Strategies for the prevention, diagnosis and treatment of COPD in low- and middle- income countries:the importance of primary care

INTRODUCTION: Low- and middle-income countries (LMICs) bear a high proportion of the global morbidity and mortality caused by COPD. Increased exposure to risk factors throughout life (e.g. malnutrition, indoor and outdoor air pollution, smoking) is associated with higher COPD prevalence in LMICs and the lack of treatment availability increases avoidable harm.AREAS COVERED: This review covers the epidemiology and burden of COPD in LMICs, and challenges and recommendations related to healthcare systems, prevention, diagnosis and treatment. Main challenges are related to under-resourced healthcare systems (such as limited availability of spirometry, rehabilitation and medicines). Lack of policy and practical local guidelines on COPD diagnosis and management further contribute to the low diagnostic and treatment rates. In the absence of, or limited number of respiratory specialists, primary care practitioners (general practitioners, nurses, pharmacists, physiotherapists and community health workers) play an even more pivotal role in COPD management in LMICs.EXPERT OPINION: Raising awareness on COPD, educating healthcare workers, patients and communities on cost-effective preventive measures as well as improving availability, affordability and proper use of diagnostic and pharmacological and non-pharmacologic treatment in primary care are the key interventions needed to improve COPD prevention, diagnosis and care in LMICs.