Gaps In using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites

L. Gnatiuc; A. S. Buist; B. Kato; C. Janson; N. Aït-Khaled; R. Nielsen; P. A. Koul; E. Nizankowska-Mogilnicka; D. Obaseki; L. F. Idolor; I. Harrabi; P. G.J. Burney; W. Vollmer; S. Gillespie; M. McBurnie; A. Jithoo; S. Coton; H. Azhar; N. S. Zhong; S. M. Liu; J. C. Lu; P. X. Ran; D. L. Wang; J. P. Zheng; Y. M. Zhou; A. Kocabas; A. Hancioglu; I. Hanta; S. Kuleci; A. S. Turkyilmaz; S. Umut; T. Unalan; M. Studnicka; T. Dawes; B. Lamprecht; L. Schirhofer; E. Bateman; A. Jithoo; D. Adams; E. Barnes; J. Freeman; A. Hayes; S. Hlengwa; C. Johannisen; M. Koopman; I. Louw; I. Ludick; A. Olckers; J. Ryck; J. Storbeck; T. Gislason; B. Benedikdtsdottir; K. Jorundsdottir; L. Gudmundsdottir; S. Gudmundsdottir; G. Gundmundsson; J. Frey; R. Harat; F. Mejza; P. Nastalek; A. Pajak; W. Skucha; A. Szczeklik; M. Twardowska; T. Welte; I. Bodemann; H. Geldmacher; A. Schweda-Linow; A. Gulsvik; T. Endresen; L. Svendsen; W. C. Tan; W. Wang; D. M. Mannino; J. Cain; R. Copeland; D. Hazen; J. Methvin; R. B. Dantes; L. Amarillo; L. U. Berratio; L. C. Fernandez; N. A. Francisco; G. S. Garcia; T. S. De Guia; L. F. Idolor; S. S. Naval; T. Reyes; C. C. Roa; Ma F. Sanchez; L. P. Simpao; C. Jenkins; G. Marks; T. Bird; P. Espinel; K. Hardaker; B. Toelle; C. Amor; J. Potts; M. Tumilty; F. McLean; E. F.M. Wouters; G. J. Wesseling; C. Barbara; F. Rodrigues; H. Dias; J. Cardoso; J. Almeida; M. J. Matos; P. Simao; M. Santos; R. Ferreira; I. S. Olafsdottir; K. Nisser; U. Spetz-Nyström; G. Hägg; G. M. Lund; R. Jõgi; H. Laja; K. Ulst; V. Zobel; T. J. Lill; S. Malik; N. A. Hakim; U. H. Khan; R. Chowgule; V. Shetye; J. Raphael; R. Almeda; M. Tawde; R. Tadvi; S. Katkar; M. Kadam; R. Dhanawade; U. Ghurup; M. Denguezli; Z. Tabka; H. Daldoul; Z. Boukheroufa; F. Chouikha; W. B. Khalifa; L. F. Idolor; T. S. De Guia; N. A. Francisco; C. C. Roa; F. G. Ayuyao; C. Z. Tady; D. T. Tan; S. Banal-Yang; V. M. Balanag; M. T.N. Reyes; Renato B. Dantes; S. Salvi; S. Hirve; B. Brashier; J. Londhe; S. Madas; S. Sambhudas; B. Chaidhary; M. Tambe; S. Pingale; A. Umap; A. Umap; N. Shelar; S. Devchakke; S. Chaudhary; S. Bondre; S. Walke; A. Gawhane; A. Sapkal; R. Argade; V. Gaikwad; M. C. Benjelloun; C. Nejjari; M. Elbiaze; K. El Rhazi; G. Erhabor; O. Awopeju; O. Adewole; R. O. Crapo; R. L. Jensen; P. Enright; G. Harnoncourt; R. Hooper

