WHO/NMH/CHP/CPM/05.4

Global Alliance against Chronic

Respiratory Diseases (GARD)

Report of the General Meeting

Geneva, Switzerland, 10-11 May 2005

Noncommunicable Diseases and Mental Health Department of Chronic Diseases and Health Promotion Chronic Diseases Prevention and Management

Chronic Respiratory Diseases and Arthritis

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© World Health Organization 2006

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Printed by the WHO Document Production Services, Geneva, Switzerland

Acknowledgements WHO wishes to acknowledge the help of Ms Anna Bedbrook and Mrs Marie-Christine Nedelec in the organization of the meeting.

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Contents 1. Preamble............................................................................................................................................................... 4 2. Introduction ........................................................................................................................................................ 4

2.1 GARD stepwise approach .......................................................................................................................... 5 3. Building and promoting the Alliance ............................................................................................................ 6

3.1 Participant profiles...................................................................................................................................... 6 3.2 Atlas of chronic respiratory diseases......................................................................................................... 6 3.3 GARD logo ................................................................................................................................................. 7 3.4 GARD web site........................................................................................................................................... 7 3.5 Article in a scientific journal ..................................................................................................................... 8 3.6 Government and private-sector relations in preparation for the launch.................................................. 8

3.6.1 Issues involved in planning the launch ................................................................................................ 8 3.6.2 Discussion .............................................................................................................................................. 8

4. Country activities................................................................................................................................................ 9 4.1 Standardization of treatment: the WHO Stop TB approach .................................................................... 9 4.2 Practical Approach to Lung health (PAL) project in Tunisia.................................................................. 9 4.3 Primary health centre survey in Cape Verde .......................................................................................... 10 4.4 Primary health care survey in Ryazan (Russian Federation) ................................................................. 10

5. GARD action plan............................................................................................................................................ 11 5.1 Working group 1: Burden, risk factors and surveillance of chronic respiratory diseases ................... 11

5.1.1 Products available at WHO................................................................................................................. 12 5.1.2 Deliverables proposed for Step 1........................................................................................................ 12

5.2 Working group 2: Health promotion and prevention of chronic respiratory diseases ......................... 13 5.2.1 Products available at WHO................................................................................................................. 13 5.2.2 Deliverables proposed for Step 1........................................................................................................ 13

5.3 Working group 3: Diagnosis of chronic respiratory diseases ................................................................ 14 5.3.1 Products available at WHO................................................................................................................. 14 5.3.2 Deliverables proposed for Step 1........................................................................................................ 14

5.4 Working group 4: Control of chronic respiratory diseases and access to drugs................................... 14 5.4.1 Products available at WHO................................................................................................................. 15 5.4.2 Action plans. ........................................................................................................................................ 15 5.4.3 Availability and accessibility of drugs for all patients with chronic respiratory diseases .............. 16 5.4.4 National action plan coordination and coordinator ........................................................................... 16 5.4.5 Deliverables proposed for Steps 1, 2 and 3........................................................................................ 16

5.5 Working group 5: Paediatric chronic respiratory diseases .................................................................... 16 5.5.1 Products available at WHO................................................................................................................. 17 5.5.2 Discussion ............................................................................................................................................ 17

5.6 Working group 6: Awareness and advocacy for chronic respiratory diseases ..................................... 17 5.6.1 Products available at WHO................................................................................................................. 17

5.7 Research needs and genomics ................................................................................................................. 18 5.7.1 World Health Assembly resolution .................................................................................................... 18 5.7.2 Promotion of WHO’s role in genomics research and facilitation of exchanges between developed and developing countries ................................................................................................................................... 18

6. General discussion ........................................................................................................................................... 19 7. Issues related to Terms of Reference............................................................................................................. 19

7.1 Discussion ............................................................................................................................................ 20 8. References........................................................................................................................................................... 21 9. List of participants .......................................................................................................................................... 22 10. Annex: GARD Participants as of May 2005………………………………………… ………………. 25

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1. Preamble The enormous human suffering caused by chronic respiratory diseases was recognized by the Fifty-third World Health Assembly, which requested the WHO Director-General to continue giving priority to the prevention and control of noncommunicable diseases, including chronic respiratory disease, with special emphasis on developing countries and other deprived populations.1

After several consultations (WHO Headquarters, Geneva, 11-13 January 2001 (1); Montpellier, 11-12 February 2002 (2); Montpellier, 27-28 July 2002 and Paris, 10 June 2003 (3); WHO Headquarters, Geneva, 17-19 June 2004 (4)), the Global Alliance against Chronic Respiratory Diseases (GARD) was approved by WHO and the first GARD meeting was held at WHO Headquarters, Geneva, on 18-19 January 2005 (5).

This report summarizes the consultation of experts from 33 governmental and nongovernmental organizations who participated in the General Meeting of GARD (WHO Headquarters, Geneva, 10-11 May 2005).

2. Introduction Dr Robert Beaglehole, Director, Department of Chronic Diseases and Health Promotion, Noncommunicable Diseases and Mental Health, World Health Organization, opened the meeting and welcomed the participants. Chronic respiratory diseases are high on the global health agenda. WHO has a mandate from the World Health Assembly to address the issue, and Member States give high priority to chronic respiratory diseases. GARD needs to prepare a comprehensive action plan and provide rational and integrated advice. Its work plans should be clear and unambiguous. Dr Beaglehole proposed that recommendations should be phased out and replaced by a stepwise approach in order to make best use of the additional resources which will be made available. The Framework Convention on Tobacco Control started with a simple approach and was transformed into a global action plan after a number of years.

However, it is important to create an integrated action plan with other chronic diseases, such as cancer, cardiovascular disease and diabetes. This is essential in low-income and middle-income countries, where separate action plans are not feasible, partly because of limited resources. Thus, the integrated approach should be extended to all chronic diseases, particularly since many of them share similar risk factors. It is more important to assess all diseases and risk factors globally than to determine risk factors individually.

GARD should be represented in all countries, although it is of particular interest to low-income and middle-income countries. More participants should be recruited from those countries. The gender balance among representatives should also be considered.

Dr Nikolai Khaltaev, Responsible Officer, Chronic Diseases Prevention and Management, WHO, said that the meeting was intended to formalize the GARD structure, organization and launch. The Alliance should focus on an integrated approach to chronic diseases, with chronic respiratory diseases as one component.

For this meeting, the participants nominated Dr Jean Bousquet, France and Dr Ronald Dahl, Denmark to serve as Co-Chairs and Dr Bruce Pfleger, United States of America and Dr Paolo Matricardi, Italy, to serve as Co-Rapporteurs.

1 World Health Assembly resolution WHA53.17 of 20 May 2000, endorsed by all WHO Member States (191

at that time).

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2.1 GARD stepwise approach GARD is to adopt a stepwise approach with short-term (Step 1), medium-term (Step 2) and long-term (Step 3) objectives and action plans (Fig. 1). Specific, measurable deliverables will be proposed for each step.

In Step 1, (2005-mid-2006), GARD will draw up a list of priorities and an action plan to be used by national coordination groups in order to build up a country-based approach (Fig. 2)

In Step 2, (mid-2006-end 2008), the integrated GARD action plan will be developed and pilot demonstration studies will be started in countries.

In Step 3, (2007-2010), the GARD action plan will be integrated into the global chronic disease action plan, adapted as necessary in the light of the pilot studies and implemented in a number of countries.

Fig. 1

GARD stepwise approach

GARD stepwise approach

GARD priorities

Integrated GARD action plan

Integrated NCD/GARD

action plan

Step 1Step 2

Step 3

2005 2006 2007 2008 2009 2010

Pilot studies in countries

GARD action plan in countries

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Fig. 2

GARD Step 1 action plan

WG – Working Group; CRD – chronic respiratory disease; PAA – Prevention of Allergy and Allergic Asthma; PFT – pulmonary function testing; PAL – Practical Approach to Lung health; PALSA – Practical Approach to Lung health in South Africa; COPD – chronic obstructive pulmonary disease; GIFT – WHO Global Initiative for Treatment of Major Chronic Diseases.

3. Building and promoting the Alliance During the first GARD meeting (WHO Headquarters, 18-19 January 2005), several proposals were made for building and promoting the Alliance. These proposals were updated and presented at the current meeting.

3.1 Participant profiles Dr Eva Mantzouranis presented a template to be used as a guide for illustrating the profile of the GARD participant organizations. The information submitted should include the name of the organization, the year it was established, the president or a contact individual within the organization, the title of the organization's official journal(s) (if any), the URL of its web site, its mission, the category of organization, the interest sections of its assemblies, the number of members and their representation in the WHO regions. The participants' profiles will be posted on the GARD web site.

Each organization will revise the draft sent by Dr Mantzouranis and sign an agreement form authorizing the information to appear on the GARD web site. Forms should be received by the WHO GARD secretariat office before the end of July 2005. The participants' profiles form part of the GARD Step 1 action plan (Fig. 2).

3.2 Atlas of chronic respiratory diseases Work on the atlas will begin soon, but it will not be completed in the period covered by the Step 1 action plan.

WG1

• inventory of studies

• risk factors

• prevalence/morbidity

• economic burden

• CRD module in STEP

• CRD module in Infobase

WG2

• tobacco ban action plan

• update Prevent Allergy Asthma

• healthy indoor environment

WG3

• Pulmonary function tests

• simple allergy diagnosis

WG4

• PAL

• PALSA

• asthma

• rhinitis

• COPD

• infections in COPD

• Pulmonary Hypertension

• occupational CRD

• sleep CRD

• accessibility of drugs (GIFT)

WG5

• inner city asthma programme

• priorities in childhood asthma

WG6

Genomics

Promotion of the Alliance

• GARD participant profile

• GARD logo

• GARD web site

• GARD atlas

• GARD launch documents

Description of some priorities

06-05 09-05 10-05 12-05 02-06 04-06

GARD Step 1 action plan

Step 2

Continuous update

Launch

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3.3 GARD logo Organizations are asked to propose an eye-catching logo for GARD before the end of June 2005. The proposed designs will be circulated and a decision will be taken at the next GARD meeting.

3.4 GARD web site Dr Bruce Pfleger presented the new web site for chronic respiratory diseases, which is being developed at WHO. The main sections on the site will cover GARD, chronic obstructive pulmonary disease, asthma, other chronic respiratory diseases and publications. The home page includes information on the structure and financing of the Alliance and will include the participant profiles.

Various ways of navigating the WHO site were discussed, as were links to the developing site. The web site will list the GARD participants and provide links to their own web sites. Any site may link to WHO, as long as the link is not used for advertising or endorsement. WHO will only link to external partners if it is working closely with them.

The web site will be developed initially in English; it may be translated into one or more of the other five United Nations official languages in future, if the necessary resources become available. Documents and reports in English or other languages will be posted in PDF and HTML formats. Each document must be approved by the national coordinator of the originating country.

The launch of the GARD web site is part of the Step 1 action plan and should take place before 1 September 2005. The home page is shown in Fig. 3. Fig. 3

GARD home page: http://www.who.int/respiratory/gard/en

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3.5 Article in a scientific journal Dr Bousquet agreed to draft a short paper about GARD for submission to a scientific journal (The Lancet and the British Medical Journal were suggested: Dr Bousquet proposed the New England Journal of Medicine).

3.6 Government and private-sector relations in preparation for the launch

Mr Igor Rozov (Government, Civil Society and Private Sector Relations, External Relations and Governing Bodies, WHO) explained that he and his colleagues had helped to launch a number of initiatives similar to GARD. On the basis of his experience, he raised a number of issues which stimulated further discussion.

3.6.1 Issues involved in planning the launch A partnership must have an identified purpose and clear objectives, which must be accepted by the WHO Member States. For example, the Vision 2020 campaign, involving about 30 nongovernmental organizations and coordinated by the WHO Prevention of Blindness and Deafness unit, had stated early on that its purpose was to eliminate preventable blindness which, it is estimated, constitutes 80% of the overall burden.

When considering the financing needed to initiate a launch, the partnership must pay particular attention to long-term financing. This can best be achieved by linking the activities surrounding the launch with resource mobilization.

A memorable name is needed for the Alliance. Slogans such as “the right to sight” were used for Vision 2020. “GARD, the right to breathe” was suggested.

The communication campaign should be carefully planned in advance and include the following: a press kit, consisting of a press release and fact sheets; a video news release, prepared in advance and preferably involving prominent public figures; carefully planned media events, with the participation of prominent figures to attract media attention. A panel, consisting of around four experts and the Minister of Health of the host country, should hold a press conference for the launch.

The site of the launch is critical. It should be a major developing country, such as India or China, where the burden of chronic respiratory disease is high and GARD prevention and treatment initiatives could have a strong impact. The launch must enjoy the full support of the Government. Regional and public relations launches should follow. These help to bring the messages of the partnership before the targeted audiences.

