Table 1:

Availability of tests considered relevant in the diagnosis of chronic obstructive pulmonary disease, by country income group

	Primary and specialist care	Primary care only	Specialist care only	Limited* availability in primary or specialist care, or both	Not available
Lower-middle-income countries (n=11)
Spirometry	2 (18%)	0	4 (36%)	5 (45%)	0
Reversibility testing	1 (9%)	0	6 (55%)	4 (36%)	0
Whole body plethysmography	0	0	3 (27%)	5 (45%)	3 (27%)
Diffusion capacity measurement	0	0	3 (27%)	5 (45%)	3 (27%)
Arterial blood gas analysis	0	0	6 (55%)	5 (45%)	0
Chest radiography	6 (55%)	3 (27%)	0	2 (18%)	0
Chest CT	1 (9%)	0	7 (64%)	3 (27%)	0
Upper-middle-income countries (n=15)
Spirometry	3 (20%)	2 (13%)	6 (40%)	4 (27%)	0
Reversibility testing	2 (13%)	1 (7%)	8 (53%)	4 (27%)	0
Whole body plethysmography	0	0	5 (33%)	9 (60%)	1 (7%)
Diffusion capacity measurement	0	0	6 (40%)	8 (53%)	1 (7%)
Arterial blood gas analysis	1 (7%)	2 (13%)	8 (53%)	4 (27%)	0
Chest radiography	8 (53%)	4 (27%)	3 (20%)	0	0
Chest CT	3 (20%)	0	10 (67%)	2 (13%)	0
High-income countries (n=17)
Spirometry	12 (71%)	1 (6%)	3 (18%)	1 (6%)	0
Reversibility testing	8 (47%)	0	9 (53%)	0	0
Whole body plethysmography	0	0	16 (94%)	1 (6%)	0
Diffusion capacity measurement	1 (6%)	0	14 (82%)	2 (12%)	0
Arterial blood gas analysis	1 (6%)	0	15 (88%)	1 (6%)	0
Chest radiography	12 (71%)	0	4 (24%)	1 (6%)	0
Chest CT	4 (24%)	0	12 (71%)	1 (6%)	0

Data are n (%). We sent an online survey to more than 100 national and regional respiratory societies worldwide, including the American Thoracic Society, European Respiratory Society, the Pan African Thoracic Society, and the Asociación Latinoamericana de Tórax. We received responses from societies representing 43 of the 120 countries approached. Countries were categorised into the four World Bank income groups based on the 2019 gross national income per person. The lower-middle-income countries that responded were Algeria, India, Kenya, Kyrgyzstan, Moldova, Nepal, Pakistan, Philippines, Sri Lanka, Tunisia, and Viet Nam. The upper-middle-income countries were Albania, Brazil, Bulgaria, Costa Rica, Iran, Jordan, Kazakhstan, Lebanon, Malaysia, Mexico, North Macedonia, Serbia, South Africa, Thailand, and Türkiye. The high-income countries were Australia, Austria, Belgium, Canada, Finland, France, Germany, Lithuania, Norway, Poland, Portugal, Slovenia, Spain, Switzerland, Taiwan, Uruguay, and the USA. No surveys were returned from physicians in low-income countries (see appendix for additional methods).

^*The availability of a diagnostic test was defined as “limited” if it was available to a maximum of 15% of patients.