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Stolbrink M, Ozoh OB, Halpin DMG, Nightingale R, Meghji J, Plum C, Allwood BW, Jayasooriya S, Mortimer K. Availability, cost and affordability of essential medicines for chronic respiratory diseases in low-income and middle-income countries: a cross-sectional study. Thorax 2024; 79:676-679. [PMID: 38760170 PMCID: PMC11187362 DOI: 10.1136/thorax-2023-221349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Contemporary data on the availability, cost and affordability of essential medicines for chronic respiratory diseases (CRDs) across low-income and middle-income countries (LMICs) are missing, despite most people with CRDs living in LMICs. Cross-sectional data for seven CRD medicines in pharmacies, healthcare facilities and central medicine stores were collected from 60 LMICs in 2022-2023. Medicines for symptomatic relief were widely available and affordable, while preventative treatments varied widely in cost, were less available and largely unaffordable. There is an urgent need to address these issues if the Sustainable Development Goal 3 is to be achieved for people with asthma by 2030.
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Affiliation(s)
- Marie Stolbrink
- Clinical Sciences, Stellenbosch University, Stellenbosch, South Africa
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Obianuju B Ozoh
- Department of Medicine, University of Lagos College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos University Teaching Hospital, Surulere, Nigeria
| | - David M G Halpin
- Department of Respirology, Royal Devon and Exeter Hospital, Exeter, UK
| | | | | | - Catherine Plum
- University Hospitals of Morecambe Bay NHS Trust, Kendal, UK
| | - Brian William Allwood
- Department of Pulmonology, Tygerberg Academic Hospital, Cape Town, South Africa
- Department of Pulmonology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | | | - Kevin Mortimer
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Medicine, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Athanazio RA, Bernal Villada L, Avdeev SN, Wang HC, Ramírez-Venegas A, Sivori M, Dreyse J, Pacheco M, Man SK, Noriega-Aguirre L, Farouk H. Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study. BMJ Open Respir Res 2024; 11:e002101. [PMID: 38637115 PMCID: PMC11029392 DOI: 10.1136/bmjresp-2023-002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/16/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION The EXAcerbations of Chronic obstructive lung disease (COPD) and their OutcomeS (EXACOS) International Study aimed to quantify the rate of severe exacerbations and examine healthcare resource utilisation (HCRU) and clinical outcomes in patients with COPD from low-income and middle-income countries. METHODS EXACOS International was an observational, cross-sectional study with retrospective data collection from medical records for a period of up to 5 years. Data were collected from 12 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Hong Kong, Mexico, Panama, Russia and Taiwan. The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU. RESULTS In total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. A statistically significant decrease in mean (SD) FEV1 from baseline to post-baseline was observed in patients with ≥1 severe exacerbation (1.23 (0.51) to 1.13 (0.52) L; p=0.0000). Mean BEC was 0.198 x109 cells/L, with 64.7% of patients having a BEC ≥0.1 x109 cells/L and 21.3% having a BEC ≥0.3 x109 cells/L. The most common comorbidity was hypertension (58.3%). An increasing number of severe exacerbations per year was associated with greater HCRU. DISCUSSION The findings presented here indicate that effective treatment strategies to prevent severe exacerbations in patients with COPD remain a significant unmet need in low-income and middle-income countries.
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Affiliation(s)
- Rodrigo Abensur Athanazio
- Pulmonology Division, Heart Institute-InCor-Clinical Hospital, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sergey N Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Alejandra Ramírez-Venegas
- Tobacco Smoking and COPD Research Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Martín Sivori
- Pneumology Unit, Dr J M Ramos Mejía Pulmonology University Center, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Jorge Dreyse
- Department of Internal Medicine and Critical Care Center, Clínica Las Condes and School of Medicine Universidad Finis Terrae, Santiago, Chile
| | - Manuel Pacheco
- Internal Medicine Research Group, Universidad Tecnológica de Pereira, Pereira, Colombia
- Fundación Universitaria Visión de las Américas y Respiremos Unidad de Neumología, Pereira, Colombia
| | - Sin Kit Man
- Department of Medicine and Geriatrics, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong Special Administrative Region (HKSAR), Tuen Mun, People's Republic of China
| | - Lorena Noriega-Aguirre
- Center for Diagnosis and Treatment of Respiratory Diseases (CEDITER), Panama City, Panama
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Mortimer K, Kurtulus S, Yorgancıoğlu A, Romero-Tapia SDJ, Singh N, Ahmed R, Boladuadua S, Masekela R. Living with Asthma in Low- and Middle-Income Countries in the Six WHO Regions. NEJM EVIDENCE 2024; 3:EVIDpp2300292. [PMID: 38320510 DOI: 10.1056/evidpp2300292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Living with AsthmaAsthma is a highly prevalent disease. Although most people with asthma can be treated effectively with certain inhaled medicines, accessing affordable care near their homes is a challenge for many people in low- and middle-income countries. We present stories from six men, women, and children living with asthma in such countries.
