Burden of major Respiratory Diseases WHO Survey Ryazan region of Russia,
Ryazan region of Russia, health care system: 104 hospitals district hospitals 32 rural hospitals 44 65 out-patient departments 792 feldsher's stations
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General characteristics of the study Region Stage Study period Number of health facilities Number of patients Scopin district PHC based 18.10.04-02.11.04 24 1505 Household based 22.11.04-28.12.04 18 2116 Clinical survey & lung function test 08.02.05-30.03.05 8 812 Shilovo district PHC based 01.11.04-20.11.04 29 962 Household based 22.11.04-28.12.04 18 2030 Clinical survey & lung function test 08.02.05-30.03.05 8 725
Education level of respondents, %, by stages Stage Higher Second ary Primary No education PHC based 7,38 59,22 27,32 6,08 Household based 5,31 50.10 31.65 6.10
Age distribution of risk factors, by stages (self-reported by patients) Stage Risk factor 5-14 years 15-49 years >= 50 years PHC based Worked for a year or more in any dusty job - - 6.33 14.08 13.82 24.66 Ever smoked cigarettes 0 0.79 5.17 64.32 0.84 58.71 Now smoke cigarettes 0 1.57 4.67 60.68 0.60 45.40 Heat or cook using an open fire 46.34 35.43 85.5 67.48 90.26 72.39 Household based Worked for a year or more in any dusty job - - 4.18 11.10 8.99 24.67 Ever smoked cigarettes 0 2.5 8.76 58.55 1.61 55.83 Now smoke cigarettes 0 2.71 7.06 54.72 1.71 43.79 Heat or cook using an open fire 48.46 39.58 83.98 72.45 88.22 78.78
Age distribution of symptomatic respiratory patients, by stages (self-reported by patients) Stage Cough 5-14 years 15-49 years >= 50 years PHC based usually have a cough 9,76 12,60 13,00 26,70 16,71 43,97 usually cough as much as 4 to 6 times a day, 4 or more days out of the week 4,88 8,66 7,83 17,72 11,78 32,17 Household based usually have a cough 0.88 1.25 4.68 14.67 9.10 28.11 usually cough as much as 4 to 6 times a day, 4 or more days out of the week 0.22 0 2.09 7.91 5.67 19.89
Age distribution of symptomatic respiratory patients, by stages (self-reported by patients) Stage Phlegm 5-14 years 15-49 years >= 50 years PHC based usually bring up phlegm 8,13 6,30 7,17 18,93 9,38 33,24 usually bring up phlegm twice a day, 4 or more days out of the week 6,50 4,72 5,33 14,56 7,69 26,27 Household based usually bring up phlegm 0,44 0,21 2,29 9,06 5,35 17,59 usually bring up phlegm twice a day,4 or more days out of theweek 0,22 0,21 1,00 4,97 4,28 13,19
Age distribution of symptomatic respiratory patients, by stages (self-reported by patients) Stage Wheezing 5-14 years 15-49 years >= 50 years PHC based ever had an attack of wheezing 13,82 14,96 15,17 13,59 16,59 23,59 had 2 or more such episodes 9,76 13,39 12,00 10,19 14,06 18,23 Househol d based ever had an attack of wheezing 2,64 3,13 3,58 2,93 7,17 9,18 had 2 or more such episodes 2,42 3,33 2,89 2,68 5,57 6,69
Age distribution of symptomatic respiratory patients, by stages (self-reported by patients) Stage Breathlessness 5-14 years 15-49 years >= 50 years PHC based MRC 1 MRC 2 6,50 2,44 0,79 17,17 9,50 9,71 5,83 52,04 43,51 39,95 34,32 MRC 3 2,44 5,17 4,13 31,13 26,01 MRC 4 2,44 3,50 1,21 19,71 15,28 MRC 5 0,67 0,97 4,93 4,56 Household based MRC 1 MRC 2 0,22 0,22 0,21 8,16 5,47 2,42 1,40 42,72 33,62 26,39 20,27 MRC 3 0,42 2,89 0,38 26,66 16,06 MRC 4 0,21 1,29 0,51 13,81 7,07 MRC 5 0,10 0,13 4,60 3,63
Prevalence of bronchial obstruction, % Stage 5-14 years 15-49 years >= 50 years Household based clinical survey & lung function test FEV1/FVC <70 2,72 1,28 5,07 6.69 15,65 23,72
Prevalence of smoking by Age & Sex, % Smoking 21 70 60 50 40 30 20 10 0 f f Adult Children
Bronchial obstruction and smoking Pack-years, mean Bronchial obstruction degree
Bronchial obstruction and dyspnea Part of patients with dyspnea Bronchial obstruction degree
12 31% 12 11% 14 *19%
Treatment Only 2 from 100 patients with respiratory symptoms and low pulmonary function regularly use inhalation of bronchodilators
Among the patients with bronchial asthma: regularly use inhalation of glucocorticoids less than 1% regularly use inhalation of bronchodilators 1,5% regularly use theophylline 15 % Treatment