doi:10.5588/ijtld.14.0263

Gaps In using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites

L. Gnatiuc, A. S. Buist, B. Kato, C. Janson, N. Aït-Khaled, R. Nielsen, P. A. Koul, E. Nizankowska-Mogilnicka, D. Obaseki, L. F. Idolor, I. Harrabi, P. G.J. Burney, W. Vollmer, S. Gillespie, M. McBurnie, A. Jithoo, S. Coton, H. Azhar, N. S. Zhong, S. M. LiuJ. C. Lu, P. X. Ran, D. L. Wang, J. P. Zheng, Y. M. Zhou, A. Kocabas, A. Hancioglu, I. Hanta, S. Kuleci, A. S. Turkyilmaz, S. Umut, T. Unalan, M. Studnicka, T. Dawes, B. Lamprecht, L. Schirhofer, E. Bateman, A. Jithoo, D. Adams, E. Barnes, J. Freeman, A. Hayes, S. Hlengwa, C. Johannisen, M. Koopman, I. Louw, I. Ludick, A. Olckers, J. Ryck, J. Storbeck, T. Gislason, B. Benedikdtsdottir, K. Jorundsdottir, L. Gudmundsdottir, S. Gudmundsdottir, G. Gundmundsson, J. Frey, R. Harat, F. Mejza, P. Nastalek, A. Pajak, W. Skucha, A. Szczeklik, M. Twardowska, T. Welte, I. Bodemann, H. Geldmacher, A. Schweda-Linow, A. Gulsvik, T. Endresen, L. Svendsen, W. C. Tan, W. Wang, D. M. Mannino, J. Cain, R. Copeland, D. Hazen, J. Methvin, R. B. Dantes, L. Amarillo, L. U. Berratio, L. C. Fernandez, N. A. Francisco, G. S. Garcia, T. S. De Guia, L. F. Idolor, S. S. Naval, T. Reyes, C. C. Roa, Ma F. Sanchez, L. P. Simpao, C. Jenkins, G. Marks, T. Bird, P. Espinel, K. Hardaker, B. Toelle, C. Amor, J. Potts, M. Tumilty, F. McLean, E. F.M. Wouters, G. J. Wesseling, C. Barbara, F. Rodrigues, H. Dias, J. Cardoso, J. Almeida, M. J. Matos, P. Simao, M. Santos, R. Ferreira, I. S. Olafsdottir, K. Nisser, U. Spetz-Nyström, G. Hägg, G. M. Lund, R. Jõgi, H. Laja, K. Ulst, V. Zobel, T. J. Lill, S. Malik, N. A. Hakim, U. H. Khan, R. Chowgule, V. Shetye, J. Raphael, R. Almeda, M. Tawde, R. Tadvi, S. Katkar, M. Kadam, R. Dhanawade, U. Ghurup, M. Denguezli, Z. Tabka, H. Daldoul, Z. Boukheroufa, F. Chouikha, W. B. Khalifa, L. F. Idolor, T. S. De Guia, N. A. Francisco, C. C. Roa, F. G. Ayuyao, C. Z. Tady, D. T. Tan, S. Banal-Yang, V. M. Balanag, M. T.N. Reyes, Renato B. Dantes, S. Salvi, S. Hirve, B. Brashier, J. Londhe, S. Madas, S. Sambhudas, B. Chaidhary, M. Tambe, S. Pingale, A. Umap, A. Umap, N. Shelar, S. Devchakke, S. Chaudhary, S. Bondre, S. Walke, A. Gawhane, A. Sapkal, R. Argade, V. Gaikwad, M. C. Benjelloun, C. Nejjari, M. Elbiaze, K. El Rhazi, G. Erhabor, O. Awopeju, O. Adewole, R. O. Crapo, R. L. Jensen, P. Enright, G. Harnoncourt, R. Hooper

Pulmonary and Critical Care Medicine

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

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 19000 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.