Public relations campaigns are expensive, but WHO can conduct a campaign more effectively and at lower cost than external agencies. WHO has a list of 5000 media outlets for the press kit. A campaign including production of a press kit, translation into 1-5 languages, distribution of the kit, production of a video and monitoring of its exposure in the media would cost around US$50 000. A similar campaign using an external public relations organization would cost between US$220 000 and US$250 000.

Raising awareness is not enough by itself. A plan of action, targeted initially at 1-2 regions rather than globally, will coordinate better with the public relations campaign.

3.6.2 Discussion A participant asked whether the launch would attract money for local action plans only, or also for regional or global use. One solution would be to ensure that a percentage of local funds goes to the region.

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The location of the launch was discussed again. It was pointed out that a launch in Geneva would have some advantages: WHO’s presence would be obvious, some 250 press correspondents are located nearby, and some costs would be reduced. However, the advantages of launching in China or India were again stressed.

A final comment was made pointing out that the success or otherwise of a launch could not be predicted in advance: a high-impact global story, such as the Asian tsunami of December 2004, would inevitably dominate the media.

4. Country activities 4.1 Standardization of treatment: the WHO Stop TB approach The Stop TB Partnership represents an alliance of various groups and individuals working in the field of tuberculosis, coordinated by the WHO Stop TB Department. Dr Salah-Eddine Ottmani of the Stop TB Department stressed the significance of tuberculosis around the world. Tuberculosis rates are still increasing, but globally the rate of increase is slowing down, albeit with considerable differences between countries.

Despite the great variations between health care systems, it is essential to follow universal standards of diagnosis and treatment. Diagnostic standards cover laboratory findings and the need to consider concomitant conditions (e.g. HIV/AIDS). Treatment should take a patient-centred approach, and patients’ response to therapy should be monitored. Standards should be consistent with tuberculosis guidelines: at present, however, there are around 80 different guidelines, which should be combined into an international standard.

All health care providers are responsible for providing adequate treatment and ensuring the best possible compliance. Treatment is now standardized, but a patient-centred approach should be developed for all patients. New and recurring tuberculosis cases and their treatment outcomes should be reported to local public health authorities in line with national legislation.

4.2 Practical Approach to Lung health (PAL) project in Tunisia Dr Ali Ben Kheder reported the results of a PAL pilot study in Tunisia. PAL was officially approved by the Tunisian Government in December 2003, and a pilot study was carried out in four districts of Tunis: the baseline study was conducted in January-February 2004. The training period consisted of a two-day course for 73 general practitioners (of the 98 originally proposed). The impact study was carried out in March-April 2004 to assess the effect of training on the health of patients over five years of age with respiratory symptoms.

Selected results show that respiratory patients accounted for 36% of all patients in the baseline study and 31% of the patients in the impact study. At baseline, 58.3% of the patients had acute bronchitis; 34.3% acute upper respiratory infections; 4% asthma; 2.5% pneumonia; 1.4% chronic obstructive pulmonary disease; 0.2% tuberculosis.

When the patient population at the impact stage was compared with the baseline stage, significant increases were seen in diagnoses of asthma, chronic obstructive pulmonary disease and tuberculosis. Significant changes were also seen in the syndrome used for diagnosis (cough, dyspnoea, sputum). Referrals rose significantly, as well as requests for sputum smear examination. A significant decrease was observed in the number of drugs used per patient and the number of antibiotics prescribed, which resulted in an average cost saving of 19.3% on prescriptions. Total direct costs decreased as well.

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4.3 Primary health centre survey in Cape Verde Dr José Rosado Pinto described the health system in Cape Verde, which is well-developed in comparison with other sub-Saharan African countries. In particular, there are physicians in all primary health centres, and the hospitals are equipped for the management of patients with chronic respiratory diseases and allergies.

An epidemiological survey showed that the prevalence of asthma is around 8% in children. Five per cent of children admitted to paediatric emergency care units are asthmatic patients. A protocol for assessing the prevalence of major chronic respiratory diseases in Cape Verde has been drawn up by Isabella Annesi-Maesano, Nikolai Khaltaev and Paolo Matricardi. The Portuguese version of the protocol (adapted for local use in Cape Verde) was presented during the meeting.

A two-stage project is to be developed under the responsibility of WHO and the Ministry of Health, with Portuguese collaboration. The first stage will examine the prevalence of respiratory diseases, using a population-based survey of 4000 inhabitants. The survey will cover chronic obstructive pulmonary disease, asthma, allergic rhinitis, tuberculosis and pneumonia. Spirometry will be applied to a subsample. During the second stage, patients with respiratory symptoms will be evaluated by means of a questionnaire and spirometry measurement by both general practitioners and WHO-recommended respiratory experts. The problem of underdiagnosis and undermanagement of respiratory diseases at the primary health care level will be addressed. Future plans include expansion of the study to other Portuguese-speaking populations.

4.4 Primary health care survey in Ryazan (Russian Federation) Dr Alexander Chuchalin reported on the results of the Primary Health Care survey carried out between October 2004 and March 2005 in Ryazan (Russian Federation) in close collaboration with Dr Nikolai Khaltaev. The Ryazan region is approximately 175 km south of Moscow. It is 39 600 km2 in size. Its population is 1 306 600 (urban population: 68.4%). It is divided into 25 districts and includes 12 towns, 26 urban-type settlements and 456 rural administrations. The capital is Ryazan, with 536 900 inhabitants.

Two population centres, Scopin district with 40 000 people and Shilovo district with 60 000 people, were chosen to assess the prevalence of respiratory diseases. The region’s health care system consists of 104 hospitals, 65 outpatient clinics and 792 feldsher stations (a small clinic, usually with one medical assistant). A multistage study is underway to assess the burden of chronic respiratory disease. Lung function tests were carried out on around 45% of subjects. Risk factors were assessed.

A pilot study was conducted in October 2004 to finalize the questionnaire and protocol and recruit the necessary health professionals. A population-based survey was conducted in primary health care settings towards the end of 2004, involving residents over five years of age. The questionnaire covered symptoms, diseases, diagnoses, comorbidity, sociodemographics and risk factors. The survey was then conducted in households, likewise covering subjects over five years of age.

In February-March 2005, a clinical survey and lung function test were conducted in 16 randomly selected primary health care settings. All patients from the household stage were included. Selected results show that males are at far greater risk, owing to the high prevalence of smoking (60% of male adults and 8% of male children smoked) and exposure to dust at work (40% of males and 20% of females). The prevalence of dyspnoea, cardiovascular disease and chronic respiratory diseases is twice as high in women as in men. Sputum

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production occurs in 14% of men and 4% of women. The prevalence of chronic obstructive pulmonary disease, at 1.6%, is similar to other parts of the Russian Federation. Low pulmonary function was found in 14% of the population. The underuse of asthma treatment is significant, since less than 1% of asthmatics were treated by inhaled corticosteroids. Theophylline was the most common drug administered.

5. GARD action plan During the first GARD meeting (5) working groups were set up to develop an action plan, using existing materials from WHO or other action plans to meet the objectives of GARD. During the current meeting, Step 1 action plan deliverables were proposed for each working group so that they could be prepared by the end of 2005. The action plan will be used by national coordination groups in order to create a country-based approach (Fig. 4). Some proposals for Steps 2 and 3 were also put forward.

Fig. 4 From GARD action plan to national action plan

5.1 Working group 1: Burden, risk factors and surveillance of chronic respiratory diseases

Chair: Dr Giovanni Viegi; Vice-Chair: Dr Sonia Buist This working group should work closely with working groups 2 and 6 on prevention and awareness. Dr Giovanni Viegi presented data based on the European lung white book (6). This book, produced by the European Respiratory Society, is a comprehensive survey of lung health. The text includes a preliminary inventory of studies indicating the prevalence of respiratory diseases and risk factors and a preliminary inventory of studies on the economic burden of disease. Dr Viegi also presented recent epidemiological data from the European Community Respiratory Health Survey, from the Obstructive Lung Disease in Northern

GARD National

Action plan endorsed

by Ministry of Health

GARD National

Action plan

GARD

Action plan

National

Coordination

Members of national societies

respiratory

allergy

ENT

GPs

pharmacists

others

Members of NGOs

Patients

Member of Health Ministry

Others if required

From GARD action plan to National action plan

Test in selected countries

(WHO regions)

with indicators of success

12-05

06-06

12-06

Starting 06 to 12-06

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Sweden (OLIN) studies, and from the Po Delta and Pisa studies. He drew particular attention to the 2003 article in Chest by Halbert RJ et al. (7), which clearly showed that the WHO expert opinions on which the Global Burden of Disease report (8) is based may underestimate the true figure by up to a factor of 10. Finally, Dr Viegi presented a list of preliminary deliverables.

Important activities in the GARD epidemiology project include linking its results with similar efforts at WHO, such as the Surveillance of Risk Factors (SuRF) project which, in collaboration with the chronic respiratory diseases unit, is adding the chronic respiratory disease modules to its database, and the STEPwise approach to Surveillance of risk factors (STEPS) project. Methodologies must be standardized: epidemiology studies need to employ standard disease definitions and methods for diagnosis (at present, estimates of chronic obstructive pulmonary disease prevalence may be incorrect owing to a lack of uniformity). A comprehensive approach should be adopted, employing tools which also capture other diseases associated with the same risk factors, such as cardiovascular disease. The number of patients should be counted as well as the number of diseases, as the latter approach may mean that the same patient is counted more than once. Finally, Dr Viegi emphasized the usefulness of the Burden of Obstructive Lung Disease (BOLD) study (9) for capturing economic cost data. 5.1.1 Products available at WHO

• A standardized, validated questionnaire to assess national capacity for surveillance, prevention and control of chronic respiratory diseases.

• A methodology for collecting existing information on the prevalence of chronic diseases and their risk factors (Global InfoBase).

• A methodology for acquiring new information on the prevalence of chronic diseases and their risk factors (STEPwise approach).

• A methodology for assessing patients with respiratory symptoms at the primary health care level.

5.1.2 Deliverables proposed for Step 1 The first deliverables for Step 1 should include preliminary inventories of existing studies of prevalence rates of diseases and risk factors, and existing studies providing data on the economic burden of disease.

Dr Sonia Buist noted that better awareness of chronic respiratory diseases will actually increase the number of patients identified as having chronic respiratory disease, as well as the burden on health services, although one of the goals of GARD is to reduce the burden of chronic respiratory diseases. This point should be clearly stated when the long-term goals of GARD are proposed.

Dr Ali Kocabas gave details of the prevalence of chronic obstructive pulmonary disease in Adana, Turkey, taken from the BOLD study (9). Physicians diagnosed chronic obstructive pulmonary disease in 5.7% of adults over 40 years of age. However, if the criteria of the Global Initiative for Chronic Obstructive Lung Disease are used, there are indications of a very substantial underdiagnosis of this disease.

Dr Eva Mantzouranis gave an update on the chronic respiratory diseases module of the WHO Global Infobase. Asthma will be the first module to be added to the infobase, using data from the International Study of Asthma and Allergy in Children (ISAAC) and the European Community Respiratory Health Survey (ECRHS). There are considerable

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differences in prevalence and incidence of asthma within a single country, and mean values may not be sufficient. The Global Burden of Asthma report (10) may be difficult to add to the module, because it gives the overall prevalence or incidence within a country. However, the figures from this document could be used for other purposes, such as the web site. For rhinitis, data from the ISAAC and ECRHS studies will also be used.

5.2 Working group 2: Health promotion and prevention of chronic respiratory diseases

Chair: Dr Michael Boland; Vice-Chair: Dr Adnan Custovic Dr Michael Boland commented on health promotion and disease prevention. National governments have various priorities. GARD needs to create a situation where environmental control and a ban on tobacco smoking are at the top of the agenda. There is also a need to generate enthusiasm about the impact of GARD and convince the world that GARD is really going to make a difference to health. Chronic obstructive pulmonary disease is underdiagnosed and undertreated, and affects many poor people.

Dr Boland made some proposals for an optimal action plan at the country level. The national coordinator will be the champion of the campaign and should have some access to the Government or parliament. The national coordinator should have an appropriate support structure.

Everyone in the country – patients, physicians and legislators – should be educated about the importance of chronic respiratory diseases. Trade unions and workers’ representatives are the campaign’s natural allies, defending people’s right to work in a smoke-free environment. Public education campaigns must be conducted for several years in order to form public opinion before new legislation is adopted, and successes must be widely publicized.

