
Breathe Well Global Group

About
Breathe Well, the National Institute for Health and Care Research (NIHR) Global Health Research Group on Global COPD in Primary Care, was formed in June 2017, led by Professors Rachel Jordan and Peymané Adab. Working with teams in four countries – China, Brazil, Georgia and Republic of North Macedonia and the International Primary Care Respiratory Group (IPCRG) – the University of Birmingham team provided oversight for locally-delivered research projects under three main themes.
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Our Partnership
The UoB research team provided oversight, research method design and training. Partner countries were responsible for the conduct and delivery of agreed research projects and linking with policy makers to embed findings into local services.
IPCRG facilitated collaboration and dissemination by hosting international meetings and liaising with other countries through their established network.
Brazil investigators
Brazil investigators
Leads:
- Professor Rafael Stelmach (Pulmonologist, University of São Paulo) Co-ordinator and Ambassador of Global Initiative for Asthma (GINA) in Brazil and Planning Group member of Global Alliance against CRD (GARD-WHO).
- Dr Sonia Martins (Family and Community Physician) coordinator of Matrix Support Program in Respiratory Health and Smoking Program (Department of Community Health of the Faculty of Medicine of ABC (FMABC)), São Bernardo do Campo, São Paulo, Brazil.
Research team:
- Dr Aldo Agra (Pulmonologist, São Bernardo do Campo).
China investigators
China investigators
Leads:
- Chunhua Chi (Professor, Department of Respiratory and Critical Care Medicine, Director, Department of General Practice, Peking University First Hospital and Executive President of Chinese Alliance for Respiratory Disease in Primary Care).
- Professor KK Cheng, Professor at the University of Birmingham since 1995. He is also Director of the General Practice Development and Research Center, Peking University Health Science Center. His main interests are in the epidemiology, prevention and control of important non-communicable diseases, and the development of primary care in China.
Research team:
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Dr Zihan Pan (Resident of General Practice in Peking University First Hospital); Dr Xia Kong (Research Fellow on Breathe Well, Health Management Centre, Peking University First Hospital).
Republic of North Macedonia investigators
Republic of North Macedonia investigators
Leads:
- Dr Radmila Ristovska (GP researcher, Centre for Family Medicine, Medical Faculty, Skopje).
- Professor Katarina Stavrikj (GP researcher, Centre for Family Medicine, Medical Faculty, Skopje).
Georgia investigators
Georgia investigators
Leads:
- Dr Mariam Maglakelidze (Consultant, Environmental Health, National Centre for Disease Control and Public Health).
- Professor Tamaz Maglakelidze (Head of Pulmonology, Department of G.Chapidze, Emergency Cardiology Center in Georgia and President of Georgian Respiratory Association).
- Dr Nino Magladkelidze (Head of Tobacco Control Unit at the National Center for Disease Control and Public Health of Georgia. European Regional Coordinator for World Health Organization Framework Convention on Tobacco Control (WHO FCTC)).
International Primary Care Respiratory Group
International Primary Care Respiratory Group
- Siân Williams, Executive Officer.
- Assistant Professor Jaime Correia de Sousa (Associate Professor and Chair of the Community Health Department in the School of Medicine at the University of Minho, Portugal). Family physician in Porto and is former Chair of the Portuguese Primary Care Respiratory Group. Jaime is also past President of the International Primary Care Respiratory Group.
Research projects
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.
Brazil: A cross-sectional study to evaluate the test accuracy of different screening strategies for identifying undiagnosed COPD amongst patients (≥40 years) with systemic arterial hypertension.
China: A study to evaluate the test accuracy of different screening strategies for identifying undiagnosed COPD in China, amongst patients (≥40 years) attending community health centres.
Theme two: Promotion of smoking cessation in the community
Aim: To evaluate different motivational approaches to assist smoking cessation among smokers identified through primary care settings.
North Macedonia: A randomised controlled trial to determine if the additional assessment and communication of lung age or feedback on exhaled carbon monoxide levels among smokers in primary care increases their likelihood of quitting smoking compared to giving very brief smoking cessation advice alone.
Theme three: Behavioural interventions to improve disease management
Aim: to assess the feasibility and evaluate an adapted pulmonary rehabilitation programme for people with COPD identified through primary care settings.
Georgia: A randomised controlled feasibility trial of a pulmonary rehabilitation programme adapted to the Georgian context compared to usual care, for patients with symptomatic COPD of MRC grade 2+.
