{
  "abstract": "Introduction Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are among the leading non-communicable diseases (NCDs) worldwide. However, diagnosing CRDs in low-income and middle-income countries (LMICs) remains challenging due to limited access to spirometry and trained professionals. Aggravating the burden, CRDs often coexist with other NCDs, increasing healthcare costs, reducing quality of life and elevating mortality. These challenges highlight the need for simple case-finding approaches for CRDs, such as the COPD in Low-Income and Middle-Income Countries Assessment (COLA-6) questionnaire, to support prompt identification and appropriate care within NCD services in LMICs.Objective To evaluate the discriminative accuracy, feasibility and implementation of the COLA-6 questionnaire in identifying and managing CRDs in Brazilian Primary Healthcare (PHC) services for NCDs.Methods and analysis The Multimorbidity Approach for REspiratory Solutions (MARES) study consists of three work packages to be conducted in PHC services in São Carlos/SP and São Paulo/SP, Brazil.MARES-1: A cross-sectional observational study enrolling 859 individuals with at least one NCD receiving care in PHC. The COLA-6 questionnaire will be administered by the research team and compared with quality-assured spirometry. The Chronic Airways Assessment Test (CAAT), Asthma Control Questionnaire (ACQ-7) and fractional exhaled nitric oxide (FeNO) will also be assessed. The diagnostic performance of COLA-6 for identifying CRDs—including COPD, asthma, preserved ratio impaired spirometry, restriction and overlaps—will be assessed using area under receiver operating characteristic curves and 95% CIs.MARES-2: A cross-sectional observational study enrolling 20 healthcare professionals (physicians, physiotherapists, community health agents and nurses) from five PHC services. These professionals will apply the COLA-6 during routine NCD care to a total sample of 1000 patients. Qualitative interviews will be conducted to explore barriers and facilitators to the implementation of COLA-6, using deductive thematic analysis.MARES-3: A longitudinal, prospective observational study in which patients from MARES-1 and MARES-2 will be reassessed at 6-month follow-up. A total sample of 473 participants with abnormal spirometry, a diagnosis of CRD or high risk for CRDs is expected. Participants will undergo spirometry, and a subset will be interviewed to explore their healthcare experiences through qualitative thematic analysis. Access to diagnostic and treatment services in Brazil will be assessed. Changes in spirometry values, FeNO, CAAT and ACQ-7 scores from baseline to 6 months in patients from MARES-1 will be analysed.Ethics and dissemination This study has been approved by the Ethics Committees of Federal University of São Carlos and University of Santo Amaro (UNISA). Ethical approval was also granted by the University College London. Results will be disseminated through peer-reviewed medical journals and presentations at international conferences. Results will improve identification of CRDs, addressing a significant gap in current PHC settings.Trial registration number NCT07050823/NCT07093021/NCT07134855.",
  "authors": [
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Renata Gonçalves Mendes"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Naiara Tais Leonardi"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Viviane Castello-Simões"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Débora Mayumi de Oliveira Kawakami"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil",
        "University of Santo Amaro, São Paulo, Brazil"
      ],
      "name": "João Victor Rolim Souza"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Nathany Souza Schafauser-Segundo"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Rodrigo Polaquini Simões"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Fernanda Gabriely Pinto"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Gustavo Henrique Guimarães Araujo"
    },
    {
      "affiliations": [
        "University of Santo Amaro, São Paulo, Brazil",
        "Bioengineering Program, Scientific and Technological Institute, Brazil University, São Paulo, Brazil"
      ],
      "name": "Marcela Maria Carvalho da Silva"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Cristiane Shinohara Moriguchi"
    },
    {
      "affiliations": [
        "Rede D’Or Sao Luiz, São Paulo, Brazil"
      ],
      "name": "Francisco José Barbosa Zörrer Franco"
    },
    {
      "affiliations": [
        "Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil"
      ],
      "name": "Valéria A Pires Di Lorenzo"
    },
    {
      "affiliations": [
        "Public Health and Epidemiology, University of Birmingham, Birmingham, UK"
      ],
      "name": "Rachel Jordan"
    },
    {
      "affiliations": [
        "Center for Public Health Studies (CESCO), University Center of the ABC Medical School, São Paulo, Brazil"
      ],
      "name": "Sonia Martins"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, Florida, USA"
      ],
      "name": "Trishul Siddharthan"
    },
    {
      "affiliations": [
        "UCL Respiratory, University College London, London, UK"
      ],
      "name": "Saleh Al Sharmah"
    },
    {
      "affiliations": [
        "Department of Statistical Science, University College London, London, UK"
      ],
      "name": "Julie Barber"
    },
    {
      "affiliations": [
        "UCL Respiratory, University College London, London, UK"
      ],
      "name": "John R Hurst"
    }
  ],
  "title": "Mitigating chronic respiratory disease through the lens of multimorbidity: the MARES mixed-methods study protocol",
  "uid": "74b12f47-dd4a-5867-8021-9b228d5c19c8"
}