The research projects within the collaboration are under 3 main themes and are based on priorities identified by patients, clinicians and policy makers in each partner country:
Theme one: Case finding for undiagnosed COPD
Aim: To evaluate the accuracy of different screening strategies for identifying undiagnosed COPD and inform future case-finding strategies.
Our partners in Brazil and China have completed recruitment to their studies (recruiting 2,498 and 1,201 participants, respectively) which are investigating the accuracy of different screening methods and their cost effectiveness. The results of these studies are likely to be available by the end of 2020.
Theme two: Promotion of smoking cessation in the community
Smoking is a main contributor to COPD and smoking rates remain high in many LMIC. Smoking cessation has numerous health benefits, and is the main strategy for improving the health of people with COPD.
Aim: To evaluate different motivational approaches to assist smoking cessation among smokers identified through primary care settings.
1,366 participants were recruited from 32 GP Practices in North Macedonia into a randomised controlled trial which evaluates feedback on lung age and on exhaled Carbon Monoxide to smokers. Results should be available by the end of 2020.
Theme three: Behavioural interventions to improve disease management
Within low resource settings, availability of pharmacotherapy is limited. Behavioural interventions are a low cost, effective alternative, shown to be effective in improving the outcome with people with COPD in high income settings.
Aim: to assess the feasibility and evaluate an adapted pulmonary rehabilitation programme for people with COPD identified through primary care settings.
A feasibility trial of a culturally adapted pulmonary rehabilitation programme recruiting 60 participants with COPD was carried out by the team in Georgia. Results of this study are likely to be available by the end of 2020.
The Brazilian team also has a qualitative project which explores the barriers and enablers to physical activity and exercise programmes amongst COPD patients with and without mood disorders (anxiety and / or depression), which will inform the design of a future intervention for those patients.
A mixed-method study in China describes the management and understanding of COPD reported by patients in China and explores patient & GP opinion on current management of COPD and the design of a future “lung health” service which will focus on non-pharmacological interventions. Results for these studies are likely to be available in early 2021.
The Georgian team are conducting a qualitative study which crosses all of the themes, exploring barriers and enablers in the diagnosis and management of COPD in primary healthcare settings and identifying the need for capacity building of primary care professionals regarding COPD diagnosis, management and treatment.
Other milestones or activities
Training and networking
The UoB team have created and delivered bespoke training and mentoring which includes the areas of clinical, research skills and research management. Training examples include: specific research study design and protocol development, spirometry, spirometry overreading, health economics, statistics, writing for publication and stakeholder engagement. The whole Breathe Well team meet annually at the IPCRG conferences for training, planning, presenting and networking with international colleagues. Travel has been an important part of our developing relationships and many successful collaborative visits have been carried out each year.
Engaging Stakeholders
Stakeholder engagement is a substantial element of the Breathe Well programme, the aims of which are to identify and prioritise local research needs, ensure that cultural factors are accounted for, and also to establish a sustainable process for future collaborations. All countries have developed bespoke protocols with support from the UK team and the International Primary Care Respiratory Group.
International Collaboration
The Breathe Well research team is a member of the UK Global Health Respiratory Network, made up of MRC and NIHR-funded global health groups/units. The Network advocates increased respiratory research funding, sharing expertise and resources between members.