Indoor air pollution is of great concern, since over 2 billion people in the developing world burn traditional biomass fuels indoors for cooking and heating and are thus exposed to health risks. WHO estimates that increased exposure in this group leads to an estimated 1.6 million premature deaths each year, largely among women and children. Chronic respiratory diseases are an environmental health issue. The Partnership for Clean Indoor Air (11) has the mission of improving health, livelihood and quality of life by reducing exposure to air pollution, primarily among women and children, from household energy use. 5.2.1 Products available at WHO

• A series of tools produced by the Tobacco Free Initiative for the implementation of the Framework Convention on Tobacco Control.

• A document on prevention of allergy and allergic asthma (12). • The Indoor Air Pollution and Exposure Database: Household Pollution Levels in

Developing Countries. 5.2.2 Deliverables proposed for Step 1 Tobacco ban action plan: the action plan for the Framework Convention on Tobacco Control and plans which have been successful at the country level (e.g. in Ireland) should be reviewed in order to identify simple measures which can be used at Step 1. The number of countries where GARD helps to implement tobacco-free initiatives and encourage ratification of the Framework Convention on Tobacco Control may provide an outcome measure for Step 3.

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Improvement of indoor air quality in dwellings, in particular in developing countries, to reduce chronic obstructive pulmonary disease: tobacco smoke is a major cause of indoor air pollution in high-income countries. However, in many middle-income and low-income countries (e.g. China), chronic obstructive pulmonary disease is a major disease in nonsmoking women because of indoor heating and cooking in dwellings with insufficient ventilation. Simple proposals should be made to improve ventilation in new buildings and, where possible, in older ones (Step 1). Any barrier that may apply to this action plan should be discussed at both national and regional levels. For Step 2, GARD should produce a document on indoor air pollution.

Allergy prevention: the WHO publication on prevention of allergy and allergic asthma (12) was based on a WHO workshop in January 2002. For Step 2, an update will be proposed by members of working group 2.

5.3 Working group 3: Diagnosis of chronic respiratory diseases Chair: Dr Klaus Rabe; Vice-Chair: Dr Sally Wenzel The goal of this working group is to develop an integrated action plan for the diagnosis of chronic and related allergic respiratory diseases. However, this cannot be achieved in Step 1.

Dr Klaus Rabe presented a strengths/weaknesses/opportunities/threats (SWOT) analysis for the diagnosis of chronic respiratory diseases. The strengths are a broad approach, global backing, the prevalence of these diseases and the simple messages which can be disseminated about lung function and allergies. The weaknesses are the heterogeneity of chronic respiratory diseases, countries and providers. There are opportunities to combine our efforts, put chronic respiratory diseases on the global map, introduce pulmonary function tests for all and increase awareness of allergies. The threats are the timeless nature of the chronic disease problem, the issue of deliverables and implementation.

The Practical Approach to Lung health (PAL) is used in primary health centres. It is a syndromic approach to respiratory symptoms: however, where possible, objective methods should be added to supplement the symptomatic approach.

5.3.1 Products available at WHO • Diagnostic algorithms in the PAL guidelines.

5.3.2 Deliverables proposed for Step 1 Availability and accessibility of pulmonary function tests for all patients is an essential part of GARD. Working group 3 should work closely with the Forum of International Respiratory Societies for this purpose and prepare a report by 31 December 2005.

Availability and accessibility of simple and affordable allergy tests is an important part of GARD. Working group 3 should prepare a report by 31 December 2005.

5.4 Working group 4: Control of chronic respiratory diseases and access to drugs

Chair: Dr Jean Bousquet; Vice-Chairs: Dr Eric Bateman, Dr Leonardo Fabbri, Dr Chris Van Weel GARD’s principal role is not to devise new guidelines, but to catalogue existing guidelines and lend the authority of organizations and WHO to certain of them. The goal of this working group is to create an integrated action plan for the control of chronic respiratory and related allergic diseases, which should be implemented in Step 2.

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5.4.1 Products available at WHO • Practical Approach to Lung health (PAL) guidelines. • Global Initiative for Treatment of Major Chronic Diseases (GIFT).

5.4.2 Action plans. Action plans need to be tailored to low-income, middle-income and high-income countries or regions within countries.

In areas where communicable diseases are prevalent and primary health centres exist, the PAL approach will be used. The number of countries where this approach is implemented may be one of the deliverables for years 3 and 5.

In areas where there is also an HIV epidemic, the Practical Approach to Lung health in South Africa (PALSA) will be used. The number of countries where PALSA is implemented may be one of the deliverables for years 3 and 5.

In developed countries, PAL is only applicable to some low/middle-income areas. A comprehensive group of diseases should be considered, including asthma/rhinitis, chronic obstructive pulmonary disease and its related infections, occupational lung diseases, chronic respiratory diseases associated with sleep disorders and pulmonary vascular disease. Additional diseases can be added depending on the country.

The proposed group of experts should review the available management plans which have already been successfully introduced in various countries, and establish a list of priorities by 31 December 2005. For each disease, the group of experts will propose a list of up to six priorities.

The following process is proposed. For each disease, two or three experts will review the available management plans after the European Respiratory Society congress (Copenhagen, 21-22 September 2005). The final list of priorities will be drawn up by 30 October 2005 and will then be submitted to the group of experts (including health economists) by 15 December 2005. Fig. 5

Distribution of diseases depending on the economic status of the country

communicable

diseases

noncommunicable

diseases

low -incomecountry

middle -incomecountry

high -incomecountry

Distribution of diseases depending on the

economic status of the country

16

5.4.3 Availability and accessibility of drugs for all patients with chronic respiratory diseases

This is essential. Members of this working group should meet the members of the Global Initiative for Treatment of Major Chronic Diseases (GIFT) and prepare a report by 31 December 2005. The working group should collaborate closely with the International Union Against Tuberculosis and Lung Disease, which is launching an important action plan on drug donations for asthma (beclomethasone and salbutamol).

5.4.4 National action plan coordination and coordinator In order to initiate changes in action plans at the country level, coordination should take place between GARD and the national coordination group, leading to a national GARD action plan to be approved by the Minister of Health. Resulting action plans should be tested in selected countries, with success indicators. Implementation of the final action plan should begin by 2007.

The GARD action plan should be applied at the country level. There is therefore a need to establish working groups in the different countries, with a national action plan coordinator. The group will include members of societies of respiratory, allergic, paediatric, ear/nose/throat and occupational diseases; members of societies of internal medicine, general practitioners, public health (including pharmacoeconomics) and lung health associations; other health care workers; patients and representatives from the Ministry of Health (Fig. 4).

The national coordination group will assess the needs of the country in question, review the GARD action plan and identify specific needs and proposals required to adapt it to the country’s needs and develop a country-specific action plan. 5.4.5 Deliverables proposed for Steps 1, 2 and 3 The following deliverables should be proposed: a written action plan for Step 1; an integrated action plan for Step 2; number of countries with a national coordination group (after one year (Step 1), three years (Step 2) and five years (Step 3)); number of countries where the GARD action plan has been approved by the Ministry of Health (after three years (Step 2) and five years (Step 3)); number of countries where the GARD action plan has been implemented (after five years (Step 3)).

5.5 Working group 5: Paediatric chronic respiratory diseases Chair: Dr Carlos Baena-Cagnani; Vice-Chairs: Dr Erkka Valovirta, Dr Estelle F. Simons The GARD action plan, as applied to children, should consider low-income, middle-income and high-income settings, and establish short-term, medium-term and long-term goals. The focus initially should be on asthma and rhinitis, the major chronic respiratory diseases in children.

An asthma management plan for children based on the inner-city asthma management plan will be used in low-income areas of developed countries and in suburban areas of developing countries. The deliverable will consist of a short action plan document (10 printed pages or shorter) (Step 1). In developed countries, the short-term action plan should list up to six priorities for asthma. The group of experts should review the available management plans which have already been successfully introduced in various countries, and establish a list of priorities for Step 1. Rhinitis is a significant comorbid condition of asthma in children, and should be taken into consideration as well. An integrated recommendation for diagnosing and treating asthma in schoolchildren should be prepared for Step 2. GARD should use data from the ISAAC phase III study for the prevalence of asthma and wheeze in children.

17

Epidemiological studies should begin in low-income areas where no data currently exist, in order to assess the prevalence and severity of childhood asthma. These studies should be discussed and proposed between the Working groups 1 and 5, at step 2. Management of recurrent wheezing in infants and in preschool children should be considered separately. 5.5.1 Products available at WHO

• None 5.5.2 Discussion The GARD recommendations should cover the best available options, but alternatives should be included for low-income and middle-income countries. Research is needed to determine the prevalence and severity of asthma in areas where no data are available. More information and action plans are required about passive and active smoking in children, particularly in developing countries. Lung function tests cannot be performed in children under 5-6 years of age. Furthermore, many asthmatic children have normal pulmonary function tests. The importance of differential diagnosis was emphasized.

5.6 Working group 6: Awareness and advocacy for chronic respiratory diseases

Chair: Dr Claude Lenfant; Vice-Chairs: Mr Archie Turnbull, Dr Paul Van Cauwenberge The two guiding questions for GARD in relation to awareness are “who should be aware?” and “what should they be aware of?”. There are three target populations to which GARD must effectively convey its message.

Governments have a critical role to play, and WHO is in a good position to address them. The World Health Assembly will not consider GARD in 2005, but could do so in future years. The Bulletin of the World Health Organization could also prove an effective medium.

Physicians, although not able to cure chronic diseases, are still the key to implementation of GARD. The pharmaceutical industry can play a big role in education. However, there should be rules governing the interaction between GARD and the private sector (5).

Patients and the general public remain the ultimate focus of GARD. The media and the Internet will be of great importance. Asthma has benefited from the fact that many famous athletes have competed on the world stage despite having the disease. Chronic obstructive pulmonary disease has not benefited the same way, partly because of the stigma associated with it, since patients have brought the disease upon themselves. Nevertheless, the use of celebrities to raise public awareness should be explored. Education of children can be very effective, as they can strongly influence their parents and raise issues which will lead to the message of GARD. We also need to involve “important people” to raise awareness of GARD.

There are 192 Member States of WHO, with enormous differences in economic status and health systems. It is impossible to reach them all with a single message. For example, spirometry is generally recommended for diagnosis, but most people in the world do not have access to it. 5.6.1 Products available at WHO See references 1, 2, 3, 12, 13, 14, 15.

18

5.7 Research needs and genomics There are many gaps in the understanding of chronic respiratory disease. Research is needed in order to assess the disease burden and risk factors more effectively, improve surveillance and identify better methods of diagnosis, control and prevention.

5.7.1 World Health Assembly resolution At its fifty-seventh session in May 2004, the World Health Assembly adopted Resolution WHA57.13, in which it, inter alia: expresses the wish to promote the potential benefits of the genomics revolution for the health of populations in developed and developing countries alike; calls upon Member States to facilitate greater collaboration among all relevant partners; requests the Director-General to promote WHO’s role in collaboration with relevant partners, including the private sector, in convening regional and international forums, coordinating genomics research and facilitating exchanges between developed and developing countries; takes note of the recommendations in the report of the Advisory Committee on Health Research on genomics and world health (16).

5.7.2 Promotion of WHO’s role in genomics research and facilitation of exchanges between developed and developing countries Envirogenomics of Chronic Obstructive Lung Diseases (GENOCOLD):

GARD, thanks to its network of scientific societies in the fields of respiratory medicine, allergy and immunology, is in a unique position to coordinate global research on the role of environmental factors in genomics (envirogenomics) of chronic obstructive pulmonary disease. WHO has recognized the importance of collaborative efforts in genomics to improve health in all countries, including developing countries. Since lung cancer is often related to the environmental factors involved in chronic obstructive pulmonary disease, it seems best to include both diseases in GENOCOLD.

GENOCOLD will also facilitate exchanges between developed and developing countries and, since standardized protocols will be used around the world, there will be a transfer of knowledge to developing countries.

Research conferences on respiratory disease: the Fifty-seventh World Health Assembly requested the Director-General to facilitate the exchange of knowledge about genomics between developed and developing countries. GARD is able to comply with this request by establishing research conferences on respiratory diseases. All the conferences should follow the same format.

Attendance:

• scientists with significant grants on the topic from around the world • scientists from the private sector who are conducting major research activities

on the topic • at least 30% of the attendees will be from developing countries, with a focus

on young scientists who do not necessarily hold a research grant • members of funding organizations

• government representatives • representatives of the private and public sectors, including major foundations.

The genomic aspect of the various topics will be discussed, but ethical and public health issues, as well as practical guidance, should form part of each conference. It is

19

proposed that the conferences should last for three days. On day 1, participants will discuss their own research. On day 2, small working groups will seek possible collaborations with scientists and laboratories from developing countries. On day 3, each working group will present its conclusions, with proposals for collaborative studies; ethical and public health issues; knowledge transfer to developing countries. Proceedings or a summary report will be published in a peer-reviewed journal. Some topics of interest have already been selected: genomics in asthma, prevention of allergy and asthma.

6. General discussion The discussion of the reports of the working groups dealt with a number of important topics. Flexibility is of paramount importance for all GARD activities. Research is needed, particularly in relation to phenotypes and genetics.

Drug regulatory agencies should be represented, e.g. European Medicines Agency, United States Food and Drug Administration. Regional representatives and national coordinators are needed to provide stability for GARD. These should work with ministries of health, which have the power to change health care policy. Other ministries may be involved as well (e.g. environment, education, labour, research). Ministries should be asked to recommend national representatives to attend events.

A suggestion by Parliament to the Government that a national strategy group should be created was found to be important in some countries (e.g. Norway).

Working groups should involve nongovernmental organizations rather than individuals. Every working group should include patient representatives. Outreach action plans are needed for schoolteachers and school nurses.

7. Issues related to Terms of Reference Dr Paolo Matricardi said that the number of GARD participants had increased from 16 in January 2005 to 38 in May 2005. More organizations are expected to join. All participants have voting rights during the General Meeting.

A Committee was elected for the period up to the launch, including Dr Nikolai Khaltaev (WHO GARD Secretariat), Dr Jean Bousquet (Chair), Dr Ronald Dahl (Co-Chair), Dr Eric Bateman, Dr Michael Boland, Dr Claude Lenfant, Dr Ruby Pawankar, Mr Archie Turnbull and Dr Erkka Valovirta.

Possible amendments to the terms of reference were discussed pending formal approval by the Office of the WHO Legal Counsel.

The Chair of the General Meeting, the Co-Chair, the WHO Secretariat and other members selected by the General Meeting will form the Planning Group. The participants of the meeting discussed the possibility of having an Executive Board, as part of the Planning Group, which will meet at least three times a year. The responsibilities of this Executive Board would consist of preparing the reports and proposals to be discussed by the Planning Group and preparing the agenda of the GARD General Meetings. The Planning Group will be elected at the next meeting. All the WHO regions should be represented.

Participants of GARD are encouraged to make an annual voluntary financial contribution. This contribution is essential for the efficient functioning of the secretariat and the Alliance as a whole. Some nongovernmental organizations with limited resources may not be able to contribute financially. However, others could contribute by providing human resources, e.g. seconding staff to GARD.

20

7.1 Discussion GARD needs to be global and multidisciplinary. A wide representation on the Planning Group is very important. GARD is targeted at developing countries, so there should be representation from all WHO regions, but also from middle-income and low-income countries.

All major organizations should be represented on the Planning Group. It was proposed that the number of members should not exceed 12. There is no limit on the number of participants in the General Meeting.

Permanent and rotating members may be appointed (as is done in the European Commission’s Global Allergy and Asthma European Network). A balance must be maintained between specialists, regions, types of members and representation of developing countries.

The next General Meeting of GARD will take place in Beijing, People's Republic of China, in March 2006, immediately after the launch of GARD on 28 March.

21

8. References 1. WHO consultation on the development of a comprehensive approach for the prevention and control of

chronic respiratory diseases, 11-13 January 2001 (internal WHO document WHO/NMH/MNC/CRA/01.1). Geneva, World Health Organization, 2001.

2. Implementation of the WHO strategy for prevention and control of chronic respiratory diseases, Montpellier, 11-12 February 2002 (internal WHO document WHO/MNC/CRA/02.2). Geneva, World Health Organization, 2002.

3. Prevention and control of chronic respiratory diseases in low and middle-income African countries: a preliminary report (internal WHO document WHO/NMH/CRA/04.1). Geneva, World Health Organization, 2003.

4. Prevention and control of chronic respiratory diseases at country level: Towards a Global Alliance against Chronic Respiratory Diseases (GARD), Geneva, Switzerland, 17-19 June 2004 (internal WHO document WHO/NMH/CHP/CPM/CRA/05.1). Geneva, World Health Organization, 2004.

5. WHO Meeting on the Global Alliance against Chronic Respiratory Diseases (GARD), Geneva, Switzerland, 18–19 January 2005 (internal WHO document WHO/NMH/CHP/CPM/05.2). Geneva, World Health Organization, 2005.

6. Loddenkemper R, Gibson GJ, Sibille Y. European lung white book. Sheffield, European Respiratory Society Journals/European Lung Foundation, 2003.

7. Halbert RJ et al. Interpreting COPD prevalence estimates: what is the true burden of disease? Chest, 2003, 123:1684-92.

8. Murray CJL, Lopez AD. The global burden of disease. Geneva, World Health Organization/Harvard School of Public Health/World Bank, 1996.

9. http://www.kpchr.org/boldcopd/apps/default.aspx, accessed 30 December 2005. 10. Masoli M et al. The global burden of asthma: executive summary of the GINA Dissemination

Committee report. Allergy, 2004, 59(5):469-78. 11. www.PCIAonline.org, accessed 31 December 2005. 12. Prevention of allergy and allergic asthma, Geneva, 8-9 January 2002 (internal WHO document

WHO/NMH/MNC/CRA/03.2). 13. Preventing chronic diseases: a vital investment: WHO global report. Geneva, World Health

Organization. 2005. http://www.who.int/chp/chronic_disease_report/full_report.pdf, accessed 9 February 2006.

14. Global Initiative for Asthma. NHLBI/WHO workshop report: global strategy for asthma management and prevention, January 1995 (NIH publication No. 02-3659).

15. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO report, March 2001.:

16. Genomics and world health: report of the Advisory Committee on Health Research. Geneva, World Health Organization, 2002.

22

9. List of participants GARD participants1 Dr Ignacio J. ANSOTEGUI, International Association of Asthmology, INTERASMA, C/Aita Roman Urtiaga 19A, 48340 Amorebieta, Spain, email: ija@meditex.es/interasma@interasma.org Professor Jean-Philippe ASSAL, President, Foundation Education and Research for Patient Education, 40, chemin de Conches, 1231 Geneva, Switzerland, email: jphassal@hotmail.com Professor Carlos BAENA-CAGNANI, World Allergy Organization (WAO), 555 East Wells Street, Suite 1100, Milwaukee, WI 53203-3823, United States of America, email: cebaenac@arnet.com.arg Professor Eric BATEMAN, Groote Schur Hospital, University of Cape Town, Cape Town 7925, South Africa, email: ebateman@uctgsh1.uct.ac.za Professor Ali BEN KHEDER, Ministère de la Santé publique, Hôpital A. Mami Ariana, 2080 Ariana, Tunisia, email: ali.benkheder@rns.tn Dr Karl-Christian BERGMANN, Allergy-Center-Charite (ECARF), Clinic for Dermatology and Allergy, Luisenstr. 2-5, D-10117 Berlin, Germany, email: kcbergmann@hotmail.com Dr Michael BOLAND, Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, Ireland, email: bolandgp@indigo.ie Professor Sergio BONINI, IRCCS San Raffaele - Tosinvest Sanità, Research Center, Via dei Bonacolsi snc, 00163 Rome, ITALY, email: se.bonini-cnr@flashnet.it Professor Jean BOUSQUET (Chair), Service des Maladies Respiratoires, INSERM U454, Hôpital Arnaud de Villeneuve, F-34295 Montpellier Cédex 5, FRANCE, email: bousquet@montp.inserm.fr Dr A. Sonia BUIST, Pulmonary & Critical Care Medicine, Oregon Health & Science University, Mail Code UHN 67, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, United States of America, email: buists@ohsu.edu Professor Alexander G. CHUCHALIN, National Institute of Pulmonology, 11th Parkovaya St, 32/61, Moscow 105077, Russian Federation, email: pulmo@orc.ru Professor Ronald DAHL (Co-Chair), University Hospital of Aarhus, Dept of Respiratory Diseases, DK-8000 Aarhus, Denmark, email: rdahl@akh.aaa.dk Professor Leonardo FABBRI, Section of Respiratory Diseases, University of Modena & Reggio Emilia, Largo del Pozzo 71, 41100 Modena, Italy, email: fabbri.leonardo@unimo.it Ms Birthe HELLQUIST, Head Nurse, Department of Respiratory Diseases, Aarhus University Hospital, 8000 Aarhus, Denmark, email: bhell@as.aaa.dk Professor Guy JOOS, Dept. of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium, email: Guy.Joos@UGent.be Professor You-Young KIM, Korea Asthma Allergy Foundation (KAF), Department of Internal Medicine, Seoul National University, College of Medicine, 28 Yongon-dong, Chongno-Gu, 110-744 Seoul, Republic of Korea, email: youyoung@plaza.snu.ac.kr Professor Ali KOCABAS, Turkish Thoracic Society (TTS), Chief, Department of Respiratory Medicine, Cukurova University School of Medicine, 01330 Balcali, Adana, Turkey, email: kocabasa@superonline.com Dr ssa Giovanna LAURENDI, Direzione Generale della Prevenzione Sanitaria, Ufficio IX, Via della Civiltà Romana 7, 00144 Rome, Italy, email: g.laurendi@sanita.it Dr Claude LENFANT, P.O. Box 83027, Gaithersburg, MD 20883-3027, United States of America, email: lenfantc@prodigy.net Dr Carlos LUNA, Latin American Thoracic Association (ALAT), 11450 Buenos Aires, Argentina, email: cymluna@advancedsl.com.ar

23

Professor Sohei MAKINO, Dokkyo University School of Medicine, 880 Kita-kobayashi, Mibu Shimotsuga-gun, Tochigi 321-0293, Japan, email: s-makino@dokkyomed.ac.jp Mr Svein-Erik MYRSETH, European Federation of Allergy and Airways Diseases Patients’ Associations (EFA), EFA Central Office, Avenue Louise 327, 1050 Brussels, Belgium, email: EFAOffice@skynet.be Professor Markku NIEMINEN, Finnish Lung Health Association, Sibeliuksenkatu 11A Tampere, 00250 Helsinki, Finland, email: mnieminen@tays.fi Professor Ruby PAWANKAR, Asian Allergy & Asthma Foundation, Nippon Medical School, Dept of Otolaryngology, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan, email: susan@nms.ac.jp Professor Klaus RABE, Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands, email: K.F.Rabe@lumc.nl Dr José ROSADO PINTO, Head of Immunoallergy Department, Hospital Dona Estefania, Serviço de Immunoalergologia, Rua Jacinta Marto 1169-045, Lisbon, Portugal, email: hde.imunoalergo@mail.telepac.pt Mr Archie TURNBULL, Forum of International Respiratory Societies, European Respiratory Society, 4, avenue Ste-Luce, CH-1003 Lausanne, Switzerland, email: archie.turnbull@ersnet.org Dr Erkka VALOVIRTA, Turku Allergy Center, Kotkankatu 2, FIN-20610 Turku, Finland, email: erkka.valovirta@allergiakeskus.fi Professor Paul VAN CAUWENBERGE, University Hospital of Ghent, Dept of Oto-Rhino-Laryngology, De Pintelaan 185, B-9000 Ghent, Belgium, email: Paul.Vancauwenberge@rug.ac.be Professor Chris VAN WEEL, World Organization of Family Doctors (WONCA), HAG-229, Postbox 9101, 6500 HB-Nijemegen, Netherlands, email: c.vanweel@hag.umcn.nl Dr Giovanni VIEGI, CNR Istituto di Fisiologia Clinica, Via Trieste 41, I-56126 Pisa, Italy, email: viegig@ifc.cnr.it Professor Ulrich WAHN, European Academy of Allergology and Clinical Immunology (EAACI), Charité Hospital, Augustenburger Platz 1, D-13353 Berlin, Germany, email: ulrike.lehmkuhl@charite.de Professor Arzu YORGANCIOGLU, Turkish Thoracic Society (TTS), Celal University School of Medicine, Bayor, 45010 Manisa, Turkey, email: arzuyo@hotmail.com

World Health Organization Dr Robert BEAGLEHOLE, Director, Department of Chronic Diseases and Health, Promotion (CHP), Noncommunicable Diseases and Mental Health, email: beagleholer@who.int Dr Leopold Joseph BLANC, Coordinator, Stop TB Department, email: blancl@who.int Dr Nikolai KHALTAEV (Secretary), Responsible Officer, Chronic Respiratory Diseases and Arthritis, Chronic Diseases Prevention and Management, (CHP/CPM/CRA), email: khaltaevn@who.int Dr Eva MANTZOURANIS, Medical Officer, Chronic Respiratory Diseases and Arthritis, Chronic Diseases Prevention and Management, (CHP/CPM/CRA), email: mantzouranise@who.int Dr Paolo Maria MATRICARDI (Co-Rapporteur), Research Officer, Chronic Respiratory Diseases and Arthritis, Chronic Diseases Prevention and Management, (CHP/CPM/CRA), email: matricardip@who.int Dr Salah-Eddine OTTMANI, Medical Officer, Stop TB Department, email: ottmanis@who.int Dr Bruce PFLEGER (Co-Rapporteur), Research Officer, Chronic Respiratory Diseases and Arthritis, Chronic Diseases Prevention and Management (CHP/CPM/CRA), email: pflegerb@who.int Dr Serge RESNIKOFF, Coordinator, Chronic Diseases Prevention and Management (CHP/CPM), email: resnikoffs@who.int Mr Igor ROZOV, External Relations Officer, External Relations and Governing Bodies, Government, Civil Society and Private Sector Relations (EGB/GPR), email: rozovi@who.int

24

1Unable to attend: Professor Norbert Berend, Woolcock Institute of Medical Research, Royal Prince Alfred Hospital, P.O. Box M77, Missenden

Road, NSW 2050, Australia, email: nberend@med.usyd.edu.au Dr Nils Billo, International Union Against Tuberculosis and Lung Disease (IUATLD), 68, boulevard Saint-Michel, F-75006

Paris, France Dr Michael Blaiss, American College of Allergy, Asthma and Immunology (ACAAI), 85 West Algonquin Road, Suite 550,

Arlington Heights, IL 60005, United States of America, email: mail@acaai.org Professor Giorgio Walter Canonica, University of Genoa, Allergy & Respiratory Diseases, Pad. Maragliano - L.go R. Benzi

10, I-16132 Genoa, Italy, email: gcanonica@qubisoft.it Professor Yoshinosuke Fukuchi, Dept of Respiratory Medicine, Juntendo University School of Medicine, 2-1-1 Hongo,

Bunkyo-ku, Tokyo, Japan, email: yfukuchi@med.juntendo.ac.jp Professor Takeshi Fukuda, Asia Pacific Association of Allergology and Clinical Immunology (APAACI), Dept of Pulmonary

Medicine, Dokkyo University School of Medicine, 880 Kita-kobayashi, Mibu-machi, Tochigi 321-0293, Japan, email: t-fukuda@dokkyomed.ac.jp

Professor Donato Greco, Centro Nazionale per il Controllo e la Prevenzione della Malattie (CCM), Ministero Della Salute, Via della Civiltà Romana 7, 00144 Rome, Italy, email: d.greco@sanita.it

Dr Lawrence D. Grouse, International Coalition for Chronic Obstructive Pulmonary Disease (ICC), 8316 86th Ave. NW, Gig Harbor, WA 98332, United States of America, email: lgrouse1@email.msn.com (replaced by Dr Dmitry Nonikov, email: nonikov@t-online.de)

Professor Bruno Housset, Société de Pneumologie de Langue Française (SPLF), 66, boulevard Saint-Michel, F-75006 Paris, France, email: SPLF@splf.org

Dr Suzanne Hurd, P.O. Box 83027, Gaithersburg, MD 20883-3027, United States of America, email: shurd@prodigy.net Dr James Kiley, Division of Lung Diseases, National Heart, Lung & Blood Institute (NHLBI), National Institute of Health,

DHHS, Rockledge Bldg. Room 10018, Bethesda, MD 20892-7952, United States of America, email: kileyj@nih.gov Professor Paul O'Byrne, St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada, email:

Obyrnep@fhs.mcmaster.ca Professor Pekka Puska, Director-General, National Public Health Institute (KTL), Mannerheimintie 166, FIN-00300

Helsinki, Finland, email: pekka.puska@ktl.fi Professor Estelle R. Simons, American Academy of Allergy, Asthma and Immunology (AAAAI), University of Manitoba -

Room AE101, 671 William Avenue, Winnipeg, MB R3E OZ2, Canada, email: lmcniven@hsc.mb.ca Professor Umberto Solimene, World Federation of Hydrotherapy and Climatotherapy, Via Cicognara, 7, I-20129 Milan,

Italy, email: umberto.solimene@unimi.it.

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d ad

vanc

e di

agno

stic

and

th

erap

eutic

ski

lls o

f mem

bers

; spo

nsor

and

con

duct

ed

ucat

iona

l and

sci

entif

ic p

rogr

amm

es a

nd p

ublic

atio

ns;

deve

lop

and

diss

emin

ate

educ

atio

nal i

nfor

mat

ion

for

mem

bers

, pat

ient

s, h

ealth

-pla

n pu

rcha

sers

and

ad

min

istra

tors

, and

oth

er p

hysi

cian

s an

d he

alth

pro

fess

iona

ls.

Non

gove

rnm

enta

l pr

ofes

sion

al a

ssoc

iatio

n fo

r alle

rgis

ts a

nd

imm

unol

ogis

ts

4900

alle

rgis

ts a

nd im

mun

olog

ists

: A

MR

O a

nd p

ossi

bly

othe

r reg

ions

th

roug

h in

tern

atio

nal a

ffilia

te

mem

bers

hip

Am

eric

an T

hora

cic

Soc

iety

(A

TS).

Pre

side

nt:

Dr P

eter

D.

Wag

ner

(pdw

agne

r@uc

sd.e

du)

1905

Am

eric

an J

ourn

al o

f R

espi

rato

ry a

nd C

ritic

al C

are

Med

icin

e; A

mer

ican

Jou

rnal

of

Res

pira

tory

Cel

l and

Mol

ecul

ar

Bio

logy

; P

roce

edin

gs o

f the

A

mer

ican

Tho

raci

c S

ocie

ty

ww

w.th

orac

ic.o

rg

To p

reve

nt a

nd tr

eat r

espi

rato

ry d

isea

se th

roug

h re

sear

ch,

educ

atio

n, p

atie

nt c

are

and

advo

cacy

; to

decr

ease

mor

bidi

ty

and

mor

talit

y fro

m re

spira

tory

dis

orde

rs a

nd li

fe-th

reat

enin

g ac

ute

illne

sses

in p

eopl

e of

all

ages

, int

erac

ting

with

nat

iona

l an

d in

tern

atio

nal o

rgan

izat

ions

that

hav

e si

mila

r goa

ls.

Non

gove

rnm

enta

l, no

npro

fit, i

nter

natio

nal,

prof

essi

onal

and

sci

entif

ic

soci

ety

for r

espi

rato

ry a

nd

criti

cal-c

are

med

icin

e.

12 s

peci

aliz

ed a

ssem

blie

s13

000

glo

bally

: AFR

O, A

MR

O,

EM

RO

, EU

RO

, SE

AR

O, W

PR

O

Asi

an A

llerg

y an

d A

sthm

a Fo

unda

tion

(AA

AF)

. P

resi

dent

: Pro

fess

or R

uby

Paw

anka

r.

(Paw

anka

rRub

y<su

san@

nms.

ac.jp

)

2004

web

site

in p

repa

ratio

n

To a

dvan

ce e

xcel

lent

clin

ical

pra

ctic

e of

alle

rgic

dis

ease

s an

d to

redu

ce th

eir

burd

en th

roug

h ed

ucat

ion,

trai

ning

, res

earc

h,

cost

effe

ctiv

e tre

atm

ent a

nd p

ublic

aw

aren

ess

thro

ugh

cont

inuo

us d

ialo

gue

with

the

heal

th m

inis

try a

nd w

orld

or

gani

zatio

ns w

ith th

e sa

me

goal

s.

Reg

iona

l no

ngov

ernm

enta

l or

gani

zatio

n

50 m

embe

rs re

pres

entin

g al

l Asi

an

coun

tries

: S

EA

RO

, WP

RO

Asi

an P

acifi

c A

ssoc

iatio

n of

A

llerg

olog

y an

d C

linic

al

Imm

unol

ogy

(APA

AC

I).

Pre

side

nt:

Pro

f Tak

eshi

Fu

kuda

(t-

fuku

da@

dokk

yom

ed.a

c.jp

)

1989

ww

w.a

paac

i.org

To s

uppo

rt th

e de

velo

pmen

t of t

he d

isci

plin

e of

alle

rgy,

as

thm

a an

d cl

inic

al im

mun

olog

y in

the

regi

on; t

o en

cour

age

and

assi

st in

form

ing

natio

nal s

ocie

ties

whe

re n

one

exis

t; to

pr

omot

e th

e ex

chan

ge a

nd p

rogr

ess

of k

now

ledg

e in

the

regi

on; t

o st

udy

the

prev

entio

n an

d tre

atm

ent o

f alle

rgy,

as

thm

a an

d im

mun

e-m

edia

ted

dise

ases

spe

cific

to th

e re

gion

; to

pro

mot

e ex

chan

ges

in tr

aini

ng p

rogr

amm

es b

etw

een

mem

ber c

ount

ries;

to h

elp

coop

erat

ion

betw

een

clin

ical

and

ba

sic

rese

arch

; to

deve

lop

prog

ram

mes

for p

ublic

edu

catio

n;

to c

oope

rate

with

oth

er in

tern

atio

nal o

rgan

izat

ions

with

sim

ilar

goal

s; to

dis

sem

inat

e kn

owle

dge

thro

ugh

inte

rnat

iona

l co

ngre

sses

and

by

othe

r mea

ns.

Ass

ocia

tion

of n

atio

nal

soci

etie

s of

alle

rgy

and

clin

ical

imm

unol

ogy

in th

e A

sia-

Pac

ific

regi

on

15 n

atio

nal s

ocie

ties

in S

EA

RO

, W

PR

O

Asi

an P

acifi

c S

ocie

ty o

f R

espi

rolo

gy (A

PSR

).

Pre

side

nt:

Pro

fess

or Y

. Fu

kuch

i (y

fuku

chi@

med

.junt

endo

.ac.

jp)

1985

Res

piro

logy

w

ww

.aps

resp

.org

To a

dvan

ce a

nd p

rom

ote

know

ledg

e of

the

resp

irato

ry s

yste

m

in h

ealth

and

dis

ease

; to

striv

e to

enc

oura

ge re

sear

ch a

nd

impr

ove

clin

ical

pra

ctic

e th

roug

h te

achi

ng; t

o in

crea

se

awar

enes

s of

hea

lth p

robl

ems

in th

e ar

ea a

nd to

pro

mot

e ex

chan

ge o

f kno

wle

dge

amon

g re

spiro

logi

sts

in th

e A

sia-

Pac

ific

regi

on.

Reg

iona

l no

ngov

ernm

enta

l or

gani

zatio

n10

,150

: SE

AR

O, W

PR

O

Ann

ex: G

AR

D P

artic

ipan

ts a

s of

May

200

5

Nam

e of

Org

aniz

atio

nY

ear

esta

blis

hed

Jour

nal a

nd W

ebsi

te a

ddre

ssM

issi

onC

ateg

ory

(Int.O

rg./N

GO

/etc

.)In

tere

st s

ectio

ns o

r ass

embl

ies

No.

of m

embe

rs/p

artn

ers

and

repr

esen

tatio

n by

WH

O R

egio

n

Dan

ish

Lung

Hea

lth

Ass

ocia

tion

(DLA

). P

resi

dent

: C

harlo

tte F

ugls

ang

(Cha

rlotte

.Fug

lsan

g@lu

nge.

dk)

1901

ww

w.lu

ngef

oren

ing.

dkTo

impr

ove

prev

entio

n an

d tre

atm

ent o

f lun

g di

seas

es in

D

enm

ark

and

to h

elp

patie

nts

with

thes

e di

seas

es (e

spec

ially

ch

roni

c ob

stru

ctiv

e pu

lmon

ary

dise

ase)

in

this

cou

ntry

.

Nat

iona

l no

ngov

ernm

enta

l or

gani

zatio

n

3493

mem

bers

from

the

Faro

e Is

land

s an

d G

reen

land

: EU

RO

Dok

kyo

Uni

vers

ity S

choo

l of

Med

icin

e, W

HO

Col

labo

ratin

g C

entre

for P

reve

ntio

n an

d C

ontro

l of C

hron

ic R

espi

rato

ry

Dis

ease

s, J

apan

. H

ead:

P

rofe

ssor

S. M

akin

o (s

-m

akin

o@do

kkyo

med

.ac.

jp)

Term

s of

refe

renc

e as

WH

O C

olla

bora

ting

Cen

tre; A

sia-

Pac

ific

Initi

ativ

e fo

r Chr

onic

Res

pira

tory

Dis

ease

s.

WH

O C

olla

bora

ting

Cen

treS

EA

RO

, WP

RO

Eur

opea

n A

cade

my

of A

llerg

y an

d C

linic

al Im

mun

olog

y (E

AA

CI).

