Non-communicable, chronic lung diseases are a major burden on health worldwide. About 80 million people suffer from COPD globally and a further 300 million are affected by asthma.
Their impact is particularly severe in low-resource environments. According to World Health Organization (WHO) figures, more than 90 % of COPD deaths and over 80 % of asthma deaths occur in these settings.
Although the evidence base for clinically sound and cost-effective treatments in high-resource settings is well developed, translating this knowledge to low-resource areas remains a challenge.
The EU-funded FRESH AIR project set out to address the growing burden of chronic non-communicable disease by improving their prevention, diagnosis and treatment in low-resource settings.
The project uses an implementation research approach to explore how existing knowledge and evidence-based interventions proven to work in high-resource settings can be adapted to practical challenges in low-resource settings in four target countries: Greece, Uganda, Vietnam and Kyrgyzstan.
“Implementation research is still a relatively young field,” explains project coordinator Rianne van der Kleij.
“It focuses on how we can facilitate the uptake of evidence-based interventions. What is necessary to make professionals use these interventions? And how can we better adapt them to the different geographical and cultural contexts in which they are applied?”
From theory to practice
FRESH AIR is an implementation research project which is aiming to improve the context-specific fit and acceptability of evidence-based interventions.
For example, after a local church service, Ugandan health workers taught their communities about the dangers of household air pollution. Several groups of Greek and Vietnamese COPD patients successfully completed a culturally tailored pulmonary rehabilitation course. In Kyrgyzstan, a training seminar on reducing smoking was delivered to a large group of general practitioners.
In the short term, FRESH AIR has improved the health outcomes of entire communities and of the COPD and asthma patients who received the tailored interventions. Healthcare workers involved in such intervention have also acquired improved skills, knowledge and experience enabling them to better diagnose and treat patients.
For instance, healthcare professionals in all four countries were trained in the accurate use of spirometry (to measure lung function) through a remote training programme developed by the University of Washington.
The project also helped to reduce household air pollution in the countries by raising awareness and the distribution of clean cooking stoves. Collaboration with the World Bank resulted in scaling up the project, and 5 000 extra clean cooking stoves are now being distributed in Kyrgyzstan.
“A key lesson we have learned is that collaboration is vital to success. The involvement of not only practitioners, but also patients and other local stakeholders ensures a sense of ownership of the project and its results. And it will help to make sure that interventions introduced will continue beyond the project’s lifetime,” Van der Kleij concludes.
FRESH AIR is actively collaborating with other research projects focusing on asthma and COPD, such as RESPIRE and BREATHWELL, as well as with the World Bank and the Global Alliance for Chronic Diseases (GACD). The project’s knowledge base, which is currently being designed, will be made available to other projects to share lessons learnt and to disseminate their results.