In Salvador, Brazil, a programme that cut asthma hospital admissions across a city of 3 million people by 74% over three years is now being adapted to prevent attacks in two Latin American countries. The research group, based at St George’s, University of London, is expanding this approach to adults in Brazil and children in Ecuador, where inhaled medications like beclomethasone and salbutamol—listed as essential drugs by the WHO—are often unavailable in the public health system. The problem is that asthma attacks send people to emergency rooms repeatedly, especially among untreated adults and children. Current care is reactive, not preventive. This project tests a strategy: provide immediate specialist care at hospitals, then guide patients into primary care with free inhalers and spacers. If successful, the research could give Ecuador’s health ministry the local evidence it needs to make these medications widely available. In Brazil, it targets a major unmet need—adults with untreated asthma who account for high rates of emergency visits. The project also tracks risk factors for attack recurrence over one year, aiming to identify who needs the most support.
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This NIHR Global Health Research Group (GHRG) is based at St George’s University of London (SGUL) within the Institute of Infection and Immunity [I&I], supported by the Public Health Research Institute [PHRI]) which has an extensive track record of epidemiologic and implementation research in the UK. We are building on these strengths through established links with Brazil (Universidade Federal da Bahia, UFBa) and Ecuador (Fundacion Ecuatoriana Para Investigacion en Salud [FEPIS] and Universidad Internacional del Ecuador [UIDE]) and new academic links in the UK (University of East Anglia [UEA]) and Ecuador (Universidad de Cuenca/Universidad de Azuay [UC&UA]). The PHRI at SGUL has played a key role in defining the global burden of asthma and asthma risk factors through the International Study of Asthma and Allergies in Childhood [ISAAC]), while UFBa (Prof Cruz) has led the development of reference centres for severe asthma in Salvador, Brazil, that reduced hospital admissions due to asthma in the entire City of 3 million inhabitants by 74% over a 3 year period [9]. Prof Cruz is a member of the Executive Committee of the WHO Global Alliance against Chronic Respiratory Diseases (GARD) and of the Board of Directors of the Global Initiative for Asthma (GINA). This NIHR investment is complementing existing funding in asthma research at SGUL, UEA, UFBa, and UC&UA. Current asthma funding at these centres include: i) SGUL holds grants from the European Research Council and the Bill and Melinda Gates Foundation; ii) UEA holds NIHR grants for asthma research (Project: At-Risk Registers Integrated into primary care to Stop Asthma crises in the UK); iii) UFBa holds grants from the State Agency for Research Support of Bahia (FAPESB) and the Brazilian National Research Council (CNPq); and iv) UC&UA holds grants from University research funds and RED CEDIA. The Group’s strategy is to: 1. Set up a Global Health Research Group at St George’s in collaboration with key partners in Brazil, Ecuador, and the UK. 2. Deliver on a programme of implementation and epidemiological research through: a. Prevention of severe asthma attacks among adults in Brazil (Salvador) and asthma attacks in children and adolescents in Ecuador (Quito, Cuenca, and Esmeraldas) through a strategy for provision of immediate specialized care at collaborating hospitals followed by guided reference within the primary health care system (in Brazil and a pilot study in Ecuador), offering free inhaled beclomethasone, salbutamol and spacers to guarantee efficient inhalation. These medications are listed as essential drugs by WHO and are expected to be offered for free in every country. In Brazil, this has started to happen over the past 4 years, justified partly through the success of programmes such Programa de Controle da Asma da Bahia (ProAR) in Salvador. In Ecuador, inhaled salbutamol and beclomethasone, although listed as essential drugs by the Ministry of Public Health, have limited availability within the public health system. An objective of the present programme will be to provide a local evidence base to justify the wide availability of both medications within the public health care system in Ecuador. The focus in Brazil will be on adults with untreated asthma who, through ProAR, were found to have high rates of attacks requiring ER visits and have been identified as a major unmet need for better asthma care. The studies in Ecuador will focus on children and adolescents with asthma attacks who represent the major burden of disease. b. Identification of risk factors associated with asthma attacks and recurrence of asthma attacks in one month, 6 months and 1 year as well as re-attendance at emergency rooms due to an asthma attack. 3. Collaborative links with LMIC partners: a. Strengthening existing links with Brazilian and Ecuadorian partners. b. Establish new links with academic institutions in Ecuador involved in asthma resear
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