Case Finding and Effectiveness of a COPD Action Plan in Low and Middle Income Countries (GECo)

Background

More than 90% of chronic obstructive pulmonary disease (COPD) related deaths occur in low- and middle-income countries (LMICs), and in 15 years COPD is expected to become the leading cause of death worldwide. Moreover, the human and economic cost of COPD is expected to rise: in 2001, COPD was responsible for 2.4 million deaths and 33 million DALYs lost in LMICs, and it is projected that by 2020 COPD will become the fourth leading cause of disease burden in LMICs. The economic impact of COPD among LMICs was £700 billion in 2010 and is expected to increase to £1.7 trillion by 2030. LMICs face unique challenges in managing COPD, including deficient primary care systems which present challenges with diagnosis and management, especially during exacerbation. Given the high and rising global burden of COPD, a revolution in diagnosis and management of COPD and exacerbations in LMICs is an urgent priority.

Aims

Primary aim
To assess the diagnostic accuracy of simple case-finding tools for COPD in three diverse LMIC settings.
Secondary aim
To assess the cost-effectiveness of community health worker-based support for people living with COPD in three diverse LMIC settings.

Project plan

Objective 1

To determine whether case-finding for COPD can be facilitated using a modified 5-item questionnaire. We hypothesise that a modified 5-item questionnaire will be a valid casefinding tool for COPD in LMIC and will be acceptable and feasible for use in these settings.

Clinical Aim 1: Determine the diagnostic accuracy of the 5-item case-finding questionnaire.
Implementation Aim 1: Assess the appropriateness, acceptability and feasibility of using questionnaires to identify COPD cases from the perspective of local community members, community health workers, local health centre physicians and ministries of health.

Objective 2

To determine whether a self-directed COPD Action Plan for the management of COPD exacerbations can be implemented with CHWs and local health care centres. We hypothesise that COPD action plans with disease-specific education will lead to improved quality of life and will be locally-appropriate, acceptable, and feasible to implement.

Clinical Aim 2: Assess the clinical effectiveness of COPD Action Plans in LMICs by comparing change in disease-specific quality of life measures (SGRQ).
Implementation Aim 2: Assess the appropriateness, acceptability, and feasibility of implementing a self-directed COPD Action Plan for management of COPD exacerbations.

Impact

The project showed that a simple questionnaire can be used to identify people with COPD in LMIC settings. Evidence from this project influenced the international GOLD COPD strategy and the project team developed a resource to help support policymakers implementing the global guidelines around COPD management in LMICs.

Publications and output

You may listen to an interview with Professor Hurst.

You may visit the project website for more information.