Select campus:UKDubai
University of Birmingham
Menu

IPCRG Breathe Well accessible infographic

Breathe Well

Building global research in Chronic Obstructive Pulmonary Disease (COPD).

  • 250+ million people in the world live with COPD. It affects 1 in 10 adults over 40 years old, although less than half have a diagnosis.
  • 3 million people die every year from COPD: that's about 6 people per minute.
  • 80% of all COPD deaths in the world occur in low-and-middle income countries (LMICs).
  • 1 in 5 or 20% of all people in the world smoke tobacco. Smoking is one of the biggest risk factors for COPD. Around 20% of smokers will go on to develop COPD. 
  • 50-70% of those living with COPD in poor countries remain undiagnosed due to limited healthcare capacity and lack of knowledge about the condition.
  • $2.6 trillion is the expected economic cost of illness due to COPD in LMICs by 2030. This is 2.5 times the estimated cost in 2010.

COPD can leave people breathless, fatigued and prone to chest infections. This results in high personal, healthcare and societal costs through loss of work. In many LMICs, COPD hospitalisation and care can cause financial hardship impacting social and mental health. However, these problems can be avoided or managed by timely diagnosis and the right care. 

In LMICs, COPD is mostly diagnosed and managed in hospitals, often miles from people's homes. Primary care is the first point of contact with healthcare services and is strategically placed in local communities. It has the potential to prevent, diagnose and treat COPD, but is either poorly resourced, without adequately trained staff or does not have the authority to diagnose and treat COPD.

Breathe Well is a collaboration between the University of Birmingham and researchers from four LMICs to produce evidence for improved prevention, diagnosis and management of COPD.

Breathe Well research studies

Brazil, China, Georgia, and the Republic of North Macedonia.

  • Identifying cost-effective screening/testing strategies for finding people with undiagnosed COPD in primary care/community hospitals
  • Testing the feasibility of a culturally-adapted pulmonary rehabilitation service
  • Testing smoking cessation interventions in primary care
  • Exploring barriers and enablers for physical activity in individuals living with COPD
  • Exploring views of patients and clinicians in the design of a new Lung Health Service.

What we learned

Breathe Well studies have identified the most appropriate, low-cost approached for COPD case finding, applicable in low-resource settings. Our research has highlighted the pressing need for culturally relevant smoking cessation support in LMICs where smoking prevalence remains high and where policies are poorly implemented. 

We have also demonstrated the feasibility of delivering culturally adapted rehabilitation programmes for individuals with COPD. Our research has shown that primary care systems play an essential role in the prevention, early diagnosis and management of people with COPD, improving their quality of life.

Components

[The following components all link together, and also Stakeholder engagement links directly with Sustainability and Capacity Building]

  • Stakeholder engagement
  • Research
  • Sustainability and Capacity Building

Development

  • Stakeholder engagement leads to Prioritising research questions
  • Research leads to Developing protocols
  • Sustainability and capacity building leads to Training needs assessment

Delivery

  • Prioritising research questions leads to Supporting and monitoring research, through:
    • Trial steering committees
    • Stakeholder advisory groups
    • Patient support groups
    • Primary care engagement aided recruitment to studies
  • Developing protocols leads to Key findings, including:
    • Peak flow is a useful low cost tool for COPD case finding
    • Culture impacts engagement with exercise interventions
    • PR is feasible to deliver in a low resource setting
    • Effectiveness of smoking cessation interventions are context-specific
    • Smoking cessation success is hampered by back of access to pharmacotherapy
  • Training needs assessment leads to Bespoke training:
    • Conducting and interpreting spirometry
    • Pulmonary rehabilitation delivery
    • Identifying and engaging with key stakeholders

Dissemination

  • Supporting and monitoring research leads to Engaging with health ministries and the media to influence policy change:
    • Brazil: Design COPD care pathway
    • China: Inform implementation of COPD case finding
    • Georgia: Implement PR programme
    • Republic of North Macedonia: Embedding smoking cessation education into the medical student curriculum
  • Key findings lead to
    • Conference presentations
    • More than 10 papers prepared
    • Research recommendations for key stakeholders
    • New collaborative research
  • Bespoke training leads to:
    • New CPD courses
    • Medical training
    • Pulmonary Rehabilitation Training manuals
    • Research and clinical skills
    • Patient education material.

Recommendations

  1. Increase community awareness about the risks and symptoms of COPD and influence timely care seeking through primary care teams, community networks and uptake to PR and behaviour change programmes.
  2. Build the capacity of primary care practitioners in smoking cessation support and COPD care through clinical curricula and cascaded education programmes.
  3. Influence individuals to quit smoking by providing smoking cessation as a preventive service and enlisting pharmacological treatments in the state health insurance coverage
  4. Evaluate the implementation and long-term benefit of low-cost COPD case-finding approaches in a range of LMIC settings.
  5. Invest in capacity building and infrastructure to deliver high-quality research in primary care. Evaluate locally-relevant interventions to improve population health.

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 authors and not necessarily those of the NIHR or the UK Department of Health and Social Care.

Learn more: IPCRG website

We gratefully acknowledge IPCRG for introducing us to the primary care networks involved in this study and for its continued facilitation of clinical engagement.