Among patients with chronic lung disease, how does severity and progression predict healthcare seeking treatement?

There is a global epidemic of non-communicable disease. Lung diseases including asthma and COPD are major contributors to the global burden of disease. There are substantial inequities in access to basic effective care around the world and within individual countries.

The broad objective is to investigate the severity and progression of chronic lung disease and its relationship with acute health care seeking, in two hard to reach populations. The first, drugs user accessing methadone clinics in Liverpool, UK and the second a cohort of post Pulmonary Tuberculous (PTB) patient in Blantyre, Malawi. Both populations have potential to put burden on the respective health care systems. Drugs users, particularly heroin smokers appear to have increased risk of acute presentations with respiratory disease, however tend not to present to available primary care facilities(Bernstein et al., 1997, Choi et al., 2015). It is well recognised that there is some residual lung disease following treatment for pulmonary TB, however the nature and severity is not fully understood (Meghji et al., 2016). Although the pattern of health care seeking and treatment is not known in these patients, given the association between chronic cough and previous TB it is likely this population presents to acute care after completion of TB treatment with respiratory symptoms (Ehrlich et al., 2004). This study aims to achieve the following objectives;
- To determine the change in lung function in Heroin user with COPD in Liverpool, UK - 2 years from baseline
- To assess the relationship between chronic lung disease in Heroin user and health care usage and treatments
- To determine the prevalence and severity of chronic respiratory symptoms, 2 & 3 years from initial episode of PTB in Blantyre, Malawi.
- To determine the relationship between severity of chronic respiratory symptoms and acute health care usage and repeated TB treatment
- To explore the experiences of PTB patient with chronic lung disease in relation to health services usage and TB-re treatment.