1) Respiratory diseases such as COPD pose a major public health challenge globally and in Moldova. 2) A national strategy is needed to prevent onset and progression through education, limit risk factors like smoking and pollution, and screen at-risk populations. 3) The strategy should also accurately diagnose and treat COPD through quality testing, clinical assessments, and management of comorbidities, while educating patients to self-manage their condition.

1. New Strategies for the
Prevention of
Respiratory Diseases
Alexandru Corlateanu, MD, PhD
MEDICAL CLINIC No. 2,
“N.TESTEMITANU” SUMP

2. POPULATION MORTALITY BY THE MAIN
CAUSES OF DEATH
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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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
COPD4
1.World Health Organization. World Health Report 2004. Statistical Annex - table 2 and 3: 120-131
1.World
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.
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3. The NHS Information Centre for Health and Social Care. Quality of outcomes framework 2008/09 – Prevalence. http://www.ic.nhs.uk Date last accessed : July 2010
4. European Respiratory Society. European Lung White Book. Huddersfield, European Respiratory Society Journals Ltd, 2003.

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, www.goldcopd.org

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

7. European Respiratory Roadmap
 Prevention
 Clinical medicine
 Research
 Education
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8. 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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9. Recommendations for prevention
of respiratory diseases
 Promote physical activity and diets
 Develop cost-efficient methods of early
diagnosis and detection of respiratory diseases
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10. Achievements at the national level
• 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
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11. 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.
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12. 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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13. Implementation of a national strategy
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

14. 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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15. 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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16. 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
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17. 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