Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; MRC Unit on Child and Adolescent Lung Health, University of Cape Town, Cape Town, South Africa.
Lancet Respir Med. 2015 Feb;3(2):159-170. doi: 10.1016/S2213-2600(15)00004-1.
Demographic and epidemiological transitions are changing the age structure of the population and the most common diseases. Non-communicable respiratory diseases are an increasing problem at both ends of the age range in low-income and middle-income countries. In children, who represent a large proportion of the total population, the increasing problem of asthma is a strain on health services. Improved survival of the older population is increasing the proportion of morbidity and mortality attributable to chronic lung diseases. Health services in low-resource countries are poorly adapted to treating chronic diseases. Designed to respond episodically to acute disease, almost all historical investment has focused on infectious diseases. Crucial to the successful management of chronic diseases is an infrastructure designed to support pro-active management, providing not only an accurate diagnosis, but also a secure supply of cost effective drugs at an affordable price. The absence of such an infrastructure in many countries and the market failure that makes drugs generally more expensive in low-resource regions means that many people with chronic non-communicable lung diseases are not given effective treatment. This has damaging economic consequences. The common causes of poor lung health in low-income countries are not the same as those in richer countries, and there is a need to study why they are so common and how best to manage them.
人口结构和流行病学的转变正在改变人口的年龄结构和最常见的疾病。在中低收入国家，非传染性呼吸系统疾病在年龄范围的两端都是一个日益严重的问题。在儿童中，他们占总人口的很大比例，哮喘问题的日益严重给卫生服务带来了压力。老年人口的存活率提高，使慢性病导致的发病率和死亡率比例增加。资源匮乏国家的卫生服务机构对慢性病的治疗适应能力很差。卫生服务机构的设计目的是应对急性疾病，因此几乎所有历史投资都集中在传染病上。慢性病的成功管理取决于支持积极管理的基础设施，这不仅需要准确的诊断，还需要以负担得起的价格提供安全的、具有成本效益的药物供应。许多国家缺乏这样的基础设施，以及使药品在资源匮乏地区普遍更昂贵的市场失灵，意味着许多患有慢性非传染性肺部疾病的人没有得到有效的治疗。这会带来破坏性的经济后果。低收入国家肺部健康状况不佳的常见原因与较富裕国家的原因不同，因此需要研究为什么这些原因如此普遍，以及如何最好地管理这些原因。
