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Australia

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Austria

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Belgium

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Brazil

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Canada

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Estonia

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Finland

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Greece

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Hungary

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India

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Latvia

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Lithuania

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New Zealand

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Norway

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Poland

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Switzerland

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Following normalisation, country scores for each indicator category were averaged and then multiplied by 10 to give a score out of 100 points. The following weights were applied to each indicator category when calculating the overall Index score for each country:

Weighting and Scoring

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Examine the global impact of Severe Asthma & COPD. Explore general insights, compare country scores, or download and share the research data.

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Explore and Compare Severe Asthma & COPD Index Data

The COPD Index evaluates country health systems’ approach to the management and prevention of COPD across five diverse categories of indicators. The weighted overall average score for all countries is 63.4/100, and the range between country scores is a modest 22.6 points. However, there are still clear differences in the Index, with Australia scoring the highest (71.5/100), followed closely by the United Kingdom, Finland, Estonia, and Spain. Conversely, India scored the lowest (48.9/100), followed by China, Latvia, Belgium, and Poland. Importantly, the scores within each indicator category also vary significantly among all countries. Therefore, even the top performers show clear areas for improvement, and there is no consistently high or low scorer across all Index categories.
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Overall, all countries demonstrate some major strengths, as well as significant areas for improvement. Notably, a high Policy Context score was the strongest predictor of a high overall score. However, a strong Policy Context score—and, by extension, a more favourable policy environment—is not a guarantor of high scores in the other indicator categories. In addition, a strong policy environment does not universally and consistently imply that policy implementation is successful and uniform in the COPD Index countries. It is important to note that the overall scores and category scores provide only a general indication of countries’ goodness of fit with the COPD Index model. 

Overall Scores

- **COPD strategy**
  - **Description**:Provides insight into national policy prioritisation of and engagement with COPD.
  - **Scoring**: 1=country has a COPD strategy; 2=low level of strategy implementation; 3=moderate level of strategy implementation; 4=high level of strategy implementation; 0=country has no COPD strategy
- **Guidelines for COPD care**
  - **Description**: Assessment of whether a country has guidelines for COPD and the general level of adherence to the guidelines among healthcare practitioners.
  - **Scoring**: 1=country has guidelines; 2=there is a low level of adherence to the guidelines; 3=there is a moderate level of adherence to the guidelines; 4=there is a high level of adherence to the guidelines 
- **Occupational exposure policy**
  - **Description**: Assessment of chemical exposure regulations that may influence COPD risk factors and patient outcomes and their level of implementation.
  - **Scoring**: 1=country has chemical regulations; 2=there are variations in implementation of regulations in country; 3=there is uniform implementation of the regulations in the country
- **Personalised COPD care**
  - **Description**: Whether a country encourages the use of individualised treatment plans for COPD patients
  - **Scoring**: 1=Yes; 0=No
- **Tobacco control policy**
  - **Description**: Strength and scope of tobacco consumption and sale regulations
  - **Scoring**: Normalised average of M, P, W, E, R elements of WHO’s framework. (“O” element on smoking cessation is assessed as a separate indicator in the Access and Care Coverage category)


