NIHR Breathe Well

The National Institute for Health Research (NIHR) Global Health Research Group on Global COPD in Primary Care was set up in 2017 and ended in July 2021, although publications are still in progress and negotiations with  stakeholders to sustain the work continues.  It is a partnership between the University of Birmingham, the International Primary Care Respiratory Group (IPCRG) and primary care or public health research teams in  Brazil, China, Republic of North Macedonia and Georgia. IPCRG facilitated the introductions. The partnership is known as Breathe Well.


Aim

The aim of the Breathe Well partnership was to foster research in primary care and the community to improve the diagnosis, management and prognosis of COPD patients in low- and middle-income countries. Together, we aimed to:

  • Develop and consolidate a sustainable collaboration and shared vision;
  • Strengthen local research capacity in the partner countries in community-based COPD research and in generic population research methods;
  • Co-create a local plan for evaluating approaches for identifying undiagnosed COPD in the community, adapted to cultural needs and local healthcare infrastructure;
  • Adapt evidence-based behavioural approaches for the management of COPD, according to cultural needs and the local healthcare infrastructure and to assess the feasibility of their implementation;
  • Build a robust platform for future collaborative research with the partner countries and other similar settings.

Rationale

Chronic obstructive pulmonary disease (COPD) is a long-term incapacitating respiratory condition. The Global Burden of Disease Study for 2016 estimates 251 million people worldwide suffer from COPD.  It is currently the 4th  leading cause of death worldwide.  COPD is also a major cause of morbidity due to persistent symptoms, reduced lung function and intermittent exacerbations that adversely affect functional status and quality of life.  Around 90% of COPD deaths occur in low- and middle-income countries (LMICs) and it disproportionately affects the most disadvantaged populations.

The main causes of COPD, including smoking and exposure to indoor and outdoor air pollution, are more common in LMICs. However, awareness of COPD and its causes is very low.  Access to diagnosis and treatment services is also inadequate. Over half of people who have COPD do not know they have the condition and are not receiving treatment which could help them. Services to help smokers quit are patchy, inhaler medications are often too expensive and other forms of effective treatment eg education, support for physical activity and management of breathlessness are rarely available.

In China, recent estimates are that 99.9 million people aged over 20 have COPD, mainly due to tobacco smoking, exposure to PM2.5 from indoor biomass and ambient air pollution.

However, awareness of COPD is very low. Over half of people who have COPD do not know they have the condition and are not receiving treatment which could help them. Local community healthcare systems are in development and limited treatment is available, especially in poorer areas. Services to help smokers quit are patchy, inhaler medications are often too expensive and other forms of effective treatment eg immunisation, education, support for physical activity and management of breathlessness are rarely available. Improving access to healthcare and identification of cost-effective approaches for earlier detection, smoking cessation and pulmonary rehabilitation for people with COPD are therefore important priorities for health systems. 

The research projects fall into three themes:

  1. Case finding for undiagnosed COPD (Brazil and China)
  2. Promotion of smoking cessation in the community (Republic of North Macedonia)
  3. Behavioural interventions to improve disease management (Georgia).

The Breathe Well leadership

The Breathe Well partnership has been led by the University of Birmingham,  which has developed an international track record in COPD research in community/primary care settings. The directors of the Breathe Well collaboration are Dr Rachel Jordan, Reader in Epidemiology and Primary Care at the University of Birmingham, and Professor Peymané Adab, Professor of Public Health and Chronic Disease Epidemiology at the University of Birmingham.  More details of the partnership.

IPCRG role

IPCRG is a member of the Breathe Well partnership and has led on clinical engagement, communication and dissemination using its extensive primary care network.

Milestones or activities

Training

The UoB team created bespoke training which includes the areas of clinical, research skills and research management. Training examples include: spirometry, spirometry overreading, health economics, statistics, writing for publication and stakeholder engagement.

Engaging Stakeholders

Stakeholder engagement has been a substantial element of the Breathe Well programme. The aims were to identify stakeholders at each stage of the research.  This started with engaging them to identify and prioritise local research needs, ensure that cultural factors are accounted for in intervention design, and also to establish a sustainable process for future collaborations and for potential implementation of successful interventions. All countries have developed bespoke plans with support from IPCRG; these have been tested out in an innovative "Dragons' Den" online contest and the learning incorporated into infographics and policy briefings.  The teams’ current focus is to develop the evaluation of the engagement, to plan resources and how to make stakeholder engagement sustainable.

Publications

Click here to see all publications.

 

NIHR assessment

Many of Breathe Well's achievements are noted in this report by NIHR that summarises learning from the Call 1 NIHR-funded programmes.

Contact Breathe Well

More information about the Breathe Well research team at the University of Birmingham and their work is available here.

To contact the Breathe Well team, please email us at breathewell [at] contacts [dot] bham [dot] ac [dot] uk