Clinical algorithm to screen for cardiopulmonary disease in low-income settings

Africa faces many health challenges, many of which are unique to the continent. Although rarely considered an important contributor to premature death in high-income countries, cardiopulmonary disease (CPD) is, for a number of reasons, a common condition affecting Africans at a young age. In addition to recognizing CPD as an important condition, we outline a pragmatic screening protocol for identifying CPD in the African context. Any attempts to understand the burden of disease in sub-Saharan Africa are doomed to failure if viewed through the prism of experiences in high-income countries. This situation is particularly evident when considering the limited capacity and resources to diagnose complex diseases in many parts of this region. This critical limitation is exacerbated when the complex conditions remain poorly characterized on a global basis. In this Comment article, we outline the conundrum of screening for and diagnosing cardiopulmonary disease (CPD) in the African context on the basis on the following definition: a broad spectrum of conditions concurrently affecting the heart and lungs that ranges from those at high risk of developing right heart failure and death owing to the presence of largely asymptomatic, mild-to-moderate pulmonary hypertension that represents latent CPD, to those who have already developed concurrent and symptomatic lung and/or cardiac pathology that represents established CPD.