Original language	English (US)
Pages (from-to)	21-30
Number of pages	10
Journal	International Journal of Tuberculosis and Lung Disease
Volume	19
Issue number	1
DOIs	https://doi.org/10.5588/ijtld.14.0263
State	Published - Jan 1 2015

Keywords

Copd and asthma treatments
Determinants for use
Essential respiratory medications
Prevention of exacerbations

ASJC Scopus subject areas

General Medicine

Access to Document

10.5588/ijtld.14.0263

Cite this

Gnatiuc, L., Buist, A. S., Kato, B., Janson, C., Aït-Khaled, N., Nielsen, R., Koul, P. A., Nizankowska-Mogilnicka, E., Obaseki, D., Idolor, L. F., Harrabi, I., Burney, P. G. J., Vollmer, W., Gillespie, S., McBurnie, M., Jithoo, A., Coton, S., Azhar, H., Zhong, N. S., ... Hooper, R. (2015). Gaps In using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites. International Journal of Tuberculosis and Lung Disease, 19(1), 21-30. https://doi.org/10.5588/ijtld.14.0263

Gnatiuc, L, Buist, AS, Kato, B, Janson, C, Aït-Khaled, N, Nielsen, R, Koul, PA, Nizankowska-Mogilnicka, E, Obaseki, D, Idolor, LF, Harrabi, I, Burney, PGJ, Vollmer, W, Gillespie, S, McBurnie, M, Jithoo, A, Coton, S, Azhar, H, Zhong, NS, Liu, SM, Lu, JC, Ran, PX, Wang, DL, Zheng, JP, Zhou, YM, Kocabas, A, Hancioglu, A, Hanta, I, Kuleci, S, Turkyilmaz, AS, Umut, S, Unalan, T, Studnicka, M, Dawes, T, Lamprecht, B, Schirhofer, L, Bateman, E, Jithoo, A, Adams, D, Barnes, E, Freeman, J, Hayes, A, Hlengwa, S, Johannisen, C, Koopman, M, Louw, I, Ludick, I, Olckers, A, Ryck, J, Storbeck, J, Gislason, T, Benedikdtsdottir, B, Jorundsdottir, K, Gudmundsdottir, L, Gudmundsdottir, S, Gundmundsson, G, Frey, J, Harat, R, Mejza, F, Nastalek, P, Pajak, A, Skucha, W, Szczeklik, A, Twardowska, M, Welte, T, Bodemann, I, Geldmacher, H, Schweda-Linow, A, Gulsvik, A, Endresen, T, Svendsen, L, Tan, WC, Wang, W, Mannino, DM, Cain, J, Copeland, R, Hazen, D, Methvin, J, Dantes, RB, Amarillo, L, Berratio, LU, Fernandez, LC, Francisco, NA, Garcia, GS, De Guia, TS, Idolor, LF, Naval, SS, Reyes, T, Roa, CC, Sanchez, MF, Simpao, LP, Jenkins, C, Marks, G, Bird, T, Espinel, P, Hardaker, K, Toelle, B, Amor, C, Potts, J, Tumilty, M, McLean, F, Wouters, EFM, Wesseling, GJ, Barbara, C, Rodrigues, F, Dias, H, Cardoso, J, Almeida, J, Matos, MJ, Simao, P, Santos, M, Ferreira, R, Olafsdottir, IS, Nisser, K, Spetz-Nyström, U, Hägg, G, Lund, GM, Jõgi, R, Laja, H, Ulst, K, Zobel, V, Lill, TJ, Malik, S, Hakim, NA, Khan, UH, Chowgule, R, Shetye, V, Raphael, J, Almeda, R, Tawde, M, Tadvi, R, Katkar, S, Kadam, M, Dhanawade, R, Ghurup, U, Denguezli, M, Tabka, Z, Daldoul, H, Boukheroufa, Z, Chouikha, F, Khalifa, WB, Idolor, LF, De Guia, TS, Francisco, NA, Roa, CC, Ayuyao, FG, Tady, CZ, Tan, DT, Banal-Yang, S, Balanag, VM, Reyes, MTN, Dantes, RB, Salvi, S, Hirve, S, Brashier, B, Londhe, J, Madas, S, Sambhudas, S, Chaidhary, B, Tambe, M, Pingale, S, Umap, A, Umap, A, Shelar, N, Devchakke, S, Chaudhary, S, Bondre, S, Walke, S, Gawhane, A, Sapkal, A, Argade, R, Gaikwad, V, Benjelloun, MC, Nejjari, C, Elbiaze, M, El Rhazi, K, Erhabor, G, Awopeju, O, Adewole, O, Crapo, RO, Jensen, RL, Enright, P, Harnoncourt, G & Hooper, R 2015, 'Gaps In using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites', International Journal of Tuberculosis and Lung Disease, vol. 19, no. 1, pp. 21-30. https://doi.org/10.5588/ijtld.14.0263

