Chronic obstructive pulmonary disease (COPD) is a growing but under-recognised global health crisis. More than 3.5 million people die from COPD each year; the disease now causes about 5 per cent of deaths worldwide and is the fourth leading cause of death. COPD includes emphysema and chronic bronchitis and often goes undiagnosed until it is advanced.
About 90 per cent of COPD deaths occur in low- and middle-income countries. In those settings diagnostic capacity is limited, specialist pulmonary care is scarce and access to essential medicines is unequal. Primary healthcare systems are frequently overstretched, and recommended combination inhalers — a bronchodilator paired with a corticosteroid — are often unavailable or unaffordable, so many patients receive only short-term relievers.
Reductions in foreign aid have reduced support for clinics and training, causing closures and loss of continuity of care. Capacity building requires sustained training, retention policies, competitive salaries, academic roles and integration into health systems. José Luis Castro noted that about 20 years ago Ethiopia had only one pulmonologist; a training programme, led in part by Tedros Adhanom Ghebreyesus at the health ministry, increased specialist numbers over two decades.
Air quality and tobacco control are essential to prevent future illness. Indoor pollution from cooking with wood or biomass and children born into polluted cities are particular concerns. As experts say, “We have the tools to prevent an entire generation from developing these diseases.”
- Prevention: better tobacco control and cleaner cooking.
- Care: stronger primary health systems and trained staff.
- Policy: affordable access to recommended inhalers.
Difficult words
- obstructive — causing blockage or reduced airflow in lungs
- pulmonary — related to the lungs and their function
- diagnostic capacity — ability of health services to identify disease
- bronchodilator — a drug that widens airways in the lungs
- corticosteroid — a medicine that reduces inflammation in the body
- pulmonologist — a doctor who specialises in lung diseases
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- What are the main barriers to good COPD care in low- and middle-income countries? Give reasons and examples from the article.
- Which prevention measures mentioned (tobacco control, cleaner cooking) would be most practical where you live, and why?
- How can health systems keep trained staff and maintain continuous COPD care over time? Use ideas from the article.
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