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Affiliation(s)
- Kevin Mortimer
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
- Cambridge Africa, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
- Liverpool University Hospitals, NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Serif Kurtulus
- Department of Chest Diseases, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | | | | | | | - Rana Ahmed
- The Epidemiological Laboratory (Epi-Lab), Khartoum, Sudan
| | - Sainimere Boladuadua
- Department of Paediatrics: Child & Youth Health, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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Labaeka AA, Falade AG, Addo-Yobo EOD, Mortimer K, Zurba L, Lesosky M, Ellwood P, Asher MI. Decreased prevalence and severity of asthma symptoms among adolescents in Ibadan, Nigeria, 1995-2018. Int J Tuberc Lung Dis 2023; 27:925-930. [PMID: 38042979 PMCID: PMC10719893 DOI: 10.5588/ijtld.23.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/27/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: Phases I and III of the International Study of Asthma and Allergies in Childhood (ISAAC) documented increased asthma symptoms among Nigerian 13-14-year old adolescents. We investigated the trend further using the Global Asthma Network (GAN) surveillance.METHODS: Using ISAAC methodology, GAN Phase I data on symptoms and risk factors for asthma and asthma management were obtained from February to July 2018.RESULTS: There were 2,897 adolescents from 23 secondary schools. For current wheeze, there was an absolute prevalence fall per decade of -1.4 with -1 standard error (SE) in 16 years from 2002 (ISAAC Phase III) to 2018 (GAN Phase I). This pattern was evident for prevalence of reported asthma ever, severe asthma symptoms and night cough with ≥1 SE. During the 23-year interval between ISAAC Phase I and GAN Phase I, there was a fall (≥1 SE) in the absolute prevalence of reported asthma ever, severe asthma symptoms and night cough, except for severe asthma symptoms (-0.2 SE). Respectively 36% and 43% of symptomatic adolescents purchased and used salbutamol and prednisolone.CONCLUSION: The prevalence and severity of asthma symptoms remain high among adolescents in Ibadan. This could be mitigated by improved access to affordable and effective asthma treatments.
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Affiliation(s)
- A A Labaeka
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - A G Falade
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - E O D Addo-Yobo
- Kwame Nkrumah University of Science and Technology, Kumasi, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - K Mortimer
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, University of KwaZulu Natal, Durban
| | - L Zurba
- Spirometry Training Services Africa, Durban
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - P Ellwood
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - M I Asher
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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Khaltaev N, Axelrod S. Decline of the chronic respiratory disease mortality in the WHO Western Pacific Region. J Thorac Dis 2023; 15:5801-5810. [PMID: 37969316 PMCID: PMC10636449 DOI: 10.21037/jtd-22-1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 09/01/2023] [Indexed: 11/17/2023]
Abstract
Background Non-communicable diseases (NCDs) are major cause of death all over the world killing 41 million of the 57 million deaths (72%) in 2016. According to World Health Organization (WHO) Director General the biggest decrease in NCD mortality between 2000 and 2019 globally were for chronic respiratory diseases (CRDs) a 37% decline. The WHO Western Pacific Region (WPRO) made the biggest gains against CRD a 55.9% drop. We analysed CRD mortality in the WPRO comparing with other WHO regions. Methods Assessment of the risk factors was made in all WHO countries mainly in 2016. Lifestyle modifications concerning tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol in 2020. We used WHO assessment of ambient and household air pollution attributable to chronic obstructive pulmonary disease (COPD) mortality. Results WPRO comprises 27 countries, 10 high-income countries (HIC) and 17 middle-income countries (MIC). A total of 52 countries in other WHO regions belong to HIC and 86 countries to MIC. No difference was found in the tobacco demand-reduction measures. Clear difference was demonstrated in the prevalence of the raised blood pressure (RBP) which was lower in the WPRO. In the WPRO HIC every fifth has RBP while in other regions it was every forth. Similar difference was observed for MIC. COPD mortality linked to air pollution was twice higher in the WPRO. It was highest in MIC. CRD management probably plays a crucial role in the decline of the observed mortality in the region since numerous WHO global, regional and national prevention and management CRD approaches and activities have been successfully initiated and implemented there. WHO Global Alliance against Chronic Respiratory Diseases (GARD) was successfully initiated in Beijing in 2006. Two subsequent global GARD meetings held in Seoul [2007] and Beijing [2019] had a tremendous impact on the CRD awareness, prevention and control strategies in the region. These events have stimulated development of the national CRD programmes. Beijing's declaration "Call for action for lung health" stressed the better management of CRD at primary healthcare level. Conclusions Better RBP control, improved prevention, diagnosis and treatment of CRD could contribute to the observed decline of premature CRD mortality in the region.
