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Newsletter 24th September, 2015
Dear IPCRG colleague
The International Primary Care Respiratory Group (IPCRG) is one of fourteen partners that will collectively receive a grant of 3 million euros from the European Commission (the Horizon 2020 research programme) to help find solutions for chronic lung disorders in low and middle income countries. These disorders are common in these countries because a large proportion of the population smokes or cooks in very basic conditions. “The great thing about this project is that we’re working with the local population right from the start,” explains Professor Niels Chavannes, principal investigator of the FRESH AIR Study and Immediate Past President of IPCRG.

Two sources of smoke pose a threat to the lungs of billions of people around the world: cigarette smoke and the smoke produced when cooking in very basic conditions. Every day, around three billion people (usually women) cook inside the home with fuel such as wood, cow dung or coal, generating a great deal of smoke that can damage the lung function. In addition, low and middle income countries are home to approximately three-quarters of the world’s tobacco smokers. “Chronic lung diseases are now the third leading cause of death around the world, after cardiovascular disease and cancer,” says Professor Chavannes, Professor of General Medicine at the Department of Public Health and Primary Healthcare (PHEG) at the Leiden University Medical Center.

Now that infectious diseases are being combatted effectively in countries with low incomes, the chronic lung disease chronic obstructive pulmonary disease (COPD) has been found to be a major problem. The IPCRG has already supported pilot FRESH AIR studies in a number of countries such as Uganda, Vietnam and the Kyrgyz Republic and now is time to scale these up and find out more about the problem and how to tackle it in these countries and also in Greece, particularly in its rural areas. “In those countries, we’ve built up a network of committed local researchers who are now taking part in this large project. We plan to map out the problem of lung diseases in detail, but also to see how best to adapt solutions for the local populations’ needs,” explained Siân Williams, Executive Officer of the IPCRG.
Recognising that there is a problem so that solutions are urgently sought
In many of the communities it is so normal to have symptoms such as cough or breathlessness that few people report them to the health services, or make the connection between the smoke they breathe and how they feel. Prof Talant Sooronbaev from the Kyrgyz Republic says “My people often just say they are tired.” So the project aims to describe the problem so that local people, healthcare professionals and governments agree there is a problem and work together to find solutions.

Clean cooking stoves
Research has shown that those solutions can differ for each country so it is important to ask the population to contribute ideas and to give them a greater say in the matter. A project being implemented by colleagues working in Bangalore, India has uncovered that the clean cooking stoves available cook the food too fast and don’t fit the large cooking pots used by the families. In Ethiopia, another project failed because the fuel used by the very efficient cooking stoves was too expensive. In the end, all the stoves ended up as scrap on the black market.
The IPCRG projects have encountered similar experiences. “In Vietnam, we wanted people to build chimneys in their homes, something that had been done very successfully in China. In the end, however, it turned out that people didn’t want the chimneys because they believed ghosts would use them to enter the house. Cooking under canopies outside the house turned out to be a much more viable solution.” In the highlands of the Kyrgyz Republic stoves are also used to heat the yurts that have to be kept closed for eight months of the year due to the cold. The highlanders live about the treeline and therefore use animal dung as fuel, which creates a permanently smoky atmosphere. The researchers hope to develop a checklist with the local communities, in which a number of variables, such as local cooking habits, cultural practices and the available fuel, determine which solution is the most suitable for them.

“One thing we discovered in earlier research is that it’s important to demonstrate the link between smoke and children’s health. People everywhere want their children to be healthy, yet children’s health is often seriously affected by smoke because they often sit close to their mother while she is cooking. In some cases, children’s lungs are even damaged before they are born.” Many children under the age of five have already been prescribed an average of two courses of antibiotics for respiratory disorders. The FRESH AIR Study will examine whether this can be reduced, because some of these ‘respiratory disorders’ are actually caused by smoke poisoning rather than infections.
“We want to focus on education, using resources such as information films, animation and texting via mobile phones. We also want to test an app that people can use to measure their own lung function by blowing into the speaker of their phones. It’s vitally important that people are given accurate information because healthcare workers in rural areas in poor countries often have very little training in how to prevent or treat chronic diseases and may not even realise that smoking and kitchen smoke are unhealthy,” says Chavannes.
More information
1. Leiden University Medical Center (LUMC) will coordinate the grant and can be contacted via the Communication Directorate, telephone +31 71 526 8005, e-mail:
2. The International Primary Care Respiratory Group (IPCRG) is a charity registered in Scotland working internationally (SC No: 035056) and a company limited by guarantee (Company number 256268). Registered Offices: 4th Floor, 115 George Street, Edinburgh, Scotland, EH2 4JN. Correspondence address: PO Box 11961, Westhill, AB32 9AE, U.K. Tel: +44 1224 743753 Email:
3. The FRESH AIR pilots are all described with documentaries, photos and peer-reviewed reports here:
About the IPCRG
The IPCRG is a not-for-profit clinically-led organisation registered as a charity and company limited by guarantee in Scotland that operates internationally. It represents national primary care respiratory groups and facilitates communities of practice and networks across the world with the aim of improving the quality of care for people with respiratory problems delivered in and to the community worldwide.
Through its network of over 125,000 primary care professionals, the IPCRG initiates, shares, spreads and supports the implementation of evidence in community settings for the prevention, treatment and care of breathing and lung problems such as asthma, chronic obstructive pulmonary disease, tobacco dependence, allergic rhinitis, sleep apnoea and respiratory infection. It has a long track record of delivering research and education projects funded through public and private funds.

The IPCRG is the primary care representative on the World Health Organization (WHO)-Global Alliance against chronic Respiratory Diseases (GARD) Planning Executive, the Respiratory Special Interest Group of The World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe and an Organisation in Collaborative Relations with WONCA Global, a member of the European COPD Coalition, and a supporter of the NCD Alliance. Its peer-reviewed journal, npj Primary Care Respiratory Medicine is published by Nature Publishing Group.
Current Members and active research locations: Australia, Bangladesh, Belgium, Brazil, Bulgaria, Canada, Chile, Cyprus, Denmark, France, Georgia, Germany, Greece, India, Ireland, Italy, Kyrgyzstan, Macedonia FYR, Malaysia, New Zealand, Norway, Pakistan, Philippines, Portugal, Romania, Singapore, Spain, Sri Lanka, Sweden, The Netherlands, Turkey, Uganda, UK, Ukraine, USA, Vietnam.
With kind regards
Ron Tomlins
President IPCRG
The International Primary Care Respiratory Group (IPCRG) is a charity registered in Scotland working internationally (SC No: 035056) and a company limited by guarantee (Company number 256268)

The IPCRG is the Respiratory Special Interest Group of WONCA Europe and an Organisation in Collaborative Relations with WONCA Global 

The IPCRG is the primary care representative on WHO-Global Alliance against Chronic Respiratory Diseases (GARD) Planning Executive

Supporter of the NCD Alliance