Adequate education, should be available, in order to ensure correct diagnosis and treatment, in particular in primary care. World Health Organization Noncommunicable Diseases and Mental Health Department of Chronic Diseases and Health Promotion Chronic Respiratory Diseases and Arthritis 2005
Educational program Key stones Optimization of prophylactic programs for primary care settings to reduce risk factors Diagnostic algorithm for primary care settings based on the main symptoms and risk factors Using spirometry like routine method in primary care Optimization of rehabilitation program for primary care settings to reduce patients disability
Comparison of age distribution, in years, by stages between sexes Stage Mean age (+/- SD) in females Mean age (+/- SD) in males p PHC based 49,57 21,29 42,47 21,80 6,67535E-16 Household based 41,03 24,04 34,89 22,60 6,92384-17
Working population, %, by stages Stage 5-14 years 15-49 years >= 50 years PHC based - - 72,00 59,22 16,71 24,66 Household based - - 45,87 45,15 12,63 17,97
Migrants, %, by stages Stage PHC based Household based 3.36 3,21
Prevalence of respiratory diseases, by stages (self-reported by patients) Stage Disease 5-14 years 15-49 years >= 50 years PHC based Emphysema 0,50 1,46 2,76 8,58 Asthma 4,07 6,30 3,83 4,13 4,33 4,29 Chronic bronchitis 2,44 5,51 8,17 9,95 15,14 26,01 Tuberculosis 0,17 1,94 0,36 2,95 Current pneumonia 4,07 2,36 0,67 1,46 1,32 2,14 Allergic rhinitis 5,69 1,57 3,50 3,88 2,40 1,07 Another respiratory disease* 45,53 48,03 27,67 19,66 14,78 11,80 Household based Emphysema Asthma 0,22 0,21 0,40 0,26 1,02 0,43 1,82 0,38 1,15 Chronic bronchitis 0,22 1,46 4,78 5,99 10,06 16,06 Tuberculosis 0,42 0,40 0,64 1,07 1,72 Current pneumonia 0,40 0,64 0,32 1,15 Allergic rhinitis 0,88 0,63 1,00 0,77 0,54 Another respiratory disease* 20,04 22,50 22,99 20,41 15,10 13,19
Prevalence of respiratory diseases (reported by medics) Stage Disease 5-14 years 15-49 years >= 50 years Household based clinical survey & lung function test Emphysema Asthma Chronic bronchitis 0,33 0,33 0,17 0,84 2,19 0,89 1,33 7,33 Tuberculosis 0,34 0,22 Current pneumonia 2,00 2,02 4,00 Allergic rhinitis 0,33 1,18
Main symptoms and medical diagnosis of chronic bronchitis Cough Wheezing Phlegm Dyspnea Part of patients with symptoms Patients without established diagnosis Patients with established diagnosis
Risk factors and chronic cough Work in any dusty job Smoke Heat or cook using an open fire Part of patients with risk factors Patients without chronic cough Patients with chronic cough
Risk factors and phlegm production Work in any dusty job Smoke Heat or cook using an open fire Part of patients with risk factors Patients without phlegm Patients with phlegm
Risk factors and wheezing Work in any dusty job Smoke Heat or cook using an open fire Part of patients with risk factors Patients without wheezing Patients with wheezing
Risk factors and dyspnea Work in any dusty job Smoke Heat or cook using an open fire Part of patients with risk factors Patients without dyspnea Patients with dyspnea
Risk factors and medical diagnosis of chronic bronchitis Work in any dusty job Smoke Heat or cook using an open fire Part of patients with risk factors Patients without with established diagnosis Patients with with established diagnosis
Bronchial obstruction and risk factors Part of patients with risk factors Bronchial obstruction degree
Bronchial obstruction and medical diagnosis of chronic bronchitis Part of patients with established diagnosis Bronchial obstruction degree
Bronchial obstruction and chronic cough Part of patients with chronic cough Bronchial obstruction degree
Bronchial obstruction and chronic phlegm productin Part of patients with phlegm production Bronchial obstruction degree
Bronchial obstruction and weezing Part of patients with wheezing Bronchial obstruction degree
Have ever taken drug for respiratory diseases Stage Drug category 5-14 years 15-49 years >= 50 years Household based clinical survey & lung function test Antibiotics Inhalation bronchodilators Theophylline 13.71 0.33 1.00 11.99 1.37 2.57 14.03 1.11 4.68 Mucolitics 2.34 5.31 6.90 Inhalation glucocorticoids 0.33 0.34 0.22 Oral steroids 0 0.68 0.22
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