Challenges in the implementation of chronic obstructive pulmonary disease guidelines in low- And middle-income countries an official American thoracic society workshop report

John R. Hurst, A. Sonia Buist, Mina Gaga, Gonzalo E. Gianella, Bruce Kirenga, Ee Ming Khoo, Renata Gonçalves Mendes, Anant Mohan, Kevin Mortimer, Sarah Rylance, Trishul Siddharthan, Sally J. Singh, Job F.M.V. Van Boven, Sian Williams, Jing Zhang, William Checkley

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

There is a substantial burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), in lowand middle-income countries (LMICs). LMICs have particular challenges in delivering cost-effective prevention, diagnosis, and management of COPD. Optimal care can be supported by effective implementation of guidelines. This American Thoracic Society workshop considered challenges to implementation of COPD guidelines in LMICs. We make 10 specific recommendations: 1) relevant organizations should provide LMIC-specific COPD management guidance; 2) patient and professional organizations must persuade policy-makers of the importance of lung function testing programs in LMICs; 3) healthcare education and training should emphasize the early-life origins of COPD; 4) urgent action is required by governments to reduce airborne exposures, including exposures to tobacco smoke and indoor and outdoor air pollution; 5) guidance for COPD in LMICs should explicitly link across Essential Medicine Lists and the World Health Organization package of essential noncommunicable disease interventions for primary health care in low-resource settings and should consider availability, affordability, sustainability, and cost-effective use of medicines; 6) the pharmaceutical industry should work to make effective COPD and tobacco-dependence medicines globally accessible and affordable; 7) implementation of locally adapted, cost-effective pulmonary rehabilitation programs should be an international priority; 8) the World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases should specify how improvements in respiratory health will be achieved; 9) research funders should increase the proportion of funding allocated to COPD in LMICs; and 10) the respiratory community should leverage the skills and enthusiasm of earliercareer clinicians and researchers to improve global respiratory health

Original languageEnglish (US)
Pages (from-to)1269-1277
Number of pages9
JournalAnnals of the American Thoracic Society
Volume18
Issue number8
DOIs
StatePublished - Aug 2021

Keywords

  • Chronic obstructive pulmonary disease
  • Guidelines
  • Implementation
  • Low- and middle-income countries

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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