Gaps in COPD guidelines of low- and middle-income countries: a systematic scoping review.

07 Oct 2020
Respiratory conditions
  • COPD
Respiratory topics
  • Global Health
Type of resource
Peer-reviewed article
Project(s)
  • FRESH AIR
Author(s)
Tabyshova A, Hurst JR, Soriano JB, Checkley W, Wan-Chun Huang E, Trofor AC, Flores-Flores O, Alupo P, Gianella G, Ferdous T, Meharg D, Alison J, Correia de Sousa J, Postma MJ, Chavannes NH, van Boven JF, Collaborators.

BACKGROUND

Guidelines are critical for facilitating cost-effective COPD care. Development and implementation in low-and middle-income countries (LMICs) is challenging. To guide future strategy, an overview of current global COPD guidelines is required.

RESEARCH QUESTION

We systematically reviewed national COPD guidelines, focusing on worldwide availability and identification of potential development, content, context and quality gaps that may hamper effective implementation.

STUDY DESIGN

& Methods: Scoping review of national COPD management guidelines. We assessed: (1) global guideline coverage, (2) guideline information (authors, target audience, dissemination plans), (3) content (prevention, diagnosis, treatments), (4) ethical, legal, socio-economic aspects and (5) compliance with the eight Institute of Medicine (IOM) guideline standards. LMICs guidelines were compared to those from high-income countries (HICs).

MAIN RESULTS

Of the 61 national COPD guidelines identified, 30 were from LMICs. Guidelines did not cover 1.93 billion (30.2%) people living in LMICs, whereas only 0.02 billion (1.9%) in HICs were without national guidelines. Compared with HICs, LMIC guidelines targeted fewer healthcare professional groups and less often addressed case finding and co-morbidities. Over 90% of all guidelines included smoking cessation advice. Air pollution reduction strategies were less frequently mentioned in both LMICs (47%) and HICs (42%). LMIC guidelines fulfilled on average 3.37 (42%) of IOM standards compared to 5.29 (66%) in HICs (p<0.05). LMICs scored significantly lower compared with HICs regarding conflicts of interest management, updates, articulation of recommendations and funding transparency (all, p<0.05).

INTERPRETATION

Several development, content, context and quality gaps exist in COPD guidelines from LMICs that may hamper effective implementation. Overall, COPD guidelines in LMICs should be more widely available and should be transparently developed and updated. Guidelines may be further enhanced by better inclusion of local risk-factors, case finding and co-morbidity management, preferably tailored to available financial and staff resources.

 

READ MORE AT: https://journal.chestnet.org/article/S0012-3692(20)34869-8/fulltext