overall view over chronic diseases

1. Chronic Diseases
By : ali sarhan

2. The chronic non-communicable
disease
is defined as “an impairment in body function that
persisted for a long length of time
It necessitates a modification in person’s life-style.

3. Chronic Diseases
Diabetes
Congestive Heart Failure
Hypertension
Hyperlipidemia
Asthma

4. What about obesity ?

5.  Is a type of malnutrition that is characterized by abnormal growth of
adipose tissue (number and size of fat cells).
 BMI > 30 : obesity
 BMI <= 30 : overweight
 BMI <18.5 : underweight
 Aetiology OF Obesity : Age, Sex, Sedentary Life Style, Genetic Factors, Diet,
Psychosocial Factors, Endocrine Factors.

6. Hazards of Obesity :
IHD, hypertension, renal diseases, gallstones, osteoarthritis ,post-operative
complications skin infections, DM , dyslipidemia.
Prevention and Control:
 1. Diet: decrease fat, carbohydrate and increase protein intake. Avoid
processed food and stress the need of fibers.
 2. Physical Exercise: walking and swimming are the safest and most
 3. Other Measures: drugs, surgery, treat underlying cause ( if available )

7. Coronary Heart Disease CHD/IHD
 impairment of the heart function due to inadequate blood
flow to the heart, compared to its needs, caused by
obstructive changes in the coronary Arterial circulation to
the heart.
 CHD may manifest itself as : Angina pectoris, Myocardial
infarction, Heart irregular rhythms, Cardiac failure, Sudden
death.

8.  cause of 1/4 deaths in industrialized countries.
 first leading cause of death in the world.
 25 to 28% heart attacks die suddenly instantly or within 24
hours
 55% of all cardiac deaths, mortality occurs within the first
hours.
 17 million people die annually due to CHD.
 Masked by other causes.
 Problems in diagnosis and reporting also play a role.
 Declining in USA, due to improve prevention & education
 Singapore, death rate doubled ,within 20 years

9. Epidemiology
 More among older people, with positive family history.
 Critically related to social habits
 Non- modifiable factors (i.e. risk markers): age, sex (male), genetic and personality.
 Modifiable factors (i.e. risk factors):smoking, hypertension, cholesterol , diabetes ,
obesity, High alcohol intake, sedentary habits and stress.

10. Prevention of CHD:
I. Primary prevention:
1. Control of risk factors among populations:
a) Dietary changes:
- Reduction of fat intake (saturated, cholesterol )
- Avoid alcohol consumption.
b) Smoke free society
c) Blood pressure:
d) Physical activity:
2. Identification of high risk groups: specificadvice.

11.  II. Secondary prevention: Prevent recurrence and regression of
CHD:
1. Screening high risk groups & suitable Rx.
2. Drugs, coronary surgery, pace- makers.. etc.
3. Control of risk factors i.e. smoking, HTN, DM, diets, exercise... etc.
 III Tertiary prevention: Rehabilitation irreversible limitations of
cardiac function through:
1. changes in behavior, habits, life- styles, diets,
2. use of drugs,
3. occupational rehabilitation,
4. control of risk factors
5. psychological rehabilitation

12. Hypertension : is the elevation in arterial blood
pressure

13.  In Iraq, the prevalence of high blood pressure among the
adult population (25 years and above) and the use of
medication to control it, was found to be 40% in 2008.
Prevalence is higher among males than females. About 50%
of total mortality in Iraq is caused by noncommunicable
diseases (NCDs).
 In USA, Hypertension costs $47.2billion (NHLBI 2003) In 50
million people.
 To address this problem , Awareness must be initiated and
enhanced ,Treatment must be based on guidelines , Control
the identified cases.
 Only 20% of the identified cases are controlled well !!!

14. What is needed?
 Educate the professionals on prevention and treatment of HTN.
 Improve the teaching on life style modifications to the medical and
general public
 Improve the general public awareness of the importance of normalized
BP.
 Cooperate with policy makers to project multitudes of actions to fight HTN
through out the society all year long
 Develop training packages for health care providers in prim. care centers.

15. Management Plan
 Establish Good patient relationship.
 Educate patient & family on the consequences
 Encourage Self monitoring.
 BP goal (CONTROL).
 Non pharmacological therapy (life style modification).
 Pharmacological therapy.
 Simplify drug regimen.

16. Diabetes Mellitus (DM)
 It is a chronic disease due to deficiency or diminished
effectiveness of insulin. The disease affects the metabolism of
carbohydrates, proteins, fats, water and electrolytes.
 It causes serious consequences.

