Improving lung health in low-income and middle-income countries: from challenges to solutions

doi:10.1016/S0140-6736(21)00458-X

Review

. 2021 Mar 6;397(10277):928-940.

doi: 10.1016/S0140-6736(21)00458-X. Epub 2021 Feb 22.

Improving lung health in low-income and middle-income countries: from challenges to solutions

Jamilah Meghji¹, Kevin Mortimer², Alvar Agusti³, Brian W Allwood⁴, Innes Asher⁵, Eric D Bateman⁶, Karen Bissell⁷, Charlotte E Bolton⁸, Andrew Bush⁹, Bartolome Celli¹⁰, Chen-Yuan Chiang¹¹, Alvaro A Cruz¹², Anh-Tuan Dinh-Xuan¹³, Asma El Sony¹⁴, Kwun M Fong¹⁵, Paula I Fujiwara¹⁶, Mina Gaga¹⁷, Luis Garcia-Marcos¹⁸, David M G Halpin¹⁹, John R Hurst²⁰, Shamanthi Jayasooriya²¹, Ajay Kumar¹⁶, Maria V Lopez-Varela²², Refiloe Masekela²³, Bertrand H Mbatchou Ngahane²⁴, Maria Montes de Oca²⁵, Neil Pearce²⁶, Helen K Reddel²⁷, Sundeep Salvi²⁸, Sally J Singh²⁹, Cherian Varghese³⁰, Claus F Vogelmeier³¹, Paul Walker³², Heather J Zar³³, Guy B Marks³⁴

Affiliations

¹ Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
² Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Global Initiative for Asthma (GINA), Fontana, WI, USA; Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Global Asthma Network (GAN), Auckland, New Zealand; Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France. Electronic address: kevin.mortimer@lstmed.ac.uk.
³ Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain.
⁴ Division of Pulmonology, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa.
⁵ Global Asthma Network (GAN), Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
⁶ Global Initiative for Asthma (GINA), Fontana, WI, USA; Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
⁷ Global Asthma Network (GAN), Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand.
⁸ British Thoracic Society Global Health Group, London, UK; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham UK.
⁹ British Thoracic Society Global Health Group, London, UK; Imperial College and Royal Brompton Hospital, London, UK.
¹⁰ Global Initiative for COPD (GOLD), Fontana, WI, USA; Harvard Medical School, Boston, MA, USA.
¹¹ International Union Against Tuberculosis and Lung Diseases, Paris, France; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹² Global Initiative for Asthma (GINA), Fontana, WI, USA; Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil.
¹³ Cochin Hospital, Université de Paris, Paris, France; European Respiratory Society, Lausanne, Switzerland.
¹⁴ Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Epidemiological Laboratory (EPI Lab) for Public Health and Research, Khartoum, Sudan.
¹⁵ The University of Queensland Thoracic Research Centre and The Prince Charles Hospital, Queensland, QLD, Australia; Asian Pacific Society of Respirology, Tokyo, Japan.
¹⁶ International Union Against Tuberculosis and Lung Diseases, Paris, France.
¹⁷ Athens Chest Hospital Sotiria, Athens, Greece; World Health Organization, Geneva, Switzerland.
¹⁸ Global Asthma Network (GAN), Auckland, New Zealand; Paediatric Pulmonology and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain; BioHealth Research Institute of Murcia, Murcia, Spain; ARADyAL network, Madrid, Spain.
¹⁹ Global Initiative for COPD (GOLD), Fontana, WI, USA; University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.
²⁰ British Thoracic Society Global Health Group, London, UK; UCL Respiratory, University College London, London, UK.
²¹ British Thoracic Society Global Health Group, London, UK; Academic Unit of Primary Care, University of Sheffield, Sheffield, UK.
²² Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad de la Republica, Montevideo, Uruguay.
²³ Pan African Thoracic Society, Durban, South Africa; College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa.
²⁴ Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France; Douala General Hospital, Douala, Cameroon.
²⁵ Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad Central de Venezuela, Caracas, Venezuela.
²⁶ Global Asthma Network (GAN), Auckland, New Zealand; London School of Hygiene & Tropical Medicine, London, UK.
²⁷ Global Initiative for Asthma (GINA), Fontana, WI, USA; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
²⁸ Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmocare Research and Education Foundation, Pune, India.
²⁹ British Thoracic Society Global Health Group, London, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK.
³⁰ Department of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland.
³¹ Global Initiative for COPD (GOLD), Fontana, WI, USA; Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Marburg, Germany; German Center for Lung Research (DZL), Giessen, Germany.
³² British Thoracic Society Global Health Group, London, UK; Department of Respiratory Medicine, Liverpool Teaching Hospitals, Liverpool, UK.
³³ Pan African Thoracic Society, Durban, South Africa; Department of Paediatrics & Child Health, Red Cross Childrens Hospital, Cape Town, South Africa; SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
³⁴ Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; UNSW Medicine, Sydney, NSW, Australia.

PMID: 33631128
DOI: 10.1016/S0140-6736(21)00458-X

Review

Improving lung health in low-income and middle-income countries: from challenges to solutions

Jamilah Meghji et al. Lancet. 2021.

. 2021 Mar 6;397(10277):928-940.

doi: 10.1016/S0140-6736(21)00458-X. Epub 2021 Feb 22.

