Unmet Diagnostic and Therapeutic Opportunities for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Countries.
Unmet Diagnostic and Therapeutic Opportunities for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Countries.
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DOI：
10.1164/rccm.202302-0289oc
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发表时间：
2023-08-15
影响因子：
24.7
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中科院分区：
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慢性阻塞性肺疾病（COPD）是低收入和中等收入国家（LMIC）的一种流行和负担沉重的疾病。改善护理的挑战包括更有效的诊断和获得负担得起的干预措施。既往没有报告描述通过筛选确定的LMIC中COPD人群的治疗需求。描述在LMIC环境中筛选检测到的COPD中未满足的治疗需求。我们比较了国际慢性阻塞性肺疾病全球倡议COPD战略文件推荐的干预措施，以及在尼泊尔、秘鲁和乌干达的三个LMIC地点通过人群筛查确定的1,000名COPD患者接受的干预措施。我们使用有关药物可用性和可负担性的数据计算成本。非药物干预的最大未满足需求是教育和疫苗接种（适用于所有人），肺康复（49%），戒烟（30%）和生物质烟雾暴露的建议（26%）。95%的病例以前未被诊断，很少有人接受治疗（4.5%使用短效β受体激动剂）。在47名先前诊断为COPD的患者中，只有3人（6%）能够获得与建议一致的药物。没有一个更严重的COPD患者获得适当的维持吸入器。即使有，维持治疗也是负担不起的，30天的治疗费用超过了低技能工人的日平均工资。我们发现，在LMIC环境中，由于大多数病例未确诊，因此错过了一个显著的机会来减轻COPD的负担。虽然在开发新疗法方面存在未满足的需求，但在负担最重的中低收入国家，更好的诊断加上获得负担得起的干预措施可以转化为直接的好处。
Chronic obstructive pulmonary disease (COPD) is a prevalent and burdensome condition in low- and middle-income countries (LMICs). Challenges to better care include more effective diagnosis and access to affordable interventions. There are no previous reports describing therapeutic needs of populations with COPD in LMICs who were identified through screening. To describe unmet therapeutic need in screening-detected COPD in LMIC settings. We compared interventions recommended by the international Global Initiative for Chronic Obstructive Lung Disease COPD strategy document, with that received in 1,000 people with COPD identified by population screening at three LMIC sites in Nepal, Peru, and Uganda. We calculated costs using data on the availability and affordability of medicines. The greatest unmet need for nonpharmacological interventions was for education and vaccinations (applicable to all), pulmonary rehabilitation (49%), smoking cessation (30%), and advice on biomass smoke exposure (26%). Ninety-five percent of the cases were previously undiagnosed, and few were receiving therapy (4.5% had short-acting β-agonists). Only three of 47 people (6%) with a previous COPD diagnosis had access to drugs consistent with recommendations. None of those with more severe COPD were accessing appropriate maintenance inhalers. Even when available, maintenance treatments were unaffordable, with 30 days of treatment costing more than a low-skilled worker’s daily average wage. We found a significant missed opportunity to reduce the burden of COPD in LMIC settings, with most cases undiagnosed. Although there is unmet need in developing novel therapies, in LMICs where the burden is greatest, better diagnosis combined with access to affordable interventions could translate to immediate benefit.