Policy Context

- **Treatment and drug access**
  - Description: Assessment of extent of public payor (insurance) coverage for a range of drugs and treatments for COPD
  - **Score**: 3=full payor coverage; 2=partial payor coverage; 1=drugs and treatments generally commercially approved but not covered; 0=drugs and treamtents generally not commercially available
- **Diagnosis**
  - **Description**: Assessment of public payor (insurance) coverage for a range of diagnostic tools and methods for COPD screening, characterisation, evaluation of health status, and disease severity
  - **Score**: 1=diagnostics commercially available but not generally covered by public payor; 2=partial payor coverage; 3=full
payor coverage; 0=diagnostics not commercially available
- **Spirometry access**
  - **Description**: Assessment of the availability of spirometry at the primary care level for diagnosis of COPD
  - **Score**: 1=yes; 0=no OR no information
- **Pulmonary rehabilitation access**
  - **Description**: Assessment of the availability of pulmonary rehabilitation for treatment of COPD
  - **Score**: 1=available to patients but no reimbursement information available/ no coverage provided; 2=partial payor coverage; 3=full payor coverage; 0=no coverage/not available
- **Ambulatory oxygen access**
  - **Description**:  oxygen access Assessment of the availability of ambulatory oxygen for treatment of COPD
  - **Score**: 1=oxygen treatment commercially available but not generally covered by public payor; 2=partial payor coverage; 3=full payor coverage; 0=oxygen treatment not commercially available
- **Home care reimbursement**
  - **Description**: Assessment of the availability of home care for treatment and management of COPD
  - **Score**: 1=home care services commercially available but not generally covered by public payor; 2=partial payor coverage; 3=full payor coverage; 0=home care services not commercially available
- **Availability of nicotine replacement therapy**
  - **Description**: Assessment of availability of nicotine replacement therapy in the public healthcare system and of public payor coverage
  - **Score**: 1=yes; 0=no OR no information
- **Care referral pathways**
  - **Description**: Assessment of specific specialist referral pathways for COPD patients, direct access to specialists, and extent of public payor (insurance) coverage for specialist care
  - **Score**: 1 point for existence of national care pathways for COPD 1 point for ability to access specialist care directly 1 point for partial payor coverage of specialist care OR 2 points for full payor coverage of specialist care
- **Telemedicine and remote care**
  - **Description**: Assessment of use of telemedicine and remote care in a country and extent of public payor (insurance) coverage for telemedicine and remote care consultations
  - **Score**: 1=telemedicine services commercially available but not generally covered by public payor; 2=partial payor coverage; 3=full payor coverage; 0=telemedicine services not commercially available
- **Digital therapeutics**
  - **Description**: Assessment of access to digital therapeutics (e.g., approved condition management apps/monitoring tools) and extent of public payor (insurance) coverage for digital therapeutics
  - **Score**: 1=digital therapeutics commercially available but not generally covered by public payor; 2=partial payor coverage; 3=full payor coverage; 0=digital therapeutics not commercially available
- **Health service access and equity**
  - **Description**: Percentage of the national population reporting unmet healthcare needs due to distance from points of care, financial barriers, and waiting lists
  - **Score**: Percentage of national population reporting unmet healthcare needs due to distance from care, financial barriers, and waiting lists - NOTE: NEGATIVE DIRECTION INDICATOR
- **Universal Health Care Coverage**
  - **Description**: Assessment of coverage of universal health care services for national population
  - **Score**: Universal Health Care Service Coverage Index
- **Proportion of population in relative poverty**
  - **Description**: Assessment of economic barriers to care
  - **Score**: Percentage of population earning below 60% of median income NOTE: NEGATIVE DIRECTION INDICATOR

Access and Care Coverage

- **COPD hospitalisations**
  - **Description**: Number of COPD- related hospitalisations per 100,000 population
  - **Score**: Annual COPD Hospitalisations (per 100,000) NOTE: NEGATIVE DIRECTION INDICATOR
- **Hospital readmissions**
  - **Description**: Percentage of patients readmitted for a COPD exacerbation within 365 days of a COPD exacerbation
  - **Score**: Percentage of COPD patients readmitted to hospital within 365 days of previous admission due to an exacerbation NOTE: NEGATIVE DIRECTION INDICATOR
- **Health data collection and reporting**
  - **Description**: Assessment of level of granularity and interoperability of COPD-relevant health and outcome data and to which kinds of registries these data are reported.
  - **Score**: 1=Recorded to regional database(s); 2=Recording to regional database(s) that are federated or connected at national level; 3=Recording to national database; 0=No recording or no data available
- **Respiratory specialist density**
  - **Description**: Number of respiratory specialists per 100,000 population
  - **Score**: Number of respiratory specialists per 100,000
- **Primary care physician density**
  - **Description**: Number of primary care doctors per 100,000 population
  - **Score**: Number of primary care doctors per 100,000 population
- **Influenza immunisation rate**
  - **Description**: Percentage of population over 65 years of age receiving the influenza vaccine
  - **Score**: Influenza immunisation rate
- **COVID-19 immunisation rate**
  - **Description**: Vaccination rate per 100 population
  - **Score**: Covid-19 vaccination rate
- **Pneumococcal vaccination rate among newborns**
  - **Description**: Pneumococcal conjugate vaccines (PCV3) immunization coverage among 1-year-olds (%)
  - **Score**: Pneumococcal vaccination rate (among newborns only)

