To our best knowledge, this is the first study that has evaluated public awareness toward COPD in the Syrian population. Although the majority of our participants were university students/graduate, the awareness of COPD was only around 25% when excluding participants involved in health-related fields, which reflected low awareness of COPD in the Syrian population. COPD awareness in our study was different from other reported results from Slovenia (50%) [14], Singapore where (35%) had ever heard of the term COPD [9], Spain where only 17% spontaneously recognised COPD term [15], France where 8% of participants were able to identify the COPD acronym [16], and India where they had the lowest level of awareness about COPD as only 0.9 had heard the word COPD [10]. Our result may be explained by our studied group having higher socioeconomical status than the general population.
Among participants who stated they had heard of COPD before in our sample, there were around 40% of them who were not aware that COPD was common worldwide in our study and did not realize COPD was prevalent in Syria. Furthermore, in the population when excluding health-related field population, awareness did not differ with governorate, living in the city or the countryside, gender, smoking, or age. The only determinant factor was working/studying in a health-related field.
Among people who stated they have heard of the term COPD, smoking was stated by around 80% as the main risk factor for COPD. However, this did not significantly affect the smoking habits of the participant. A study in Turkey found that around half of the respondents chose tobacco smoking as the most important risk factor of COPD [12]. Furthermore, a previous study in Syria found that 37.9% of participants were tobacco smokers, meaning they smoke either shisha, cigarette or both [17]. That emphases the need to increase public awareness regarding harmful impacts of smoking on health between Syrians.
About three quarters of those who had heard about COPD were aware that COPD refers to chronic bronchitis or/and emphysema. One study in Singapore mentioned that only 10% of its participants were aware of what COPD acronym refers to [9]. In our study, respiratory symptoms were the most common reported symptom. In the Slovenian study, dyspnoea also was the most knowledgeable symptom of COPD followed by cough [14].
Around three quarters of those who stated that they know about COPD were aware that PFT was necessary to diagnose COPD, and only 50-60% stated that COPD could be a lethal disease, which showed the necessity to increase the knowledge about the danger of COPD on health.
In the Syrian community many COPD risk factors are prevalent, mainly high smoking rates found by our study and others [17]. Negative or second-hand smoking was also prevalent in our study which is also a risk factor for COPD. Biofuel is another risk factor that is very common in Syria as people use it due to the deteriorating economy. Biofuel was found to be a risk factor of COPD [18]. One study found that around 3 billion people worldwide use biofuel, mainly in developing countries which was a risk factor of COPD [19]. Air quality, either indoors or outdoors, is also an important factor in developing COPD as many pollutant can increase the risk of developing COPD [20] and Syria has heavy air pollution, mainly in major cities.
Our finding indicated that there is an urgent need for enhancing levels of public awareness related to COPD in the Syrian community, mainly in participants who were not involved in health-related fields. Increasing awareness about COPD in this population is essential for both an early diagnosis of COPD and managing it, especially with the high prevalence rate of COPD in the Syrian population [6]. Increasing awareness could be accomplished through possible interventions such as using social media in providing information related to COPD by health authorities. Social media platforms provide information easily accessible and could reach a great number of people. Doing awareness campaigns in targeted groups could be effective in increasing public COPD awareness
This study came with limitation that affect the generalizability of the results, mainly two; using online methods limited the targeted population and having high educational levels in this study indicate that the estimated prevalence is probably overestimated.
In conclusion, there is a lack of awareness of COPD in the Syrian population. Increasing it is an emergent priority to help COPD diagnosis and management. COPD and its risk factors are very common in Syria, mainly air pollutants exposure from either actively smoking or indoors/outdoors exposure to particles. There was no significant difference of awareness in non-health related participants when comparing genders, ages, governorates, living in the city or countryside and smoking habits.