@article{bf10516342084f7182149ac6f71fcf75,

title = "Gaps In using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites",

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 19000 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.",

keywords = "Copd and asthma treatments, Determinants for use, Essential respiratory medications, Prevention of exacerbations",

author = "L. Gnatiuc and Buist, {A. S.} and B. Kato and C. Janson and N. A{\"i}t-Khaled and R. Nielsen and Koul, {P. A.} and E. Nizankowska-Mogilnicka and D. Obaseki and Idolor, {L. F.} and I. Harrabi and Burney, {P. G.J.} and W. Vollmer and S. Gillespie and M. McBurnie and A. Jithoo and S. Coton and H. Azhar and Zhong, {N. S.} and Liu, {S. M.} and Lu, {J. C.} and Ran, {P. X.} and Wang, {D. L.} and Zheng, {J. P.} and Zhou, {Y. M.} and A. Kocabas and A. Hancioglu and I. Hanta and S. Kuleci and Turkyilmaz, {A. S.} and S. Umut and T. Unalan and M. Studnicka and T. Dawes and B. Lamprecht and L. Schirhofer and E. Bateman and A. Jithoo and D. Adams and E. Barnes and J. Freeman and A. Hayes and S. Hlengwa and C. Johannisen and M. Koopman and I. Louw and I. Ludick and A. Olckers and J. Ryck and J. Storbeck and T. Gislason and B. Benedikdtsdottir and K. Jorundsdottir and L. Gudmundsdottir and S. Gudmundsdottir and G. Gundmundsson and J. Frey and R. Harat and F. Mejza and P. Nastalek and A. Pajak and W. Skucha and A. Szczeklik and M. Twardowska and T. Welte and I. Bodemann and H. Geldmacher and A. Schweda-Linow and A. Gulsvik and T. Endresen and L. Svendsen and Tan, {W. C.} and W. Wang and Mannino, {D. M.} and J. Cain and R. Copeland and D. Hazen and J. Methvin and Dantes, {R. B.} and L. Amarillo and Berratio, {L. U.} and Fernandez, {L. C.} and Francisco, {N. A.} and Garcia, {G. S.} and {De Guia}, {T. S.} and Idolor, {L. F.} and Naval, {S. S.} and T. Reyes and Roa, {C. C.} and Sanchez, {Ma F.} and Simpao, {L. P.} and C. Jenkins and G. Marks and T. Bird and P. Espinel and K. Hardaker and B. Toelle and C. Amor and J. Potts and M. Tumilty and F. McLean and Wouters, {E. F.M.} and Wesseling, {G. J.} and C. Barbara and F. Rodrigues and H. Dias and J. Cardoso and J. Almeida and Matos, {M. J.} and P. Simao and M. Santos and R. Ferreira and Olafsdottir, {I. S.} and K. Nisser and U. Spetz-Nystr{\"o}m and G. H{\"a}gg and Lund, {G. M.} and R. J{\~o}gi and H. Laja and K. Ulst and V. Zobel and Lill, {T. J.} and S. Malik and Hakim, {N. A.} and Khan, {U. H.} and R. Chowgule and V. Shetye and J. Raphael and R. Almeda and M. Tawde and R. Tadvi and S. Katkar and M. Kadam and R. Dhanawade and U. Ghurup and M. Denguezli and Z. Tabka and H. Daldoul and Z. Boukheroufa and F. Chouikha and Khalifa, {W. B.} and Idolor, {L. F.} and {De Guia}, {T. S.} and Francisco, {N. A.} and Roa, {C. C.} and Ayuyao, {F. G.} and Tady, {C. Z.} and Tan, {D. T.} and S. Banal-Yang and Balanag, {V. M.} and Reyes, {M. T.N.} and Dantes, {Renato B.} and S. Salvi and S. Hirve and B. Brashier and J. Londhe and S. Madas and S. Sambhudas and B. Chaidhary and M. Tambe and S. Pingale and A. Umap and A. Umap and N. Shelar and S. Devchakke and S. Chaudhary and S. Bondre and S. Walke and A. Gawhane and A. Sapkal and R. Argade and V. Gaikwad and Benjelloun, {M. C.} and C. Nejjari and M. Elbiaze and {El Rhazi}, K. and G. Erhabor and O. Awopeju and O. Adewole and Crapo, {R. O.} and Jensen, {R. L.} and P. Enright and G. Harnoncourt and R. Hooper",