Health System Characteristics

- **Societal cost of COPD**
  - **Description**: Modeled per capita loss 2020-2050, 2017 INT$
  - **Score**: Modeled per capita loss 2020-2050, 2017 INT$ NOTE: NEGATIVE DIRECTION INDICATOR
- **Burden of COPD**
  - **Description**: COPD disability- adjusted lifeyears (DALYs) as a percentage of all country DALYs
  - **Score**: COPD disability- adjusted lifeyears (DALYs) as a percentage of all country DALYs NOTE: NEGATIVE DIRECTION INDICATOR
- **COPD deaths**
  - **Description**: COPD deaths per 100,000 population
  - **Score**: COPD deaths rate, total population NOTE: NEGATIVE DIRECTION INDICATOR
- **COPD prevalence**
  - **Description**: Percentage of population diagnosed with COPD
  - **Score**: Percentage of population diagnosed with COPD NOTE: NEGATIVE DIRECTION INDICATOR
- **Sex-based inequality**
  - **Description**:  inequality Absolute difference in DALYs accountable to COPD between men and women
  - **Score**: Absolute difference in DALYs accountable to COPD between men and women NOTE: NEGATIVE DIRECTION INDICATOR
- **Adult tobacco use rate**
  - **Description**: Rate of tobacco use among the adult population
  - **Score**: Rate of tobacco use among the adult population NOTE: NEGATIVE DIRECTION INDICATOR
- **Maternal smoking rate**
  - **Description**: Percentage of women smoking during pregnancy
  - **Score**: Maternal smoking rate NOTE: NEGATIVE DIRECTION INDICATOR
- **Prevalence of Tuberculosis**
  - **Description**: Cases of tuberculosis per 100,000 population
  - **Score**: Prevalence of TB NOTE: NEGATIVE DIRECTION INDICATOR
- **Prevalence of cardiovascular disease**
  - **Description**: Percentage of population diagnosed with cardiovascular disease
  - **Score**: Prevalence of cardiovascular disease NOTE: NEGATIVE DIRECTION INDICATOR
- **Prevalence of HIV**
  - **Description**: Percentage of population diagnosed with HIV
  - **Score**: Prevalence of HIV NOTE: NEGATIVE DIRECTION INDICATOR

Disease Burden

- **Indoor air quality**
  - **Description**: Assessment of issues with housing stock that may impact indoor air quality
  - **Score**: Percentage of population living in a dwelling with a leaking roof, damp walls, floors or foundation, or rot in window frames of floor NOTE: NEGATIVE DIRECTION INDICATOR
- **Particulate matter levels**
  - **Description**: Average level of exposure of a nation's population to concentrations of suspended particles measuring less than 2.5 microns in aerodynamic diameter
  - **Score**: Average level of exposure of a nation's population to concentrations of suspended particles measuring less than 2.5 microns in aerodynamic diameter NOTE: NEGATIVE DIRECTION INDICATOR
- **Surface temperature increase**
  - **Description**: Mean surface temperature change during the period 1961-2023, using temperatures between 1951 and 1980 as a baseline.
  - **Score**: Mean surface temperature change during the period 1961-2023, using temperatures between 1951 and 1980 as
a baseline NOTE: NEGATIVE DIRECTION INDICATOR
- **Biomass smoke exposure**
  - **Description**: Access to clean fuels and technologies for cooking
  - **Score**: Proportion of total population primarily using clean cooking fuels and technologies for cooking
- **Tobacco production**
  - **Description**: Hectares unprocessed tobacco harvested
  - **Score**: Hectares unprocessed tobacco harvested NOTE: NEGATIVE DIRECTION INDICATOR
- **Mining production**
  - **Description**: Production of minerals through mining by tonnage
  - **Score**: Mining production NOTE: NEGATIVE DIRECTION INDICATOR
- **Share of primary energy consumption from fossil fuels**
  - **Description**: Percentage of energy consumption that is supported by fossil fuels
  - **Score**: Percentage of total primary energy consumption from fossil fuels NOTE: NEGATIVE DIRECTION INDICATOR
- **Occupational exposure**
  - **Description**: Percentage of COPD DALYs attributable to occupational exposure
  - **Score**: Percentage of COPD DALYs attributable to occupational exposure - NOTE: NEGATIVE DIRECTION INDICATOR
- **Environmental exposure**
  - **Description**: Percentage of COPD DALYs attributable to air pollution
  - **Score**: Percentage of COPD DALYs attributable to air pollution - NOTE: NEGATIVE DIRECTION INDICATOR

