Chronic Lower Respiratory Tract Diseases
Authors: Peter Burney, Rogelio Perez-Padilla, Guy Marks, Gary Wong, Eric Bateman, Deborah Jarvis
Reports that lower- and middle-income countries (LMICs) typically have a high burden of disease associated with chronic respiratory conditions, yet the information on which to formulate policy remains negligible when compared with that in high-income countries (HICs), a lack compounded by generally poor infrastructure for commissioning, providing, and monitoring services and training and supporting staff members. The highest mortality attributed to COPD occurs in South-East Asia, a region with very high age-specific mortality from the condition. The descriptive epidemiology of chronic respiratory diseases remains sketchy in many low-income areas, so extrapolating from high- to low-income contexts remains unwarranted. Information on the efficacy and safety of different medications also remains largely drawn from HICs, and relatively little information specifically addresses the assessment of these medications elsewhere. Infrastructure for effective implementation remains inadequate, as health services require a reliable and secure supply of diagnostic services—as well as medications and other treatments—to function well, though examples of effective primary care and tuberculosis control programs in LMICs provide some encouragement.