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GARD
Global Alliance against Chronic
Respiratory Diseases
WHO
J Bousquet, R Dahl, N Khaltaev, HJ Bekedam
www.who.int/chp
GARD Launch Press Conference
N Zhong (China): Chronic respiratory diseases (CRD) are a major burden in
China
S Hurd (USA): The burden of CRD
N Khaltaev (WHO): From the fragmented CRD programs to GARD
J Bousquet (France): The GARD action plan
M Boland (Ireland): Health promotion and CRD prevention
J Walsh (USA): The patient’s expectations
Suzanne S. Hurd - USA
The burden of CRD
• The World Health Organization estimates that over 1 billion people suffer from chronic respiratory diseases worldwide
• Prevalence and severity are increasing globally
• Cause substantial socioeconomic burden to individuals and societies
• In all countries, chronic respiratory diseases are:
– Under recognized
– Under diagnosed
– Under treated
Chronic Respiratory Diseases: An Increasing Global Public Health
Problem
Chronic Respiratory Diseases (CRD)
• Asthma• Allergic rhinitis• Chronic obstructive
pulmonary disease (COPD)
• Secondary pulmonary hypertension
• Occupational chronic respiratory diseases
• Chronic rhinosinusitis
• Post-infectious chronic respiratory diseases
• Lung cancer; neoplasms of the respiratory organs
• Pulmonary embolism• Cor pulmonale• Sleep apnea syndrome• Lung fibrosis
Injuries
Other Chronic Diseases
Diabetes
Chronic RespiratoryDiseases (CRD)
Cancer
Cardiovascular
Communicable diseases; Maternal/perinatal,Nutritional deficiencies
Source: Preventing Chronic Diseases, a vital investment, WHO, 2005
7%
> 4,000,000
Global Distribution – Chronic Disease Mortality: All ages,
2005
19991999 20202020
Increasing Burden of Diseases and Injuries:Change in Rank Order of DALYs*
*DALY = Disability-adjusted life year
1. Acute lower respiratory infections2. HIV/AIDS3. Perinatal conditions4. Diarrhoeal diseases5. Unipolar major depression6. Ischemic heart disease7. Cerebrovascular disease8. Malaria9. Road traffic injuries10. COPD10. COPD11. Congenital abnormalities12. Tuberculosis
1. Ischemic heart disease2. Unipolar major depression3. Road traffic injuries4. Cerebrovascular disease5. COPD5. COPD6. Acute lower respiratory
infections7. Tuberculosis8. War9. Diarrhoeal diseases10. HIV ……. 15. Trachea, bronchus, lung
cancers
Source: WHO Evidence, Information and Policy, 2000
Chronic Respiratory Diseases
(CRD)
Global Prevalence
Asthma > 300 million
Allergic rhinitis > 400 million
Chronic obstructive > 80 million moderate pulmonary disease to severe COPD; many millions with mild COPD
Burden of Asthma
• Asthma is one of the most common chronic diseases in the world
• Prevalence ranges from 1% to 18%
• An estimated 250,000 deaths annually, many of them preventable
• Direct costs (hospital, medications) account for 1-3% of total medical expenses in most countries
Affordability of Asthma DrugsModerate persistent asthma, 1998
0 100 200 300 400
Turkey
Burkina Faso
Ivory Coast
Mali
Guinea
Syria
Vietnam
Algeria
Drug cost (per year) Nurse's salary (per year)
N. Ait-Khaled and al Int J Tuberc Lung Dis 2000; 4, 3: 268-271
Cost in US$
Burden of COPD
• COPD is a major cause of morbidity, mortality and disability
• High prevalence, morbidity and mortality of COPD present challenges for healthcare systems
• Despite its ease of diagnosis, COPD remains an under-diagnosed disease, chiefly in its milder and more treatable form
COPD Mortality by Gender, USA, 1980-2000
0
10
20
30
40
50
60
70
1980 1985 1990 1995 2000
Men
Women
YearYear
Number Deaths x 1000Number Deaths x 1000Number Deaths x 1000Number Deaths x 1000
Source: Mannino D, US CDC, August 2002
Cigarette Smoke
Environmental tobacco smoke
Fumes/gases
Indoor/outdoor pollution
Occupational
dusts
Risk Factors for COPD
Nutrition
Socio-economic status
Infections
Chronic Respiratory Diseases
are a
Global Public Health Problem
N Khaltaev - WHO
From the fragmented CRD programs to GARD
WHA resolution 53.17The 53rd World Health Assembly
• recognized the enormous human suffering caused by chronic respiratory diseases (CRDs)
• and requestedrequested the WHO Director General to continue
giving priority to the prevention and control of CRDs
• with special emphasis on developing countries and other deprived populations
WHA resolution 53.17, May 2000
endorsed by all 191 WHO Member States
WHO calls for a global and coordinated effortto fight chronic respiratory diseases
GARDGARD
GARD
• The Global Alliance against Chronic Respiratory Diseases (GARD) is a voluntary alliance of organizations, institutions, and agencies working towards a common vision to improve global lung health according to the local needs.
Vision:
A world where all people can breathe freely:A world where all people can breathe freely:
Breath for all.Breath for all.