17. Each 1 mmol = 18 mg/dl
NICE recommended target blood glucose level ranges
Target Levels
by Type
Upon waking
Before meals
(pre prandial)
At least 90 minutes
after meals
(post prandial)
Non-diabetic* 4.0 to 5.9
mmol/L
72 to 106
mg/dl
under 7.8
mmol/L
Under 140
mg/dl
Type 2 diabetes 4 to 7
mmol/L
72 to 126
mg/dl
under 8.5
mmol/L
Under 153
mg/dl
Type 1 diabetes 5 to 7 mmol/L 4 to 7
mmol/L
72 to 126
mg/dl
5 to 9
mmol/L
90-162
mg/dl
Children w/ type 1
diabetes
4 to 7 mmol/L 4 to 7
mmol/L
72 to 126
mg/dl
5 to 9
mmol/L
90-162
mg/dl

18. Classification DM:
I. Diabetes mellitus:
1. Insulin dependent = Juvenile onset (IDDM, type 1).
2. Non insulin dependent DM = Maturity onset (NIDDM, type II).
* Some cases of type 1 might arise in any age , and the same for type 2
II. Impaired glucose tolerance: intermediate state between DM and normality, pregnancy
state, obesity and stress may precipitate this condition.
III. Gestational DM: Pregnancy induced.

19. Diagnostic criteria
• DM is the most common cause of RF.
• DM is the eighth leading cause of death in USA.
• Diabetics are incapacitated by many serious
complications as atherosclerotic diseases, renal failure,
neuropathy blindness & amputation.

20. Why people get DM ?
 Unknown reasons
 Genetics
 Infection ( DM type 1)
 Overweight
 Endocrine disorders
 Unhealthy life style
 Stress
 Diet

21. Preventive measures

22. I. Primary Prevention:
A) Identification of those at risk:
1. Individuals with positive family history
2. Those over 40 years of age.
3. Obese individuals.
4 Females with suggestive obstetric history
5. Cases with premature atherosclerosis.
B) Health education:
I. Maintenance of optimal body weight
2. Promotion of physical exercise.
3. Diet modification.
4.Avoidance of diabetogenic drugs. e.g. contraceptive pills, corticosteroids.
5.Family life style education.
6. Prevention of complicated pregnancy.

23. II. Secondary prevention:
a) Screening: The preventive significance of early
detection is two fold:
1.Discovery of the disease in its pre-symptomatic state if
followed by adequate treatment minimize the danger of
complications such as coma and infection.
2.Early therapy reduces the progress of disease and may
reverse the pathologic changes.

24. b) Treatment:
Aim is to maintain serum glucose within normal:
1. diet modification
2. oral hypoglycemic drugs or insulin
3. Life style changing
N.B. controlled diabetics life expectation is approximating that of general
c) Health education:
1. Maintain the ideal body weight
2. Train diabetic for self care as it is crucial for good prognosis. (stick to treatment measures,
to detect dangerous signs and Symptoms , capable to test his blood, choose his diet,
regulate his physical activities, administer his own -and even adjust- his daily insulin dosage.
3. Health education should also stress the use of diabetic cards.

25. III. Tertiary prevention:
 Treat complications and rehabilitate patient to lead a life as normal as possible.
• periodic checkups for visual acuity (retinopathy), renal functions (nephropathy), and
testing peripheral nerves sensation (neuropathy
• Diabetics cards which provide information needed for emergency situations as
hypoglycemic and ketoacidotic episodes.
• Diabetics with no or minimal complications at the time of diagnosis have a
death rate less than one third that of patients with serious complications at time
of diagnosis.

26. Asthma
 Asthma is a chronic inflammatory condition of the lung airways
resulting in episodic airflow obstruction through heightening the
"twitchiness" of the airways and their hyperresponsiveness to
provocative exposures.
 Aetiology
1. Atopy (familial) is the strongest identifiable predisposing factor.
2. Exposure to tobacco smoke
3. Wheezing with viral infections in the first few years of life.
4. Sensitization to inhalant allergens (dust mite, animal dander)
5. Rarely, foods may provoke isolated asthma symptoms.

27.  Triggers can include exercise, cold air, cigarette smoke, pollutants,
strong chemical odors, and rapid changes in barometric pressure.
 Psychological factors may precipitate asthma exacerbations and
place the patient at high risk from the disease
 The prevalence is 8-10 times higher in developed countries than
in the developing countries.
 In the United States, the mortality rate due to asthma is more than
17 deaths per 1 million people.
 Before puberty, the prevalence is 3 times higher in boys than in
girls. During adolescence, the prevalence is equal among males
and females.
 In most children, asthma develops before they are aged 5 years,
and, in more than half, asthma develops before they are aged 3
years. . 60% no longer have wheezing when they are aged 6
years.

28. Components of Optimal Asthma Management
 REGULAR ASSESSMENT AND MONITORING through asthma check-ups &
lung function monitoring every 2-4 wk until good control is achieved and 2-4
times per year to maintain good control
 CONTROL OF FACTORS AND TRIGGERS CONTRIBUTING TO ASTHMA
SEVERITY through eliminating or reducing problematic environmental exposures
&treating co-morbid conditions: rhinitis, sinusitis, gastroesophageal reflux
 ASTHMA PHARMACOTHERAPY
 PATIENT EDUCATION
 DRUGS TO AVOID b-blocker, NSAID (ibuprofen , naproxen , diclofenac,
aspirin , mefenamic acid) , ACE inhibitor * they might cause cough )