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Affiliation(s)
- Nikolai Khaltaev
- Global Alliance against Chronic Respiratory Diseases, Geneva, Switzerland
| | - Svetlana Axelrod
- Institute for Leadership and Health Management, I. M. Sechenov First Moscow State University (Sechenov University), Moscow, Russia
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Stolbrink M, Streicher C, Mcimeli K, Allwood B, Mortimer K, Chinouya M. "Asthma is a very bully disease" - patient experiences of living with chronic respiratory diseases in Cape Town, South Africa. Int J Equity Health 2023; 22:190. [PMID: 37710307 PMCID: PMC10500759 DOI: 10.1186/s12939-023-02002-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Chronic respiratory diseases are common in Cape Town, South Africa. Yet the experiences of how adults with these conditions, such as asthma or COPD (chronic obstructive pulmonary disease), negotiate the health system are poorly understood. Qualitative methodology lends itself to investigate this question. AIM OF STUDY To explore the "emic" experiences of adults with CRDs in Cape Town when they were negotiating the health system using semi-structured interviews. METHODS Interviews were conducted following informed consent with purposively sampled adults who had attended public hospitals in Cape Town with chronic respiratory disease flare-ups. This work was nested in the quantitative "Diagnosing Airways Disease" study. The topic guide explored patients' experiences of accessing healthcare including receiving and interpretations of the diagnosis and management, and impacts on daily life. Interviews were conducted in Afrikaans, isiXhosa, or English; transcribed, and translated into English and thematically analysed until saturation. RESULTS Thirty-two interviews (16 in Afrikaans, 8 in isiXhosa, 8 in English) were completed in 2022. 17 women and 15 men participated. Most participants were older than 50 years (25/32), and most were unemployed (13/32) or retired (11/32). The identified themes were: Perceived causes of illness; experiences of healthcare; perceived risks and barriers when accessing healthcare; and impact on earnings. The perceived causes of their illness and risks were structural, and included air pollution, poor quality housing, occupational exposures, limited healthcare services, and fear of violence. These factors led to self-treatment, sharing of medicines, and delay in receiving a diagnosis. Many paid privately for treatments or services to overcome identified shortcomings of the public healthcare system, and many reported additional significant indirect costs. Being ill had a profound impact on income. The identified themes were explored through the lens of "structural violence", where "social structures stop individuals … from reaching their full potential" (Galtung, 1969). CONCLUSION In Cape Town structural elements such as stretched healthcare professionals, insufficiently enforced policies on e.g., housing or work-place exposures, poverty and crime made it difficult for participants to successfully navigate their illness experience. It forced some to pay out of pocket to receive perceived better healthcare privately.
