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

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...

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Published in:	The international journal of tuberculosis and lung disease Vol. 19; no. 1; pp. 21 - 30
Main Authors:	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., for the BOLD Collaboration
Format:	Journal Article
Language:	English
Published:	France International Union Against Tuberculosis and Lung Disease 01-01-2015
Subjects:	Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - therapeutic use Aged Asthma - diagnosis Asthma - drug therapy Asthma - epidemiology Bronchodilator Agents - therapeutic use COPD and asthma treatments Cross-Sectional Studies Determinants For Use Essential Respiratory Medications Female Humans Influenza Vaccines - therapeutic use Male Middle Aged Mycobacterium Poverty Prevalence Prevention Of Exacerbations Pulmonary Disease, Chronic Obstructive - diagnosis Pulmonary Disease, Chronic Obstructive - drug therapy Pulmonary Disease, Chronic Obstructive - epidemiology Socioeconomic Factors Surveys and Questionnaires Vaccination - statistics & numerical data
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Summary:	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.
Bibliography:	1027-3719(20150101)19:1L.21;1- (R) Medicine - General ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1027-3719 1815-7920 1815-7920
DOI:	10.5588/ijtld.14.0263