Chronic respiratory disease surveys in adults in low- and middle-income countries: A systematic scoping review of methodological approaches and outcomes

Abstract

Background Chronic respiratory diseases (CRDs) contribute significantly towards the global burden of disease, but the true prevalence and burden of these conditions in adults is unknown in the majority of low-and middle-income countries (LMICs). We aimed to identify strategies -in particular the definitions, study designs, sampling frames, instruments, and outcomes -used to conduct prevalence surveys for CRDs in LMICs. The findings will inform a future RESPIRE Four Country ChrOnic Respiratory Disease (4CCORD) study, which will estimate CRD prevalence, including disease burden, in adults in LMICs. MethodsWe conducted a scoping review to map prevalence surveys conducted in LMICs published between 1995 and 2018. We followed Arksey and O'Malley's six-step framework. The search was conducted in OVID Medline, EMBASE, ISI Web of Science, Global Health, WHO Global Index Medicus and included three domains: CRDs, prevalence and LMICs. After an initial title sift, eight trained reviewers undertook duplicate study selection and data extraction. We charted: country and populations, random sampling strategies, CRD definitions/phenotypes, survey procedure (questionnaires, spirometry, tests), outcomes and assessment of individual, societal and health service burden of disease. ResultsOf 36 872 citations, 281 articles were included: 132 from Asia (41 from China). Study designs were cross-sectional surveys (n = 260), cohort studies (n = 11) and secondary data analysis (n = 10). The number of respondents in these studies ranged from 50 to 512 891. Asthma was studied in 144 studies, chronic obstructive pulmonary disease (COPD) in 112. Most studies (100/144) based identification of asthma on symptom-based questionnaires. In contrast, COPD diagnosis was typically based on spirometry findings (94/112); 65 used fixed-ratio thresholds, 29 reported fixed-ratio and lower-limit-of-normal values. Only five articles used the term 'phenotype'. Most studies used questionnaires derived from validated surveys, most commonly the European Community Respiratory Health Survey (n = 47). The burden/impact of CRD was reported in 33 articles (most commonly activity limitation). ConclusionSurveys remain the most practical approach for estimating prevalence of CRD but there is a need to identify the most predictive questions for diagnosing asthma and to standardise diagnostic criteria.

Predictors for detecting chronic respiratory diseases in community surveys: A pilot cross-sectional survey in four South and South East Asian low- and middle-income countries

“…Most published surveys focus on one disease [ 10 ]. For example, in a recent systematic review, the global prevalence of COPD in adults 30-79 years was calculated as 7.7% (95% CI = 5.7-10.1) using the LLN-COPD definition (10.2% using FEV 1 /FVC<70%) [Adeloye D: personal communication].…”

“…Our estimate of 4.7% (using LLN) is lower, in part because our wide recruitment strategy included adults between 18 and 30 (unlikely to have significant COPD by virtue of age). In addition, this systematic review, in common with many surveys [ 10 ], equated obstructive spirometry with a diagnosis of COPD. In line with GOLD 2020 guidelines, we took a clinical perspective and only categorised a participant as having COPD if they reported at least one relevant symptom (shortness of breath, cough, phlegm) [ 23 ].…”

“…Detecting asthma in a survey is even more problematic. Our systematic review highlighted that the definitions of asthma used in surveys were usually based on symptoms or patient/participant-reported diagnosis and medication usage [ 10 ]. The Global Burden of Disease define asthma as ‘a doctor’s diagnosis and wheezing in the past year’ [ 24 ] and reported a global prevalence of 3.6% (3.2% to 4.0%).…”

“…Interpretations are fuelled by debates over spirometric thresholds and predictive value of (largely non-specific) respiratory symptoms [ 9 ]. Our previous scoping review of 281 CRD prevalence studies in LMICs identified several limitations that need to be addressed in future surveys [ 10 ]. These included:…”

The Obstructive Lung Diseases Program: Integrated obstructive lung disease services within primary care in Pakistan

“…In low-middle-income countries (LMICs), the prevalence of COPD and asthma cannot be fully understood due to underdiagnosis, 5 yet a recent systemic review showed over 80% of deaths were attributed to them 6 . In South Asia, these diseases accounted for 8% of all Disability–Adjusted Life Years.…”