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Affiliation(s)
- Marie Stolbrink
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.
| | - Chantel Streicher
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Khanyisa Mcimeli
- Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Brian Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Kevin Mortimer
- Cambridge Africa, University of Cambridge, Cambridge, UK
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Martha Chinouya
- Faculty of Education, Liverpool School of Tropical Medicine, Liverpool, UK
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Jayasooriya S, Stolbrink M, Khoo EM, Sunte IT, Awuru JI, Cohen M, Lam DC, Spanevello A, Visca D, Centis R, Migliori GB, Ayuk AC, Buendia JA, Awokola BI, Del-Rio-Navarro BE, Muteti-Fana S, Lao-Araya M, Chiarella P, Badellino H, Somwe SW, Anand MP, Garcí-Corzo JR, Bekele A, Soto-Martinez ME, Ngahane BHM, Florin M, Voyi K, Tabbah K, Bakki B, Alexander A, Garba BL, Salvador EM, Fischer GB, Falade AG, ŽivkoviĆ Z, Romero-Tapia SJ, Erhabor GE, Zar H, Gemicioglu B, Brandão HV, Kurhasani X, El-Sharif N, Singh V, Ranasinghe JC, Kudagammana ST, Masjedi MR, Velásquez JN, Jain A, Cherrez-Ojeda I, Valdeavellano LFM, Gómez RM, Mesonjesi E, Morfin-Maciel BM, Ndikum AE, Mukiibi GB, Reddy BK, Yusuf O, Taright-Mahi S, Mérida-Palacio JV, Kabra SK, Nkhama E, Filho NR, Zhjegi VB, Mortimer K, Rylance S, Masekela RR. Clinical standards for the diagnosis and management of asthma in low- and middle-income countries. Int J Tuberc Lung Dis 2023; 27:658-667. [PMID: 37608484 PMCID: PMC10443788 DOI: 10.5588/ijtld.23.0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.
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Affiliation(s)
- S Jayasooriya
- Academic Unit of Primary Care, University of Sheffield, Sheffield
| | - M Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E M Khoo
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - I T Sunte
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - J I Awuru
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - M Cohen
- Hospital Centro Médico, Guatemala City, Guatemala, Mexico, Asociación Latinoamericana de Tórax, Montevideo, Uruguay
| | - D C Lam
- Department of Medicine, University of Hong Kong, Hong Kong, Asian Pacific Society of Respirology, Hong Kong, China
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como
| | - D Visca
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Department of Medicine, University of Hong Kong, Hong Kong
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - A C Ayuk
- College of Medicine, University of Nigeria, Enugu, Nigeria
| | - J A Buendia
- Affiliation Departamento de Farmacologia y Tóxicologia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - B I Awokola
- Medical Research Council, The Gambia at the London School of Tropical Medicine, The Gambia
| | | | - S Muteti-Fana
- Department of Primary Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - M Lao-Araya
- Division of Allergy and Clinical Immunology, Chian Mai University, Chiang Mai, Thailand
| | - P Chiarella
- Health Sciences School, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - H Badellino
- Head Pediatric Respiratory Medicine Department, Clinica Regional del Este, San Francisco, Argentina
| | - S W Somwe
- Paediatrics and Child Health, University of Lusaka, Lusaka, Zambia
| | - M P Anand
- Department of Respiratory Medicine, JSS Medical College, Mysore, India
| | - J R Garcí-Corzo
- Department of Pediatrics, Universidad Industrial de Santander, Santander, Colombia
| | - A Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Soto-Martinez
- Department of Pediatrics, Universidad de Costa Rica, San Jose, Costa Rica
| | - B H M Ngahane
- Douala General Hospital, University of Douala, Douala, Cameroon
| | - M Florin
- Institute of Pneumology M. Nasta, Bucharest, Romania
| | - K Voyi
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - K Tabbah
- College of Medicine, Ajman University, Ajman, United Arab Emirates
| | - B Bakki
- University of Maiduguri Teaching Hospital, Maiduguri
| | - A Alexander
- Deparment of Medicine, University of Abuja, Abuja
| | - B L Garba
- Department of Paediatrics, Usmanu Danfodiyo, University Teaching Hospital, Sokoto, Nigeria
| | - E M Salvador
- Deparment of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - G B Fischer
- University of Medical Sciences, Porto Alegre, RS, Brazil
| | - A G Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Zorica ŽivkoviĆ
- Dragiša Mišovic, Childrens Hsopital for Lung Disease and TB, Belgrade, Serbia
| | - S J Romero-Tapia
- Health Sciences, Academic Division, Juarez Autononous, University of Tabasco, Villahermosa, Mexico
| | - G E Erhabor
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - H Zar
