and clinical details were also recorded.

A total of 100 patients with diagnosed chronic obstructive pulmonary disease (COPD) were included in the study. The mean age of participants was 69.12 ± 8.72 years, with the majority belonging to the 61–70 years age group (40%), followed by 71–80 years (28%) and 50–60 years (20%). There was a slight male predominance, with 55% males and 45% females. Most participants were from lower socioeconomic strata, with 30% belonging to the lower class and 29% to the upper-lower class. Educational status was generally poor, with 45% illiterate and 33% educated up to primary level, indicating low literacy levels in the study population.

Knowledge

Knowledge regarding COPD among patients was markedly inadequate. Only 7% of participants reported being aware of COPD, while 93% had no knowledge of the disease. Furthermore, none of the patients (0%) were able to correctly state what COPD stands for.

When assessed for disease understanding, only 46% correctly identified the lungs as the organ affected. A considerable proportion had misconceptions, with 23% identifying the heart, 13% naming other organs, and 18% having no knowledge.

Awareness regarding etiological factors showed variability. While 89% of patients recognized smoking as a causative factor, awareness of other important risk factors was significantly lower. Only 35% were aware of the role of biomass fuel exposure, and merely 16% recognized occupational exposure as a contributing factor, indicating a substantial gap in comprehensive disease knowledge.

Attitude

Attitude toward COPD was largely unfavorable. Only 7% of patients believed that COPD is curable, whereas a vast majority (93%) perceived the disease as incurable. This reflects a pessimistic perception of the disease and suggests limited understanding of the potential for symptom control and disease management with appropriate treatment.

Practices

Practices related to COPD management were found to be inadequate. Only 36% of patients reported understanding correct inhaler technique, while 64% lacked proper knowledge regarding inhaler use, which is a cornerstone of COPD management. This highlights a critical gap in patient education and self-management practices.

The study reveals markedly poor knowledge of COPD and its causes, accompanied by negative attitudes toward disease prognosis and inadequate treatment practices, particularly regarding inhaler use. These findings highlight significant gaps in patient awareness and self-management, especially among elderly individuals with low literacy and lower socioeconomic status.

The present study highlights significant deficiencies in the knowledge, attitude, and practices (KAP) of COPD patients, particularly in a predominantly elderly, low-literacy, and socioeconomically disadvantaged population. The findings demonstrate that only 7% of patients were aware of COPD, with none knowing its full form, indicating extremely poor disease awareness. This level of knowledge is markedly lower than that reported in other studies, where at least partial awareness has been documented. The poor understanding observed in this study may be attributed to low educational status and limited access to health information, as nearly half of the participants were illiterate and most belonged to lower socioeconomic groups. These findings reinforce the strong association between literacy and disease awareness.

A key observation in this study is the disparity in knowledge of risk factors. While 89% of patients recognized smoking as a cause, awareness regarding biomass fuel (35%) and occupational exposure (16%) was significantly lower. This is particularly relevant in the Indian context, where non-smoking risk factors play a major role in COPD pathogenesis. Similar patterns have been reported in other studies, which show that patients tend to recognize smoking as a risk factor but lack awareness about environmental and occupational contributors.This gap may lead to continued exposure to preventable risk factors, especially in rural settings.⁶

Attitudinal assessment revealed that 93% of patients perceived COPD as incurable, reflecting a pessimistic outlook toward the disease. Such negative perceptions can adversely affect treatment adherence and health-seeking behavior. Previous research has shown that patient attitudes significantly influence disease management, with better attitudes correlating with improved adherence and outcomes .⁷ The pessimistic perception observed in the present study likely stems from inadequate counseling and lack of understanding of disease control strategies.

Practices related to COPD management were also suboptimal, with only 36% of patients demonstrating understanding of inhaler use. This finding is consistent with multiple studies reporting poor inhaler technique among COPD patients. ^8-9 For instance, studies have shown that only about 35–40% of COPD patients correctly use inhalers, highlighting widespread deficiencies in practical skills . Improper inhaler technique has been directly linked to poor disease control, increased exacerbations, and reduced quality of life. Evidence suggests that structured education and repeated demonstration can significantly improve inhaler technique and clinical outcomes .¹⁰

The overall KAP profile observed in this study suggests a critical gap between disease burden and patient awareness. Unlike some studies where patients may have moderate knowledge but poor adherence, this study demonstrates deficiencies across all three domains—knowledge, attitude, and practice—indicating a more fundamental problem of health education. The findings are particularly concerning given the high prevalence of modifiable risk factors such as biomass exposure (81%) and poor ventilation (87%) in the study population.

These results emphasize the need for comprehensive, patient-centered educational interventions. Strategies should include community-based awareness programs, simplified communication tailored to low-literacy populations, and repeated demonstration of inhaler techniques. Healthcare providers play a pivotal role in bridging this gap by reinforcing education during every patient interaction. Additionally, integrating family members into counseling sessions may further improve adherence and long-term outcomes.

The study reveals poor knowledge, negative attitudes, and inadequate practices among COPD patients, particularly regarding disease awareness and inhaler use. Limited understanding of risk factors beyond smoking and a pessimistic perception of the disease further contribute to poor management. Targeted patient education and structured counseling are essential to improve outcomes

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