Summary

1. WHO’S STRATEGYPREVENTION & CONTROL ofCHRONIC RESPIRATORY DISEASESDr Nikolai Khaltaev MD, PhDDept. of Noncommunicable Diseases ManagementWorld Health OrganizationGeneva, Switzerland

2. Summary Burden of Respiratory Diseases Contributing factors Goals & Objectives of the WHO strategy General principles Strategic directions Priorities for WHO Role of member states

3. source: World Health Report 2000

4. Five leading causes of death by the year 2020

5. Respiratory diseases in developing countries communicable tbc, pneumoina, etc. % % changes in: demographics, HCSs schooling, income, tobacco XXth XXIth non-communicable asthma, COPD, lung cancer

6. Summary Burden of Respiratory Diseases Contributing factors Goals & Objectives of the WHO strategy General principles Strategic directions Priorities for WHO Role of member states

7. tobacco smoke COPD indoor pollution CRD outdoor pollution occupation malnutrition Asthma low birth weight multiple early lung infections CONTRIBUTING FACTORS (1) LC atopy hygiene + indoor allergens

8. CONTRIBUTING FACTORS (2) socioeconomic factors: POVERTY rising trend type of occupation level of education other priorities level of nutrition no attention type of housing environmental determinants no action trend rising further prevalence & severity poor access to health care

9. Summary Burden of Respiratory Diseases Contributing factors Goals & Objectives of the WHO strategy General principles Strategic directions Priorities for WHO Role of member states

10. Goal of the strategy to support Member States in their efforts to reduce : MORBIDITY COPD CRD DISABILITY LC MORTALITY Asthma

11. 1. map the magnitude of CRD 2. analyse CRD determinants (esp. poor, disadvanteged) 3. monitor future trends Global Strategy NCD Prevention & Control OBJECTIVES OF THE STRATEGY surveillance tobacco smoke indoor pollution outdoor pollution occupation malnutrition low birth weight primary prevention multiple early lung infections reduce exposure of individuals & populations to RFs secondary & tertiary prevention 1. identifying cost-effective interventions 2. upgrading standards of care 3. upgrading accessibility of care (at different levels of the HCS)

12. Summary Burden of Respiratory Diseases Contributing factors Goals & Objectives of the WHO strategy General principles Strategic directions Priorities for WHO Role of member states

13. 5. GENERAL PRINCIPLES prevention & control programmes implementation of P&C programmes BARRIERS measures 1. Strengthening partnerships 4. Initiating cost-effectiveness studies secondary prevention risk factors reduction Gov. NGOs INT. INSTs EPAs Industry Schools tobacco smoke extending the capacity of health care professionals beyond the traditional focus on acute care of communicable respiratory diseases indoor pollution outdoor pollution HCS occupation malnutrition low birth weight multiple early lung infections 5. Adapting the existing guidelines for the P&T of CRDto the needs of developing countries and to their primary health care level through the use of the syndromic approach, if feasible 2. Developing globally accepted criteria for the diagnosis of CRDs 6. Improving access of HCS to equipment & supplies 3. Integrating CRD prevention into a comprehensive NCD prevention programme of patients to essential drugs of patients to prevention trough care providers

14. Summary Burden of Respiratory Diseases Contributing factors Goals & Objectives of the WHO strategy General principles Strategic directions Priorities for WHO Role of member states

15. STRATEGIC DIRECTIONS standardize epidemiological methods 1. quantify and track CRD 2. to improve comparability across member states surveillance develop uniform set of diagnostic criteria/tools National surveillance systems monitoring quality of health care 1. availability, cost and quality of drugs 2. existence of local guidelines & policies 3. level of training of health professionals developing & implementing simple methodologies for providing objectives measures of trends 1. cause specific mortality 2. risk factor prevalence 3. morbidity data: a. hospital admissions b. hospital consultations c. therapeutic trends Standard indicators: 1. lung function measurements 2. disease progression 3. absenteeism from school/work 4. hospitalizations

16. STRATEGIC DIRECTIONS (2) primary prevention reduction or avoidance of personal exposure to primary risk factorsto be started during pregnancy and childhood tobacco smoke low birth weight poor nutrition multiple early res. infections indoor pollution outdoor pollution occupational risk factors other 3 NCD pgms information to the population about HEALTHY LIFESTYLE: 1. healthy nutritional habits 2. regular exercise 3. avoidance of: tobacco irritants allergens other sectors of the community must be actively engaged more research is needed before effective strategies for primary prevention of asthma can be established

17. STRATEGIC DIRECTIONS (3) secondary & tertiary prevention early detection of occupational asthma early detection of COPD prevention of COPD 1. prevention of further progression 2. cost-effective managment cost-effectiveness to be still fully evaluated 1. smoking cessation 2. pulmonary rehabilitation 3. reduction exposure irritants 4. influenza vaccination 1. reduction of symptoms 2. improvement of QoL 3. increase physical fitness 1. avoidance of allergens 2. avoidance of triggers secondary & tertiary prevention of asthma primary prevention of COPD & reduction of mortality optimal pharmacological treatment (including anti-.inflammatory medication)

18. Summary Burden of Respiratory Diseases Contributing factors Goals & Objectives of the WHO strategy General principles Strategic directions Priorities for WHO Role of member states

19. PRIORITIES FOR WHO Development and evaluation of reproducible and inexpensive methodologies to monitor COPD, suitable in developing countries Identifying and addressing barriers to drugs and essential device accessibility Developing approaches to improve accessibility to essential drugs in low income countries, designing and implementing a study of CRD drug and device availability and pricing in low and middle income countries Identifying gaps in existing guidelines, utilizing EBM, considering cost-effectiveness and feasibility in developing countries, using guidelines as the rational basis for inclusion of drugs into the Essential Drugs List Strenghtening research on primary & secondary prevention intervention of CRD Identifying research priorities for prevention strategies, therapeutic regimens, alternative drug delivery systems, traditional medicine, alternative therapeutic approaches Establishment and promotion of partnerships with professional, scientific, and educational institutions to promote and implement the initiative

20. Summary Burden of Respiratory Diseases Contributing factors Goals & Objectives of the WHO strategy General principles Strategic directions Priorities for WHO Role of member states

21. ROLE OF MEMBER STATES Development National Programmes for Prevention and Control of CRDs Comprehensiveness: covering Surveillance, Prevention, Management Integrating primary prevention of CRD with other NCDs (CVDs, diabetes, and certain cancers Involve public and private health systems Establish a connection between Health Care providers and Schools about dangers of tobacco smokes and the importance of minimizing LRI Ensure the involvement of all levels of Health care providers, universities, patients, patients support groups, third party payers, and NGOs provide proper training and continuing education and prevention and management of CRD promote and implement research for better understanding of molecular and cellular pathogenic mechanisms of CRD implement mechanisms for promoting access to basic drugs and adherence to long-term therapy particularly for poor and disadvantaged people include a rigorous method of evaluation and audit of health systems to ensure implementation and to test local effectiveness