Smoking habits in the Middle East and North Africa: results of the BREATHE study.

Few recent comparative data exist on smoking habits in the Middle East and North Africa (MENA) region. The objective of this analysis was to evaluate smoking patterns in a large general population sample of individuals aged ≥ 40 years in ten countries in the region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan, using a standardised methodology. A random sample of 457,258 telephone numbers was generated and called. This identified 65,154 eligible subjects, of whom 62,086 agreed to participate. A screening questionnaire was administered to each participant, which included six questions relating to cigarette consumption and waterpipe use. The age- and gender-adjusted proportion of respondents reporting current or past smoking of cigarettes or waterpipes was 31.2% [95% CI: 30.9-31.6%]. This proportion was significantly higher (p < 0.001) in men (48.0%) than in women (13.8%), but no relevant differences were observed between age groups. Smoking rates were in general lowest in the Maghreb countries and Pakistan and highest in the Eastern Mediterranean countries, ranging from 15.3% in Morocco to 53.9% in Lebanon. Consumption rates were 28.8% [28.4-29.2%] for cigarette smoking and 3.5% [3.4-3.6%] for waterpipe use. Use of waterpipes was most frequent in Saudi Arabia (8.5% of respondents) but remained low in the Maghreb countries (< 1.5%). Cumulative cigarette exposure was high, with a mean number of pack · years smoked of 18.5 ± 20.5 for women and 29.1 ± 26.2 for men. In conclusion, smoking is a major health issue in the MENA region.

Psychometric evaluation of the COPD assessment test: data from the BREATHE study in the Middle East and North Africa region.

The objective of this study was to assess the validity and performance of the Arabic and Turkish versions of the COPD Assessment Test (CAT) for evaluating the severity and impact of COPD symptoms. The data were obtained from the BREATHE study in the Middle East and North Africa region, a large general population survey of COPD conducted in ten countries of the region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), using a standardised methodology. A total of 62,086 subjects were screened, of whom a random sample of 5,681 subjects were administered the CAT by telephone. 5,639 evaluable questionnaires were recovered, representing a completion rate of 99%. In addition, the CAT was administered to an additional 833 subjects fulfilling the epidemiological diagnostic criteria for COPD. Mean scores in the general population were 6.99 ± 6.91 for the Arabic version and 9.88 ± 9.04 for the Turkish version. In patients with COPD, mean scores were 16.2 ± 9.1 and 20.9 ± 10.2 respectively. Scores were consistently higher in smokers than in non-smokers. In the general population, the proportion of respondents fulfilling criteria for COPD rose with higher CAT scores, and particularly above the 80th percentile, where 63% of COPD cases were to be found. This suggests that the CAT may be useful as a case-finding tool in the general population. In the COPD population, healthcare resource consumption rose linearly with CAT score above a threshold score of twenty, arguing in favour of the good criterion validity of the CAT. The internal consistency of the CAT was high (Cronbach's α 0.85 for the Arabic and 0.86 for the Turkish versions) and the factorial structure was unidimensional. In conclusion, this study performed in Arabic and Turkish speaking populations confirms the utility and validity of the CAT as a simple tool to collect data on the severity and impact of COPD symptoms, and suggests that it may potentially be useful as a case-finding tool to identify people at risk for COPD in the general population.