- Department of Paediatrics & Child Health & SA MRC Unit on Children & Adolescent Health, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University, Cerrahpasa, Turkey
| | - H V Brandão
- State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - X Kurhasani
- UBT Higher Education Institution, Prishtina, Kosovo
| | | | - V Singh
- MJ Rajasthan Hospital, Jaipur, India
| | | | - S T Kudagammana
- Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - M R Masjedi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J N Velásquez
- Medical School, Santander Industrial, Bucaramanga, Colombia
| | - A Jain
- Department of Community Medicine, Kasturba Medical College, Mangalore
| | | | - L F M Valdeavellano
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Francisco Morroguín University, Guatemala City, Guatemala
| | - R M Gómez
- Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - E Mesonjesi
- Department of Allergy and Clinical Immunology, University Hospital Centre "Mother Teresa", Tirana, Albania
| | | | - A E Ndikum
- The University of Yaounde 1, Yaounde, Cameroon
| | | | - B K Reddy
- Shishuka Children's Speciality Hospital, Bangalore, India
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - S Taright-Mahi
- Medecin Faculty, Mustapha Universitary Hospital Algiers, Algeria
| | - J V Mérida-Palacio
- Centrode Investigación de Enfermedades Alérgicas y Respiratorias SC, Mexico DF, Mexico
| | - S K Kabra
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - E Nkhama
- Levy Mwanawasa Medical University, School of Public Health and Environmental Sciences, Lusaka, Zambia
| | - N R Filho
- Federal University of Parana, Curitiba, PA, Brazil
| | - V B Zhjegi
- Social Medicine, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - K Mortimer
- University of Cambridge, Cambridge, Imperial College, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - S Rylance
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - R R Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
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Agustí A, Anzueto A, Celli BR, Mortimer K, Salvi S, Vogelmeier CF. GOLD 2023 Executive Summary: responses from the GOLD Scientific Committee. Eur Respir J 2023; 61:2300616. [PMID: 37321613 PMCID: PMC10269375 DOI: 10.1183/13993003.00616-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 06/17/2023]
Abstract
We thank the authors of the five letters received in relation to the recent publication of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Executive Summary in the European Respiratory Journal [1] for their interest and insightful comments. We address them below, albeit necessarily briefly, under three categories: a global perspective, diagnostic issues, and management of exacerbations. The GOLD Scientific Committee respond to five letters to the Editor in relation to the GOLD 2023 Executive Summary https://bit.ly/41wJzhk
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Affiliation(s)
- Alvar Agustí
- Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Barcelona, Spain
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas, San Antonio, TX, USA
| | - Bartolome R Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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9
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Ouédraogo AR, Boncoungou K, Ouédraogo JCRP, Ouédraogo GA, Kiendrebeogo JA, Sourabie A, Maiga S, Kafando S, Ouédraogo G, Badoum G, Ouédraogo M. [Availability and affordability of diagnosis and treatment for asthma and COPD in Ouagadougou, Burkina Faso]. Rev Mal Respir 2023; 40:382-390. [PMID: 37062632 DOI: 10.1016/j.rmr.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Chronic respiratory diseases, particularly asthma and Chronic Obstructive Pulmonary Disease (COPD), pose a significant threat to public health. This study aims to determine the accessibility and affordability of means of diagnosis and treatment. METHODS This was a cross-sectional study covering the period from August to December 2021 in Ouagadougou, Burkina Faso. This study involved 107 health centers and 135 pharmacies. The World Health Organization/Health Action International definition was used as a benchmark for accessibility to medicines. RESULTS Out of 107 health centers, 29 (27.1%) had a spirometer. The average cost of spirometry represented 19.88 days of salary for a patient paid at the minimum wage. The most widely available drugs were salbutamol in a pressurized metered dose inhaler (pMDI) (88.1%) and prednisone 20mg tablet (87.4%). No disease-modifying drug was available in public pharmacies. Affordable drugs were salbutamol 4mg tablet and aminophylline 100mg tablet. CONCLUSION The means of diagnosis and treatment of asthma and COPD are insufficiently available, especially in the public sector, which is characterized by a nearly total absence of basic treatment.
