New Strategies for the Prevention of

Respiratory Diseases

Alexandru Corlateanu, MD, PhDMEDICAL CLINIC No. 2,

“N.TESTEMITANU” SUMP

POPULATION MORTALITY BY THE MAIN CAUSES OF DEATH

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World Health Organization. Top Ten Causes of Death. Fact Sheet. www.who.int/mediacentre/factsheets/fs310_2008.pdf Date last updated: November 2008.

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COPD – a public health problem

1.1.World Health Organization. World Health Report 2004. Statistical Annex - table 2 and 3: 120-131World Health Organization. World Health Report 2004. Statistical Annex - table 2 and 3: 120-1312. 2. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997 ; 349(9064): 1498-504.Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997 ; 349(9064): 1498-504.3. 3. The NHS Information Centre for Health and Social Care. Quality of outcomes framework 2008/09 – Prevalence. http://www.ic.nhs.ukThe NHS Information Centre for Health and Social Care. Quality of outcomes framework 2008/09 – Prevalence. http://www.ic.nhs.uk Date last accessed : July 2010Date last accessed : July 20104. 4. European Respiratory Society. European Lung White Book. Huddersfield, European Respiratory Society Journals Ltd, 2003.European Respiratory Society. European Lung White Book. Huddersfield, European Respiratory Society Journals Ltd, 2003.

• On a global scaleOn a global scale – – 210 mil210 million of patientslion of patients andand 3 3 millionmillion of deathsof deaths annually annually (5% (5% ofof global global mortality mortality))11

• PrevPrevaalenlencece isis on the riseon the rise: : the 6the 6thth cause of mortality globally cause of mortality globally inin 1990, 1990, roughlyroughly – – the 3the 3rdrd cause cause iin 2020n 202022

• Under-diagnosedUnder-diagnosed andand under-treated diseaseunder-treated disease: : GreatGreat Brita Britainin - - 20082008: : 835000 835000 ofof COPD COPD diagnosdiagnosed patientsed patients,, the the real number is estimated real number is estimated at over at over 3 mil3 millionslions33

• SignificantSignificant economic economic burdenburden – – EuropeanEuropean Union Union: respirator: respiratory y diseasesdiseases - 6% - 6% of the health budgetof the health budget, 56%, 56% of which are allocated for of which are allocated for COPDCOPD44

• Deficit of 1-antitrypsin• Bronchial

hyperreactivity• Lungs maldevelopment

Endogeneous risk factors Exogeneous risk factors• Tobacco smoke• Industrial dust

and fume• Home and

environment pollution• Infections• Low social and

economic status

GOLD 2011, www.goldcopd.org

97% of the public health expenses are currently used  for treatment, and only 3% are invested in the prevention of respiratory diseases

In 2010 COPD incurred EUR 280 billion as costs for the world economy

European Respiratory Roadmap

Prevention Clinical medicine Research Education

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Recommendations for prevention of respiratory diseases

Implement the WHO Framework Convention on Tobacco Control in Europe

Implement the Parma Declaration on Air Pollution and Climate Change

Implement the UNO Acts related to the prevention of non-transmissible chronic respiratory diseases

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Promote physical activity and diets Develop cost-efficient methods of early

diagnosis and detection of respiratory diseases

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Recommendations for prevention of respiratory diseases

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• A round-table on the World No Tobacco Day was held for promotion of the project of the National Tobacco Control Programme for 2011-2016, where there was considered information on “The Tobacco Consumption Epidemic in the Republic of Moldova and the draft National Action Plan on Tobacco Control for 2011-2016”, “Tax and Customs Policy in the field of Tobacco Control”, “Perspectives on Implementation of Agricultural Alternatives to Tobacco in the Republic of Moldova”

Conference Workshop WHO Framework Convention on Tobacco Control

• Information, education and communication campaigns related to the healthcare promotion and education for health were organized during the World Days

Achievements at the national level

• The project is part of an international study BOLD (Burden of Obstructive Lung Diseases), which has already been conducted in many countries (USA, Turkey, China, Great Britain, Austria, etc).

• Highlight the risk factors, study the prevalence and clinical and functional characteristics in the patients with chronic obstructive lung disease (obstructive pulmonary diseases) in order to improve the early diagnosis, upgrade the therapeutic methods and draft forecasting criteria for implementation of prophylactic activities in the patients with obstructive pulmonary diseases.

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Primary problems at the national level

PRIMARY GOALS:

• Assess the age and gender related prevalence of the risk factors of COPD compared to other countries

• Assess the prevalence of comorbidities in COPD patients

• Estimate the COPD impact on the quality of life, limited the physical activity and respiratory symptoms

• Develop a validated model to forecast the COPD impact

• Based on the data obtained in the study, develop practical recommendations on enhancing the COPD diagnosis at different stages of health care provision

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Primary goals of the national strategy

Prevent the onset and progression of chronic respiratory diseases

Accurately identify and diagnose the cases Ensure the access of the patient to quality healthcare Provide self-care information and education to patients

Implementation of a national strategy

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Prevention of onset and progression of respiratory diseases

Inform the population Campaigns for information and promotion of respiratory health Anti-smoking social marketing policies and campaigns

Limit the action of risk factors Professional support to quit smoking Air quality standards in living and professional environment

Population screening for respiratory diseases Identify the population groups at risk Questionnaires to asses the clinical symptoms Respiratory functional tests

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COPD Detection and Diagnosis

Accurate diagnosis of COPD Quality spirometry – establishing the diagnostic and stage Clinical assessment: effort tolerance, dyspnea (MRC), arterial blood

gases, deficit of α-1-Antitripsyn, state of nutrition, etc. Anticipatory management of the chronic disease – clinical and

functional periodical respiratory reassessment by revising the therapy based on the stages of severity

Periodical assessment and reassessment for presence of comorbidities (coronary heart diseases, diabetes, depression, osteoporosis, etc.)

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Education of Patients and Self-care Promotion

Education and information programmes for the patients related to Education and information programmes for the patients related to the new respiratory diseases:the new respiratory diseases:

• Control of risk factorsControl of risk factors• Evolutional character– recurrent exacerbations, comorbiditesEvolutional character– recurrent exacerbations, comorbidites• Treatment administrationTreatment administration• Correct access to healthcare servicesCorrect access to healthcare services

• Compliance of the patient with the prevention and treatment Compliance of the patient with the prevention and treatment actionsactions

• Make the patient responsible for the chosen lifestyleMake the patient responsible for the chosen lifestyle• Active relation – partnership with the medical and social Active relation – partnership with the medical and social

professionals and care implied personsprofessionals and care implied persons• Develop the self-care interests and skillsDevelop the self-care interests and skills• Stimulate the creation of communities /social networks of patientsStimulate the creation of communities /social networks of patients

Reality •Under-diagnosed•Under-estimated•Under-treated

Hope • Conduct the BOLD (Impact of Obstructive Respiratory

Diseases) study to identify the unapproached needs in the chronic respiratory disease management

• Develop the national intersectorial strategy to approach the chronic respiratory diseases, particularly, at primary medical aid and by an integral approach with other chronic diseases

• Active participation in drafting and carrying out the European Respiratory RoadMap and the WHO Global Strategy against non-transmissible diseases (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes)