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FRESH AIR (Free Respiratory Evaluation and Smoke-exposure reduction by primary Health cAre Integrated gRoups) is a three year implementation science research project to improve the prevention, diagnosis and treatment of non-communicable lung diseases in low and middle income countries (LMICs) and other low-resource settings.  

Start date:

October 2015

End date:

September 2018


Leiden University Medical Center

Project management contact

Rianne van der Kleij

Total project funding over 3 years

€ 2.99 m

Number of partners



European Commission Horizon 2020 fund

The challenge

Research shows that worldwide about 80 million people have COPD and it is now the third leading cause of death worldwide.[1] Asthma affects an estimated 300 million individuals worldwide.[2] Data shows that the greatest burden of lung disease occurs in in low-resource settings. According to WHO figures over 90% of COPD deaths and over 80% of asthma deaths occur in LMICs.[3] The link between exposure to smoke, including tobacco smoke, indoor and outdoor environmental exposure, and lung diseases is well established by existing research.

Clinically and cost-effective prevention and treatment measures, including treating tobacco dependence, are widely available in high income countries. However, there are different risk factors in low-resource settings, including indoor air pollution from burning fuel for cooking and heating with inadequate ventilation. Public awareness of lung disease and its risk factors also tends to be poor. This is exacerbated by lack of knowledge and engagement of policy makers, limited access to health care and inadequate data.  


Implementation science

The project seeks to improve health outcomes for people at risk of or suffering from non-communicable lung diseases in low and middle income countries (LMICs) and other low-resource settings through interventions for prevention, diagnosis and treatment.  It uses implementation science methodologies to explore how existing knowledge and evidence-based interventions that have been proven to work in High Income Countries (HICs) can be adapted to the practical challenges experienced in low-resource settings.

As an implementation science project we will share with you resources and information over the course of the project through this web platform.   We are also building an implementation science resource centre


June 2017: feature  by FRESH AIR for the NCD Alliance on Implementation Science.

Web repository

The web platform also offers a repository for the partners to describe their implementation strategies and interventions in sufficient detail to enable replication, which often requires more words than are available in a scientific journal.  In particular, we will share material such as educational materials, video clips and photographs.

FRESH AIR Community

We aim to build a FRESH AIR community that continues to share ideas, resources and challenges once the project has ended therefore please comment and offer links to other appropriate knowledge and resources.



About Horizon 2020 FRESH AIR

Horizon 2020 FRESH AIR is testing the impact of evidence-based interventions in four countries with a range of contextual factors that are likely to have an important impact on their implementation.  These contextual factors include demography, climate, altitude, geography, health systems, country income, health care professional and population behaviours and knowledge.  These pages will provide updates in the form of photos, blogs and film about the four countries as we pass through the seasons, and engage stakeholders.  We welcome comment.



[1] Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095–128

[2] To T, Stanojevic S, Moores G, Gershon AS. Bateman ED, Cruz AA et al. Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health 2012; 12: 204.

[3] According to  WHO estimates. For COPD at and for asthma at

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