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Implementation of National/Regional programs to prevent COPD

Implementation of National/Regional programs to prevent COPD. Nan Shan Zhong Chinese Medical Association. The first five leading causes of death in China (2007). Prevalence of COPD in China: Population (>40y ): 8.2% (M-12.4% ,F-5.1% ) Total: 32.8 millions.

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Implementation of National/Regional programs to prevent COPD

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  1. Implementation of National/Regional programs to prevent COPD Nan Shan Zhong Chinese Medical Association

  2. The first five leading causes of death in China (2007)

  3. Prevalence of COPD in China: Population (>40y ):8.2% (M-12.4% ,F-5.1%)Total: 32.8 millions

  4. 8.1%-24.1% (perennial:25.6% of total)

  5. CRD in China Current patient COPD 32.8 millions Asthma 15.0 millions Allergic rhinitis 113 millions

  6. 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% COPD: one of the first leading causes of death in China (2000) Diabetes 1.2% (90,000) Cardiovascular disease 15.0% (1.0M) COPD 17.60% (1.28M) Cerebrovascular disease 19.10% (1.4M) Tumor 19.30% (1.4M) MOH Disease Control Department and NCDC. Report on Chronic Disease in China. 2006. Kong Lingzhi. 2005 Report in NCDC Annual Conference. % Cause of death (2000)

  7. GARD China Network Dept of Chronic Disease Control, Ministry of Public Health, China China GARD Alliance Chinese Association of Respir.Dis China Asthma Alliance China COPD Alliance

  8. CRD listed as priority in the 15year plan of the control and prevention of chronic non communicable diseases (MOH 2007-2022) • Hypertension • Diabetes • Heart disease • Malignant tumor • Chronic respiratory disease

  9. National/Regional programs to manage COPD • ↓Risk factors (Smoking cessation, reduction of indoor/outdoor air pollution) • Intervention as early as possible • Development of effective and affordable medication

  10. WHO Framework Convention on Tobacco Control (WHO/FCTC) • Government ratified: Aug 28th, 2005 • Enforcement: Jan 9th, 2006

  11. Tobacco Control Organizations in China • Ministry of Health • China CDC- National Tobacco Control Office • WHO Collaborating Center for Tobacco or Health • China Association On Tobacco Control • National Health Education Institute

  12. Policy on Smoke Free Healthcare Facilities Smoking forbidden in hospitals in China 50% hospitals at the end of 2010 100% hospitals at the end of 2011 MOH Document 21st May 2009 11th, March2008 22th, May 2009

  13. Regulations on No-Smoking in Public Places in Beijing Smoking is forbidden in the following public places: 1. Indoor areas of medical organizations; 2. Infant institutions and kingdergartens; 3. Middle schools, primary schools, mid-level vocational schools; 4. Universities and other teaching areas of educational and training organizations. 5. Theatres, music halls, exhibition halls, museums, art galleries, libraries, science and technology museums, archives, children’s palaces, memorial halls and other places for science & teaching, culture and art. 6. Business center of commerce, finance, post and tele-communications; 7. Inside buses, taxis, rail transits and other public transportation tools, related ticket offices and indoor platforms; 8. Cultural relics protection units open to the public; 9. Gymnasiums; 10. Contest area and seating area of stadium These regulations are enacted from May 1st, 2008

  14. Three National Prevalence Surveys Year 1984 1996 2002 2009 Total smoking rate 33.9% 37.6% 35.8% (Aged>15) Male 66.9% 66.0% 48% Female 4.2% 3.08% 2.6% Smoking rate in 60.0% 56.8% male medical doctors

  15. Haze in large cities

  16. “Hazy sky” (NO VOC O3 etc) firstly listed in the category of air pollution in the Pearl River Delta Region Document of Guangdong Government 1th May 2009

  17. National/Regional programs to manage CRD • ↓Risk factors (Smoking cessation reduction of indoor/outdoor air pollution) • Intervention as early as possible • Development of effective and affordable medication

  18. The trend towards development of medicine——Early prevention and intervention • A 3P modality • Predictive • Preventive • Personalized • Strategy of COPD management : moving to the community level

  19. Medical costs Medical costs Rescue Clinical management Early management Early prevention Early prevention Early management Clinical management Rescue

  20. How to improve COPD management at the community level • Increase government investment • Education among medical staff at the community medical system • Research to early implement intervention ;to develop “effective, affordable, simple and safe” medications

  21. China’s total health expenditure takes up only 17% of government’s budget, compared with a mean of 40% in developing countries Data from MoH China (2006)

  22. Increased government investment • More investment in the community health care system (in the next 3 years) Additional healthcare budget 850 billion Yuan Wen Jiabao National People’s Congress 2009

  23. Routine (regular) lung function test in the community Health care system – necessary !

  24. How to improve community health-care • Increase government investment • Education among medical staff at the community medical system • Research to early implement intervention ;to develop “effective, affordable, simple and safe” medications

  25. 2007;175

  26. Diagnosed Rate of COPD Before Epidemiologic Survey

  27. Usage of Lung Function Test

  28. The Launch Meeting of China COPD Alliance in Guangzhou, Nov 4, 2006

  29. Program of COPD Prevention & Management • Awareness: burden ,smoking hazards, air pollution (including biomas fuels) • Smoking cessation campaign • Reduction of outdoor/indoor pollution • Public education (TV newspaper) • Research work: a/ Early intervention-more treatable and reversible b/ Develop effective and affordable medication

  30. Training programme of the medical staff in the community health care system (Early 2007) Haerbin Mar 19 Shenyang Mar 26 Beijing Feb 25 Tianjin Feb 26 Jinan Apr 1 Nanjing Mar 25 Wuhan Mar 12 Shanghai Mar 4 Chongqing Mar 5 Hangzhou Mar 18 Guangzhou Mar 11 1st turn 2nd turn

  31. Training programme of the medical staff in the community health care system (late 2008) Haerbin Sep 9 Shenyang Oct 14 Beijing Sep 10 Jinan Sep 24 Nanjing Sep 17 Wuhan Oct 21 Shanghai Sep 23 Chendu Sep 16 Hangzhou Oct 15 Guangzhou Oct 8 1st turn 2nd turn

  32. The Launch Meeting of China Asthma Alliance in Zhengzhou, June , 2005

  33. Asthma Alliance • Implementation of 2008 GINA Guidelines • Training program of physicians in community level • Knowledge of prevention and management of asthma in the public and media • Development of a simplified guideline available for the rural area (cost-effective) • Boycott fake medicine

  34. Effective and affordable • Carbocisteine, theophylline in COPD • Half of GINA recommended dose in asthma • Chinese traditional medicine

  35. THANKS

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