Managing Chronic Obstructive Pulmonary Disease in Rural India: A Pilot Study

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a significant global public health issue. Limited data exists on COPD management in low- and middle-income countries (LMIC). We report our experience in managing COPD at the primary health center (PHC) and at a village level (home-based) in India.
Methods: This prospective project (July 2025 and February 2026) was conducted in a PHC in Maharashtra State, India. We implemented a structured program for managing COPD using the existing infrastructure and personnel. The COPD diagnosis was based on the modified Medical Research Council (nMRC) criteria: chronic productive cough (sputum) lasting at least 3 months per year for 2+ consecutive years, and the presence of low-pitched crepitations on chest auscultation.
Initial treatment included a doxycycline loading dose of 200 mg, followed by 100 mg daily for 5 days, a long-acting theophylline 300 mg at bedtime for 1 month, to be refilled monthly, and a single intramuscular dose of vitamin D (600,000 IU). A structured follow-up plan was adhered to.
Results: A total of 76 COPD cases were managed (PHC: 32; Home-based: 44) during the study period. 71 (93.4%) responded within 7 days of treatment, and only 5 (6.6%) needed 7 days or more. Regular refill rates (93.4%) and prolonged overall follow-up duration of 90 days or more (90.2%) suggest strong community acceptance of the program.
Conclusion: Symptom-based case detection without spirometry and low-cost, user-friendly treatment without inhalers, using low-dose oral theophylline, are the key elements of the project. The validity of our results needs to be confirmed in large studies in similar setups.