Brazil: A qualitative study which explored the barriers and enablers to physical activity and exercise programmes amongst COPD patients with and without mood disorders (anxiety and / or depression), to inform the design of a future intervention for those patients.
China: a mixed-method study describing the management and understanding of COPD reported by patients in China and exploring patient and GP opinion on current management of COPD and the design of a future “lung health” service focusing on non-pharmacological interventions.
Published papers
Published papers
- D'Elia, A, Jordan, RE, Cheng, KK, et al. COPD burden and healthcare management across four middle income countries within the Breathe Well research programme: a descriptive study. Global Health Research 2024. https://doi.org/10.3310/WKVR4250
- Martins, SM, Adams, R, Rodrigues, EM, et al. Living with COPD and its psychological effects on participating in community-based physical activity in Brazil: a qualitative study. Findings from the Breathe Well group. NPJ Primary Care Respiratory Medicine 2024;34:33. https://doi.org/10.1038/s41533-024-00386-7
- Dickens, AP, Gale, N, Adab, P, et al. Development and application of a rapid research prioritisation process for identifying health research priorities in low- and middle-income countries: the RAPID-RP stakeholder analysis. Global Health Research 2024. https://doi.org/10.3310/CTHF1385
- Williams, S, Fernandes, G, Adab, P, et al. Strengthening clinician-researchers’ communication and knowledge translation skills: An innovative game model from the Breathe Well group. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2024;61. https://doi.org/10.1177/00469580241273178
- Fernandes, G, Williams, S, Adab, P, et al. Engaging stakeholders to level up COPD care in LMICs: lessons learned from the “Breathe Well” programme in Brazil, China, Georgia, and North Macedonia. BMC Health Services Research 2024;24:66. https://doi.org/10.1186/s12913-023-10525-4
- Gjorgjievski, D, Stavrikj, K, Jordan, R, et al. Randomised controlled trial testing effectiveness of feedback about lung age or exhaled CO combined with very brief advice for smoking cessation compared to very brief advice alone in North Macedonia: findings from the Breathe Well group. BMC Public Health 2023; 23:1887. https://doi.org/10.1186/s12889-023-16644-1
- Maglakelidze M, Kurua I, Maglakelidze N, et al. Feasibility of a pulmonary rehabilitation programme for patients with symptomatic chronic obstructive pulmonary disease in Georgia: a single site, randomized controlled trial from the Breathe Well Group. BMJ Open2022;12: https://doi.org/10.1136/bmjopen-2021-056902
- Pang H, Pan Z, Adams R, et al. Community lung health service design for COPD patients in China by the Breathe Well group. NPJ Prim Care Respir Med 2022; 32:27. doi: 10.1038/s41533-022-00286-8.
- Martins SM, Dickens A, Salibe-Filho W, et al. Accuracy and economic evaluation of different screening tests and their combinations for undiagnosed COPD among people with hypertension in Brazil. NPJ Primary Care Respiratory Medicine 2022; 32:55. https://doi.org/10.1038/s41533-022-00303-w
- Riley, M, Swann, A, Morris, AJ, et al. Knowledge, attitudes and practices of patients and healthcare professionals regarding oral health and COPD in São Paulo, Brazil: a qualitative study. NPJ Prim Care Respir Med 2021; 31(1):20. https://doi.org/10.1038/s41533-021-00235-x
- Pan Z, Dickens AP, Chi C, et al. Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group. BMJ Open 2021;11:e051811. https://doi.org/10.1136/bmjopen-2021-051811
- Pan, Z, Dickens, A, Chi, C, et al. Study to evaluate the effectiveness and cost-effectiveness of different screening strategies for identifying undiagnosed COPD amongst residents (≥40 years) in four cities in China: protocol for a multicenter cross-sectional study. On behalf of the Breathe Well group. BMJ Open 2020;10: e035738. https://doi.org/10.1136/bmjopen-2019-035738
Other milestones and activities
Training and networking
The UoB team created and delivered bespoke training and mentoring including clinical, research skills and research management. The whole Breathe Well team met annually at the IPCRG conferences for training, planning, presenting and networking with international colleagues. Travel was an important part of our developing relationships and many successful collaborative visits were carried out each year.
Engaging Stakeholders
Stakeholder engagement was a substantial element of the Breathe Well programme, the aims of which were to identify and prioritise local research needs, ensure that cultural factors were accounted for, and also to establish a sustainable process for future collaborations. All countries 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.


This research was funded by the National Institute for Health Research (NIHR), NIHR global group on global COPD in primary care, University of Birmingham, (project reference: 16/137/95) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.