Pre

side

nt: P

rofe

ssor

A

ntho

ny J

. Fre

w

(ajf@

eaac

i.org

)

1956

Alle

rgy

(Eur

opea

n Jo

urna

l of

Alle

rgy

and

Clin

ical

Im

mun

olog

y) w

ww

.eaa

ci.n

et

To p

rom

ote

basi

c an

d cl

inic

al re

sear

ch; a

sses

s an

d di

ssem

inat

e sc

ient

ific

info

rmat

ion;

func

tion

as a

refe

renc

e bo

dy fo

r oth

er s

cien

tific

, hea

lth a

nd p

oliti

cal o

rgan

izat

ions

; en

cour

age

and

prov

ide

train

ing

and

cont

inui

ng e

duca

tion;

pr

omot

e go

od p

atie

nt c

are

for a

llerg

ic a

nd im

mun

olog

ical

di

seas

es.

Non

gove

rnm

enta

l, no

npro

fit o

rgan

izat

ion

for

acad

emic

ians

, res

earc

h in

vest

igat

ors

and

clin

icia

ns

Sec

tions

for a

sthm

a, d

erm

atol

ogy,

ot

orhi

nola

ryng

olog

y, im

mun

olog

y an

d pa

edia

trics

to im

prov

e in

form

atio

n ex

chan

ge a

nd

colla

bora

tion

betw

een

scie

ntis

ts

with

in a

nd o

utsi

de E

AA

CI.

Sec

tions

can

pro

pose

task

forc

es

and

join

t ses

sion

s w

ith o

ther

sp

ecia

list s

ocie

ties.

39 E

urop

ean

natio

nal s

ocie

ties,

ov

er 3

500

mem

bers

: E

UR

O

Eur

opea

n C

entre

for A

llerg

y R

esea

rch

Foun

datio

n (E

CA

RF)

. H

ead:

Pro

fess

or

Dr.

med

. Tor

sten

Zub

erbi

er

(eca

rf@ch

arite

.de)

2003

ww

w.e

carf.

org

To im

prov

e kn

owle

dge,

rese

arch

and

aw

aren

ess

of a

llerg

ies;

de

crea

se th

e bu

rden

of d

isea

se in

pat

ient

s an

d in

soc

iety

th

roug

h st

ruct

ural

rese

arch

in a

llerg

y, s

prea

ding

of e

xcel

lenc

e an

d kn

owle

dge

amon

g ph

ysic

ians

and

the

publ

ic, i

nitia

tives

for

impr

ovin

g pa

tient

car

e, a

ctiv

ities

for a

bet

ter q

ualit

y of

life

for

alle

rgic

pat

ient

s.

Non

gove

rnm

enta

l fo

unda

tion

Col

labo

ratio

n w

ith A

llerg

y C

entre

C

harit

é, s

peci

aliz

ed in

clin

ical

w

ork,

rese

arch

and

dis

sem

inat

ion

of k

now

ledg

e in

alle

rgy:

E

UR

O

Eur

opea

n Fe

dera

tion

of A

llerg

yan

d A

irway

s D

isea

ses

Pat

ient

s' A

ssoc

iatio

ns (E

FA).

P

resi

dent

: Sve

in-E

rik M

yrse

th

(EFA

Offi

ce@

skyn

et.b

e)

1992

ww

w.e

fane

t.org

To im

prov

e th

e qu

ality

of l

ife o

f peo

ple

with

ast

hma,

chr

onic

ob

stru

ctiv

e pu

lmon

ary

dise

ase

and

alle

rgy

and

of th

eir c

arer

s th

roug

hout

Eur

ope,

con

tribu

ting

to a

Eur

opea

n co

mm

unity

tha t

shar

es th

e re

spon

sibi

lity

for s

ubst

antia

lly re

duci

ng th

e fre

quen

cy a

nd s

ever

ity o

f the

se c

ondi

tions

and

reco

gniz

es th

e so

cial

, env

ironm

enta

l, ec

onom

ic a

nd h

ealth

impl

icat

ions

.

Foun

datio

n A

llian

ce o

f 41

orga

niza

tions

in 2

3 co

untri

es in

Eur

ope

repr

esen

ting

250

000

pers

ons:

EU

RO

Eur

opea

n R

espi

rato

ry S

ocie

ty

(ER

S).

Pre

side

nt: D

r Gio

vann

i V

iegi

(vi

egig

@ifc

.cnr

.it)

1990

Eur

opea

n R

espi

rato

ry J

ourn

al,

Eur

opea

n R

espi

rato

ry

Mon

ogra

ph,

Eur

opea

n R

espi

rato

ry R

evie

w,

Eur

opea

n R

espi

rato

ry T

opic

,E

RS

New

slet

ter,

Bre

athe

w

ww

.ers

net.o

rg

Pro

mot

ing

rese

arch

; fos

terin

g ed

ucat

ion;

exc

hang

ing

know

ledg

e; im

prov

ing

patie

nt c

are.

Non

gove

rnm

enta

l, no

npro

fit in

tern

atio

nal

med

ical

org

aniz

atio

n

10 s

cien

tific

ass

embl

ies

serv

e as

fo

rum

to p

rese

nt a

nd d

iscu

ss

scie

ntifi

c w

ork

at y

early

con

gres

s

Ove

r 700

0 m

embe

rs in

100

co

untri

es:

AFR

O, A

MR

O, E

MR

O,

EU

RO

, SE

AR

O, W

PR

O

Finn

ish

Lung

Hea

lth

Ass

ocia

tion

(FIL

HA

). P

resi

dent

: Pro

fess

or M

arkk

u M

. Nie

min

en

(mni

emin

en@

tays

.fi o

r m

arkk

u.ni

emin

en@

filha

)

1907

ww

w.fi

lha.

fi

Trai

ning

and

edu

catio

n of

man

agem

ent o

f chr

onic

resp

irato

ry

dise

ases

; des

ign,

impl

emen

tatio

n of

nat

iona

l pro

gram

mes

for

dise

ases

(ast

hma,

chr

onic

obs

truct

ive

pulm

onar

y di

seas

e,

slee

p ap

noea

), fo

r sm

okin

g ce

ssat

ion

(sin

ce 1

994)

and

im

plem

enta

tion

of in

tern

atio

nal p

roje

ct (t

uber

culo

sis)

; re

sear

ch, e

xper

t net

wor

king

and

hum

an re

sour

ce

deve

lopm

ent.

Nat

iona

l no

ngov

ernm

enta

l or

gani

zatio

n W

HO

col

labo

ratin

g ce

ntre

EU

RO

(Fin

land

, Rus

sian

Fe

dera

tion,

Bal

tic n

atio

ns),

SE

AR

O (K

yrgy

zsta

n, M

ongo

lia),

WP

RO

(Chi

na)

Foru

m o

f Int

erna

tiona

l R

espi

rato

ry S

ocie

ties

(FIR

S).

Exe

cutiv

e S

ecre

tary

: Arc

hie

Turn

bull

(a

rchi

e.tu

rnbu

ll@er

snet

.org

)

2002

Adv

ocac

y fo

r glo

bal r

espi

rato

ry h

ealth

and

iden

tific

atio

n of

ne

w a

reas

for g

loba

l ini

tiativ

es. A

ims

to b

e at

tain

ed b

y th

e co

nsid

erat

ion

of n

eeds

and

the

prop

osal

of r

elat

ed p

roje

cts,

im

plem

ente

d jo

intly

or i

ndiv

idua

lly b

y th

e m

embe

r or

gani

zatio

ns.

Coo

pera

tive

unio

n of

in

tern

atio

nal p

rofe

ssio

nal

and

scie

ntifi

c so

ciet

ies

Par

ticip

atin

g or

gani

zatio

ns in

clud

e A

CC

P, A

LAT,

AP

SR

, ATS

, ER

S,

UN

ION

and

ULA

STE

R.

Nam

e of

Org

aniz

atio

nY

ear

esta

blis

hed

Jour

nal a

nd W

ebsi

te a

ddre

ssM

issi

onC

ateg

ory

(Int.O

rg./N

GO

/etc

.)In

tere

st s

ectio

ns o

r ass

embl

ies

No.

of m

embe

rs/p

artn

ers

and

repr

esen

tatio

n by

WH

O R

egio

n

Glo

bal A

llerg

y an

d A

sthm

a E

urop

ean

Net

wor

k (G

A2L

EN).

Cha

irman

: Pro

fess

or P

aul V

an

Cau

wen

berg

e (P

aul.V

anca

uwen

berg

e@ru

g.a

c.be

or

paul

.van

cauw

enbe

rge@

UG

ent

.be)

2004

ww

w.g

a2le

n.ne

t

To e

stab

lish

an in

tern

atio

nally

com

petit

ive

netw

ork;

to

enha

nce

qual

ity a

nd re

leva

nce

of re

sear

ch a

nd a

ddre

ss a

ll as

pect

s of

the

dise

ase;

to

decr

ease

the

burd

en o

f alle

rgy

and

asth

ma

thro

ugho

ut E

urop

e. A

ctiv

ities

con

sist

of i

nteg

ratio

n,

coor

dina

tion

of s

cien

tific

act

iviti

es a

nd s

prea

ding

exc

elle

nce.

Res

earc

h ne

twor

k in

al

lerg

y an

d as

thm

a

Wor

k pa

ckag

es in

clud

e: n

utrit

ion,

in

fect

ion,

env

ironm

ent a

nd

pollu

tion,

occ

upat

ion,

gen

der

sens

itiza

tion

and

alle

rgic

dis

ease

, ai

rway

rem

odel

ling,

clin

ical

car

e,

gene

tics

and

geno

mic

s

26 le

adin

g E

urop

ean

team

s,

EA

AC

I and

EFA

, one

or m

ore

cent

res

in e

ach

Eur

opea

n co

untry

: E

UR

O

Glo

bal I

nitia

tive

for A

sthm

a (G

INA

). C

hair

of E

xecu

tive

Com

mitt

ee: P

rofe

ssor

Pau

l O'

Byr

ne

(oby

rnep

@fh

s.m

cmas

ter.c

a),

Cha

ir of

Sci

entif

ic C

omm

ittee

: S

uzan

ne H

urd

(shu

rd@

prod

igy.

net)

1991

ww

w.g

inas

thm

a.co

m

Wor

ks w

ith h

ealth

car

e pr

ofes

sion

als

and

publ

ic h

ealth

of

ficia

ls a

roun

d th

e w

orld

to re

duce

ast

hma

prev

alen

ce,

mor

bidi

ty a

nd m

orta

lity.

Thr

ough

evi

denc

e-ba

sed

guid

elin

es

for a

sthm

a m

anag

emen

t, an

d ev

ents

suc

h as

the

annu

al

cele

brat

ion

of W

orld

Ast

hma

Day

, the

Glo

bal I

nitia

tive

for

Ast

hma

wor

ks to

impr

ove

the

lives

of p

eopl

e w

ith a

sthm

a in

ev

ery

corn

er o

f the

glo

be.

Pro

gram

me

laun

ched

in

colla

bora

tion

with

WH

O

and

Nat

iona

l Ins

titut

es o

f H

ealth

/Nat

iona

l Hea

rt,

Lung

and

Blo

od In

stitu

te

Exe

cutiv

e, S

cien

ce a

nd

Dis

sem

inat

ion

Com

mitt

ees;

na

tiona

l lau

nch

lead

ers

AFR

O, A

MR

O, E

MR

O, E

UR

O,

SE

AR

O, W

PR

O (G

AR

D ta

rget

co

untri

es: A

rgen

tina,

Bra

zil,

Cos

ta

Ric

a, P

ortu

gal,

Geo

rgia

, Rus

sian

Fe

dera

tion,

Syr

ian

Ara

b R

epub

lic,

Vie

tnam

)

Glo

bal I

nitia

tive

for C

hron

ic

Obs

truct

ive

Lung

Dis

ease

(G

OLD

). C

hair

of E

xecu

tive

Com

mitt

ee: D

r A. S

onia

Bui

st

(bui

st@

ohsu

.edu

), C

hair

of

Sci

entif

ic C

omm

ittee

: Suz

anne

H

urd

(shu

rd@

prod

igy.

net)

1998

ww

w.g

oldc

opd.

com

Incr

ease

aw

aren

ess

of m

edic

al c

omm

unity

, pub

lic h

ealth

of

ficia

ls a

nd g

ener

al p

ublic

that

chr

onic

obs

truct

ive

pulm

onar

y di

seas

e is

a p

ublic

hea

lth p

robl

em; d

ecre

ase

its m

orbi

dity

and

m

orta

lity

thro

ugh

impl

emen

ting

effe

ctiv

e pr

ogra

mm

es fo

r its

di

agno

sis,

man

agem

ent a

nd p

reve

ntio

n st

rate

gies

for u

se in

al

l cou

ntrie

s an

d pr

omot

ing

stud

ies

into

the

etio

logy

of i

ts

incr

easi

ng p

reva

lenc

e.

