The National Institute for Health Research (NIHR) Global Health Research Group on Global COPD in Primary Care was set up in 2017. It is a partnership between the University of Birmingham, the International Primary Care Respiratory Group (IPCRG) and primary care or public health research teams in Brazil, China, Republic of North Macedonia and Georgia. IPCRG facilitated the introductions. The partnership is known as Breathe Well.
The aim of the Breathe Well partnership is to foster research in primary care and the community to improve the diagnosis, management and prognosis of COPD patients in low- and middle-income countries. Together, we aim to:
- Develop and consolidate a sustainable collaboration and shared vision;
- Strengthen local research capacity in the partner countries in community-based COPD research and in generic population research methods;
- Co-create a local plan for evaluating approaches for identifying undiagnosed COPD in the community, adapted to cultural needs and local healthcare infrastructure;
- Adapt evidence-based behavioural approaches for the management of COPD, according to cultural needs and the local healthcare infrastructure and to assess the feasibility of their implementation;
- Build a robust platform for future collaborative research with the partner countries and other similar settings.
Chronic obstructive pulmonary disease (COPD) is a long-term incapacitating respiratory condition. The Global Burden of Disease Study for 2016 estimates 251 million people worldwide suffer from COPD. It is currently the 4th leading cause of death worldwide. COPD is also a major cause of morbidity due to persistent symptoms, reduced lung function and intermittent exacerbations that adversely affect functional status and quality of life. Around 90% of COPD deaths occur in low- and middle-income countries (LMICs) and it disproportionately affects the most disadvantaged populations.
The main causes of COPD, including smoking and exposure to indoor and outdoor air pollution, are more common in LMICs. However, awareness of COPD and its causes is very low. Access to diagnosis and treatment services is also inadequate. Over half of people who have COPD do not know they have the condition and are not receiving treatment which could help them. Services to help smokers quit are patchy, inhaler medications are often too expensive and other forms of effective treatment eg education, support for physical activity and management of breathlessness are rarely available.
In China, recent estimates are that 99.9 million people aged over 20 have COPD, mainly due to tobacco smoking, exposure to PM2.5 from indoor biomass and ambient air pollution.
However, awareness of COPD is very low. Over half of people who have COPD do not know they have the condition and are not receiving treatment which could help them. Local community healthcare systems are in development and limited treatment is available, especially in poorer areas. Services to help smokers quit are patchy, inhaler medications are often too expensive and other forms of effective treatment eg immunisation, education, support for physical activity and management of breathlessness are rarely available. Improving access to healthcare and identification of cost-effective approaches for earlier detection, smoking cessation and pulmonary rehabilitation for people with COPD are therefore important priorities for health systems.
Breathe Well is working in four countries, introduced by IPCRG to the University of Birmingham. National partners are implementing research projects that are based on priorities identified by their own patients, clinicians and policy makers.
The four countries are:
The research projects fall into three themes:
- Case finding for undiagnosed COPD (Brazil and China)
- Promotion of smoking cessation in the community (Republic of North Macedonia)
- Behavioural interventions to improve disease management (Georgia).
The Breathe Well leadership
The Breathe Well partnership is led by the University of Birmingham, which has developed an international track record in COPD research in community/primary care settings. The directors of the Breathe Well collaboration are Dr Rachel Jordan, Reader in Epidemiology and Primary Care at the University of Birmingham, and Professor Peymané Adab, Professor of Public Health and Chronic Disease Epidemiology at the University of Birmingham.
IPCRG is a member of the Breathe Well partnership and leads on clinical engagement, communication and dissemination using its extensive primary care network.
Milestones or activities
The UoB team has created bespoke training which includes the areas of clinical, research skills and research management. Training examples include: spirometry, spirometry overreading, health economics, statistics, writing for publication and stakeholder engagement.
Stakeholder engagement is a substantial element of the Breathe Well programme. The aims are to identify stakeholders at each stage of the research. This started with engaging them to identify and prioritise local research needs, ensure that cultural factors are accounted for in intervention design, and also to establish a sustainable process for future collaborations and for potential implementation of successful interventions. All countries have developed bespoke plans with support from IPCRG. The teams’ current focus is to develop the evaluation of the engagement, to plan resources and how to make stakeholder engagement sustainable.
Breathe Well Research Outputs
Abstracts and research papers from the Breathe Well project.
University of Birmingham Breathe Well webpages: https://www.birmingham.ac.uk/research/applied-health/research/breathe-well/about-breathe-well.aspx
Contact Breathe Well
More information about the Breathe Well research team at the University of Birmingham and their work is available here.
To contact the Breathe Well team, please email us at breathewell [at] contacts [dot] bham [dot] ac [dot] uk