Burden of respiratory problems in low-income and middle-income countries

Abstract

Purpose of reviewChronic respiratory diseases are a leading cause of morbidity and mortality in low-income and middleincome countries (LMICs). We aim to review prevalence of respiratory diseases and related symptoms, which contribute significantly to burden of disease in LMICs. We report global estimates of respiratory problems amongst adults in LMICs and recent findings relating to community prevalence and impact of respiratory problems. We conclude by identifying research priorities for improved recognition and palliation of respiratory problems. Recent findingsWe report findings from 16 studies, highlighting key issues relevant to burden of respiratory problems in LMICs. COPD and associated symptoms are identified as important drivers of increasing respiratory problems in LMICs, with an estimated prevalence of 7.2%. Negative impacts of respiratory diseases include: reduced physical function (capacity to work), quality of life (depression; anxiety) and socioeconomic wellbeing (healthcare costs; earning potential). Locally appropriate palliative care interventions may improve quality of life without increasing costs.

Global respiratory health priorities at the beginning of the 21st century

“…There is a high burden of respiratory illnesses in both females and males across races in LMICs. Some of the negative impacts include a reduced capacity to work due to impaired physical function, depression and anxiety which feed into poorer overall quality of life and impaired socioeconomic wellbeing, compounded by contextually high healthcare costs coupled with decreased earning potential [75]. MARSHALL et al [76] studied the potential existence of global disparity in RCTs based on investigating whether RCT numbers were significantly disproportionate in countries with lower socioeconomic development compared to richer countries.…”

Prevalence, severity and impacts of breathlessness in Indian adults: An exploratory, nationally representative, cross-sectional online survey

“…LMICs account for the highest global burden of illnesses associated with breathlessness (e.g., over 90% of people with chronic obstructive pulmonary disease (COPD) live in LMICs [ 17 , 18 ], with respiratory diseases being the most frequently attributed cause of breathlessness) [ 19 ]. Behavioural, workplace and environmental risk factors [ 20 – 23 ], and lack of access to affordable health care [ 20 , 24 ] are also likely to contribute to prevalence of breathlessness in these settings [ 25 ]. As such, breathlessness is likely more frequent and impactful in LMICs, but potentially less visible.…”

“…Much of the research to date in both HICs and LMICs has focused on measuring the impact of disease rather than symptom . The limited available evidence on prevalent symptoms in people with chronic complex or chronic progressive conditions in LMICs, derived mostly from qualitative studies, indicates that breathlessness presents complex and manifold challenges for the person’s physical activity, social interaction with family and friends, quality of life, income (e.g., through inability to work, having to change work or reduce hours worked) and financial burden (e.g., transportation costs to/from health facilities) [ 20 ]. Its management may be compromised by poor access to healthcare (even when this may be available), resources and health professionals’ knowledge and beliefs [ 21 , 26 ].…”

Editorial: Advancing the management of respiratory problems

“…Research to explore potentially distinct or overlapping underlying mechanisms in posthospital and nonhospitalized Post-COVID-19 patients is required, alongside further research to address post-COVID-19 sequelae [7]. And, finally, prevalence surveys are required in LMICs to investigate the impact of respiratory problems on employment, productivity and absenteeism, in relation to earnings lost, and means need to be identified to enable the effective use technology to address emerging chronic respiratory problems without marginalizing some of the most vulnerable people in those LMICs [8]. There are therefore plentiful well delineated opportunities to advance our knowledge and care in relation to this advancing field.…”

“…Finally, the current burden of respiratory problems in low and middle income countries (LMICs) is reviewed explored by Clark et al [8] through exploration of the prevalence of respiratory problems as contributors to disease burden in LMICs, global estimates to highlight trends, and the prevalence and impact of respiratory problems on quality of life in communities. Impacts are identified in relation to physical activity, quality of life and the socio-economic burden.…”