Dr SUNDEEP SALVI MD, DNB, PhD(UK)
CHEST RESEARCH FOUNDATION
Pune
WHY DO WE NEED A REFRESHER COURSE
ON OBSTRUCTIVE AIRWAYS ...
LUNGS: THE ORGAN OF RESPIRATION
420 Lts of oxygen delivered every day
350 Lts of carbon dioxide removed every day
10,000 L...
WHY DO WE NEED A REFRESHER
COURSE ON
OBSTRUCTIVE AIRWAYS DISEASES?
• Is OAD a major health problem in
India?
• A good hist...
0
10000000
20000000
30000000
40000000
50000000
60000000
70000000
Cancer IHD Stroke Diabetes Chronic respiratory
disease
0....
0
5
10
15
20
25
30
35
ESTIMATED NUMBER OF OBSTRUCTIVE
AIRWAY DISEASE PATIENTS IN INDIA
Million
Asthma
COPD28 million
17 mi...
PREVALENCE OF ASTHMA IN SCHOOL
CHILDREN IN INDIA
(ISAAC STUDY)
(n = 15,621)
0
5
10
15
20
25
30
35
1979 1984 1989 1994 1999...
TOBACCO SMOKING
5- times more harmful
1 cigarette = 1 bidi
Not 15-20%, but close to 50% of smokers develop COPD
1 BILLION ...
NON-SMOKING COPD
70% of Indian homes
50% of COPDs are non-smokers
3 BILLION PEOPLE WORLD-WIDE EXPOSED
0
1
2
3
4
5
6
7
8
Cancer IHD Stroke Diabetes Chronic Resp
diseases
Injuries
2.92
1.20
1.02
0.21
5.77
7.49
ESTIMATED MORTAL...
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Coronary
Heart
Disease
Stroke Other CVD COPD All Other
Causes
0.5
1.0
1.5
2.0
2.5
3.0
1965 - 1...
OADs ARE A MAJOR AND
GROWING HEALTH BURDEN
IN INDIA?
UNIQUE SET OF RISK FACTORS FOR
OAD IN INDIA
HOW DO WE DIAGNOSE
OBSTRUCTIVE AIRWAYS DISEASES IN
CLINICAL PRACTICE?
HOW RELIABLE IS THIS?
UNDERDIAGNOSIS OF OLD IN OUT-PATIENT
CLINICS AND COMMUNITY SURVEYS
• American Study – NHANES III, >20,000 US
adults underw...
• More than 75% of patients with OAD have never
had a spirometry done in their life
• Spirometry is poorly utilized in Ind...
HOW GOOD ARE WE AT
MANAGING ASTHMA AND COPD IN
CLINICAL PRACTICE?
• 420 cases of Obstructive Airways Disease
• 43.8% Asthma; 56.2% COPD
• Exacerbations - Daily: 52.6%
- Monthly: 31.2%
- < ...
Tablet Salbutamol 2-4mg thrice daily
Versus
Inhaled Salbutamol 100-200mcg thrice daily
1000 excess tablets over a period o...
0
10
20
30
40
50
60
UQMP QMP Specialist Institute
Use of pMDI by asthmatic subjects
(Rohtak, India)
Prescribed inhaler Cor...
(Chest Research Foundation and B.J. Medical College Pune, 2006)
DO MEDICAL PERSONNEL KNOW HOW TO USE
pMDI CORRECTLY?
1. Educate Patients
2. Assess and Monitor Severity
3. Avoid Exposure to Risk Factors
4. Establish Medication Plans for Chr...
0
2000
4000
6000
8000
10000
12000
14000
1995 2000 2005 2010 2015
Current If we follow guidelines
7641 crores
(Murthy KJR e...
SUMMARY
• Obstructive Airways Diseases are a major health
burden in India.
• The prevalence of OAD is only going to increa...
REFRESHER COURSE ON OBSTRUCTIVE AIRWAYS DISEASE
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COPD Asthma Workshop

