More than half of people with COPD in low- and middle-income countries are never diagnosed, and this research aims to change that by training primary care doctors to spot and treat the disease earlier. COPD is one of the top ten causes of years of life lost in Brazil, Georgia, Macedonia, and China—the four partner countries in this programme. Yet their primary care systems are not set up to tackle underdiagnosis, smoking cessation, or pulmonary rehabilitation, which are three of the World Health Organization’s global priorities for non-communicable diseases. The problem is driven by lack of training, high drug costs, and limited experience with low-cost behavioural interventions. Most existing research comes from hospitals, not the community clinics where patients first seek help. If this succeeds, the project will produce practical, cost-effective approaches for earlier detection, smoking cessation support, and pulmonary rehabilitation that can be delivered in primary care settings across diverse low- and middle-income countries. The University of Birmingham team brings expertise in respiratory epidemiology, health economics, and qualitative research, and has already secured institutional support from offices in China and Brazil to sustain partnerships beyond the grant period.
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INSTITUTE INFRASTRUCTURE The University of Birmingham (UoB) has global ambitions around the reach and impact of its research, based on effective engagement and collaboration with partners to inform, utilise and contextualise its research. Alongside this broad strategy UoB also supports focused engagement in several key strategic regions including China and Brazil (two of the partner LMICs on our current programme grant). The Institute of Applied Health Research (IAHR) hosts the multidisciplinary COPD research group (2005), led by Adab/Jordan. The group has a growing international reputation for respiratory research, with a previous NIHR programme grant (~£2.4m) focusing on earlier identification & development of interventions to improve prognosis and work productivity in UK COPD patients, and the current global NIHR programme grant. The team includes experts in respiratory epidemiology, biostatistics, health economics, and qualitative research. Collaboration with other IAHR and UoB colleagues provides access to additional expertise, including respiratory medicine, physiology, and global research. Cheng (applicant) established one of the first academic GP departments in China. SUPPORT FROM UOB Our campus-based International Office, China Office (Guangzhou) & Brazil Office (Sao Paulo) facilitates collaborative working with international partners (eg links to healthcare providers/government departments, assisting organisation of stakeholder meetings). UoB supports this research by subsidising input from senior academics (especially development/delivery of training), provision of office/facilities & general research support. In recognition of the importance of these partnerships, UoB provides honorary contracts to international partner co-applicants, allowing access to resources eg e-journals. To support sustainability post-grant, UoB will deliver a workshop for co-applicants after the end of the project and support further grant application development for future work in this important area. PROGRAMME: BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is an increasingly important chronic respiratory disease. Disease burden disproportionately affects the most disadvantaged populations in LMICs [1-4]. Improving access to healthcare and identification of cost-effective approaches for earlier detection, smoking cessation and pulmonary rehabilitation for people with COPD (our 3 areas of focus), are part of the WHO 4 global priorities for non-communicable diseases [2,3]. Substantial underdiagnosis of COPD (>50% of cases) contributes to delayed intervention and poor outcomes, and is more marked in LMIC where population and health professional awareness is low and use of spirometry limited [4]. Whilst smoking is the main risk factor for disease onset and progression, passive smoking, occupational, indoor & outdoor air pollution exposures are additional contributors, particularly in LMICs [4]. LMIC PARTNERS COPD is one of the 10 leading causes of yrs of life lost in the 4 LMIC partners in our NIHR programme grant (Brazil, Georgia, Macedonia, China)[5] and all have identified diagnosis and management of COPD as an unmet need. Partners were selected from the International Primary Care Respiratory Group (IPCRG) network, representing LMICs with different populations, varying risk exposures, and healthcare systems. The primary healthcare systems in all settings are still in development, none are actively tackling underdiagnosis and implementation of effective approaches for management of COPD, including delivery of smoking cessation services, are limited. Initial discussion with experts in our partner countries suggests low awareness and adherence to international guidelines for the diagnosis & management are driven by lack of training, the high cost of pharmacological treatments and limited experience and delivery of effective lower cost behavioural interventions. Research is very limited; & mainly in hospitals. AIMS & OBJECTIVES Thr
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