NIHR Global Health Research Unit on Respiratory Health (RESPIRE)

Estimating chronic respiratory disease burden

This project is led from India, working with partners in Bangladesh, Malaysia and Pakistan


  • Project title:  Estimating Chronic Respiratory Disease (Asthma and COPD) Burden in Adults in Asian Low and Middle-income Countries (4CCORD)
  • Acute or chronic:  Chronic
  • Based at:  KEM Hospital Research Centre, Pune
  • Start date:  September 2018
  • End date:  October 2020
  • Principal investigator:  Sanjay Juvekar
  • Project team:  Samir K Saha, Rita Isaac, Mohammad Osman Yusuf, Ee Ming Khoo, Hilary Pinnock, Sanjay Juvekar, Dhiraj Agarwal, Nik Sherina Hanafi, Deesha Ghorpade, Mohsin Saeed Khan, Mohammed Shaidul Islam, Soumya Chippagiri


Chronic Respiratory Diseases (CRD), especially asthma and Chronic Obstructive Pulmonary Disease (COPD), are common public health problems with high prevalence and mortality rates across the world. Although the majority of deaths and disability occur in low- and middle-income countries (LMICs), there is very little data on their true prevalence in these countries.

Chronic respiratory symptoms are common in the general population but primary health care systems in resource-poor countries are often unable to diagnose the underlying disease condition.

Determining the prevalence of asthma and COPD in the community has remained a challenge because of the poor sensitivity and specificity of the widely used questionnaire-based research tools.

Aim and impact

The aim is to review existing questionnaires/screening procedures used in LMICs to detect CRDs in adults, to identify the optimal procedure. The feasibility of using the selected screening procedure will then be tested in RESPIRE partner sites (in Bangladesh, India, Malaysia and Pakistan).

The findings of the study will be used to inform a future fully powered survey to determine the prevalence of asthma, COPD and other CRD in the community. Health policies related to CRD can only be developed if we know the true burden of these diseases in the community.

Key developments

  • Protocol for scoping review was published in npj Primary Care Respiratory Medicine Journal and an abstract, based on scoping review preliminary findings, was presented at IPCRG 2019.
  • The scoping review is complete.
  • A successful workshop was held in February 2019 to review the preliminary findings of the scoping review and agree procedures and survey tools. The survey has been completed in all five partner centres.
  • Held a meeting with 4CCORD stakeholders in Malaysia to disseminate findings and raise awareness.
  • Provided training in spirometry technique and data analysis for Partners and healthcare workers in Kuala Lumpur, Malaysia, as part of the study.


Chronic respiratory disease surveys in adults in low- and middle-income countries: A systematic scoping review of methodological approaches and outcomes

Hanafi NS, Agarwal D, Chippagiri S, Brakema EA, Pinnock H, Sheikh A, Liew SM, Ng CW, Isaac R, Chinna K, Wong LP, Hussein N, Abu Bakar AI, Pang YK, Juvekar S, Khoo EM; on behalf of the RESPIRE Collaborators.

J Glob Health 2021;11:04026. doi: 10.7189/jogh.11.04026


Systematic scoping review protocol of methodologies of chronic respiratory disease surveys in low/middle-income countries.

Agarwal D, Hanafi NS, Chippagiri S, Brakema EA, Pinnock H, Khoo EM, Sheikh A, Liew SM, Ng CW, Isaac R, Chinna K, Ping WL, Hussein NB, Juvekar S & the RESPIRE Collaborators.

NPJ Prim Care Respir Med. 2019 May; 29:17

Project data

Download the Data Management Plan, Allergy and Asthma Institute, Pakistan

Download the Data Management Plan, Child Health Research Foundation

Download the Data Management Plan, Christian Medical College Vellore

Download the Data Management Plan, King Edward Memorial Hospital Research Centre

Download the Data Management Plan, University of Malaya

View metadata from Christian Medical College Vellore on the Health Data Research Innovation Gateway

View metadata from King Edward Memorial Hospital Research Centre on the Health Data Research Innovation Gateway

View metadata from University of Malaya on the Health Data Research Innovation Gateway