Fragmented success stories
• Asthma and COPD plans:
- Brasil
- China
- Finland
- France
- Portugal
- USA
Experience from Brazil
• In Brazil since 2002 the ministry of health provides free pharmaceutical assistance for severe asthmatics.
• In the province of Salvador this lead to the reduction of 55% of hospital submissions. The mean annual income of families of severe asthmatics increased by 10 %.
• The public health system has saved 566 US$ per patient per year.
A Success Story: France
• Increase awareness on asthma (patients and public)
• Improve
– management of acute severe asthma
– follow-up of asthmatics
– diagnosis and management of childhood asthma in schools
• Increase patient education
• Better manage and prevent occupational asthma
• Surveillance of asthma and risk factors
Healthcare benefits from asthma intervention
As
thm
a In
dic
es(b
ase
10
0 in
198
1)
Reimbursement asthmaHospitalization daysDeath rate
Year
350
300
250
200
150
100
50
0
1981 1983 1985 1987 1989 1991 1993 1995
Haahtela et al, Thorax 1998
J Bousquet - France
The GARD Action Plan
Specific Objectives of GARD
Build a stepwise and integrated program of prevention and control of CRD.
Improve collaboration between the fragmented WHO and non-WHO programs.
Increase awareness of CRD.
Reduce the burden of CRD, and foster country-specific initiatives appropriate to local needs.
Focus on developing countries and deprived populations.
Specific Objectives of GARD
Availability and affordability of medications
Provide appropriate training for health care personnel.
Provide education to patients, care givers and families.
Comprehensive and integrated action is the means to prevent and control chronic diseases
Estimate population needs and advocate
• WG.1- Burden, risk factors and surveillance
(G Viegi, S Buist, Y Fukuchi)
• WG.2- Awareness and advocacy
(C Lenfant, A Turnbull, P van Cauwenberge)
Formulate and adopt policy
• WG.3- Prevention and health promotion
(M Boland, A Custovic)
• WG.4- Diagnosis of CRD and allergy
(K Rabe, S Wenzel)
• WG.5- Control of CRD and allergies, availability and affordability of drugs
(J Bousquet, E Bateman, L Fabbri, C van Weel)
• WG.6- Pediatric asthma
(C Baena-Cagnani, E Mantzouranis, FER Simons,
E Valovirta)
Identify Policy Implementation Steps
• The GARD action plan should be applied at the country level.
• A national coordination group will:– Provide existing national statistics on CRD – Assess the specific needs for the given
country – Review the GARD action plan – Determine the relevant issues for the country action plan – Develop a country-specific action plan
M Boland - Ireland
Health promotion and CRD prevention
Health promotion and disease prevention
Key messages:
• Everyone has the right to live in a clean air environment
• Environmental exposure to unhealthy environment causes incurable COPD, asthma, cardiovascular disease and cancer
• Complete elimination is the only way to remove the risk
• This applies to tobacco smoke and all other at risk environments
WG.3- Health promotion and disease prevention
Goals:
• Help all countries to build and implement policies to reduce the burden of – tobacco smoke, – indoor and outdoor pollution, – occupational hazards – and other risk factors of relevance for CRD
WG.3- Health promotion and disease prevention
Some WHO programs are already available:
– FCTC (Framework Convention on Tobacco Control)
– Healthy Environment for Children Alliance – WHO program on prevention of allergy and
asthma– Environment– Occupational diseases
Tobacco Cessation
0
5
10
15
20
25
30
35
1992 2000 2002 2004 2005
% Smoking
No. of Smokers fallen by 25%
‘Slan’ SurveysOTC/MRBI Tracker
Smoking Ban
WG.3- Health promotion and disease prevention
• Biomass fuels
– Over 2 billion people in the developing world burn traditional biomass fuels indoor for cooking and heating.
– Resulting in an estimated 1.6 million deaths each year, largely among women and children.
– Acute respiratory infections and COPD (700,000 deaths/yr)
J Walsh - USA
The patient’s expectations
Personal History of J. Walsh
• When did the disease start• Symptoms• Effects on daily life• Treatment• Expectations• Future
Patient’s Expectations from GARD
• Health care professionals should be able to recognize CRD at an early phase and introduce early management
• The patient must be taken more seriously about his/her symptoms
• Health care systems should be structured to manage patients with chronic disease, including regular and long term follow up
….continued
Patient’s Expectations from GARD (continued)
• Health care systems should develop a structured patient education, information and training programs
• General public should become more informed of CRDs problems and take a more positive attitude toward the needs of CRD patients
• Societies should be more receptive to the value of environmental changes
Doctors and Patients Doctors and Patients
must be must be
Partners in Care of Partners in Care of
CRDs.CRDs.
Doctors and Patients Doctors and Patients
must be must be
Partners in Care of Partners in Care of
CRDs.CRDs.
Conclusions• Hundreds of millions of people suffer from
chronic respiratory diseases
• Over 4 million people die prematurely each year
• Huge economic burden
• In all countries, and particularly in developing countries
• In all age groups
• Prevalence and mortality are increasing
www.who.int/chp