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COPD Asthma Workshop

  1. 1. Dr SUNDEEP SALVI MD, DNB, PhD(UK) CHEST RESEARCH FOUNDATION Pune WHY DO WE NEED A REFRESHER COURSE ON OBSTRUCTIVE AIRWAYS DISEASES? www.crfindia.com
  2. 2. LUNGS: THE ORGAN OF RESPIRATION 420 Lts of oxygen delivered every day 350 Lts of carbon dioxide removed every day 10,000 Lts air pass in and out every 24 hours 10,000 Lts blood pass every 24 hours
  3. 3. WHY DO WE NEED A REFRESHER COURSE ON OBSTRUCTIVE AIRWAYS DISEASES? • Is OAD a major health problem in India? • A good history and a good clinical examination are enough to diagnose OAD. Or is it not? • Are we not managing patients with OAD better in our practice?
  4. 4. 0 10000000 20000000 30000000 40000000 50000000 60000000 70000000 Cancer IHD Stroke Diabetes Chronic respiratory disease 0.6 million 25 million 1 million 28 million 65 million ESTIMATED MORBIDITY FOR NON COMMUNICABLE DISEASES IN INDIA (Nongkynrih B et al, JAPI 2004 Feb; 52: 118-123) WHO, 2002 data Asthma COPD
  5. 5. 0 5 10 15 20 25 30 35 ESTIMATED NUMBER OF OBSTRUCTIVE AIRWAY DISEASE PATIENTS IN INDIA Million Asthma COPD28 million 17 million 35 million 22.2 million 25% 30% 2006 2016 ( Murthy KJR, NCMH Background Papers – Burden of Diseases in India, 2005 )
  6. 6. PREVALENCE OF ASTHMA IN SCHOOL CHILDREN IN INDIA (ISAAC STUDY) (n = 15,621) 0 5 10 15 20 25 30 35 1979 1984 1989 1994 1999 Pune, Nagpur Bangalore 5 – 6% Prevalence of asthma in Indian school children varies from 2% - 30%
  7. 7. TOBACCO SMOKING 5- times more harmful 1 cigarette = 1 bidi Not 15-20%, but close to 50% of smokers develop COPD 1 BILLION SMOKERS WORLD-WIDE
  8. 8. NON-SMOKING COPD 70% of Indian homes 50% of COPDs are non-smokers 3 BILLION PEOPLE WORLD-WIDE EXPOSED
  9. 9. 0 1 2 3 4 5 6 7 8 Cancer IHD Stroke Diabetes Chronic Resp diseases Injuries 2.92 1.20 1.02 0.21 5.77 7.49 ESTIMATED MORTALITY FOR NON COMMUNICABLE DISEASES IN INDIA (Nongkynrih B et al, JAPI 2004 Feb; 52: 118-123) WHO, 2002 data Number in lacs
  10. 10. 0.0 0.5 1.0 1.5 2.0 2.5 3.0 Coronary Heart Disease Stroke Other CVD COPD All Other Causes 0.5 1.0 1.5 2.0 2.5 3.0 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 –59% –64% –35% +163% –7% % change in Age-Adjusted Death Rates, U.S.A., 1965-1998
  11. 11. OADs ARE A MAJOR AND GROWING HEALTH BURDEN IN INDIA?
  12. 12. UNIQUE SET OF RISK FACTORS FOR OAD IN INDIA
  13. 13. HOW DO WE DIAGNOSE OBSTRUCTIVE AIRWAYS DISEASES IN CLINICAL PRACTICE? HOW RELIABLE IS THIS?
  14. 14. UNDERDIAGNOSIS OF OLD IN OUT-PATIENT CLINICS AND COMMUNITY SURVEYS • American Study – NHANES III, >20,000 US adults underwent spirometry (1988-1994) Prevalence of OAD – 8.5% 63.3% under-diagnosis (NHANES Study, Mannino et al, Arch Int Med 2000; 160: 1683-1689) • Similar observations in UK, France, Spain and other European countries (Huchon, ERJ 2002; Pena, Am J Respir Crit Care Med 2001)
  15. 15. • More than 75% of patients with OAD have never had a spirometry done in their life • Spirometry is poorly utilized in India • Myths about of Spirometry in India – - Not really necessary for diagnosis of OAD - Expensive test for the patients - Difficult test to perform - Difficult test to interpret - Doesn’t make any difference in the management of OAD USE OF SPIROMETRY IN INDIA
  16. 16. HOW GOOD ARE WE AT MANAGING ASTHMA AND COPD IN CLINICAL PRACTICE?
  17. 17. • 420 cases of Obstructive Airways Disease • 43.8% Asthma; 56.2% COPD • Exacerbations - Daily: 52.6% - Monthly: 31.2% - < 1 mthly: 16.2% • History of hospital admissions: 52% • Usual treatment: - Antibiotics: 94.1% - Oral theophylline: 93.1% - Parenteral theophylline: 41.9% - Salbutamol Inhaler: 81.2% - Steroid Inhaler: 29.3% - Oral steroids: 23.6% EXPERIENCE OF OADs BY A CHEST PHYSICIAN IN MUMBAI (Kamat SR et al, Lung India, August 2006)
  18. 18. Tablet Salbutamol 2-4mg thrice daily Versus Inhaled Salbutamol 100-200mcg thrice daily 1000 excess tablets over a period of 6 months
  19. 19. 0 10 20 30 40 50 60 UQMP QMP Specialist Institute Use of pMDI by asthmatic subjects (Rohtak, India) Prescribed inhaler Correct use (n = 1400) (Gupta PP et al, Ind J Chest Dis Allied Sci 2001; 43: 91-95 ) %
  20. 20. (Chest Research Foundation and B.J. Medical College Pune, 2006) DO MEDICAL PERSONNEL KNOW HOW TO USE pMDI CORRECTLY?
  21. 21. 1. Educate Patients 2. Assess and Monitor Severity 3. Avoid Exposure to Risk Factors 4. Establish Medication Plans for Chronic Management: Adults and Children 5. Establish Plans for Managing Exacerbations 6. Provide Regular Follow-up Care Six-Part Asthma Management Program
  22. 22. 0 2000 4000 6000 8000 10000 12000 14000 1995 2000 2005 2010 2015 Current If we follow guidelines 7641 crores (Murthy KJR et al, NCMH Background Papers, 2005) ECONOMIC BURDEN OF ASTHMA AND COPD IN INDIA 0 5000 10000 15000 20000 25000 30000 35000 40000 45000 50000 25,209 crores 1996 2001 2006 2011 2016
  23. 23. SUMMARY • Obstructive Airways Diseases are a major health burden in India. • The prevalence of OAD is only going to increase in the future • A large number of OADs remain undiagnosed in clinical practice because of want of use of Spirometry • Inhalation therapy is poorly used in India • Patients suffering with OAD in India remain poorly managed • Doctors do not communicate effectively with patients suffering with OADs • OADs contribute to a huge economic loss in India
  24. 24. REFRESHER COURSE ON OBSTRUCTIVE AIRWAYS DISEASE

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