{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:18:58Z","timestamp":1771309138068,"version":"3.50.1"},"reference-count":24,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR156700"],"award-info":[{"award-number":["NIHR156700"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2025,6,17]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulmonary tuberculosis (PTB) and chronic respiratory diseases (CRDs) are intricately linked. People with PTB and CRDs experience similar symptoms, including breathlessness, cough and chest pain. They may have similar risk factors for disease, including smoking and occupational exposures. PTB is also a direct cause of lung damage in the form of post-TB lung disease. However, despite the overlap in risk factors, symptoms and sequelae, public health and clinical care pathways for TB and CRDs remain almost entirely separate in many low- and middle-income countries (LMICs). Those with respiratory symptoms are directed to TB services as a first point of contact where they are known as \u2018people with presumptive TB\u2019, and pathways to respiratory diagnosis and care remain largely inadequate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>In this opinion piece we describe opportunities for the integration of tuberculosis (TB) and respiratory care, as a means of improving patient outcomes in LMICs. Strategies may include upstream public health interventions to address shared risk factors, the use of shared diagnostic pathways, the provision of decentralised access to both TB and CRD care, and coordinated information provision about the risk factors and symptoms of both conditions. Health-related benefits may include more timely diagnosis of CRDs, improved CRD treatment and care, and reduced inappropriate empirical TB treatment or retreatment. We highlight the need for pilot models of integrated care, with robust design and evaluation, and we note that an integrated approach may be particularly timely given the increasing scarcity of global health donor funding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/thorax-2024-222170","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T17:25:19Z","timestamp":1756401919000},"page":"294-297","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Challenges in respiratory medicine: the need for integrated tuberculosis and respiratory care in low-resource settings"],"prefix":"10.1136","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2470-569X","authenticated-orcid":false,"given":"Jacqueline Wanjiku","family":"Kagima","sequence":"first","affiliation":[{"name":"Department of Medicine, Kenyatta National Hospital, Nairobi, Kenya"},{"name":"Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Obianuju B","family":"Ozoh","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Lagos College of Medicine, Lagos, Lagos, Nigeria"},{"name":"Department of Medicine, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stellah","family":"Mpagama","sequence":"additional","affiliation":[{"name":"Kibong\u2019oto Infectious Diseases Hospital, Kilimanjaro, United Republic of Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nora","family":"Engel","sequence":"additional","affiliation":[{"name":"The Athena Institute, Vrije University, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maia","family":"Lesosky","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Madan","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3229-2429","authenticated-orcid":false,"given":"Jeremiah","family":"Chakaya","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kenyatta National Hospital, Nairobi, Kenya"},{"name":"Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4693-8884","authenticated-orcid":false,"given":"Jamilah","family":"Meghji","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"2026021621450637000_81.3.294.1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00193413"},{"key":"2026021621450637000_81.3.294.2","unstructured":"World Health Organisation . Global tuberculosis report 2024. Geneva, Switzerland World Health Organisation; 2024."},{"key":"2026021621450637000_81.3.294.3","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-022-02297-y"},{"key":"2026021621450637000_81.3.294.4","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/S2213-2600(20)30105-3","article-title":"Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"8","year":"2020","journal-title":"Lancet Respir Med"},{"key":"2026021621450637000_81.3.294.5","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00072909"},{"key":"2026021621450637000_81.3.294.6","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1513\/AnnalsATS.202404-384OC","article-title":"Effect of Human Immunodeficiency Virus on Lung Function and Structure: A Systematic Review and Meta-Analysis","volume":"22","author":"Konstantinidis","year":"2025","journal-title":"Ann Am Thorac Soc"},{"key":"2026021621450637000_81.3.294.7","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2021-217663"},{"key":"2026021621450637000_81.3.294.8","doi-asserted-by":"publisher","DOI":"10.5588\/pha.19.0046"},{"key":"2026021621450637000_81.3.294.9","doi-asserted-by":"publisher","DOI":"10.1086\/429912"},{"key":"2026021621450637000_81.3.294.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003436","article-title":"Respiratory symptoms after TB treatment completion: A qualitative study of patient and provider experiences in urban Blantyre, Malawi","volume":"4","author":"Meghji","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"2026021621450637000_81.3.294.11","doi-asserted-by":"crossref","first-page":"e1679","DOI":"10.1016\/S2214-109X(21)00367-3","article-title":"Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae","volume":"9","author":"Menzies","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2026021621450637000_81.3.294.12","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1093\/cid\/ciad290","article-title":"Healthcare Utilization After Respiratory Tuberculosis: A Controlled Interrupted Time Series Analysis","volume":"77","author":"Romanowski","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2026021621450637000_81.3.294.13","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.1016\/S2468-2667(24)00046-X","article-title":"Achieving universal social protection for people with tuberculosis","volume":"9","author":"Fuady","year":"2024","journal-title":"Lancet Public Health"},{"key":"2026021621450637000_81.3.294.14","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-1138-z"},{"key":"2026021621450637000_81.3.294.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001675","article-title":"Defining catastrophic costs and comparing their importance for adverse tuberculosis outcome with multi-drug resistance: a prospective cohort study, Peru","volume":"11","author":"Wingfield","year":"2014","journal-title":"PLoS Med"},{"key":"2026021621450637000_81.3.294.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0208188","article-title":"Health seeking for chronic lung disease in central Malawi: Adapting existing models using insights from a qualitative study","volume":"13","author":"Saleh","year":"2018","journal-title":"PLoS One"},{"key":"2026021621450637000_81.3.294.17","doi-asserted-by":"crossref","DOI":"10.3402\/gha.v8.26292","article-title":"'For a mere cough, men must just chew Conjex, gain strength, and continue working': the provider construction and tuberculosis care-seeking implications in Blantyre, Malawi","volume":"8","author":"Chikovore","year":"2015","journal-title":"Glob Health Action"},{"key":"2026021621450637000_81.3.294.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-052105","article-title":"What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries","volume":"12","author":"Mulupi","year":"2022","journal-title":"BMJ Open"},{"key":"2026021621450637000_81.3.294.19","doi-asserted-by":"crossref","first-page":"807","DOI":"10.5588\/ijtld.17.0796","article-title":"Tuberculosis-tobacco integration in the South-East Asia Region: policy analysis and implementation framework","volume":"22","author":"Hyder","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026021621450637000_81.3.294.20","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2020-216123"},{"key":"2026021621450637000_81.3.294.21","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00002612"},{"key":"2026021621450637000_81.3.294.22","doi-asserted-by":"publisher","DOI":"10.1111\/1468-0009.12459"},{"key":"2026021621450637000_81.3.294.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-029954","article-title":"Guidance on how to develop complex interventions to improve health and healthcare","volume":"9","author":"O\u2019Cathain","year":"2019","journal-title":"BMJ Open"},{"key":"2026021621450637000_81.3.294.24","unstructured":"Fulop N , Mowlem A , Edwards N . Building integrated care: lessons from the UK and elsewhere. London, England: NHS Confederation, 2005."}],"container-title":["Thorax"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/thorax-2024-222170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T05:45:21Z","timestamp":1771307121000},"score":1,"resource":{"primary":{"URL":"https:\/\/thorax.bmj.com\/lookup\/doi\/10.1136\/thorax-2024-222170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,28]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2,16]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/thorax-2024-222170"],"URL":"https:\/\/doi.org\/10.1136\/thorax-2024-222170","relation":{},"ISSN":["0040-6376","1468-3296"],"issn-type":[{"value":"0040-6376","type":"print"},{"value":"1468-3296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,28]]}}}