Environmental Factors


The Severe Asthma Index evaluates countries’ health system approaches to the management and prevention of severe asthma across five diverse categories of indicators. The overall average score for all countries is 62.8/100, and the range between country scores is modest at nearly 25 points. However, there are still clear differences in the Index, with Australia scoring the highest (73.2/100) followed closely by France, New Zealand, Italy, and the UK. Conversely, Latvia scored the lowest (48.4/100), followed by Slovenia, Estonia, Belgium, and Slovakia. Importantly, the scores within each indicator category also vary significantly among all countries. Therefore, even the top performers show areas for improvement, and there is no consistently high or low scorer across all Index categories.
\
Overall, all countries demonstrate some major strengths as well as significant areas for improvement. Notably, a high Policy Context score was the strongest predictor of a high overall score. This is not unexpected, as the Policy Context category has the greatest weight in the Severe Asthma Index, accounting for approximately 30% of the overall score. However, a strong Policy Context score – and, by extension, a more favourable policy environment – is not a guarantor of high scores in the other indicator categories. In addition, it is important to note that the overall scores and category scores provide only a general indication of countries’ goodness of fit with the Severe Asthma Index model. Country-level observations in Appendix I provide a more detailed overview of individual indicator scores and thereby insights into additional strengths and areas for improvement among the countries.

- **Severe asthma care guidelines**
  - **Description**: Provides insight into prioritisation of and engagement with severe asthma
  - **Score**: Existence and level of implementation of guidelines for severe asthma (Out of 4)


- **Asthma strategy**
  - **Description**:  Provides insight into national policy prioritisation of and engagement with asthma
  - **Score**:  Existence of national strategy for asthma (not severe-specific) (Out of 8)

- **Best practices in asthma care**
  - **Description**: Indicates care guidelines’ alignment with internationally recognised best practices for severe asthma care
  - **Score**: National care guidelines' level of alignment with GINA strategy for "difficult-to- treat and severe asthma" (Out of 10)

- **Severe asthma registries**
  - **Description**: Whether a country reports health data to the International Severe Asthma Registry
  - **Score**: Severe Asthma Registries (Out of 1)

- **Occupational exposure policy**
  - **Description**: Indication of occupational exposures that may influence health outcomes for asthma patients
  - **Score**: Chemical Exposure Regulations (Out of 3)

- **Personalised asthma care**
  - **Description**: Whether a country encourages the use of individualised treatment plans for severe asthma patients
  - **Score**: Use of individualised/ stratified treatment regimens (Out of 1)

- **Lifestyle-oriented asthma care**
  - **Description**: Whether weight reduction or physical activity is prescribed by default for high-BMI severe asthma patients in a country
  - **Score**: BMI Individualisation (Out of 1)

- **Tobacco control**
  - **Description**: Strength and scope of tobacco consumption and sale regulations
  - **Score**: Tobacco Control Laws (Out of 18)


- **Treatment and drug access**
  - **Description**: Assessment of extent of public payor (insurance) coverage for a range of drugs for asthma treatment
  - **Score**: Treatment and Drug Access (Out of 18)

- **Access to severe asthma-specific treatments**
  - **Description**: Assessment of extent of public payor (insurance) coverage for approved biologics for the treatment of severe asthma
  - **Score**: Access to Biologics (Out of 12)

- **Diagnosis**
  - **Description**: Assessment of the application of selected diagnostic tools and methods for disease characterisation
  - **Score**: Diagnostics (Inflammatory Phenotyping) (Out of 6)

- **Asthma characterisation**
  - **Description**: Assessment of the application of FeNO for diagnostic and disease management purposes as well as public payor (insurance) coverage for FeNO
  - **Score**: Diagnostics (FeNO Access) (Out of 4)

- **Specialist care**
  - **Description**: Assessment of specific specialist referral pathways for severe asthma patients, direct access to specialists, and extent of public payor (insurance) coverage for specialist care
  - **Score**: Telemedicine/Remote Care (Out of 3)

