Practical approach to lung health: lung health for everyone?

The World Health Organization (WHO) estimates that approximately 50% of people with tuberculosis (TB) are never diagnosed as having the disease and so cannot benefit from treatment, leaving the epidemic unchecked despite increasing global coverage by treatment programmes [1, 2]. Improved passive case detection is fundamental to the control of the TB epidemic and depends on alert clinicians identifying TB in patients seeking primary care for respiratory symptoms [3]. Poor TB case detection is also linked to substandard local health facilities, which, owing to their perceived lack of quality, are shunned by people who need diagnosis and treatment [2]. Even in Europe, TB continues to pose a public-health threat with inappropriate care, particularly in multidrug-resistant disease [4].

Chronic respiratory disorders, particularly asthma and chronic obstructive pulmonary disease (COPD), have attracted limited special attention in low- and middle-income countries [2]. Primary healthcare (PHC) facilities, while geared to identify patients that might have TB, are often poorly resourced for making other respiratory diagnoses or for treating even pneumonia [5]. In many developing countries, programmes for the management of respiratory diseases are poorly developed or limited, and the quality of care offered is often of a low standard [6]. Common problems are underdiagnosis and misdiagnosis leading to inappropriate reliance upon antibiotics and underuse of inhaled corticosteroids in asthma as many national managers in the Ministry of Health consider the unit cost of inhaled corticosteroids too high, and favour oral treatment [6]. Accessibility to care and availability of essential drugs remain important obstacles to improving care in many countries.

In an effort to remedy this challenging situation, the Stop TB Department of WHO has inaugurated several initiatives to improve global TB control, among those is PAL (Practical …