Topic | Short term | Medium term | Longer term |
1) Severe/uncontrolled asthma and comorbidities | To reach consensus on a universal definition of severe/uncontrolled asthma in adults and children with identification of gaps in the knowledge | To develop and validate, in pilot studies, a protocol to estimate the prevalence, case fatality rate and comorbidities of severe/uncontrolled asthma | To characterise the phenotypes of patients with severe/uncontrolled asthma and search for specific risk factors and comorbidities |
Gaps in knowledge and gaps in knowledge translation into policies | To estimate (and monitor annually) the number of countries with access to spirometry, essential medicines for CRDs and adequate care (common to topics 1, 3, 4 and 5) | To implement studies in LMICs to confirm the impact of access to ICS on morbidity and case fatality of severe/uncontrolled asthma in children and adults | To investigate genomics |
To redefine severe asthma phenotypes according to latest research | |||
2) Impact of primary and secondary prevention of CRDs | To develop models to estimate the regional and global attributable fraction of risk of CRD related to tobacco smoke, solid fuel combustion, outdoor air pollution and allergens, and the potential impact of interventions for their reduction | To develop risk charts for COPD and OSAS using the methodology of WHO CVD risk charts, and to test its usefulness as a tool to change behaviour of health professionals, users of health services and the community | To review risk charts and assess impact of their adoption on tangible health outcomes |
To develop models to estimate the impact of healthy diet and physical activity on prevention and control of obesity and its major comorbidities, such as CVDs, type II diabetes and SDB | To develop and validate, in pilot studies, simple protocols (including questionnaires and spirometry) to assess the CRD risks | ||
To develop models to estimate the impact of early detection of occupational CRDs and subsequent intervention on the prevention of disability due to occupational CRDs | |||
3) Effectiveness of integrated prevention and management of chronic diseases in PHC in low-resource settings | To investigate the feasibility, effectiveness and affordability of integrated prevention and management strategies for CRDs, CVDs, diabetes and other priority diseases in PHC in pilot countries. Based on PAL, PALSA Plus, IMAI, IMCI and other programmes | To assess CRD burden on emergency services and PHC facilities | To evaluate benefit of large-scale community education campaigns and community participation in the prevention and control of NCDs (including CRDs) in different cultural and economic settings |
To investigate the outcomes of a tailored syndromic approach to case management of chronic diseases in PHC by trained nurses with the supervision of physicians in pilot countries using an implementation plan based on PAL, PALSA Plus, IMAI, IMCI and other programmes | To develop methods for measurement of the impact of the interventions (e.g. indicators and outcomes for audit and pragmatic randomised controlled trials) | ||
To estimate (and monitor annually) the number of countries with access to spirometry, essential medicines for CRDs and adequate care (common to topics 1, 3, 4 and 5) | |||
4) COPD and comorbidities | To reach consensus on a universal definition of COPD, COPD exacerbations and risk factors for exacerbations, and to address gaps in knowledge to understand mechanisms of exacerbations | Surveys to assess the COPD prevalence, risk factors and comorbidities (CVDs, cancer and diabetes) in population based studies (BOLD initiative) | Evaluate benefits of treatment on both COPD and all NCDs over treatment of individual diseases, PROs, and specific and general health outcomes, as well as in costs |
Planning management of a person with COPD and concomitant comorbidities (CVDs, diabetes and others) | To propose essential PROs acceptable in all countries | ||
To estimate (and monitor annually) the number of countries with access to spirometry, essential medicines for CRDs and adequate care (common to topics 1, 3, 4 and 5) | |||
5) Early determinants of CRDs | To reach consensus on the definition of major CRDs by age groups, risk factors and identify gaps in knowledge | Surveys using spirometry and other case finding strategies to determine CRD prevalence (including asthma) in children and adolescents, and to identify risk factors in early life | Birth cohort studies and other longitudinal studies to assess genetic and early environmental determinants on CRD causality (especially asthma) |
Indoor and outdoor air pollution, infections, allergens, lack of awareness and demand to health services, lack of access to proper care | Develop methodology for a survey in LMICs to study prevalence of CRD and high risk patients in children <5 yrs of age | To develop and validate strategies for the management of acute respiratory diseases and asthma in LMICs for children <5 yrs of age | Develop and evaluate efficacy of preventive interventions worldwide and in LMICs |
To estimate (and monitor annually) the number of countries with access to spirometry, essential medicines for CRDs and adequate care (common to topics 1, 3, 4 and 5) |
A global fund for CRD research in LMICs should be developed. PHC: primary health care; COPD: chronic obstructive pulmonary disease; OSAS: obstructive sleep apnoea syndrome; WHO: World Health Organization; CVD: cardiovascular disease; PAL: Practical Approach to Lung Health; PALSA Plus: Practical Approach to Lung Health and HIV/AIDS in South Africa; IMAI: Integrated Management of Adolescent and Adult Illnesses; IMCI: Intergrated Management of Childhood Illnesses; NCD: noncommunicable disease; PRO: patients’ reported outcome; BOLD: Burden of Obstructive Lung Disease; ICS: inhaled corticosteroids; SDB: sleep-disordered breathing.