Pro

gram

me

laun

ched

in

colla

bora

tion

with

WH

O

and

Nat

iona

l Ins

titut

es o

f H

ealth

/Nat

iona

l Hea

rt,

Lung

and

Blo

od In

stitu

te

Exe

cutiv

e, S

cien

ce a

nd

Dis

sem

inat

ion

Com

mitt

ees.

N

atio

nal L

aunc

h Le

ader

sA

MR

O, E

UR

O

Ghe

nt U

nive

rsity

, WH

O

Col

labo

ratin

g C

entre

(GU

-W

CC

) Dep

t. R

espi

rato

ry

Dis

ease

s. D

irect

or: P

rofe

ssor

G

uy J

oos

(Guy

.Joo

s@U

Gen

t.be)

1817

ww

w.u

gent

.be

To o

ffer h

igh-

qual

ity, r

esea

rch-

base

d ed

ucat

ion;

to p

lay

an

impo

rtant

role

in fu

ndam

enta

l and

app

lied

rese

arch

; to

be a

n op

en, p

lura

listic

, int

erna

tiona

l ins

titut

e w

ith a

soc

ial

resp

onsi

bilit

y (fu

ll m

issi

on s

tate

men

t: w

ww

.uge

nt.b

e/en

/ghe

ntun

iv/m

anag

emen

t/mis

sion

).

WH

O C

olla

bora

ting

Cen

treE

UR

O

Istit

uto

di R

icov

ero

e C

ura

e C

arat

tere

Sci

entif

ico

(IRC

CS)

S

cien

tific

Dire

ctor

: Pro

fess

or

Ser

gio

Bon

ini

(ser

gio.

boni

ni@

sanr

affa

ele.

it)

No

info

rmat

ion

avai

labl

e.

Inst

itute

of N

euro

biol

ogy

and

Mol

ecul

ar M

edic

ine

Nat

iona

l R

esea

rch

Cou

ncil

(CN

R)

Hea

d: D

r Gui

do R

asi

(gui

do.ra

si@

arto

v.in

mm

.cnr

.it)

No

info

rmat

ion

avai

labl

e.

Inte

rdis

cipl

inar

y A

ssoc

iatio

n fo

r R

esea

rch

in L

ung

Dis

ease

(A

IMA

R). P

resi

dent

: Dr

Cla

udio

F. D

onne

r (s

egre

teria

@ai

mar

netw

ork.

org)

2001

Mul

tidis

cipl

inar

y R

espi

rato

ry

Med

icin

e w

ww

.aim

arne

twor

k.or

g

To p

reve

nt lu

ng d

isea

se a

nd p

rom

ote

lung

hea

lth; t

o im

prov

e th

e qu

ality

of p

atie

nt c

are

by e

duca

ting

phys

icia

ns a

nd a

llied

pr

ofes

sion

als

and

prov

idin

g th

em w

ith p

rogr

amm

es a

nd

stra

tegi

es fo

r fig

htin

g lu

ng d

isea

se s

uch

as a

sthm

a, c

hron

ic

obst

ruct

ive

pulm

onar

y di

seas

e, in

fect

ions

, to

bacc

o an

d en

viro

nmen

tal p

ollu

tion;

to p

rom

ote

rese

arch

on

lung

dis

ease

; to

incr

ease

the

awar

enes

s of

pub

lic a

bout

lung

dis

ease

s an

d th

eir r

isks

; to

invo

lve

all d

ecis

ion-

mak

ers

in c

ampa

igns

to

redu

ce e

nviro

nmen

tal a

nd to

bacc

o po

llutio

n. T

o pr

omot

e an

d m

aint

ain

links

with

all

soc

ietie

s an

d ag

enci

es in

tere

sted

in

lung

hea

lth, i

nclu

ding

pat

ient

s' o

rgan

izat

ions

, esp

ecia

lly in

the

Med

iterr

anea

n ar

ea.

Non

prof

it in

terd

isci

plin

ary

asso

ciat

ion

for r

esea

rch

in lu

ng d

isea

se

Med

ical

are

as in

volv

ed :

envi

ronm

enta

l, ge

nera

l, in

tern

al

and

occu

patio

nal m

edic

ine,

in

tens

ive

care

, car

diol

ogy,

thor

acic

su

rger

y, ra

diol

ogy,

end

ocrin

olog

y,

epid

emio

logy

, pha

rmac

olog

y,

gast

roen

tero

logy

, ger

iatri

cs,

imm

unol

ogy,

infe

ctio

us d

isea

ses,

m

icro

biol

ogy,

neu

rolo

gy, o

ncol

ogy,

ot

olar

yngo

logy

, pae

diat

rics,

pn

eum

olog

y

EU

RO

Nam

e of

Org

aniz

atio

nY

ear

esta

blis

hed

Jour

nal a

nd W

ebsi

te a

ddre

ssM

issi

onC

ateg

ory

(Int.O

rg./N

GO

/etc

.)In

tere

st s

ectio

ns o

r ass

embl

ies

No.

of m

embe

rs/p

artn

ers

and

repr

esen

tatio

n by

WH

O R

egio

n

Inte

rnat

iona

l Ass

ocia

tion

of

Ast

hmol

ogy

(INTE

RA

SMA

).

Pre

side

nt: H

ugo

E. N

effe

n (h

enef

fen@

info

via.

com

.ar)

1954

Jour

nal o

f Inv

estig

atio

nal

Alle

rgol

ogy

& C

linic

al

Imm

unol

ogy,

Int

eras

ma

New

s ne

wsl

ette

r w

ww

.inte

rasm

a.or

g

A fo

rum

for i

nter

disc

iplin

ary

disc

ussi

ons

amon

g

pneu

mol

ogis

ts, a

llerg

ists

, pae

diat

ricia

ns a

nd g

ener

al

prac

titio

ners

to

exch

ange

info

rmat

ion

on a

sthm

a re

sear

ch,

prac

tice

and

man

agem

ent:

to fo

cus

on a

ll as

pect

s of

ast

hma,

br

idgi

ng th

e ga

p be

twee

n re

sear

ch a

nd c

linic

al p

ract

ice;

to

enco

urag

e as

thm

a ed

ucat

ion

prog

ram

mes

for a

ll he

alth

car

e pr

ofes

sion

als,

edu

cato

rs a

nd a

dmin

istra

tors

; to

impr

ove

the

qual

ity o

f life

of a

sthm

atic

s; t

o de

crea

se th

e pr

eval

ence

, m

orbi

dity

and

mor

talit

y of

ast

hma.

Inte

rnat

iona

l no

ngov

ernm

enta

l or

gani

zatio

n

Exe

cutiv

e C

omm

ittee

, reg

iona

l ch

apte

rsA

MR

O, A

FRO

, EM

RO

, EU

RO

, W

PR

O

Inte

rnat

iona

l Chr

onic

O

bstru

ctiv

e P

ulm

onar

y D

isea

se C

oalit

ion

(ICC

). C

hair

of E

xecu

tive

Com

mitt

ee: L

arry

G

rous

e (lg

rous

e@em

ail.m

sn.c

om)

1999

ww

w.in

tern

atio

nalc

opd.

org

To im

prov

e ca

re o

f chr

onic

obs

truct

ive

pulm

onar

y di

seas

e pa

tient

s th

roug

h in

crea

sing

aw

aren

ess

of th

e di

seas

e an

d an

un

ders

tand

ing

of it

s di

agno

sis

and

man

agem

ent f

or b

oth

care

rs a

nd p

atie

nts.

To

crea

te a

llian

ces

with

pro

fess

iona

l gr

oups

to a

ccom

plis

h th

ese

ends

. To

enco

urag

e an

d su

ppor

t na

tiona

l and

regi

onal

gro

ups

in a

dvoc

acy

effo

rts to

war

d po

licy-

mak

ers

to p

riorit

ize

chro

nic

obst

ruct

ive

pulm

onar

y di

seas

e in

re

sear

ch a

nd c

are.

Non

prof

it co

rpor

atio

n;

outre

ach

of G

loba

l In

itiat

ive

for C

hron

ic

Obs

truct

ive

Lung

Dis

ease

an

d th

e U

nite

d S

tate

s C

hron

ic O

bstru

ctiv

e P

ulm

onar

y D

isea

se

Coa

litio

n

220

000

mem

bers

: AM

RO

, EM

RO

, E

UR

O, W

PR

O

Inte

rnat

iona

l Uni

on A

gain

st

Tube

rcul

osis

and

Lun

g D

isea

se (U

NIO

N). E

xecu

tive

Dire

ctor

: Dr N

ils B

illo

(nbi

llo@

iuat

ld.o

rg)

1956

Inte

rnat

iona

l Jou

rnal

of

Tube

rcul

osis

& L

ung

Dis

ease

w

ww

.iuat

ld.o

rg

To p

reve

nt a

nd c

ontro

l tub

ercu

losi

s an

d lu

ng d

isea

se,

parti

cula

rly in

low

-inco

me

coun

tries

. To

prom

ote

natio

nal

auto

nom

y, w

ithin

the

fram

ewor

k of

prio

ritie

s of

eac

h co

untry

, by

dev

elop

ing,

impl

emen

ting

and

asse

ssin

g an

titub

ercu

losi

s an

d re

spira

tory

hea

lth p

rogr

amm

es. T

o di

ssem

inat

e kn

owle

dge

on tu

berc

ulos

is, l

ung

dise

ase,

HIV

and

resu

lting

co

mm

unity

hea

lth p

robl

ems

in o

rder

to a

lert

doct

ors,

dec

isio

n-m

aker

s, o

pini

on-le

ader

s an

d th

e ge

nera

l pub

lic to

the

dise

ases

' rel

ated

dan

gers

. To

coo

rdin

ate,

ass

ist a

nd p

rom

ote

the

wor

k of

its

cons

titue

nt m

embe

rs th

roug

hout

the

wor

ld. T

o es

tabl

ish

and

mai

ntai

n cl

ose

links

with

WH

O, o

ther

Uni

ted

Nat

ions

org

aniz

atio

ns, g

over

nmen

tal

and

nong

over

nmen

tal

inst

itutio

ns in

hea

lth a

nd d

evel

opm

ent s

ecto

rs.

Mem

bers

hip

orga

niza

tion

with

par

tner

s in

all

regi

ons

of th

e w

orld

Sci

entif

ic g

roup

s in

ast

hma,

tu

berc

ulos

is, t

obac

co p

reve

ntio

n,

nurs

ing,

chi

ld lu

ng h

ealth

Par

tner

s in

clud

e W

HO

tu

berc

ulos

is p

rogr

amm

e; S

top

TB

Initi

ativ

e;

Glo

bal F

und

to F

ight

A

IDS

, Tub

ercu

losi

s an

d M

alar

ia;

Cen

ters

for D

isea

se C

ontro

l and

P

reve

ntio

n: A

FRO

Kor

ea A

sthm

a A

llerg

y Fo

unda

tion

(KA

AF)

. Pre

side

nt:

Pro

fess

or K

im Y

ou Y

oung

(y

ouyo

ung@

plaz

a.sn

u.ac

.kr)

2003

No

info

rmat

ion

avai

labl

e.N

atio

nal

nong

over

nmen

tal

orga

niza

tion

286

mem

bers

focu

sing

on

resp

irato

ry m

edic

ine

and

alle

rgy,

R

epub

lic o

f Kor

ea

Latin

Am

eric

an T

hora

cic

Soc

iety

(ALA

T). P

resi

dent

: Dr

Car

los

M L

una

(c

ymlu

na@

adva

nced

sl.c

om.a

r)

1996

ww

w.a

lato

rax.

com

To re

cord

and

dis

sem

inat

e sc

ient

ific

info

rmat

ion

abou

t lun

g di

seas

es; t

o te

ach;

to p

rom

ote

rese

arch

on

thor

acic

dis

ease

s in

Lat

in A

mer

ica;

to s

timul

ate

scie

ntifi

c co

ntac

t bet

wee

n th

e so

ciet

y's

mem

bers

and

oth

er n

atio

nal a

nd in

tern

atio

nal

resp

irato

ry s

ocie

ties;

to d

evel

op g

uide

lines

for t

he

man

agem

ent o

f tho

raci

c di

seas

es; t

o de

velo

p sc

ient

ific

depa

rtmen

ts in

side

the

asso

ciat

ion;

to e

dit s

cien

tific

pu

blic

atio

ns.

Non

gove

rnm

enta

l or

gani

zatio

n

Ast

hma,

chr

onic

obs

truct

ive

pulm

onar

y di

seas

e, c

ritic

al

pulm

onol

ogy,

end

osco

py,

inte

rstit

ial l

ung

dise

ases

, lu

ng in

fect

ions

, tho

raci

c su

rger

y,

paed

iatri

c pu

lmon

olog

y, p

ulm

onar

y ci

rcul

atio

n, re

spira

tory

pa

thop

hysi

olog

y, tu

berc

ulos

is

5700

: A

MR

O,

EU

RO

Nat

iona

l Pub

lic H

ealth

In

stitu

te, F

inla

nd (

KTL

).

