Why does WHO worry? The global epidemic of chronic respiratory diseases

Transcription

1 Why does WHO worry? The global epidemic of chronic respiratory diseases Alvaro A. Cruz, M.D. Chronic Respiratory Diseases Group WHO/GARD Nordic Seminar, 15 November 2007, Oslo

2 The epidemic of chronic respiratory diseases 7% Preventing chronic diseases. A vital investment. WHO,

3 The epidemic of chronic respiratory diseases Global prevalence of chronic respiratory diseases exceeds 1 billion and everyone is exposed to risk factors There are gaps in knowledge, but also gaps in knowledge translation into policies Millions of lives can be saved if urgent action is taken Global surveillance, prevention and control of chronic respiratory diseases. WHO,

4 The epidemic of chronic respiratory diseases Disease Year of estimate Prevalence Asthma million COPD million Allergic rhinitis million Sleep apnea >100 million Global surveillance, prevention and control of chronic respiratory diseases. WHO,

5 The epidemic of chronic respiratory diseases COPD global prevalence estimate Pooled prevalence of 26 spirometry surveys: 9.2% (>40 years) Halbert et al (systematic review). ERJ 2006; 28: World population in 2007: 6.67 billion World population prospects. The 2006 revision. United Nations, % of world population older than 40 years: 34.5% Age standardization of rates: a new WHO standard ( 5

6 The epidemic of chronic respiratory diseases USA Índia Brazil Portugal China Asthma Allergic Rhinitis ISAAC Phase III n = to 14 years 106 centres 56 countries Ascher et al. Lancet 2006; 368:

7 The epidemic of chronic respiratory diseases Major risk factors Tobacco smoking Air pollution, outdoors and indoors Allergens Occupational exposure Global surveillance, prevention and control of chronic respiratory diseases. WHO,

8 The epidemic of chronic respiratory diseases Global mortality is increasing Prevalence is increasing Everyone is exposed to a risk factor 8

9 Gaps of knowledge How to stop progression of COPD? More effective strategy for smoking cessation? Primary prevention of asthma? Effective strategy for indoor environmental control in asthma and rhinitis? Global surveillance, prevention and control of chronic respiratory diseases. WHO,

10 Gaps of knowledge implementation Lack of prevention Insufficient access to early and proper diagnosis Lack of access to primary care Lack of access to referrals Effective treatment unavailable or unaffordable Global surveillance, prevention and control of chronic respiratory diseases. WHO,

11 Why should we all worry? 80% of deaths due to chronic diseases occur in low- and middle-income countries Current WHO estimates project a 17% increase in all deaths due to chronic diseases to year 2015 Chronic diseases are a major burden to individuals, families and societies Preventing chronic diseases. A vital investment. WHO,

12 WHO NCD action plan: a proposal Vision: a world free of preventable NCD, in which all people have access to appropriate care Mission: lead and catalyse an intersectoral, multilevel response to address premature mortality and ill-health Goal: to reduce global mortality due to NCD by 2% over current trends 12

13 Prioritizing approach to gaps in CRD Consultation of world experts proposed Choice of target low to middle-income countries Focus on primary health care 13

14 A demonstration project for the underprivileged Research project in Salvador, Brazil (2.7 million inhab.) Referral centres for severe asthma providing free medication Patients: (severe asthma), from Dec 2003 to Apr 2007 Training primary care teams ProAR volunteer squad Franco et al. BMC Public Health 2007; 7:82. 14

15 A demonstration project for the underprivileged Among patients enrolled: 90% reduction in admissions Compliance with treatment: 84% Reduction in costs (per patient/year): US$ 387 to the public health system US$ 733 to the family Impact on the indicators for the whole City: hospitalizations reduced from (2003) to 611 (2006) deaths reduced from 23 (2003) to 1 (2006) Franco et al. BMC Public Health 2007; 7:82. 15

16 We can control CRD in low-income settings! Cost-effective safe interventions are available High-income countries should set a model of: equitable access integration of interventions for NCD evaluation of interventions 16

17 The epidemic of chronic respiratory diseases Everybody exposed to risk factors Disease Asthma COPD Allergic rhinitis Sleep apnea Year of estimate Prevalence 300 million 210 million 400 million >100 million Over 1 billion people have CRD Four million deaths/year. Thirty eight people die of CRD every 5 minutes. Global surveillance, prevention and control of chronic respiratory diseases. WHO,

18 The World Health Assembly has: Recognized the enormous suffering related to chronic respiratory disease Requested WHO Director General and Member States to take action to prevent and control Suggested global partnerships as effective means to mobilize resources 18

19 GARD 19

20 WHO proposal for planning action 20

21 The epidemic of chronic respiratory diseases ISAAC Phase III n = centres 56 countries Ascher et al. Lancet 2006; 368:

22 Rhinitis is a major risk factor for asthma Authors Region Sample Risk Estimate Laynert et al (2004) Europe adults (sectional) 6.6 (OR) Torren et al (2002) Sweden adults (case-control) 5.4 (OR) Guerra et al (2002) USA children (case-control) 3.2 (OR) Plaschke et al (2000) Chatkin et al (2005) Sweden Brazil adults (sectional) 494 children (cohort) 4.1 (OR) allergic rhinitis 2.8 (RR) Cruz et al. ARIA update. Allergy 2007; 62: