Lung health in LMICs: tackling challenges ahead – Authors' reply

We thank Ee Ming Khoo and colleagues for welcoming our Review on improving lung health in low-income and middle-income countries (LMICs).1 We entirely agree that high quality primary care is a key component for the successful delivery of universal health coverage and has a particularly crucial role in the provision of health services for people with chronic respiratory diseases in LMICs. We applaud the efforts of the International Primary Care Respiratory Group in championing this cause. Health systems are complex and adaptive, functioning at multiple interconnected levels; therefore, improving quality of care will require system-wide action.2 It is not only primary care services but also the connections between primary care, community health workers, and secondary care services that need to be strengthened in LMICs. Furthermore, it is vital that these quality reforms are country-led.

We also thank Benoit Nemery and colleagues for their Correspondence. We had very much hoped that our Review1 would provide a wake-up call about chronic respiratory diseases in stretched health systems in LMICs, and are delighted to hear that this was well received. Although we discuss air pollution throughout our Review and specifically highlight in our conclusion the need to address tobacco smoke and household, ambient, and occupational exposures, the importance of air pollution cannot be understated as a contributor to the burden of chronic respiratory diseases and numerous other diseases.3, 4 The importance of air pollution extends well beyond human health to include climate and planetary health,5 so we could not agree more with the suggestion to go beyond medical solutions and to take a global (including planetary) health approach.

GBM reports grants and advisory board fees from AstraZeneca; and grants from GSK Australia. KM reports advisory board fees from AstraZeneca. All other authors declare no competing interests.