L Gnatiuc1, A S Buist2, B Kato1, C Janson3, N Aït-Khaled4, R Nielsen5, P A Koul6, E Nizankowska-Mogilnicka7, D Obaseki8, L F Idolor9, I Harrabi10, P G J Burney1. 1. National Heart and Lung Institute, Imperial College, London, UK. 2. Oregon Health & Science University, Portland, Oregon, USA. 3. Respiratory Medicine & Allergology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 4. International Union Against Tuberculosis and Lung Disease, Paris, France. 5. Institute of Medicine, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway. 6. Sheri Kashmir Institute of Medical Sciences, Srinagar, India. 7. Department of Internal Medicine, Jagiellonian University School of Medicine, Krakow, Poland. 8. Obafemi Awolowo University, Ile-Ife, Nigeria. 9. Department of Pulmonary Medicine, Lung Centre of the Philippines, Quezon City, The Philippines. 10. Faculty of Medicine, Sousse, Tunisia.
Abstract
BACKGROUND: Increasing access to essential respiratory medicines and influenza vaccination has been a priority for over three decades. Their use remains low in low- and middle-income countries (LMICs), where little is known about factors influencing use, or about the use of influenza vaccination for preventing respiratory exacerbations. METHODS: We estimated rates of regular use of bronchodilators, inhaled corticosteroids and influenza vaccine, and predictors for use among 19 000 adults in 23 high-income countries (HICs) and LMIC sites. RESULTS: Bronchodilators, inhaled corticosteroids and influenza vaccine were used significantly more in HICs than in LMICs, after adjusting for similar clinical needs. Although they are used more commonly by people with symptomatic or severe respiratory disease, the gap between HICs and LMICs is not explained by the prevalence of chronic obstructive pulmonary disease or doctor-diagnosed asthma. Site-specific factors are likely to influence use differently. The gross national income per capita for the country is a strong predictor for use of these treatments, suggesting that economics influence under-treatment. CONCLUSION: We still need a better understanding of determinants for the low use of essential respiratory medicines and influenza vaccine in low-income settings. Identifying and addressing these more systematically could improve the access and use of effective treatments.
BACKGROUND: Increasing access to essential respiratory medicines and influenza vaccination has been a priority for over three decades. Their use remains low in low- and middle-income countries (LMICs), where little is known about factors influencing use, or about the use of influenza vaccination for preventing respiratory exacerbations. METHODS: We estimated rates of regular use of bronchodilators, inhaled corticosteroids and influenza vaccine, and predictors for use among 19 000 adults in 23 high-income countries (HICs) and LMIC sites. RESULTS: Bronchodilators, inhaled corticosteroids and influenza vaccine were used significantly more in HICs than in LMICs, after adjusting for similar clinical needs. Although they are used more commonly by people with symptomatic or severe respiratory disease, the gap between HICs and LMICs is not explained by the prevalence of chronic obstructive pulmonary disease or doctor-diagnosed asthma. Site-specific factors are likely to influence use differently. The gross national income per capita for the country is a strong predictor for use of these treatments, suggesting that economics influence under-treatment. CONCLUSION: We still need a better understanding of determinants for the low use of essential respiratory medicines and influenza vaccine in low-income settings. Identifying and addressing these more systematically could improve the access and use of effective treatments.
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