note = "Publisher Copyright: {\textcopyright} 2015 The Union.",

year = "2015",

month = jan,

day = "1",

doi = "10.5588/ijtld.14.0263",

language = "English (US)",

volume = "19",

pages = "21--30",

journal = "International Journal of Tuberculosis and Lung Disease",

issn = "1027-3719",

publisher = "International Union against Tubercul. and Lung Dis.",

number = "1",

}

TY - JOUR

T1 - Gaps In using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites

AU - Gnatiuc, L.

AU - Buist, A. S.

AU - Kato, B.

AU - Janson, C.

AU - Aït-Khaled, N.

AU - Nielsen, R.

AU - Koul, P. A.

AU - Nizankowska-Mogilnicka, E.

AU - Obaseki, D.

AU - Idolor, L. F.

AU - Harrabi, I.

AU - Burney, P. G.J.

AU - Vollmer, W.

AU - Gillespie, S.

AU - McBurnie, M.

AU - Jithoo, A.

AU - Coton, S.

AU - Azhar, H.

AU - Zhong, N. S.

AU - Liu, S. M.

AU - Lu, J. C.

AU - Ran, P. X.

AU - Wang, D. L.

AU - Zheng, J. P.

AU - Zhou, Y. M.

AU - Kocabas, A.

AU - Hancioglu, A.

AU - Hanta, I.

AU - Kuleci, S.

AU - Turkyilmaz, A. S.

AU - Umut, S.

AU - Unalan, T.

AU - Studnicka, M.

AU - Dawes, T.

AU - Lamprecht, B.

AU - Schirhofer, L.

AU - Bateman, E.

AU - Jithoo, A.

AU - Adams, D.

AU - Barnes, E.

AU - Freeman, J.

AU - Hayes, A.

AU - Hlengwa, S.

AU - Johannisen, C.

AU - Koopman, M.

AU - Louw, I.

AU - Ludick, I.

AU - Olckers, A.

AU - Ryck, J.

AU - Storbeck, J.

AU - Gislason, T.

AU - Benedikdtsdottir, B.

AU - Jorundsdottir, K.

AU - Gudmundsdottir, L.

AU - Gudmundsdottir, S.

AU - Gundmundsson, G.

AU - Frey, J.

AU - Harat, R.

AU - Mejza, F.

AU - Nastalek, P.

AU - Pajak, A.

AU - Skucha, W.

AU - Szczeklik, A.

AU - Twardowska, M.

AU - Welte, T.

AU - Bodemann, I.

AU - Geldmacher, H.

AU - Schweda-Linow, A.

AU - Gulsvik, A.

AU - Endresen, T.

AU - Svendsen, L.

AU - Tan, W. C.

AU - Wang, W.

AU - Mannino, D. M.

AU - Cain, J.

AU - Copeland, R.

