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ABSTRACT Background Asthma and allergic diseases have increased in the developed countries. It is important to determine whether the same trends are occurring in the developing countries in Africa. We [...]

Background The existing World Health Organization (WHO) pneumonia case management guidelines rely on clinical symptoms and signs for identifying, classifying, and treating pneumonia in children up to 5 years old. We aimed to collate an individual patient-level data set from large, high-quality pre-existing studies on pneumonia in children to identify a set of signs and symptoms with greater validity in the diagnosis, prognosis, and possible treatment of childhood pneumonia for the improvement of current pneumonia case management guidelines. Methods Using data from a published systematic review and expert knowledge, we identified studies meeting our eligibility criteria and invited investigators to share individual-level patient data. We collected data on demographic information, general medical history, and current illness episode, including history, clinical presentation, chest radiograph findings when available, treatment, and outcome. Data were gathered separately from hospital-based and community-based cases. We performed a narrative synthesis to describe the final data set. Results Forty-one separate data sets were included in the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) database, 26 of which were hospital-based and 15 were community-based. The PREPARE database includes 285 839 children with pneumonia (244 323 in the hospital and 41 516 in the community), with detailed descriptions of clinical presentation, clinical progression, and outcome. Of 9185 pneumonia-related deaths, 6836 (74%) occurred in children <1 year of age and 1317 (14%) in children aged 1-2 years. Of the 285 839 episodes, 280 998 occurred in children 0-59 months old, of which 129 584 (46%) were 2-11 months of age and 152 730 (54%) were males. Conclusions This data set could identify an improved specific, sensitive set of criteria for diagnosing clinical pneumonia and help identify sick children in need of referral to a higher level of care or a change of therapy. Field studies could be designed based on insights from PREPARE analyses to validate a potential revised pneumonia algorithm. The PREPARE methodology can also act as a model for disease database assembly. [ABSTRACT FROM AUTHOR]

Background: Chronic lung diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system.Methods: We conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization's (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians' capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains.Results: One health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥ 50 % for CLD care. Scores ranged from 14.9 % in a dispensary to 53.3 % in a health center in Tanzania, and from 36.4 to 86.4 % in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians' capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care.Conclusions: Gaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centered, integrated approaches at its heart. [ABSTRACT FROM AUTHOR]

When selecting the best inhaler and drug combination for a patient with respiratory disease, a number of factors should be considered. While efficacy and safety of medical treatments are always a priority, in recent years the environmental impacts of all aspects of life have become an increasingly necessary consideration and inhaled therapies are no exception. The carbon footprint of an item, individual or organisation is one of the most important and quantifiable environmental impacts, assessed by the amount of greenhouse gases (often expressed in terms of carbon dioxide equivalents) generated throughout the life cycle. The two most commonly prescribed and manufactured inhaler types worldwide are pressurised metered-dose inhalers (pMDIs) containing hydrofluorocarbon (HFC) propellants and dry powder inhalers (DPIs). Most of the carbon footprint of current pMDIs is a result of the propellants that they contain (HFC-134a and HFC-227ea, which are potent greenhouse gases). In comparison, the powder in DPIs is dispersed by the patient's own inhalation, meaning DPIs do not contain a propellant and have a lower carbon footprint than most pMDIs currently available. Soft mist inhalers are another propellant-free option: the device contains a spring, which provides the energy to disperse the aqueous medication. In this review, we examine the published data on carbon footprint data for inhalers, providing an analysis of potential implications for treatment decision making and industry initiatives., Competing Interests: Conflict of interest: A. Woodcock is co-chair of the Montreal Protocol Technology and Economic Assessment Panel, and member of the Medical and Chemical Technical Options Committee; has received compensation for consulting activities from GlaxoSmithKline, Novartis and Sandoz UK; and has received compensation for speaker activities from Novartis, GlaxoSmithKline and Teva. Conflict of interest: K.M. Beeh and/or the institution he represents has in the past 5 years received compensation for services on advisory boards or consulting activities from AstraZeneca, Berlin-Chemie, Boehringer, Chiesi, Elpen, GlaxoSmithKline, Mundipharma, Novartis, Pohl Boskamp, Sanofi and Teva; compensation for speaker activities in scientific meetings supported by AstraZeneca, Berlin-Chemie, Boehringer, Chiesi, Elpen, ERT, GlaxoSmithKline, Novartis, Pfizer, Pohl Boskamp, Sanofi and Teva; compensation for design and performance of clinical trials from AstraZeneca, Boehringer, GlaxoSmithKline, Novartis, Parexel, Pearl Therapeutics, Teva and Sterna. Conflict of interest: H. Sagara has received compensation for speaker activities supported by AstraZeneca, GlaxoSmithKline, Novartis and Sanofi. Conflict of interest: S. Aumônier is employed by ERM, a global sustainability consulting company that undertakes engagements with a wide range of public sector companies, including many in the healthcare sector and including Novartis. Conflict of interest: E. Addo-Yobo is employed by the Kwame Nkrumah University of Science and Technology, in the Dept of Child Health, School of Medicine and Dentistry, and is Honorary Consultant Paediatrician at the Komfo Anokye Teaching Hospital, Kumasi, Ghana with special interest in paediatric asthma and respiratory care and research; has received compensation as a resource person for asthma educational activities supported by AstraZeneca in Ghana. Conflict of interest: J. Khan and/or the institution he represents has received a research grant from NIHR UK for work on Smokeless Tobacco and Campaign for Tobacco Free Kids for a pilot study on looking at smoking policies at restaurants in Karachi, and is a member of the Medical and Chemical Technical Options Committee. Conflict of interest: J. Vestbo has received honoraria for presenting and/or advising from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Teva. Conflict of interest: H. Tope is employed by Planet Futures, a consulting business providing services to government, industry and other nongovernmental organisations on climate change, ozone-depleting substances and other environmental issues. As an independent expert, she co-chairs the Medical and Chemicals Technical Options Committee, which provides technical and economic advice, including on inhalers, to the Montreal Protocol. The views expressed herein are those of the co-authors and do not represent those of the Medical and Chemicals Technical Options Committee., (Copyright ©The authors 2022.)