Practical approach to lung health: lung health for everyone?

Table 1. Equipment required for practical approach to lung health strategy implementation^#

First-level health facilities

Sputum containers

Peak flow meters with mouthpieces

Inhalation chamber with masks (for children)

Pulse oximeter

Oxygen sources (cylinder and/or concentrators and accessories)

Nebuliser with mask (manual at least)

District referral outpatient services or laboratories

Binocular microscope

Centrifuge and incubator (if cultures for TB are performed)

Basic radiology equipment

Spirometer

Pulse oximeter

Equipment for tracheal aspiration

Oxygen sources

Equipment for pleural drainage

Needles and instruments for transthoracic pleural biopsy

Blood gas analyser

Second referral level

Bronchoscope (if there is a chest specialist trained to use it)

TB: tuberculosis. ^#: according to the World Health Organization practical approach to lung health implementation guideline [8].

Table 2. Practical approach to lung health (PAL) reported results on clinical outcomes

Outcomes	Clinical outcomes	Countries
Diagnosis of chronic respiratory diseases^#	Increase in diagnosis of CRD	Algeria, Chile, Jordan, Morocco, Kyrgyzstan, South Africa, Tunisia, Syria
Quality of care of asthma and COPD patients	Improvement of patients' management Improvement of patients' quality of life	South Africa, El Salvador Chile, Nepal
Tuberculosis	Improvement in the quality of the diagnostic process of TB Improvement in TB case detection	Algeria, Bolivia, Morocco, South Africa, Syria, Tunisia South Africa, Algeria
Treatment
Antibiotics	Decrease in drug prescription, particularly antibiotics and adjuvant drugs	Algeria, Bolivia, El Salvador, Jordan, Kyrgyzstan, Morocco, Nepal, Syria, Tunisia
CRD drugs	PAL improves the quality of drug prescription for CRD patients Increase in inhaled steroid prescription Decrease in oral steroid prescription	Algeria, Chile, Jordan, Kyrgyzstan, Morocco, South Africa, Syria, Tunisia

COPD: chronic obstructive pulmonary disease; CRD: chronic respiratory diseases; TB: tuberculosis. ^#: asthma and COPD.

Table 3. Practical approach to lung health (PAL) reported results on managerial and economic outcomes

Outcomes	Clinical outcomes	Countries
Managerial
Referral	Increase in respiratory disease management in primary healthcare Decrease in referral to upper health level	Bolivia, El Salvador, Guinea, Jordan, Kyrgyzstan, South Africa
Strengthening health services	Strengthening of health workers' self confidence Upgrading of health workers' skills	South Africa
Economic
Cost	Reduction in the average cost of drug prescription per respiratory patient	Algeria, Bolivia, Jordan, Kyrgyzstan, Morocco, Syria, Tunisia
Patient out-of-pocket expense	Decrease in direct and indirect costs	Nepal
Cost effectiveness of PAL	Relatively cost effective	Nepal, South Africa

Table 4. Impact of practical approach to lung health on drug prescription in seven countries

	Algeria	Morocco	Kyrgyzstan	Tunisia	Jordan	Bolivia	Syria
Number of drugs per patient	-10.1***	-15***	-11.1***	-18.8***	-12.2***	-17.0***	-14.3***
Patients with antibiotic prescription	-10.0**	-25***	-22.0***	-21.1***	-15.9***	-12.3**	-33.3***
Drug prescription cost per patient	-13.6***	-18***	-32.4***	-19.3***	-8.7*	-17.7***	-26.2***