New strategies of Prevention of Respiratory Diseases


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  • OBIECTIVELE SECUNDARE: Compararea impactului prevalenţei BPCO folosind diferite definiţii şi criterii BPCO: the American Thoracic Society, The European Respiratory Society și GOLD Determinarea influenţei factorilor de risc asupra prevalenţei BPCO Determinarea distribuţiei BPCO conform vârstei, sexului şi statutului de fumător. Descrierea principalelor simptome clinice la pacienţii cu BPCO Evaluarea sensibilităţii şi specificităţii simptomelor BPCO, folosind spirometria şi testul bronhodilatator ca standard de aur Caracterizarea managementului clinic a pacienţilor cu BPCO
  • New strategies of Prevention of Respiratory Diseases

    1. 1. New Strategies for the Prevention of Respiratory Diseases Alexandru Corlateanu, MD, PhD MEDICAL CLINIC No. 2, “N.TESTEMITANU” SUMP
    2. 2. POPULATION MORTALITY BY THE MAIN CAUSES OF DEATHWorld Health Organization. Top Ten Causes of Death. Fact Date last updated: November 2008. 2
    3. 3. COPD – a public health problem • On a global scale – 210 million of patients and 3 million of deaths annually (5% of global mortality)1 • Prevalence is on the rise: the 6th cause of mortality globally in 1990, roughly – the 3rd cause in 20202 • Under-diagnosed and under-treated disease: Great Britain - 2008: 835000 of COPD diagnosed patients, the real number is estimated at over 3 millions3 • Significant economic burden – European Union: respiratory diseases - 6% of the health budget, 56% of which are allocated for COPD41.World Health Organization. World Health Report 2004. Statistical Annex - table 2 and 3: 120-1311.World2. 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. 33. The NHS Information Centre for Health and Social Care. Quality of outcomes framework 2008/09 – Prevalence. Date last accessed : July 20104. European Respiratory Society. European Lung White Book. Huddersfield, European Respiratory Society Journals Ltd, 2003.
    4. 4. Endogeneous risk factors Exogeneous risk factors • Tobacco smoke• Deficit of α1-antitrypsin • Industrial dust• Bronchial and fume hyperreactivity • Home and• Lungs maldevelopment environment pollution • Infections • Low social and economic status GOLD 2011,
    5. 5.  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
    6. 6. European Respiratory Roadmap Prevention Clinical medicine Research Education 7
    7. 7. 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 8
    8. 8. Recommendations for prevention of respiratory diseases Promote physical activity and diets Develop cost-efficient methods of early diagnosis and detection of respiratory diseases 9
    9. 9. Achievements at the national level• A round-table on the World No Tobacco Day was held for promotion ofthe project of the National Tobacco Control Programme for 2011-2016 ,where there was considered information on “The Tobacco ConsumptionEpidemic in the Republic of Moldova and the draft National Action Planon Tobacco Control for 2011-2016”, “Tax and Customs Policy in the fieldof Tobacco Control”, “Perspectives on Implementation of AgriculturalAlternatives to Tobacco in the Republic of Moldova”Conference Workshop WHO Framework Convention on Tobacco Control• Information, education and communication campaigns related to thehealthcare promotion and education for health were organized duringthe World Days 10
    10. 10. Primary problems 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. 11
    11. 11. 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 12
    12. 12. Implementation of a national strategyPrimary 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
    13. 13. 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 environmentPopulation screening for respiratory diseases Identify the population groups at risk Questionnaires to asses the clinical symptoms Respiratory functional tests 14
    14. 14. 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.) 15
    15. 15. Education of Patients and Self-care Promotion Education and information programmes for the patients related to the new respiratory diseases:• Control of risk factors• Evolutional character– recurrent exacerbations, comorbidites• Treatment administration• Correct access to healthcare services• Compliance of the patient with the prevention and treatment actions• Make the patient responsible for the chosen lifestyle• Active relation – partnership with the medical and social professionals and care implied persons• Develop the self-care interests and skills 16•
    16. 16. 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, c ancer, chronic respiratory