Abstract
This protocol describes a systematic scoping review of chronic respiratory disease surveys in low/middle-income countries (LMICs) undertaken as part of the Four Country ChrOnic Respiratory Disease (4CCORD) study within the National Institute for Health Research Global Health Research Unit on Respiratory Health (RESPIRE). Understanding the prevalence and burden of chronic respiratory disease (CRD) underpins healthcare planning. We will systematically scope the literature to identify existing strategies (definitions/questionnaires/diagnostics/outcomes) used in surveys of CRDs in adults in low-resource settings. We will search MEDLINE, EMBASE, ISI WoS, Global Health and WHO Global Health Library [search terms: prevalence AND CRD (COPD, asthma) AND LMICs, from 1995], and two reviewers will independently extract data from selected studies onto a piloted customised data extraction form. We will convene a workshop of the multidisciplinary 4CCORD research team with representatives from the RESPIRE partners (Bangladesh, India, Malaysia, Pakistan and Edinburgh) at which the findings of the scoping review will be presented, discussed and interpreted. The findings will inform a future RESPIRE 4CCORD study, which will estimate CRD burden in adults in Asian LMICs.
Highlights
Chronic respiratory diseases (CRDs), especially asthma and chronic obstructive pulmonary disease (COPD), are common public health problems across the world, with the Global Burden of Disease estimating that chronic respiratory disease (CRD) account for 30% of total deaths.[1]
With notable exceptions, such as the Burden of Lung Disease (BOLD),[13] surveys of the prevalence of CRDs conducted in low- and middle-income countries (LMICs) often have major limitations, and report very varied estimates of prevalence.[2,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]
Many existing surveys focus on one condition (e.g. the BOLD study detects COPD,[13] the International Study of Asthma and Allergies in Childhood (ISAAC) detects symptoms of asthma and allergy in children40) and rarely look for the broad range of less common causes of CRD or attempt to identify the phenotypes of asthma and COPD, which are increasingly regarded as important to understanding and managing the conditions.[41]
Summary
Chronic respiratory diseases (CRDs), especially asthma and chronic obstructive pulmonary disease (COPD), are common public health problems across the world, with the Global Burden of Disease estimating that CRDs account for 30% of total deaths.[1]. Chronic respiratory symptoms are common in the general population,[1] but the clinicians in primary healthcare systems in resource-poor countries lack the skills and support to diagnose the underlying disease condition.[4,5,6,7,8] Factors contributing to low rates of diagnosis include limited awareness of respiratory long-term conditions,[4,5,6,7,8,9,10] limited access to healthcare and lack of diagnostic capability in these countries.[11] Determining the prevalence of asthma and COPD remains a challenge because of the poor sensitivity and specificity of the widely used questionnaire-based research tools,[3,12] while objective testing with spirometry may be a challenge in community-based epidemiological surveys.[11]. Respiratory Disease study (4CCORD) in the partner countries of RESPIRE, we sought to systematically scope the literature to identify existing strategies—that is, definitions, questionnaires, study tools and diagnostics protocols—that have been used to conduct surveys for CRDs in LMICs
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