[Expert Solution]: Read and analyse the breifing paper…

Read and analyse the breifing paper below,Chronic Obstructive Pulmonary Disease (COPD) is a significant public health concern globally, and a critical concern in Nepal. This condition is a non-communicable chronic inflammatory lung disease that causes limited or obstructed airflow from the lungs, characterized by a degeneration of lung function over time that is not entirely reversible. This briefing paper discusses the impact of COPD, the associated environmental risk factors linked to air quality, risk assessment strategies, propose effective risk management measures, and recommendations to safeguard this public health issue in Nepal. INTRODUCTION: Globally in the year 2019, COPD had 212.3 million prevalent cases, caused over 3.23 million deaths with 5.7% global mortality and was reported as the third leading cause of death (Safiri et al., 2022; WHO 2023). Although, the global burden of disease study (GBD) ranked COPD as the second most prevalent cause of death in 2017 (Safiri et al., 2022). In 2019, COPD death associated with air-pollution accounted for 2.32% of the total global death, and the number of DALY accounted for 1.12% of the global DALY (Cheng et al.,2023). COPD is an important killer in low-and middle-income countries (LMICs) where more than 90% of COPD deaths occurred. The economic burden of COPD among LMICs is anticipated to increase to £1.7 trillion by 2030 (Karki et al., 2021). Nepal is a low-income country in South-Asia and COPD is the 2nd major cause of death in that country (Adhikari et al 2018). Safiri et al., (2022) documented that Nepal has the highest age standardized DALY rates at 3318.4 per 100,000 population. COPD is the fourth significant cause of premature death and the third cause for disability-adjusted life years DALYs in Nepal (Karki et al.,2021). Nepal has the highest standardized death rate for chronic lung disease in the world, at 182.5 per 100,000 population (Adhikari et al., 2018; Safiri et al., 2022). A study, published in 2018 based on GBD repository, estimated 16,302 Nepalese died from COPD and 960,737 Nepalese suffered from COPD in 2016 (Yadav, 2021). Evidence from various studies indicated nearly 12% of Nepal’s adult population have COPD (Parhofe et al., 2023). While a recent Nepalese cross-sectional study reported a prevalence of 15.4% for COPD among older Nepalese adults (Yadav,2021). However, Budhathoki et al., (2021) documented the pooled prevalence of COPD in Nepal as 22.7% (95% Cl 12.5%-37.7%) from January 2000 to October 2020. Additionally, Adhikari et al, (2018) indicated that some subnational studies conducted in the country reported the prevalence of COPD to range from 23% to 43% but their research estimated 11.5% as the prevalence among adults aged 40 years and over. According to (Yadav, 2021) findings from a recent study conducted by the Nepal Health Research Council (NHRC), reported that COPD was the most common chronic disease with (11.7%) when compared to other measured NCDs. COPD exerts a high economic burden on the individual as well as the health care system as it incurs two- to four-fold higher costs compared with asthma and ischemic heart disease (Adhikari et al., 2018). Furthermore, it has been projected that COPD-associated morbidity and death will increase by 160% in LMIC in Southeast Asian region like Nepal in the coming decades due to higher exposure to major risk factors (Adhikari et al.,2018). Air pollution, is the second highest risk factor for non-communicable diseases like COPD (WHO2022). According to a recent survey, Nepal’s urban air quality has been classified as one of the worst in the globe (Giri et al., 2023) Stakeholders and their Pertinent Mechanisms of Involvement: The co-design process in Nepal included collaboration of wide range relevant stakeholders which included COPD patients for Self-management health literacy and Patient activation to develop knowledge, skills and confidence in managing their own health and care, informal caregivers like friends and families, that provide care to patient with COPD at home (Yadav, 2021). Public health and health care practitioners deliver consultation, nursing care, and advocacy for more studies to understand the national prevalence, morbidity, and mortality associated with COPD, for evidence-informed policy planning and program implementation (Adhikari et al.,2018). Nepal’s government in 2015 promulgated its new constitution, replaced a unitary government with a federal system and three government levels: Federal, Provincial and Local. The new decentralized system was designed to provide equitable public health and treatment services for the people of rural and hard to reach areas in order to address health inequalities and the challenges faced by people with COPD in Nepal (Yadav, 2021). The Government of Nepal drafted a multisectoral action plan for the prevention and control of NCDs like COPD in alignment with the Global