Unmet Diagnostic and Therapeutic Opportunities for COPD in Low- and Middle-Income Countries.

Siddharthan, Trishul; Chandyo, Ram K.; Ricciardi, Federico; Kirenga, Bruce; Miranda, J. Jaime; Alupo, Patricia; Mohan, Sakshi; Flores-Flores, Oscar; Hurst, John R.; Florman, Katia Eh; Checkley, William; Mendes, Renata Gonçalves; Wosu, Adaeze C.; Rykiel, Natalie A.; Sharma, Arun K.; Pollard, Suzanne L.; Barber, Julie A.

dc.contributor.author	Florman, Katia Eh
dc.contributor.author	Siddharthan, Trishul
dc.contributor.author	Pollard, Suzanne L.
dc.contributor.author	Alupo, Patricia
dc.contributor.author	Barber, Julie A.
dc.contributor.author	Chandyo, Ram K.
dc.contributor.author	Flores-Flores, Oscar
dc.contributor.author	Kirenga, Bruce
dc.contributor.author	Mendes, Renata Gonçalves
dc.contributor.author	Miranda, J. Jaime
dc.contributor.author	Mohan, Sakshi
dc.contributor.author	Ricciardi, Federico
dc.contributor.author	Rykiel, Natalie A.
dc.contributor.author	Sharma, Arun K.
dc.contributor.author	Wosu, Adaeze C.
dc.contributor.author	Checkley, William
dc.contributor.author	Hurst, John R.
dc.coverage.spatial	Bhaktapur, Nepal
dc.coverage.spatial	Lima, Peru
dc.coverage.spatial	Distrito de Nakaseke, Uganda.
dc.date.accessioned	2023-07-18T16:18:56Z
dc.date.available	2023-07-18T16:18:56Z
dc.date.issued	2023
dc.identifier.uri	https://hdl.handle.net/20.500.12866/13919
dc.description.abstract	RATIONALE: Chronic obstructive pulmonary disease (COPD) is a prevalent and burdensome condition in low- and middle-income countries (LMICs). Challenges to better care include more effective diagnosis, and access to affordable interventions. There are no previous reports describing therapeutic needs in LMIC populations with COPD identified through screening. OBJECTIVE: To describe unmet therapeutic need in screening-detected COPD in LMIC settings. METHODS: We compared interventions recommended by the international 'GOLD' COPD strategy document, with that received, in 1000 people with COPD identified by population screening at three LMIC sites in Nepal, Peru and Uganda. We calculated costs using data on the availability and affordability of medicines. MEASUREMENT AND MAIN RESULTS: The greatest unmet need for non-pharmacological interventions was for education and vaccinations (applicable to all), pulmonary rehabilitation (49%), smoking cessation (30%) and advice on biomass smoke exposure (26%). 95% of cases were previously undiagnosed and few were receiving therapy (4.5% had short-acting beta-agonists). Only three of 47 people (6%) with a previous COPD diagnosis had access to drugs consistent with recommendations. None of those with more severe COPD were accessing appropriate maintenance inhalers. Even when available, maintenance treatments were unaffordable with 30 days of treatment more than a low-skilled workers' daily average wage. CONCLUSION: We found significant missed opportunity to reduce the burden of COPD in LMIC settings, with most cases undiagnosed. Whilst there is unmet need in developing novel therapies, in LMICs where the burden is greatest, better diagnosis together with access to affordable interventions could translate to immediate benefit.	en_US
dc.language.iso	eng
dc.publisher	American Thoracic Society
dc.relation.ispartofseries	American Journal of Respiratory and Critical Care Medicine
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	COPD	en_US
dc.subject	Pulmonary Rehabilitation	en_US
dc.subject	LMIC	en_US
dc.subject	Bronchodilator	en_US
dc.subject	Guidelines	en_US
dc.subject.mesh	Enfermedad Pulmonar Obstructiva Crónica
dc.subject.mesh	Rehabilitación
dc.subject.mesh	Países en Desarrollo
dc.subject.mesh	Guías como Asunto
dc.title	Unmet Diagnostic and Therapeutic Opportunities for COPD in Low- and Middle-Income Countries.	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1164/rccm.202302-0289OC
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.07
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.08
dc.relation.issn	1535-4970