Title: NIHR Global Health Research Unit on Respiratory Health (RESPIRE-2)
Funder: Department of Health and Social Care

Abstract: The aim of RESPIRE-2 is to deliver low-cost, scalable policy and clinical interventions to reduce respiratory morbidity and mortality across Asia. We will build on capacity development, foundational research and relationships from RESPIRE to catalyse efforts to improve global respiratory health. Our goals include: building research capacity in low- and middle-income countries (LMICs); ensuring research is driven by the needs/priorities of LMIC populations; building equitable/respectful partnerships; engaging stakeholders, including communities, at all stages; and strengthening capacity to translate research findings into impact. We are expanding from RESPIRE work in Bangladesh, India, Malaysia and Pakistan to add 3 additional LMICs - Bhutan, Indonesia and Sri Lanka, focusing on disadvantaged populations; and developing new research themes on TB and key risk factors [tobacco, air quality]. We will adopt the successful management model in RESPIRE - a Unit Management Committee (UMC) - responsible for overall governance, which will be advised by an International Steering Committee. Our 3 research programmes are on Infectious Diseases, Non-Communicable Diseases and Preventable Risk Factors. Our 4 cross-cutting translational platforms address stakeholder and community engagement and involvement; education and capacity building; open science, data and methodologies; and digital health and innovation. These will help promote good research design and practice, support innovation and promote sustainability of the work of RESPIRE-2. We will coordinate their activity and outputs to ensure that new knowledge from RESPIRE-2 results in translational activity and promotes sustainability._x000D_ _x000D_ Our research programmes are based on our formal priority setting exercises and long-standing collaboration with Asian partners to identify local priorities. We seek to adapt existing or develop new interventions and evaluate these in diverse settings with a focus on vulnerable population, where possible in multi-country studies. Close collaboration with Ministries of Health, study communities and other key stakeholders is a key aspect at all stages of our research cycle. We have worked with patient and community groups to select and design projects. We will work with partners to disseminate new knowledge and effective new approaches widely throughout Asia. We have considered the context of COVID-19 and will collaborate with ISARIC (International Severe Respiratory Infection Consortium) to build capacity in preparedness for emerging respiratory infections. Our research proposals will be subject to external peer review managed by the UMC. These assessments will also offer opportunity for input from technical experts in the platforms to ensure appropriate study design, access to digital health expertise, and data management plan/wider data sharing support - 20 RESPIRE projects deposited data in UK HDR Gateway (BREATHE) and this will continue in RESPIRE-2. _x000D_ _x000D_ In summary, RESPIRE-2 will build on established practices and processes as it works to achieve a step-change in developing applied respiratory research capacity and capability in the context of responding to urgent respiratory priorities affecting the most vulnerable populations across Asia. We remain committed to partnership working with other Units and Groups to maximize the return on these important global health investments. We request an investment of £7M with 60% spent directly in LMIC institutions.

Lay abstract: What we want to do _x000D_ The NIHR Global Health Research Unit RESPIRE aims to reduce the number of deaths and wider health and societal impacts from respiratory diseases in some of the world’s most disadvantaged populations. Respiratory conditions are one of the 3 leading causes of death in Asia and globally. Despite this, knowledge and awareness of respiratory diseases is low and they do not get the priority attention they need from health systems, policymakers and funding agencies._x000D_ _x000D_ How we’ll do it_x000D_ RESPIRE has built strong, equitable partnerships and developed capacity with research groups in Bangladesh, India, Malaysia and Pakistan. We are now expanding into Bhutan, Indonesia and Sri Lanka. We will focus on 3 research programmes supported by 4 cross-cutting platforms on stakeholder and community engagement, education and capacity building, open science and data, and digital health and innovation. These feed into a ‘global respiratory challenge hub’ which will ensure new knowledge will be used to improve healthcare and support development of appropriate health policy._x000D_ _x000D_ Programme 1 addresses respiratory infections such as pneumonia, the leading cause of child death after the first month of life. Most deaths are avoidable with existing interventions. This programme focuses on research to improve health systems to better respond (e.g. improving oxygen security and establishing how it can be best directed and used to reduce deaths). Research is also planned to help find the ‘missing millions’ of tuberculosis (TB) sufferers who go undiagnosed every year. These people fail to receive the medical care that they need, and can inadvertently spread the disease._x000D_ _x000D_ Programme 2 addresses non-communicable diseases: asthma and chronic obstructive pulmonary disease (COPD). COPD is the third leading cause of death in Asia and worldwide. This programme investigates the potential for providing treatment via telehealth (e.g. via mobile phone) for patients in remote settings (also relevant to pandemic situations with reduced face-to-face contact in health services). Another study focuses on improving asthma education and healthcare, targeting schools and adults with little understanding of health issues, to overcome literacy and language barriers. This contributes towards ‘Universal Health Coverage’ which aims to ‘leave no one behind’._x000D_ _x000D_ Programme 3 looks at the preventable risk factors for respiratory conditions e.g. tobacco smoking and exposure to air pollution which are estimated to underlie many million deaths globally each year. This programme aims to develop an air pollution ‘early warning system’ to help those with respiratory conditions to take actions to improve their health and quality of life. This programme will also develop an intervention to assist TB patients, who are most adversely impacted, to quit smoking and improve their health._x000D_ _x000D_ How patients and communities are involved_x000D_ RESPIRE has created strong collaborative partnerships in Asia, building capacity and enabling research to be led by local teams to answer the most important research questions for their country and local health services. Together with our partners we have developed strong Community Engagement and Involvement strategies, and wide networks covering policy makers and local healthcare providers, to improve the relevance and impact of our research and reduce health inequity. We focus on the problems of the poorest and underprivileged groups in our network of countries

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;4.2 EVALUATION OF MARKERS AND TECHNOLOGIES;4.5 RESOURCES AND INFRASTRUCTURE (DETECTION);8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: RESPIRATORY