Central Data Catalog

Background: The 4 Country ChrOnic Respiratory Disease Study (4CCORD) is a community survey conducted in four Low and Middle-Income Countries (LMICs) to determine prevalence of chronic respiratory diseases (CRDs).

Aim: To identify the challenges faced during the feasibility pilot.

Methods: A house-to-house survey was conducted in Bangladesh, India, Malaysia and Pakistan. 100 adults residing in each study areas were randomly selected. Participants completed symptom-based questionnaires to detect asthma, COPD or ‘other CRD’ and spirometry was performed. People identified to have CRDs and a random screened ‘normal’ participants were asked to return for clinic review by a chest physician.

Results: 508 people were surveyed. Challenges included: 1. Project approvals from relevant authorities took up to 4 months. 2. Questionnaires had to be locally adapted. Some validated translations were unclear. 3. Difficulty employing trained spirometry technicians. Rapid turnover of trained research assistants required repeated training. 4. Seasonal variation could affect CRD prevalence. Recruitment during Ramadan and weekdays, societal fear of crime, language barriers, certain cultural norms were barriers to recruitment. 5. Debate on the importance of inspiratory loop for spirometry interpretation and quality. Reluctance of participants to return for repeat spirometry or clinic review. 6. Enumerator safety and the need for insurance.

Conclusion: Conducting survey on CRDs in LMICs was challenging due to logistics, poor heath literacy and spirometry-specific technical issues.