- **Telemedicine and remote care**
  - **Description**: Assessment of use of telemedicine and remote care in a country and extent of public payor (insurance) coverage for telemedicine and remote care consultations
  - **Score**: Telemedicine/Remote Care (Out of 3)

- **Digital therapeutics**
  - **Description**: Assessment of access to digital therapeutics (e.g., approved condition management apps/ monitoring tools) and extent of public payor (insurance) coverage for digital therapeutics
  - **Score**: Digital Therapeutics (Out of 3)

- **Health service access and equity**
  - **Description**: Percentage of the national population reporting unmet healthcare needs due to distance from points of care, financial barriers, and waiting lists
  - **Score**: Equity (Unmet Need % population reporting unmet healthcare needs due to distance from care, financial barriers, and waiting lists) - NOTE: NEGATIVE DIRECTION INDICATOR


- **Asthma hospitalisations**
  - **Description**: Number of asthma-related hospitalisations per 100,000 population
  - **Score**: Annual Asthma Hospitalisations (per 100,000) (MIN: 0 / MAX: 150) - NOTE: NEGATIVE DIRECTION INDICATOR

- **Average number of days in hospital**
  - **Description**: Average number of days in hospital per asthma patient
  - **Score**: Average number of days in hospital per asthma patient (MIN: 0 / MAX: 20) - NOTE: NEGATIVE DIRECTION INDICATOR

- **Health data collection and reporting**
  - **Description**: Assessment of level of granularity and disaggregation of asthma and asthma-relevant health and outcome data and to which kinds of registries these data are reported.
  - **Score**: Health data recording/ reporting (Out of 18)

- **Respiratory specialists**
  - **Description**: Number of respiratory specialists per 100,000 population
  - **Score**: Number of respiratory specialists per 100,000 (MIN: 0 / MAX: 15)

- **Societal cost of severe asthma**
  - **Description**: Asthma disability-adjusted life years per 100,000 among population aged 0 to 40 * GDP Per Capita (purchasing power parity 2021 International Dollars)
  - **Score**: Societal Cost of Severe Asthma (Asthma DALYs per 100,000 among population aged 0 to 40 * GDP Per Capita (PPP 2021 International Dollars)

- **Burden of asthma**
  - **Description**: Asthma disability-adjusted life years (DALYs) as a percentage of all country DALYs
  - **Score**: Asthma DALYs as % of all Country DALYs (MIN: 0 / MAX: 3) - NOTE: NEGATIVE DIRECTION INDICATOR

- **Estimated severe asthma deaths**
  - **Description**: Asthma deaths as a percentage of all recorded deaths among ages 0-40
  - **Score**: Asthma Deaths % of all Deaths aged 0-40 (MIN: 0 / MAX: 2.83) - NOTE: NEGATIVE DIRECTION INDICATOR

- **Adult obesity rate**
  - **Description**: Rate of obesity among the adult population
  - **Score**: Adult obesity rate (% of adults) (MIN: 0 / MAX: 61) - NOTE: NEGATIVE DIRECTION INDICATOR

- **Adult tobacco use rate**
  - **Description**: Rate of tobacco use among the adult population
  - **Score**: Adult tobacco use rate (% of adults) (MIN: 0 / MAX: 52.1) - NOTE: NEGATIVE DIRECTION INDICATOR

- **Indoor air quality**
  - **Description**: Percentage of population living in a dwelling with a leaking roof, damp walls, floors or foundation, or rot in window frames of floor
  - **Score**: Indoor Air Quality (MIN: 0 / MAX: 100) - NOTE: NEGATIVE DIRECTION INDICATOR

- **Particulate matter levels**
  - **Description**: Average level of exposure of a nation's population to concentrations of suspended particles measuring less than 2.5 microns in aerodynamic diameter
  - **Score**: Particulate matter levels (MIN: 0 / MAX: 100) - NOTE: NEGATIVE DIRECTION INDICATOR

- **Surface temperature increase**
  - **Description**: Mean surface temperature change during the period 1961-2021, using temperatures between 1951 and 1980 as a baseline.
  - **Score**: Surface temperature increase (increase anomaly relative to 1951-1980 global average) (MIN: -0.288 / MAX: 2.543) - NOTE: NEGATIVE DIRECTION INDICATOR