AU - Hazen, D.

AU - Methvin, J.

AU - Dantes, R. B.

AU - Amarillo, L.

AU - Berratio, L. U.

AU - Fernandez, L. C.

AU - Francisco, N. A.

AU - Garcia, G. S.

AU - De Guia, T. S.

AU - Idolor, L. F.

AU - Naval, S. S.

AU - Reyes, T.

AU - Roa, C. C.

AU - Sanchez, Ma F.

AU - Simpao, L. P.

AU - Jenkins, C.

AU - Marks, G.

AU - Bird, T.

AU - Espinel, P.

AU - Hardaker, K.

AU - Toelle, B.

AU - Amor, C.

AU - Potts, J.

AU - Tumilty, M.

AU - McLean, F.

AU - Wouters, E. F.M.

AU - Wesseling, G. J.

AU - Barbara, C.

AU - Rodrigues, F.

AU - Dias, H.

AU - Cardoso, J.

AU - Almeida, J.

AU - Matos, M. J.

AU - Simao, P.

AU - Santos, M.

AU - Ferreira, R.

AU - Olafsdottir, I. S.

AU - Nisser, K.

AU - Spetz-Nyström, U.

AU - Hägg, G.

AU - Lund, G. M.

AU - Jõgi, R.

AU - Laja, H.

AU - Ulst, K.

AU - Zobel, V.

AU - Lill, T. J.

AU - Malik, S.

AU - Hakim, N. A.

AU - Khan, U. H.

AU - Chowgule, R.

AU - Shetye, V.

AU - Raphael, J.

AU - Almeda, R.

AU - Tawde, M.

AU - Tadvi, R.

AU - Katkar, S.

AU - Kadam, M.

AU - Dhanawade, R.

AU - Ghurup, U.

AU - Denguezli, M.

AU - Tabka, Z.

AU - Daldoul, H.

AU - Boukheroufa, Z.

AU - Chouikha, F.

AU - Khalifa, W. B.

AU - Idolor, L. F.

AU - De Guia, T. S.

AU - Francisco, N. A.

AU - Roa, C. C.

AU - Ayuyao, F. G.

AU - Tady, C. Z.

AU - Tan, D. T.

AU - Banal-Yang, S.

AU - Balanag, V. M.

AU - Reyes, M. T.N.

AU - Dantes, Renato B.

AU - Salvi, S.

AU - Hirve, S.

AU - Brashier, B.

AU - Londhe, J.

AU - Madas, S.

AU - Sambhudas, S.

AU - Chaidhary, B.

AU - Tambe, M.

AU - Pingale, S.

AU - Umap, A.

AU - Shelar, N.

AU - Devchakke, S.

AU - Chaudhary, S.

AU - Bondre, S.

AU - Walke, S.

AU - Gawhane, A.

AU - Sapkal, A.

AU - Argade, R.

AU - Gaikwad, V.

AU - Benjelloun, M. C.

AU - Nejjari, C.

AU - Elbiaze, M.

AU - El Rhazi, K.

AU - Erhabor, G.

AU - Awopeju, O.

AU - Adewole, O.

AU - Crapo, R. O.

AU - Jensen, R. L.

AU - Enright, P.

AU - Harnoncourt, G.

AU - Hooper, R.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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 19000 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.

AB - 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 19000 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.

KW - Copd and asthma treatments

KW - Determinants for use

KW - Essential respiratory medications

KW - Prevention of exacerbations

UR - http://www.scopus.com/inward/record.url?scp=84918793208&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84918793208&partnerID=8YFLogxK

U2 - 10.5588/ijtld.14.0263

DO - 10.5588/ijtld.14.0263

M3 - Article

C2 - 25519786

AN - SCOPUS:84918793208

SN - 1027-3719

VL - 19

SP - 21

EP - 30

JO - International Journal of Tuberculosis and Lung Disease

JF - International Journal of Tuberculosis and Lung Disease

IS - 1

ER -

Gaps In using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites

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