Authors

Affiliations

¹ Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
² Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Global Initiative for Asthma (GINA), Fontana, WI, USA; Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Global Asthma Network (GAN), Auckland, New Zealand; Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France. Electronic address: kevin.mortimer@lstmed.ac.uk.
³ Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain.
⁴ Division of Pulmonology, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa.
⁵ Global Asthma Network (GAN), Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
⁶ Global Initiative for Asthma (GINA), Fontana, WI, USA; Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
⁷ Global Asthma Network (GAN), Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand.
⁸ British Thoracic Society Global Health Group, London, UK; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham UK.
⁹ British Thoracic Society Global Health Group, London, UK; Imperial College and Royal Brompton Hospital, London, UK.
¹⁰ Global Initiative for COPD (GOLD), Fontana, WI, USA; Harvard Medical School, Boston, MA, USA.
¹¹ International Union Against Tuberculosis and Lung Diseases, Paris, France; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹² Global Initiative for Asthma (GINA), Fontana, WI, USA; Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil.
¹³ Cochin Hospital, Université de Paris, Paris, France; European Respiratory Society, Lausanne, Switzerland.
¹⁴ Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Epidemiological Laboratory (EPI Lab) for Public Health and Research, Khartoum, Sudan.
¹⁵ The University of Queensland Thoracic Research Centre and The Prince Charles Hospital, Queensland, QLD, Australia; Asian Pacific Society of Respirology, Tokyo, Japan.
¹⁶ International Union Against Tuberculosis and Lung Diseases, Paris, France.
¹⁷ Athens Chest Hospital Sotiria, Athens, Greece; World Health Organization, Geneva, Switzerland.
¹⁸ Global Asthma Network (GAN), Auckland, New Zealand; Paediatric Pulmonology and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain; BioHealth Research Institute of Murcia, Murcia, Spain; ARADyAL network, Madrid, Spain.
¹⁹ Global Initiative for COPD (GOLD), Fontana, WI, USA; University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.
²⁰ British Thoracic Society Global Health Group, London, UK; UCL Respiratory, University College London, London, UK.
²¹ British Thoracic Society Global Health Group, London, UK; Academic Unit of Primary Care, University of Sheffield, Sheffield, UK.
²² Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad de la Republica, Montevideo, Uruguay.
²³ Pan African Thoracic Society, Durban, South Africa; College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa.
²⁴ Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France; Douala General Hospital, Douala, Cameroon.
²⁵ Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad Central de Venezuela, Caracas, Venezuela.
²⁶ Global Asthma Network (GAN), Auckland, New Zealand; London School of Hygiene & Tropical Medicine, London, UK.
²⁷ Global Initiative for Asthma (GINA), Fontana, WI, USA; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
²⁸ Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmocare Research and Education Foundation, Pune, India.
²⁹ British Thoracic Society Global Health Group, London, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK.
³⁰ Department of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland.
³¹ Global Initiative for COPD (GOLD), Fontana, WI, USA; Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Marburg, Germany; German Center for Lung Research (DZL), Giessen, Germany.
³² British Thoracic Society Global Health Group, London, UK; Department of Respiratory Medicine, Liverpool Teaching Hospitals, Liverpool, UK.
³³ Pan African Thoracic Society, Durban, South Africa; Department of Paediatrics & Child Health, Red Cross Childrens Hospital, Cape Town, South Africa; SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
³⁴ Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; UNSW Medicine, Sydney, NSW, Australia.

PMID: 33631128
DOI: 10.1016/S0140-6736(21)00458-X

Abstract

Low-income and middle-income countries (LMICs) bear a disproportionately high burden of the global morbidity and mortality caused by chronic respiratory diseases (CRDs), including asthma, chronic obstructive pulmonary disease, bronchiectasis, and post-tuberculosis lung disease. CRDs are strongly associated with poverty, infectious diseases, and other non-communicable diseases (NCDs), and contribute to complex multi-morbidity, with major consequences for the lives and livelihoods of those affected. The relevance of CRDs to health and socioeconomic wellbeing is expected to increase in the decades ahead, as life expectancies rise and the competing risks of early childhood mortality and infectious diseases plateau. As such, the World Health Organization has identified the prevention and control of NCDs as an urgent development issue and essential to the achievement of the Sustainable Development Goals by 2030. In this Review, we focus on CRDs in LMICs. We discuss the early life origins of CRDs; challenges in their prevention, diagnosis, and management in LMICs; and pathways to solutions to achieve true universal health coverage.

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Comment in

Lung health in LMICs: tackling challenges ahead.
Khoo EM, Li D, Ungan M, Jordan R, Pinnock H. Khoo EM, et al. Lancet. 2021 Aug 7;398(10299):488-489. doi: 10.1016/S0140-6736(21)01230-7. Lancet. 2021. PMID: 34364520 No abstract available.
Lung health in LMICs: tackling challenges ahead.
Nemery B, Katoto PDMC, Develtere P. Nemery B, et al. Lancet. 2021 Aug 7;398(10299):489-490. doi: 10.1016/S0140-6736(21)01232-0. Lancet. 2021. PMID: 34364521 No abstract available.

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Improving lung health in low-income and middle-income countries: from challenges to solutions

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Improving lung health in low-income and middle-income countries: from challenges to solutions

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