Dire

ctor

: Pek

ka P

uska

(p

ekka

.pus

ka@

ktl.f

i)

1911

ww

w.k

tl.fi/

porta

l/eng

lish

To p

rom

ote

peop

le's

pos

sibi

lity

of li

ving

hea

lthy

lives

. In

tern

atio

nal c

olla

bora

tion

(e.g

. mul

tilat

eral

mon

itorin

g of

tre

nds

and

dete

rmin

ants

in c

ardi

ovas

cula

r dis

ease

s (M

ON

ICA

) pro

ject

).

Gov

ernm

enta

l ins

titut

e (u

nder

the

Min

istry

of

Soc

ial A

ffairs

and

Hea

lth),

WH

O C

olla

bora

ting

Cen

tre

Fin

land

: EU

RO

Nat

iona

l Hea

rt, L

ung

and

Blo

od In

stitu

te (N

HB

LI),

Div

isio

n of

Lun

g D

isea

ses.

D

irect

or: D

r Jam

es K

iley

(kile

yj@

nih.

gov)

ww

w.n

hlbi

.nih

.gov

Pro

gram

me

on a

sthm

a an

d ch

roni

c ob

stru

ctiv

e pu

lmon

ary

dise

ases

incl

udes

goa

ls o

n ep

idem

iolo

gy, r

esea

rch,

gen

etic

s an

d ph

arm

acog

enet

ics,

clin

ical

tria

ls, d

emon

stra

tion

and

educ

atio

n in

itiat

ives

.

Gov

ernm

enta

l or

gani

zatio

n

Act

ive

partn

er w

ith G

loba

l Ini

tiativ

e fo

r Chr

onic

Obs

truct

ive

Lung

D

isea

se a

nd w

ith W

HO

: A

FRO

, A

MR

O, E

MR

O, E

UR

O, S

EA

RO

, W

PR

O

Nam

e of

Org

aniz

atio

nY

ear

esta

blis

hed

Jour

nal a

nd W

ebsi

te a

ddre

ssM

issi

onC

ateg

ory

(Int.O

rg./N

GO

/etc

.)In

tere

st s

ectio

ns o

r ass

embl

ies

No.

of m

embe

rs/p

artn

ers

and

repr

esen

tatio

n by

WH

O R

egio

n

Por

tugu

ese

Soc

iety

of

Alle

rgol

ogy

and

Clin

ical

Im

mun

olog

y (S

PAIC

). P

resi

dent

: Mar

io M

orai

s de

A

lmei

da (s

paic

@sa

po.p

t)

1950

Rev

ista

Por

tugu

esa

de

Imun

oale

rgol

ogia

w

ww

.spa

ic.p

t

To p

reve

nt a

nd tr

eat a

llerg

ic d

isea

ses

thro

ugh

rese

arch

, ed

ucat

ion,

pat

ient

car

e an

d ad

voca

cy. T

o de

crea

se m

orbi

dity

an

d m

orta

lity

from

alle

rgic

and

resp

irato

ry d

isor

ders

, inc

ludi

ng

asth

ma,

in p

eopl

e of

all

ages

, int

erac

ting

with

nat

iona

l and

in

tern

atio

nal o

rgan

izat

ions

that

hav

e si

mila

r goa

ls.

Non

prof

it,

nong

over

nmen

tal,

natio

nal,

prof

essi

onal

and

sc

ient

ific

soci

ety

for

alle

rgic

and

resp

irato

ry

care

med

icin

e

12 s

peci

aliz

ed in

tere

st s

ectio

ns:

aero

biol

ogy,

alle

rgy

and

asth

ma

in

spor

ts, a

sthm

a, d

rug

alle

rgy,

ep

idem

iolo

gy, f

ood

alle

rgy,

im

mun

othe

rapy

, ins

ect v

enom

al

lerg

y, la

tex

alle

rgy,

prim

ary

imm

unod

efic

ienc

y, s

kin

alle

rgy,

rh

initi

s

355

activ

e m

embe

rs: E

UR

O

Rus

sian

Soc

iety

of

Pul

mon

olog

ists

(RSP

).

Pre

side

nt:

Pro

fess

or

Ale

xand

er G

Chu

chal

in

(Chu

chal

in@

inbo

x.ru

)

No

info

rmat

ion

avai

labl

e.

Res

pira

tory

Soc

iety

of F

renc

h S

peak

ing

coun

tries

(SPL

F).

Pre

side

nt-E

lect

: P

rofe

ssor

P

hilip

pe G

odar

d (p

resi

dent

-S

PLF

@sp

lf.or

g)

1916

Rev

ue d

es m

alad

ies

resp

irato

ires,

Info

-Res

pira

tion

ww

w.s

plf.o

rg

To p

rom

ote

all a

spec

ts o

f res

earc

h in

the

field

of l

ung

dise

ases

; to

educ

ate

heal

th p

rofe

ssio

nals

and

pat

ient

s in

or

der t

o in

crea

se q

ualit

y of

car

e an

d aw

aren

ess;

to

elab

orat

e pr

ogra

mm

es fo

r scr

eeni

ng, p

reve

ntio

n an

d tre

atm

ent o

f lun

g di

seas

es s

uch

as a

sthm

a, c

hron

ic o

bstru

ctiv

e pu

lmon

ary

dise

ase

and

occu

patio

nal d

isea

ses;

to in

tera

ct w

ith re

spira

tory

he

alth

offi

cial

s in

ord

er to

pro

duce

evi

denc

e-ba

sed

guid

elin

es.

Soc

iety

22 w

orki

ng g

roup

s in

volv

ed in

the

prep

arat

ion

and

cond

uct o

f a

year

ly c

ongr

ess

Ove

r 150

0 m

embe

rs fr

om v

ario

us

Fren

ch-s

peak

ing

coun

tries

(cen

tral

and

east

ern

Eur

ope,

Afri

can

and

Asi

an c

ount

ries)

: A

FRO

, EU

RO

, W

PR

O

Soc

iété

Fra

ncai

se

d'A

llerg

olog

ie e

t d'Im

mun

olog

ieC

liniq

ue (S

FAIC

). P

resi

dent

: P

rofe

ssor

Gab

rielle

Pau

li (G

abrie

lle.P

auli@

chru

-st

rasb

ourg

.fr)

No

info

rmat

ion

avai

labl

e.

Turk

ish

Thor

acic

Soc

iety

(T

TS).

Pre

side

nt:

Pro

fess

or H

aluk

Tur

ktas

(h

aluk

tur@

supe

ronl

ine.

com

)

1992

Turk

ish

Res

pira

tory

Jou

rnal

w

ww

.tora

ks.o

rg.tr

/eng

lish

To p

rovi

de th

e m

ost e

ffect

ive

scie

ntifi

c m

etho

ds fo

r pr

even

tion,

con

trol a

nd tr

eatm

ent o

f res

pira

tory

dis

ease

s, a

nd

to in

crea

se n

atio

nal r

espi

rato

ry h

ealth

thro

ugh

patie

nt c

are,

re

sear

ch, e

duca

tion

and

prom

otio

n of

nat

iona

l pol

icie

s.

Nat

iona

l, no

npro

fit

educ

atio

nal a

nd s

cien

tific

so

ciet

y14

sci

entif

ic w

orki

ng g

roup

s15

00 m

embe

rs, 1

5 br

anch

es

thro

ugho

ut T

urke

y: E

UR

O

Wor

ld A

llerg

y O

rgan

izat

ion

(WA

O).

Pre

side

nt: D

r Car

los

E. B

aena

-Cag

nani

(info

@w

orld

alle

rgy.

org)

1950

Jour

nal o

f Wor

ld A

llerg

y O

rgan

izat

ion,

Inte

rnat

iona

l A

rchi

ves

of A

llerg

y &

Im

mun

olog

y

ww

w.w

orld

alle

rgy.

org

To b

uild

a g

loba

l alli

ance

of a

llerg

y so

ciet

ies

to a

dvan

ce

exce

llenc

e in

clin

ical

car

e, re

sear

ch, e

duca

tion

and

train

ing.

Wor

ldw

ide

nong

over

nmen

tal

orga

niza

tion;

mem

ber o

f C

ounc

il fo

r Int

erna

tiona

l O

rgan

izat

ions

of M

edic

al

Sci

ence

s; w

orki

ng

rela

tions

hip

with

WH

O

Fede

ratio

n of

70

natio

nal,

regi

onal

an

d af

filia

te o

rgan

izat

ions

Tota

l ind

ivid

ual m

embe

rshi

p of

m

embe

r soc

ietie

s ov

er 3

8 00

0,

repr

esen

ting

92 c

ount

ries:

AFR

O,

AM

RO

, EM

RO

, EU

RO

, SE

AR

O,

WP

RO

Wor

ld F

eder

atio

n of

H

ydro

ther

apy

and

Clim

atot

hera

py (F

EMTE

C).

Pre

side

nt: D

r N. S

toro

shen

ko

(kur

ort@

onlin

e.ru

), S

ecre

tary

-G

ener

al: P

rofe

ssor

U.

Sol

imen

e (u

mbe

rto.s

olim

ene@

unim

i.it)

1937

ww

w.fe

mte

conl

ine.

com

To e

xpla

in th

e m

edic

al s

pa w

orld

; to

prom

ote

it in

an

inte

rnat

iona

l con

text

am

ong

Sta

tes

and

gove

rnin

g bo

dies

; to

enco

urag

e in

tern

atio

nal c

oope

ratio

n be

twee

n sp

as; t

o ex

chan

ge s

tudi

es, r

esea

rch

and

prac

tices

in th

e fie

ld o

f hy

drot

hera

py; t

o pr

omot

e de

velo

pmen

t of m

edic

al s

pas

and

clim

atic

reso

rts a

mon

g m

embe

rs a

nd w

orld

wid

e.

Non

gove

rnm

enta

l or

gani

zatio

n in

offi

cial

re

latio

ns w

ith W

HO

sin

ce

1985

2 50

0 m

edic

al c

entre

s in

volv

ed in

ac

tiviti

es; o

nce

a ye

ar, g

ener

al

mee

ting

of E

xecu

tive

Boa

rd;

mee

ting

of th

e fo

ur p

erm

anen

t co

mm

ittee

s -

med

ical

, eco

nom

ic,

tech

nica

l and

soc

ial

35 m

embe

rs: t

herm

al a

nd m

edic

al

spa

asso

ciat

ions

, fed

erat

ions

and

or

gani

zatio

ns d

ealin

g w

ith s

pa

prob

lem

s fro

m v

ario

us c

ount

ries:

A

FRO

, AM

RO

, EM

RO

, EU

RO

, S

EA

RO

, WP

RO

Wor

ld O

rgan

izat

ion

of F

amily

D

octo

rs (W

ON

CA

). P

resi

dent

: P

rofe

ssor

Chr

is V

an W

eel

(c.v

anw

heel

@ha

g.um

nn.n

l)

1972

ww

w.g

loba

lfam

ilydo

ctor

.com

To im

prov

e th

e qu

ality

of l

ife o

f peo

ples

of t

he w

orld

thro

ugh

defin

ing

and

prom

otin

g its

val

ues;

by

mai

ntai

ning

hig

h st

anda

rds

of c

are

in g

ener

al p

ract

ice/

fam

ily m

edic

ine;

by

prom

otin

g pe

rson

al, c

ompr

ehen

sive

and

con

tinui

ng c

are

for

the

indi

vidu

al in

the

cont

ext o

f the

fam

ily; b

y su

ppor

ting

deve

lopm

ent o

f aca

dem

ic o

rgan

izat

ions

of g

ener

al

prac

titio

ners

/fam

ily p

hysi

cian

s; b

y pr

ovid

ing

educ

atio

n to

m

embe

rs; b

y pr

esen

ting

educ

atio

nal,

rese

arch

and

ser

vice

ac

tiviti

es o

f mem

bers

in o

ther

wor

ld m

edic

al a

nd h

ealth

or

gani

zatio

ns.

Non

gove

rnm

enta

l or

gani

zatio

n in

offi

cial

re

latio

ns w

ith W

HO

Gov

erni

ng c

ounc

il m

eets

eve

ry

thre

e ye

ars;

regi

onal

cou

ncils

in

each

regi

on; e

xecu

tive

com

mitt

ee

mee

ts a

nnua

lly

97 m

embe

r org

aniz

atio

ns in

79

coun

tries

, tot

al m

embe

rshi

p ov

er

200

000

gene

ral p

ract

ition

ers

and

fam

ily p

hysi

cian

s: A

FRO

, AM

RO

, E

MR

O, E

UR

O, S

EA

RO

, WP

RO