Asthma in the Context of Other Chronic Respiratory Diseases in LMICs
Non-communicable diseases (NCDs) cause considerable morbidity and mortality in people globally (approximately 70% of all deaths). The United Nations’ Sustainable Development Goals (SDGs) aim for the risk of premature mortality from NCDs including chronic respiratory diseases (CRDs) to be reduced by a third by 2030. There is a long way to go to achieving this goal for CRDs particularly as they are common, frequently neglected and disproportionately affect people living in poverty around the world.
CRDs – mainly represented by asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and post-tuberculosis lung disease (PTLD) – are one of the major groups of NCDs. The most common CRDs, asthma and COPD, are diseases affecting predominantly the airways and therefore overlap in how people present to health services, including wheeze, cough and breathlessness, and other CRDs, too, may cause these symptoms. These diseases also overlap in other ways including how they are diagnosed, the medicines used for treatment, non-pharmacological management, health professional training and health systems needs. It is therefore logical to consider CRDs together in clinical practice where syndromic approaches to management can be effective. From a public health (programmatic) perspective health systems for people with CRDs need to be strengthened. There are several useful resources that set out pragmatic approaches to the management of CRDs in low- and middle-income countries (LMICs) including the World Health Organization’s (WHO) package of essential non-communicable disease Interventions for primary health care (PEN) and the Package of Care Kit (PACK) for children, adolescents and adults. There is a balance to be struck between pragmatic programmatic approaches aiming to deliver standardised package of care and more individualised approaches.
There is a need for greater recognition and investment in CRD care pathways in LMICs. Given the overlap in needs to improve the care of people with CRDs there would be merit in initiatives focused on asthma and COPD (perhaps tuberculosis, PTLD, and bronchiectasis) as well being expanded to unite public and private efforts and advocacy behind this cause. It is likely that post-COVID-19 lung disease will become another cause of CRD.
There is also the need to address underlying drivers of morbidity and mortality from CRDs which are often poverty related; ending poverty is another SDG goal. Improving maternal nutrition and health, reducing exposure to air pollution (including tobacco, household, ambient and occupational) and improving the prevention and treatment of respiratory tract infections throughout the life course including tuberculosis and COVID-19 are also key priorities.
CRDs represent a major burden of disease in LMICs. The SDGs have targets requiring that this large burden should be addressed through improved prevention and control of these diseases. Investment in health systems including human resources, training and capacity strengthening are needed. It is important that CRD care pathways are prioritised adequately as part of Universal Health Coverage. The recently acquired knowledge and technology on teletraining may help to scale up the capacity strengthening required.