Lung health in LMICs: tackling challenges ahead – Authors' reply

Abstract

We thank Ee Ming Khoo and colleagues for welcoming our Review on improving lung health in low-income and middle-income countries (LMICs).1Meghji J Mortimer K Agusti A et al.Improving lung health in low-income and middle-income countries: from challenges to solutions.Lancet. 2021; 397: 928-940Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar We entirely agree that high quality primary care is a key component for the successful delivery of universal health coverage and has a particularly crucial role in the provision of health services for people with chronic respiratory diseases in LMICs. We applaud the efforts of the International Primary Care Respiratory Group in championing this cause. Health systems are complex and adaptive, functioning at multiple interconnected levels; therefore, improving quality of care will require system-wide action.2Kruk ME Gage AD Arsenault C et al.High-quality health systems in the Sustainable Development Goals era: time for a revolution.Lancet Glob Health. 2018; 6: e1196-e1252Summary Full Text Full Text PDF PubMed Scopus (803) Google Scholar It is not only primary care services but also the connections between primary care, community health workers, and secondary care services that need to be strengthened in LMICs. Furthermore, it is vital that these quality reforms are country-led. We also thank Benoit Nemery and colleagues for their Correspondence. We had very much hoped that our Review1Meghji J Mortimer K Agusti A et al.Improving lung health in low-income and middle-income countries: from challenges to solutions.Lancet. 2021; 397: 928-940Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar would provide a wake-up call about chronic respiratory diseases in stretched health systems in LMICs, and are delighted to hear that this was well received. Although we discuss air pollution throughout our Review and specifically highlight in our conclusion the need to address tobacco smoke and household, ambient, and occupational exposures, the importance of air pollution cannot be understated as a contributor to the burden of chronic respiratory diseases and numerous other diseases.3Schraufnagel DE Balmes JR Cowl CT et al.Air pollution and non-communicable diseases: a review by the Forum of International Respiratory Societies' Environmental Committee, part 1: the damaging effects of air pollution.Chest. 2019; 155: 409-416Summary Full Text Full Text PDF PubMed Scopus (189) Google Scholar, 4Schraufnagel DE Balmes JR Cowl CT et al.Air pollution and non-communicable diseases: a review by the Forum of International Respiratory Societies' Environmental Committee, part 2: air pollution and organ systems.Chest. 2019; 155: 417-426Summary Full Text Full Text PDF PubMed Scopus (253) Google Scholar The importance of air pollution extends well beyond human health to include climate and planetary health,5Watts N Amann M Arnell N The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate.Lancet. 2019; 394: 1836-1878Summary Full Text Full Text PDF PubMed Scopus (512) Google Scholar so we could not agree more with the suggestion to go beyond medical solutions and to take a global (including planetary) health approach. GBM reports grants and advisory board fees from AstraZeneca; and grants from GSK Australia. KM reports advisory board fees from AstraZeneca. All other authors declare no competing interests. Lung health in LMICs: tackling challenges aheadWe welcome Jamilah Meghji and colleagues' Review1 about improving lung health in low-income and middle-income countries (LMICs), and we are particularly encouraged by the focus on the frequently neglected field of chronic respiratory diseases. However, we find that insufficient attention was paid to the role of primary care, which is the keystone for universal health coverage and, therefore, the route to improved prevention, diagnosis, and individualised and holistic treatment for most of the population. Full-Text PDF Lung health in LMICs: tackling challenges aheadJamilah Meghji and colleagues1 deliver a welcome wake-up call about chronic respiratory diseases in stretched health systems. However, the proposed solutions in their Review could be strengthened by a preventive approach addressing crucial contributors of chronic respiratory diseases. In short, we expected a stronger plea for clean air to improve lung health in low-income and middle-income countries (LMICs). Full-Text PDF Improving lung health in low-income and middle-income countries: from challenges to solutionsLow-income and middle-income countries (LMICs) bear a disproportionately high burden of the global morbidity and mortality caused by chronic respiratory diseases (CRDs), including asthma, chronic obstructive pulmonary disease, bronchiectasis, and post-tuberculosis lung disease. CRDs are strongly associated with poverty, infectious diseases, and other non-communicable diseases (NCDs), and contribute to complex multi-morbidity, with major consequences for the lives and livelihoods of those affected. Full-Text PDF