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Multicenter Study
. 2015 Jan;19(1):21-30.
doi: 10.5588/ijtld.14.0263.

Gaps in using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites

L Gnatiuc  1 , A S Buist  2 , B Kato  1 , C Janson  3 , N Aït-Khaled  4 , R Nielsen  5 , P A Koul  6 , E Nizankowska-Mogilnicka  7 , D Obaseki  8 , L F Idolor  9 , I Harrabi  10 , P G J Burney  1 ; BOLD Collaboration
Collaborators, Affiliations
Multicenter Study

Gaps in using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites

L Gnatiuc et al. Int J Tuberc Lung Dis. 2015 Jan.

Abstract

Background: Increasing access to essential respiratory medicines and influenza vaccination has been a priority for over three decades. Their use remains low in low- and middle-income countries (LMICs), where little is known about factors influencing use, or about the use of influenza vaccination for preventing respiratory exacerbations.

Methods: We estimated rates of regular use of bronchodilators, inhaled corticosteroids and influenza vaccine, and predictors for use among 19 000 adults in 23 high-income countries (HICs) and LMIC sites.

Results: Bronchodilators, inhaled corticosteroids and influenza vaccine were used significantly more in HICs than in LMICs, after adjusting for similar clinical needs. Although they are used more commonly by people with symptomatic or severe respiratory disease, the gap between HICs and LMICs is not explained by the prevalence of chronic obstructive pulmonary disease or doctor-diagnosed asthma. Site-specific factors are likely to influence use differently. The gross national income per capita for the country is a strong predictor for use of these treatments, suggesting that economics influence under-treatment.

Conclusion: We still need a better understanding of determinants for the low use of essential respiratory medicines and influenza vaccine in low-income settings. Identifying and addressing these more systematically could improve the access and use of effective treatments.

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Figures

Figure 1
Figure 1. The relative rate of use (sample unweighted) of classes of respiratory medicines and flu vaccine, by chronic respiratory conditions and by country income
A in Subjects with COPD GOLD stage 2+ with dyspnea or wheeze Rate for each class of medicines calculated as (Total number of subjects with symptomatic COPD stage 2 on a particular class of medicines in HIC / Total number of subjects with symptomatic COPD stage 2 on any respiratory medicines in HIC )*100
Figure 1
Figure 1. The relative rate of use (sample unweighted) of classes of respiratory medicines and flu vaccine, by chronic respiratory conditions and by country income
B in Subjects with reported doctor-diagnosed asthma Rate for each class of medicines calculated as (Total number of subjects with symptomatic COPD stage 2 on a particular class of medicines in HIC / Total number of subjects with symptomatic COPD stage 2 on any respiratory medicines in HIC )*100
Fig 2
Fig 2
Predictors for use of Bronchodilators of inahied corticosteroids (Overall results from meta-analysis)
Fig 3
Fig 3
Predictors for influenza vaccine uptake (results from meta-analysis)
Figure 4
Figure 4. Association of the GNIPC with use of selected medications and influenza vaccination
Adjusted for all predictors in figures 2 and 3. GNIPC <5K US$ (Low Income- baseline): India, Philippines, China, Tunisia, Nigeria GNIPC 5-10K US$ (Middle Income): S Africa, Turkey GNIPC 10-30K US$ (Low- High Income): Poland, Estonia, Portugal GNIPC 30k+ US$ (High Income): Iceland, UK, Canada, Germany, Australia, USA, Austria, Netherlands, Sweden, Norway
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Comment in

References

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