Upskilling Primary Healthcare Workers for Lung Function Assessment: Lessons from Chronic Respiratory Burden Estimation in a Rural Community of Bangladesh

Background: Chronic Respiratory Diseases (CRDs), particularly chronic obstructive pulmonary disease (COPD) and asthma, are the leading burden of mortality and morbidity worldwide. There is a need to develop new models of care for the large and growing population with CRDs in lower- and middle-income countries (LMICs). We, therefore, sought to understand the upskilling potentiality of primary health workers with a particular focus on objective lung function measurement in assessing and managing the burden of CRDs in a rural community. Methods: We employed spirometry tests on a randomly sampled CRD surveillance with adults≥18 years old in the rural community of Mirzapur, Bangladesh. Recruited research assistants/technologists with generalised education were trained for two days to conduct spirometry testing in this population. Each enrolled participant underwent three readings before and another 15 minutes after administration of 2 puffs of salbutamol. An expert panel reviewed the spirometry data to ensure the quality readout. The collected data were interpreted using appropriate case definitions to level CRD patients and their type of illness. Results: A total of 889 spirometry tests were conducted within four months by four trained staff. The expert panel accepted 829 (93.3%) spirometry reports among them. The rate of successful spirometry was approximately four spirometry reports per technician per day. Of the 132 abnormal spirometry, 45 (34.1%, 95%CI:26.1%-42.8%) had irreversible obstruction, 13 (9.9%, 95%CI:5.4%-16.3%) had a substantial reversible obstruction and 74 (56.1%, 95%CI:47.2%-64.7%), had a restrictive pattern. Discussion: We have demonstrated that it is possible to train community-based staff to undertake high-quality spirometry to support the diagnosis and management of CRDs. The challenge now is to train primary care physicians to interpret the measurements in individual clinical contexts to reduce the mis/delayed diagnosis of CRD, which could guide treatment decisions and improve the quality of life in CRD patients.