Chronic respiratory diseases in developing countries: the burden and strategies for prevention and management

In developing countries, chronic respiratory diseases represent a challenge to public health because of their frequency, severity, projected trends, a nd economic impact. Health care planners, for example, are faced with a dra matic increase in tobacco use and must establish priorities for the allocat ion of limited resources, Nevertheless, smoking prevention and standardized management programmes for asthma and chronic obstructive pulmonary disease should be implemented in developing countries whenever possible. Internati onal measures will be required to reverse tobacco smoking trends, and inter national agencies could define essential drugs and equipment and encourage the use of generic drugs, particularly for corticosteroids inhaled at high dosages. For such programmes to be effective, producers of high-quality gen erics will need to be identified, and the medications added to national lis ts of essential drugs and included in procurement procedures, Other recomme ndations for alleviating the burden of chronic respiratory diseases in deve loping countries are: adapting guidelines to local contexts and ensuring th eir distribution; upgrading equipment at district level; purchasing high-qu ality drugs at low prices; routine training and supervision of health servi ces personnel; and regular monitoring of performance. Social mobilization b y professional societies, nongovernmental organizations, and the mass media will also increase government commitment to tobacco control and standardiz ed case management.