• Aizhamal Tabyshova, John R Hurst, Joan B Soriano, William Checkley, Erick Wan-Chun Huang, Antigona C Trofor, Oscar Flores-Flores, Patricia Alupo, Gonzalo Gianella, Tarana Ferdous, David Meharg, Jennifer Alison, Jaime Correia de Sousa, Maarten J Postma, Niels H Chavannes, and van BovenJob F MJFMGroningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, the Netherlands. Electronic address: j.f.m.van.boven@rug.nl..
• Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pulmonary Diseases, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.
• Chest. 2021 Feb 1; 159 (2): 575584575-584.

BackgroundGuidelines are critical for facilitating cost-effective COPD care. Development and implementation in low-and middle-income countries (LMICs) is challenging. To guide future strategy, an overview of current global COPD guidelines is required.Research QuestionWe systematically reviewed national COPD guidelines, focusing on worldwide availability and identification of potential development, content, context, and quality gaps that may hamper effective implementation.Study Design And MethodsScoping review of national COPD management guidelines. We assessed: (1) global guideline coverage; (2) guideline information (authors, target audience, dissemination plans); (3) content (prevention, diagnosis, treatments); (4) ethical, legal, and socio-economic aspects; and (5) compliance with the eight Institute of Medicine (IOM) guideline standards. LMICs guidelines were compared with those from high-income countries (HICs).ResultsOf the 61 national COPD guidelines identified, 30 were from LMICs. Guidelines did not cover 1.93 billion (30.2%) people living in LMICs, whereas only 0.02 billion (1.9%) in HICs were without national guidelines. Compared with HICs, LMIC guidelines targeted fewer health-care professional groups and less often addressed case finding and co-morbidities. More than 90% of all guidelines included smoking cessation advice. Air pollution reduction strategies were less frequently mentioned in both LMICs (47%) and HICs (42%). LMIC guidelines fulfilled on average 3.37 (42%) of IOM standards, compared with 5.29 (66%) in HICs (P < .05). LMICs scored significantly lower compared with HICs regarding conflicts of interest management, updates, articulation of recommendations, and funding transparency (all, P < .05).InterpretationSeveral development, content, context, and quality gaps exist in COPD guidelines from LMICs that may hamper effective implementation. Overall, COPD guidelines in LMICs should be more widely available and should be transparently developed and updated. Guidelines may be further enhanced by better inclusion of local risk factors, case findings, and co-morbidity management, preferably tailored to available financial and staff resources.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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