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Manila, Philippines. BOLD Manila, Philippines. COPD a growing cause of morbidity & mortality worldwide 5 th leading cause of death (2001) ïƒ 3rd in 2020 (WHO). BOLD Manila, Philippines. Local COPD Burden ï¨ Paucity of data and only estimates
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BOLDManila, Philippines COPD a growing cause of morbidity & mortality worldwide 5th leading cause of death (2001) 3rd in 2020 (WHO)
BOLDManila, Philippines Local COPD Burden Paucity of data and only estimates Rural Banca- Banca (1987) 3.7% Urban San Andres Bukid (1990) 2.3% Estimate using a mathematical model (1999) 6.3%
Accurate estimates of the COPD prevalence using standardized methods in population-based studies: to anticipate future burden of disease target key risk factors plan for providing COPD-related health services BOLDManila, Philippines
Primary Objectives: Measure the prevalence of COPD and its various riskfactors in the city of Manila Secondary Objectives: Determine extent to which variations in risk factors contribute to variations in the prevalence of COPD Describe the distribution of COPD according to age, sex and smoking history BOLDManila, Philippines
Eligibility Criteria Residents of the City of Manila Aged 40 years and above Signed informed consent BOLDManila, Philippines
Stratified, three stage cluster sampling City of Manila (population = 1,568,092) 6 Districts of Manila sampled zones (by random sampling) (n=27) sampled barangays (random sampling) ( n=54) sampled households (systematic sampling) (n= 965) all eligible members of sampled household (n=1639) BOLD Manila, PhilippinesStudy Design
Questionnaires Validated questionnaires used in multinational studies (1978 ATS/DLD Respiratory Symptom Questionnaire and questionnaires used in the European Community Respiratory Health Study and US Lung Health Study) Linguistic validation through translation and back translation BOLDManila, Philippines
Spirometry Data sent to the Pulmonary Function Quality Center in Salt Lake City To be deemed usable for analysis, spirometry had to meet ATS acceptability and reproducibility criteria Data Management and Analysis Done at the Operating Center, Portland, Oregon BOLDManila, Philippines
Initial training—05/2005 Fieldwork—10/2005-05/2006 Participants were selected using a stratified, three-stage cluster sampling design 918 (58%) completed the full protocol i.e., questionnaire & post bronchodilator spirometry Response rates: Men 55% Women 60% BOLDManila, Philippines
Manila, PhilippinesPrevalence of ever smokingin population1 ages >40by sex Ever smoked 31% 83% Females Males Overall = 55% 1 Unweighted data for the sample of responders
National Nutrition Health StudyPrevalenceof ever smokingin population1 ages >20 years (1999) Ever smoked 17% 71% Males Females Overall = 45%
Manila, PhilippinesPopulation Prevalence ofGOLD Stage I+,GOLD Stage II+ & Doctor Diagnosed COPD *Post BD FEV1/FVC<70% ** Post BD FEV1/FVC <70% and post BD FEV1 <80% ***Includes chronic bronchitis, emphysema or COPD
COPD Prevalence in City of Manila 12% or 1 out of 8 individuals 40 years and above Out of 361,864 individuals (2002 census) 40 years and above, there are 45,233 COPD patients 2-3% doctor-diagnosed COPD highlights importance of spirometry to diagnose COPD
Manila, Philippines Estimated Population Prevalence of GOLD Stage II+ COPD* by age and sex (NHANES) * Post BD FEV1/FVC <70% and post BD FEV1 <80%
The prevalence of COPD that is GOLD stage II or higher increases steadily with age for men and women BOLD Manila, Philippines
Manila, Philippines Estimated Population Prevalence of Gold Stage II+ COPD* by pack years and sex * Post BD FEV1/FVC <70% and post BD FEV1 <80%
The relation between prevalence of GOLD stage II + COPD and pack years was evident among males but less clear with women The fairly high prevalence of GOLD stage II + COPD in the never smokers raise important questions about role of other risk factors BOLD Manila, Philippines
CONCLUSIONS COPD prevalence of 12% is much higher than previous estimates Smoking prevalence of 55% in the city of Manila may be higher than the national figure Prevalence of COPD among never smokers is 7% indicating other risk factors
CONCLUSIONS Relation between prevalence of COPD and pack years was evident in men but less clear in women Doctor-diagnosed COPD underestimates the true prevalence of the disease
USEFULNESS OF STUDY It is possible to get more accurate estimates of burden of COPD & its risk factors generated from population-based studies using standardized methods Studies like this can help assess the effectiveness of health intervention programs – preventive (anti-smoking), diagnostic (spirometry), or therapeutic (anti-inflammatory drugs) across time and even across different areas in the country
USEFULNESS OF STUDY Assist public health officials in developing best possible primary and secondary prevention policies on COPD for their areas
PHILIPPINE BOLD STUDY WHAT IS NEXT? Rural study in Nueva Ecija Other areas in the Philippines ?
BOLDManila, Philippines Investigators: Renato B. Dantes, MD Fernando Ayuyao, MD Norberto A. Francisco, MD Lakan U. Berratio Teresita S de Guia, MD Gerard Garcia, MD Camilo C. Roa, Jr., MD Leander P. Simpao, MD Lenora C. Fernandez, MD Lourdes Amarillo, MSc Luisito F. Idolor, MD Ma. Flordeliza Sanchez Sullian S. Naval, MD Thessa Reyes Daniel Tan, MD Cecil Tady, MD
BOLDManila, Philippines Acknowledgements: BOLD COLLABORATIVE RESEARCH GROUP A. Sonia Buist, MD William M. Vollmer, PhD Robert L. Jensen, PhD Suzanne Gillespie, MS Mary Ann McBurnie, PhD
SPONSORS OF THE STUDY Philippine College of Chest Physicians Philippine College of Physicians Boehringer Ingelheim (Phil) GlaxoSmithKline United Laboratories (Phil) Altana Pfizer BOLDManila, Philippines
BOLDManila, Philippines Thank you!