In Brazil, doctors in clinics for hypertension and diabetes will start asking patients a short set of questions to find undiagnosed asthma and COPD. The project tests whether routine screening for chronic respiratory diseases can be slotted into existing primary care for other long-term conditions. Most people with COPD and asthma in low- and middle-income countries are never diagnosed. Spirometry, the definitive test, is scarce. The researchers have already shown that a simple questionnaire called COLA can identify people at high risk for COPD. Now they need to know if using it in everyday clinics actually works—whether clinicians adopt it, whether patients follow through to diagnosis and treatment, and whether catching these diseases early improves health. If successful, the approach could be scaled across Brazil and other countries with similar health systems. It would turn routine chronic disease appointments into opportunities to catch respiratory disease early, without expensive equipment. The study also uses machine learning on a large Brazilian cohort to understand whether lung disease typically precedes other conditions or follows them—a fundamental question about how multiple chronic diseases develop together.
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RESEARCH QUESTION: Is case-finding for chronic respiratory diseases(CRDs) (i)-feasible and (ii)-beneficial to people and society when delivered through established services for non-communicable diseases(NCDs) in Brazilian primary care. BACKGROUND: CRDs are neglected relative to burden. The majority of people in low- and middle-income countries(LMICs) remain undiagnosed. Access to spirometry in LMICs, the primary diagnostic test, is limited. We have shown simple population-screening tools can identify people at high-risk for chronic obstructive pulmonary disease(COPD). The prevalence of COPD and asthma in Brazil are 17% and 9%, and the prevalence of a third spirometric pattern called 'PRISm' is 10%. There is urgent need for better diagnosis of CRDs(asthma, COPD and PRISm) in Brazil. We found a higher prevalence of CRDs in those with other NCDs, notably hypertension. It is not known whether co-morbidities develop before, or after CRDs. It is not known whether case-finding for CRDs using simple tools can be implemented in usual care for other NCDs, and if doing so benefits individuals and society. We will test this. AIMS and OBJECTIVES: AIM-1: What are the patterns and order in which components of multi-morbidity are acquired in people with CRDs in LMICs? Objective-1. To apply a novel machine-learning algorithm to multi-morbidity data in people with CRDs from the 10664-person GECo cohort. AIM-2: What is the discriminative accuracy of using a COPD case-finding tool for CRDs in community NCD clinics in Brazil? Objective-2: Apply a COPD case-finding tool called 'COLA' to 859 people with NCDs, in community settings in Brazil, to understand the discriminative accuracy for CRDs. AIM-3: Can CRD case-finding be successfully implemented by usual clinicians in community NCD clinics in Brazil? Objective-3: Implement case-finding for CRDs using COLA with four clinicians at each of five diverse NCD clinics in Brazil, to understand barriers and facilitators to adoption (n=1000). AIM-4: Are people identified as high-risk for CRDs at case-finding in NCD clinics able to access downstream diagnosis and treatment? Objective-4. To understand how 473 people who screen positive on COLA, or test positive on spirometry, are able to access downstream health services for diagnostic confirmation and treatment. AIM-5: Are recommendations for optimisation of care in people with asthma and COPD detected through case-finding associated with improvement in health outcomes and benefit to society? Objective-5: To assess if recommendations for care optimisation in asthma (n=100) and COPD (n=146) are associated with improved outcomes in CRD, and the primary NCD, at six months, and the barriers and facilitators to benefit. In doing so I will develop as a Global Research Professor in CRD multi-morbidity (Objective-6) and consolidate my group at UCL in equitable partnership with Universidade Federal de São Carlos, Brazil (Objective-7). TIMELINES: AIM-1 completes at 12 months. Recruitment to AIMS-2/-3 starts at 12/18 months and visits complete at 36 months. AIM-4 complete at 42 months. AIM-5 complete at 48 months. Write-up complete at 60 months. ANTICIPATED IMPACT/ DISSEMINATION: Results will be disseminated though open-access peer-review journals, and at conferences, with impact supported through media, social media and policy briefs.
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