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Affiliation(s)
- A R Ouédraogo
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Tengandogo, Ouagadougou, Burkina Faso.
| | - K Boncoungou
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - J C R P Ouédraogo
- Département MEPHATRA-PH, institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
| | - G A Ouédraogo
- Service de pneumologie, centre hospitalier universitaire régional de Ouahigouya, Ouagadougou, Burkina Faso
| | - J A Kiendrebeogo
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso
| | - A Sourabie
- Service de pneumologie, CHU de Souro-Sanou, Bobo-Dioulasso, Burkina Faso
| | - S Maiga
- Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - S Kafando
- Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - G Ouédraogo
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - G Badoum
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - M Ouédraogo
- Unité de formation et de recherche en sciences de la santé, université Joseph-Ki-Zerbo, Ouagadougou, Burkina Faso; Service de pneumologie, CHU de Yalgado Ouedraogo, Ouagadougou, Burkina Faso
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10
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Levy ML, Bacharier LB, Bateman E, Boulet LP, Brightling C, Buhl R, Brusselle G, Cruz AA, Drazen JM, Duijts L, Fleming L, Inoue H, Ko FWS, Krishnan JA, Mortimer K, Pitrez PM, Sheikh A, Yorgancıoğlu A, Reddel HK. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med 2023; 33:7. [PMID: 36754956 PMCID: PMC9907191 DOI: 10.1038/s41533-023-00330-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with "mild" asthma) as combination ICS-formoterol taken as needed for symptom relief. For patients with moderate-severe asthma, the preferred regimen is maintenance-and-reliever therapy (MART) with ICS-formoterol. Asthma treatment is not "one size fits all"; GINA recommends individualized assessment, adjustment, and review of treatment. As many patients with difficult-to-treat or severe asthma are not referred early for specialist review, we provide updated guidance for primary care on diagnosis, further investigation, optimization and treatment of severe asthma across secondary and tertiary care. While the GINA strategy has global relevance, we recognize that there are special considerations for its adoption in low- and middle-income countries, particularly the current poor access to inhaled medications.
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Affiliation(s)
| | - Leonard B. Bacharier
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Eric Bateman
- grid.7836.a0000 0004 1937 1151Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Louis-Philippe Boulet
- grid.23856.3a0000 0004 1936 8390Québec Heart and Lung Institute, Université Laval, Québec City, QC Canada
| | - Chris Brightling
- grid.9918.90000 0004 1936 8411Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK
| | - Roland Buhl
- grid.410607.4Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Guy Brusselle
- grid.410566.00000 0004 0626 3303Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium ,grid.5645.2000000040459992XDepartments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alvaro A. Cruz
- grid.8399.b0000 0004 0372 8259ProAR Foundation and Federal University of Bahia, Salvador, Bahia Brazil
| | - Jeffrey M. Drazen
- grid.38142.3c000000041936754XBrigham and Women’s Hospital and Department of Medicine, Harvard Medical School, Boston, MA USA
| | - Liesbeth Duijts
- grid.5645.2000000040459992XDivisions of Respiratory Medicine and Allergology and Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Louise Fleming
- grid.7445.20000 0001 2113 8111National Heart and Lung Institute, Imperial College, London, UK
| | - Hiromasa Inoue
- grid.258333.c0000 0001 1167 1801Department of Pulmonary Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Fanny W. S. Ko
- grid.10784.3a0000 0004 1937 0482Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jerry A. Krishnan
- grid.185648.60000 0001 2175 0319Breathe Chicago Center, University of Illinois Chicago, Chicago, IL USA
| | - Kevin Mortimer
- grid.513149.bLiverpool University Hospitals NHS Foundation Trust, Liverpool, UK ,grid.5335.00000000121885934University of Cambridge, Cambridge, UK ,grid.16463.360000 0001 0723 4123Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Paulo M. Pitrez
- grid.415169.e0000 0001 2198 9354Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Aziz Sheikh
- grid.4305.20000 0004 1936 7988Department of Primary Care Research & Development, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Arzu Yorgancıoğlu
- grid.411688.20000 0004 0595 6052Department of Pulmonology, Celal Bayar University, Manisa, Turkey
| | - Helen K. Reddel
- grid.1013.30000 0004 1936 834XThe Woolcock Institute of Medical Research and The University of Sydney, Sydney, NSW Australia
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