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Teaser, summary, work performed and final results

Periodic Reporting for period 2 - FRESH AIR (Free Respiratory Evaluation and Smoke-exposure reductionby primary Health cAre Integrated gRoups)


FRESH AIR is a 3-year project that addresses the urgent need to prevent, diagnose and treat lung diseases in LMICs and other low-resource settings. Previous research has shown that the greatest burden of non-communicable lung diseases (NCLDs) occurs in such settings. Most...


FRESH AIR is a 3-year project that addresses the urgent need to prevent, diagnose and treat lung diseases in LMICs and other low-resource settings. Previous research has shown that the greatest burden of non-communicable lung diseases (NCLDs) occurs in such settings. Most studies have, however, focused on creating an evidence-base for clinically and cost-effective treatments of NCLDs for populations in high income countries. Consequential, little is known about the application of this evidence-base to low-resource settings, contextual risk-factors and barriers that hamper implementation. FRESH AIR aims to improve health outcomes by developing capacity for implementation of evidence-based interventions.

The consortium consists of leading international researchers, clinicians and policy experts from the EU, US and the four countries that represent different low-resource settings. These settings, located in Uganda, Kyrgyzstan, Vietnam and Greece, are characterized by a high smoking prevalence and exposure to household air pollution. The consortium works to adapt and test innovation and evidence-based practice in the prevention, diagnosis and treatment of lung disease in these settings. In so doing, the consortium will transfer skills and technology from EU member states and the US to new contexts and explore a range of implementation science research questions. The generated knowledge will be disseminated nationally, regionally and internationally, ensuring the scale-up of interventions tested by the project and global impact of research findings. The project will also provide new perspectives on policy issues of concern to EU members, increase the international profile of EU funded research on key health challenges and open up markets for healthcare innovations.

The objectives of the project are specified as follows: 1. Identifying factors influencing the implementation of evidenced-based interventions. 2. Exploring which awareness-raising approaches are most effective in achieving behaviour change. 3. Adapting interventions that provide smoking cessation support 4. Testing innovative diagnostic methods for COPD5. Promoting pulmonary rehabilitation as a low cost treatment. 6. Reducing children’s risk of lung damage. 7. Generating new knowledge, innovation and scalable models.

Work performed

FRESH AIR has demonstrated positive impacts in the local communities involved and generated new knowledge on how to implement interventions aimed at the prevention, diagnosis and treatment of NLCDs. Through FRESH AIR, we gained knowledge on the local beliefs and perceptions of NLCDs and established stakeholder engagement. These aspects have proven to be vital to effectively tailor and implement evidence-based interventions aimed at NLCDs, such as Very Brief Advice (VBA) and Pulmonary Rehabilitation (PR). We furthermore learned how to raise awareness on Household Air Pollution (HAP) and tobacco smoking, and translated this knowledge into effective (mass media) campaigns that educated professionals and community members on the risks of HAP and tobacco smoking. Moreover, programs incorpoorating a teach-the-teacher approach were developed and implemented successfully, such as an HAP and tobacco smoke awareness raising program aimed at midwives. We also gained insight into the health economic consequences of NLCDs, and for instance learned that absenteeism might not be a good measure to determine the impact of NLCDs on work productivity in low resource settings.

Some key results from the FRESH AIR project include:
- Work Productivity: Chronic lung disease has an under-researched, socioeconomic impact- people may not take time of from work but are less productive.
- Asthma diagnosis & treatment: If infectious disease is highly prevalent, asthma is often unknown to health care workers and its diagnosis is missed.
- Readiness for change is high: communities want to improve the quality of the air they breath.
- Teach the teacher approaches work: Evidence-based education and training can be used to implementation capacity.
- Education and training intervention should include a wide variety of health care professionals and community health workers, not only doctors.
- Pulmonary Rehabilitation sessions can be run affordable and effectively in low resource settings
- Very Brief Advice can be delivered, but challenges remain due to a lack of availability of smoking cessation medication and counselling
- Trust: Implementation research needs to be underpinned with actions that build trust in the process and workforce

In summary, results from FRESH AIR provide data on the context of respiratory health in four different low resource settings including demographic, clinical, environmental, healthcare utilization, quality of life data and direct and indirect costs of diagnosed respiratory patients. We are actively collaborating with other research projects focusing on asthma and COPD to share our learning about stakeholder engagement and how to increase awareness amongst policymakers about non-communicable lung diseases, which tends to be less apparent than for other NCDs Our aim is thus to further disseminate the results of the FRESH AIR project, thereby ensuring FRESH AIR results can make a lasting impact on community members, health care workers and policy makers in low resource settings across the globe.

Final results

In short term, FRESH AIR will improve health outcomes for patients directly receiving the interventions adapted and implemented by the project. Skills, knowledge and experience of involved healthcare workers (HCW) will have improved and confidence in the effect of interventions will increase. This will improve outcomes for the patients and HCW outside the direct scope of the project. In mid-term, the project will improve healthcare and public health policy by providing decision makers with evidence and by supporting their capacity to use it effectively. Actions to reduce health inequities will improve by characterisation of populations who have, for example, increased exposure to risk factors. Lastly, networks that generate their own knowledge will be developed. In the long term, dissemination of new implementation knowledge generated by the project will improve prevention, diagnosis and treatment of NLCDs in other contexts.

The project will specifically contribute to each of these impacts by:
1) to demonstrate the link between the interventions and health outcome in NCLDs;
2) to reduce health inequalities in the prevention and treatment of lung diseases in both a local and global context;
3) to pursue knowledge translation and exchange approaches designed to maximise the public health benefits of research findings
4) to provide evidence to inform local health service providers, policy and decision makers on the effective scaling up of the interventions
5) appropriate leveraging of existing programmes and platforms;
6) to improve quality controls and safety (including toxicity profile) of tobacco products and electronic cigarettes;
7) to develop the necessary knowledge base for further coordination of regulatory aspects related to tobacco products and electronic cigarettes;
8) to characterise behavioural group specificity in successful intervention(s)
9); to develop lower cost therapeutic options for smoking cessation that are cost effective in LMIC;
10) to contribute to the United Nations Millennium Development Goals.

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