COPD management. Part II. Relevance for resource-poor settings.

Chronic obstructive pulmonary disease (COPD) is a preventable disease and its prevalence, already high in middle- and low-income countries, is expected to increase in the next decade. Global initiatives, including those against the tobacco industry to stop the tobacco epidemic, are fundamental to reduce the expected morbidity and mortality due to COPD. National health expenditure is generally low in the majority of developing countries, where financial and human resources are lacking and are primarily devoted to infectious diseases. To face these challenges, it is essential to strengthen political commitment to prioritising resource allocation to discourage tobacco use and to implement cost-effective standardised case management. The management of COPD could be more affordable in resource-poor countries if the cheaper spirometers currently on the market were made available and by the use of generic essential drugs. The organisation within clinical services of integrated management of respiratory diseases, including tuberculosis, as recommended by the World Health Organization in its Practical Approach to Lung Health, and by the International Union Against Tuberculosis and Lung Disease in its Comprehensive Approach to Lung Health, would help to improve health systems and skills of health personnel, reduce health costs and improve the quality of care of patients with chronic respiratory diseases.