Evidence map›Paper›PMID 41545050›Full record

ArticleBMJ open2026

Mitigating chronic respiratory disease through the lens of multimorbidity: the MARES mixed-methods study protocol.

Renata Gonçalves Mendes, Naiara Tais Leonardi, Viviane Castello-Simões, Débora Mayumi de Oliveira Kawakami, João Victor Rolim Souza, Nathany Souza Schafauser-Segundo, Rodrigo Polaquini Simões, Fernanda Gabriely Pinto, Gustavo Henrique Guimarães Araujo, Marcela Maria Carvalho da Silva and 9 more

3 registry-linked trialsAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07050823 recruitingnot on this map

Case-Finding for Chronic Respiratory Diseases in People Living With Other Long-Term Conditions

TypeobservationalSponsorUniversity College, LondonRan2025 to 2027Enrolled859ConditionsChronic Obstructive Pulmonary Disease (COPD), Asthma, Preserved Ratio Impaired Spirometry
NCT07093021 not yet recruitingnot on this map

Feasibility of Implementing the COLA-6 Case-Finding Tool to Identify Chronic Respiratory Disease in Primary Health Care in Brazil

TypeobservationalSponsorUniversity College, LondonRan2025 to 2026Enrolled1,000ConditionsChronic Obstructive Pulmonary Disease (COPD), Asthma, Preserved Ratio Impaired Spirometry
NCT07134855 not yet recruitingnot on this map

Evaluating Care Pathways for Chronic Respiratory Diseases in Brazil

TypeobservationalSponsorUniversity College, LondonRan2025 to 2028Enrolled473ConditionsChronic Obstructive Pulmonary Disease (COPD), Asthma, Preserved Ratio Impaired Spirometry (PRISM)
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Renata Gonçalves MendesPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil renatamendes@ufscar.br.ORCID http://orcid.org/0000-0003-4683-2657
Naiara Tais LeonardiPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.ORCID http://orcid.org/0000-0003-0762-3932
Viviane Castello-SimõesPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
Débora Mayumi de Oliveira KawakamiPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
João Victor Rolim SouzaPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
Nathany Souza Schafauser-SegundoPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
Rodrigo Polaquini SimõesPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
Fernanda Gabriely PintoPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
Gustavo Henrique Guimarães AraujoPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
Marcela Maria Carvalho da SilvaUniversity of Santo Amaro, São Paulo, Brazil.
Cristiane Shinohara MoriguchiPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
Francisco José Barbosa Zörrer FrancoRede D'Or Sao Luiz, São Paulo, Brazil.
Valéria A Pires Di LorenzoPhysical Therapy Department, Federal University of São Carlos, São Carlos, Brazil.
Rachel JordanPublic Health and Epidemiology, University of Birmingham, Birmingham, UK.
Sonia MartinsCenter for Public Health Studies (CESCO), University Center of the ABC Medical School, São Paulo, Brazil.
Trishul SiddharthanDepartment of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, Florida, USA.
Saleh Al SharmahUCL Respiratory, University College London, London, UK.
Julie BarberDepartment of Statistical Science, University College London, London, UK.
John R HurstUCL Respiratory, University College London, London, UK.ORCID http://orcid.org/0000-0002-7246-6040

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionChronic 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.

objectiveTo 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.

Indexed as

AsthmaMultimorbidityPulmonary Disease, Chronic ObstructiveBrazilChronic DiseaseCross-Sectional StudiesFemaleHumansObservational Studies as TopicPrimary Health CareResearch DesignSpirometrySurveys and QuestionnairesMultimorbidityPrimary Health CarePulmonary Disease, Chronic Obstructive

Identifiers

PMID41545050
PMCPMC12815162

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.