title: Gaps in using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites.
abstract: BACKGROUND
  Increasing access to essential respiratory medicines and influenza vaccination has been a priority for over three decades. Their use remains low in low- and middle-income countries (LMICs), where little is known about factors influencing use, or about the use of influenza vaccination for preventing respiratory exacerbations.
  
  
  METHODS
  We estimated rates of regular use of bronchodilators, inhaled corticosteroids and influenza vaccine, and predictors for use among 19 000 adults in 23 high-income countries (HICs) and LMIC sites.
  
  
  RESULTS
  Bronchodilators, inhaled corticosteroids and influenza vaccine were used significantly more in HICs than in LMICs, after adjusting for similar clinical needs. Although they are used more commonly by people with symptomatic or severe respiratory disease, the gap between HICs and LMICs is not explained by the prevalence of chronic obstructive pulmonary disease or doctor-diagnosed asthma. Site-specific factors are likely to influence use differently. The gross national income per capita for the country is a strong predictor for use of these treatments, suggesting that economics influence under-treatment.
  
  
  CONCLUSIONS
  We still need a better understanding of determinants for the low use of essential respiratory medicines and influenza vaccine in low-income settings. Identifying and addressing these more systematically could improve the access and use of effective treatments.
authors.affiliation: National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Gnatiuc
authors.affiliation: Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Buist
authors.affiliation: National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Kato
authors.affiliation: Respiratory Medicine & Allergology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Janson
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Aït-Khaled
authors.affiliation: Institute of Medicine, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: R
authors.initials: R
authors.lastname: Nielsen
authors.affiliation: Sheri Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: P A
authors.initials: PA
authors.lastname: Koul
authors.affiliation: Department of Internal Medicine, Jagiellonian University School of Medicine, Krakow, Poland.
authors.forename: E
authors.initials: E
authors.lastname: Nizankowska-Mogilnicka
authors.affiliation: Obafemi Awolowo University, Ile-Ife, Nigeria.
authors.forename: D
authors.initials: D
authors.lastname: Obaseki
authors.affiliation: Department of Pulmonary Medicine, Lung Centre of the Philippines, Quezon City, The Philippines.
authors.forename: L F
authors.initials: LF
authors.lastname: Idolor
authors.affiliation: Faculty of Medicine, Sousse, Tunisia.
authors.forename: I
authors.initials: I
authors.lastname: Harrabi
authors.affiliation: National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: P G J
authors.initials: PG
authors.lastname: Burney
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011203:Poverty; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D007252:Influenza Vaccines