Title: Estimating the burden of Chronic Respiratory Disease in adults in Asian low and middle-income countries [4CCORD study - 4 Country ChrOnic Respiratory Disease study]: a NIHR-RESPIRE research proposal.

Objective: Chronic Respiratory Diseases (CRD) especially asthma & chronic obstructive pulmonary disease (COPD) are common public health problems with high prevalence and mortality rates across the world. Although the majority of deaths and disability occur in developing countries, there is very little data on the true prevalence of asthma and COPD in these countries. Chronic respiratory symptoms are common in the general population but weak primary health care systems in resource-poor countries are often unable to diagnose the underlying disease condition. Factors contributing to low rates of diagnosis include limited access to, negative perceptions of, and lack of diagnostic capability in healthcare facilities. Determining the prevalence of asthma & COPD in the community has remained a challenge because of the poor sensitivity and specificity of the widely used questionnaire-based research tools, while spirometry which is the gold standard diagnostic test is a challenge to use in community-based epidemiological surveys. We therefore propose firstly to undertake a scoping review which will explore existing questionnaires and protocols used in LMICS to identify CRDs, enabling us to refine our screening processes. Secondly, to undertake a survey in four countries (Bangladesh, India, Malaysia, and Pakistan) to determine the prevalence of asthma, COPD and other CRD in the community, using robust random sampling strategies, and quality assured spirometry undertaken by field workers. KEMHRC, VRHP was one of the sites from India. This study funded by the NIHR Global Health Research Unit in Respiratory Health (RESPIRE) at the Usher Institute of Population Health Sciences and Informatics.

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