Preventable Chronic Respiratory Diseases:

A Major Global Health Problem

 Objectives
 After the end of this topic students will understand
1. Different chronic preventable respiratory diseases
2. Magnitude of the problem
3. Risk factors of chronic preventable respiratory diseases.
4. Chronic Obstructive Pulmonary Disease (Definition, risk factor and
prevention
Introduction
 Chronic respiratory diseases are chronic diseases of
the airways and the other structures of the lungs.
 Hundreds of millions of people of all ages (from
infancy to old age) suffer from preventable chronic
respiratory diseases and respiratory allergies in all
countries of the world.
 Preventable chronic respiratory diseases are
increasing in prevalence, particularly among children
and elderly people.
 They affect quality of life and cause disability of
affected individuals.
 .
Cont…

 More than 500 million of these people live in low and

middle income countries or deprived populations
 Chronic respiratory diseases account for four million deaths annually.

 Measured in DALYs, in 2005 the burden of chronic respiratory diseases

was projected to account for 4% of the global burden and 8.3% of the
burden of chronic diseases.

 Preventable chronic respiratory diseases cause premature deaths.

 Effective management plans have been shown to reduce the morbidity

and mortality caused by chronic respiratory diseases.
Preventable chronic respiratory diseases

Preventable chronic respiratory diseases include

1. asthma and respiratory allergies,
2. chronic obstructive pulmonary disease (COPD),
3. occupational lung diseases,
4. sleep apnea syndrome and
5. pulmonary hypertension.
They constitute a serious public health problem in all countries
throughout the world, in particular in low and middle income
countries and in deprived populations.
Risk factors
Many risk factors for preventable chronic respiratory diseases have been
identified:
1. Tobacco smoke
2. Indoor air pollution.
3. Allergens.
4. Occupational agents.
5. Diseases such as schistosomiasis or sickle cell disease.
6. Living at a high altitude.
A Mechanism for Action: The Global Alliance
Against Chronic Respiratory Diseases (GARD)
 The Global Alliance against Chronic Respiratory Diseases (GARD) is a
voluntary alliance of national and international organizations,
institutions and agencies working towards the common goal of
improving global lung health.
 GARD’s vision: a world where all people breathe freely.
 GARD’s goal: to reduce the global burden of chronic respiratory
diseases.
 GARD’s objective:
1. Developing a standard way of obtaining relevant data on chronic
respiratory disease risk factors;
2. Encouraging countries to implement health promotion and chronic
respiratory disease prevention policies;
3. Recommending affordable strategies for the management of chronic
respiratory diseases.
End of Part One
Chronic Obstructive
Pulmonary Disease
 Definition
 Chronic obstructive pulmonary disease (COPD) is a heterogeneous
disease with various clinical presentations.

 The basic abnormality in all patients with COPD is airflow

limitation.

 Chronic obstructive pulmonary disease was the fifth cause of

death in 2002 and it is projected to be the fourth cause by 2030.

 Tobacco smoking is the major risk factor, but the use indoors of
solid fuels for cooking and heating also presents major risks.

 Strategies to reduce exposure to major risk factors are likely to

have an impact on morbidity and mortality.
 Problem Statement
 COPD is a major public health problem in subjects over 40 years of
age.
 It is a major cause of chronic morbidity and mortality worldwide and
is projected to rank seventh in 2030 as a worldwide burden of
disease.
 The rise in morbidity and mortality from COPD will be most dramatic
in Asian and African countries over the next two decades, due to
progressive increase in the prevalence of smoking
 Prevalence of COPD
 It has been estimated to range from 4% to up to 20% in adults over 40
years of age.
 COPD occurs in people aged 20–44 years.
 Large differences exist between countries. These are attributable to
many factors, including differences in diagnostic methods, year of study,
age of the population, and prevalence of main risk factors such as
tobacco smoking.
 According to WHO, COPD will move from fifth leading cause of death in
2002, to fourth place in the rank projected to 2030 worldwide.
Cont…
 In high income countries, COPD is the major chronic disease for which
deaths are increasing. COPD is a major cause of chronic morbidity
worldwide.
 It is projected that it will rank seventh in 2030 as a worldwide burden
of disease.
 Acute exacerbations of COPD are a common cause of morbidity and
mortality.
 The common etiological factors are bacterial or viral infections and air
pollutants.
Risk factors for COPD

1. Tobacco smoke
2. Second hand tobacco smoke
3. Other indoor air pollutants
4. Outdoor air pollutants
5. Allergens
6. Occupational agents.
Causes of chronic respiratory
diseases
Prevention of COPD
 Improve the surveillance and awareness of COPD and its risk
factors, in the general population and in key groups.
 General awareness of COPD in the community is extremely poor.
 A particular effort is needed in key groups (smokers,
occupational settings), where health-care workers should be
able to recognize undiagnosed COPD.
 National campaigns are needed to promote the awareness of
COPD and its risk factors.
Promote preventive measures.
 The primary prevention of COPD in the general population, and the
secondary and tertiary prevention of COPD in key groups (High
Risk), are important worldwide, particularly in low- and middle-
income countries.
1. Preventive measures include
1. Prevention and cessation of smoking.
2. Reduction in indoor air pollution.
3. Reduction in work-related pollutants.
4. Reduction of outdoor air pollutants.
5. Prevention of recurrent respiratory infections in children.
2. Promote early diagnosis and active treatment, in particular
among smokers and people who are exposed to risk factors.
3. Recognize and treat exacerbations early
4. Start physical exercise and rehabilitation early; this should be
planned individually and implemented as part of the treatment.
5. Initiate oxygen therapy in patients with chronic respiratory
failure.
6. Educate health care professionals.
7. More scientific research.
References and Additional Reading Material

1. Global surveillance, prevention and control of CHRONIC RESPIRATORY

DISEASES, WHO. 2007
2. Chen Y, Breithaupt R, Muhajarine N. Occurence of chronic obstructive
pulmonary disease among Canadians and sex-realted risk factors. Journal of
Clinical Epidemiology, 2000, 53:755–761.
3. Rennard SI. Treatment of stable chronic obstructive pulmonary disease. The
Lancet, 2004, 364:791–802.
4. Godtfredsen NS et al. Risk of hospital admission for COPD following smoking
cessation and reduction: a Danish population study. Thorax, 2002, 57:967–
972.
5. Khaltaev N. WHO strategy for prevention and control of chronic
obstructive pulmonary disease. Experimental Lung Research,
2005, 31:55–56.
6. Prevention and control of chronic respiratory diseases at country
level: towards a Global Alliance against Chronic Respiratory
Diseases. Geneva, World Health Organization, 2005 (http://
whqlibdoc.who.int/hq/2005/WHO_NMH_CHP_CPM_CRA_05.1.pdf
7. WHO strategy for prevention and control of chronic respiratory
diseases. Geneva, World Health Organization, 2002 (
http://whqlibdoc.who.int/hq/2002/WHO_MNC_CRA_ 02.1.pdf.