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1999 Disease or Injury

Increasing burden of noncommunicable diseases and injuries change in rank order of DALYs for the 15 leading causes (baseline scenario). 1999 Disease or Injury. 2020 Disease or Injury. 1 Acute lower respiratory infections 2.HIV/AIDS 3.Perinatal conditions 4.Diarrhoeal diseases

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1999 Disease or Injury

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  1. Increasing burden of noncommunicable diseases and injuries change in rank order of DALYs for the 15 leading causes (baseline scenario) 1999 Disease or Injury 2020Disease or Injury 1 Acute lower respiratory infections 2.HIV/AIDS 3.Perinatal conditions 4.Diarrhoeal diseases 5.Unipolar major depression 6.Ischaemic heart disease 7.Cerebrovascular disease 8.Malaria 9.Road traffic injuries 10.Chronic obstructive pulmonary disease 11.Congenital abnormalities 12.Tuberculosis 13.Falls 14.Measles 15.Anaemias 1. Ischaemic heart disease 2. Unipolar major depression 3. Road traffic injuries 4. Cerebrovascular disease 5 .Chronic obstructive pulmonary 6. Lower respiratory infections 7. Tuberculosis 8. War 9. Diarrhoeal diseases 10.HIV 11.Perinatal conditions 12.Violence 13.Congenital abnormalities 14.Self-inflicted injuries 15.Trachea, bronchus and lung cancers

  2. Tobacco: deaths by World Bank regions estimates for 1990 and 2020 Middle Eastern Crescent 8.4 million Latin America & Caribbean Sub-Saharan Africa OtherAsia and Islands China India 3 million Former Socialist Countries Established Market Economies Source: Murray CJL, Lopez AD 1996

  3. Deaths (% of total) attributable to tobacco use by World Bank Region, estimates for 1990 and 2020 2020 1990

  4. Asthma and Chronic Obstructive Airway Disease (COAD) Control and Prevention

  5. Objectives: You Students will be capable to • understand the geographical distribution of COAD/COPD and Asthma. • identify risk factors posing the methods used in their prevention and control.

  6. Global distribution of causes of death,1999 (000s) Other Noncommunicable Diseases (2137) Injuries (5101) Other causes (800) Digestive Diseases (2049) Respiratory Diseases (3575) Perinatal conditions (2356) Nutritional deficiences (493) Malaria (1086) HIV/AIDS (2673) Tuberculosis (1669) Cardiovascular Diseases (16970) Diarrhoeal diseases (2213) Respiratory Infections (4039) Neuropsychiatric Disorders (911) Childhood diseases (1554) Diabetes (777) Maternal Conditions (497) Malignant neoplasms (7065)

  7. Global burden of disease in disability-adjusted life years (DALYs), 1999 (000s) Injuries (201307) Other causes (59025) Perinatal conditions (89508) Other Noncommunicable diseases (99420) Nutritional deficiences (44539) Malaria (44998) Digestive diseases (36829) HIV/AIDS (89819) Respiratory diseases (70017) Tuberculosis (33287) Cardiovascular diseases (157185) Diarrhoeal diseases (72063) Respiratory infections (101127) Childhood diseases (54638) Neuropsychiatric disorders (158721) Maternal conditions (26101) Diabetes (15070) Malignant neoplasms (84500)

  8. Deaths, 1990 among poorest 20% of global population principal causes (% of deaths) Respiratory Infections (13.4) Diarrheal Diseases (11.3) intentional and unintentional Injuries (9.4) Other (8.5) Perinatal Conditions (7.9) Childhood Cluster Diseases (7.8) Ischaemic Heart Disease (7.3) Tuberculosis (6.2) Malignant Neoplasms (5.6) Cerebrovascular Diseases (4.6) • Maternal Conditions (1.4) • Congenital Abnormalities (1.3) • Inflammatory and Rheumatic Heart Diseases (1.2) • Genito-Urinary Conditions (1.1) • HIV/AIDS (0.9) • Neuropsychiatric Conditions (0.8) • Diabetis Mellitus (0.7) Malaria (3.6) Respiratory Diseases (2.7) Digestive Diseases (2.5) Nutritional Deficiencies (1.8) Source: The Burden of Disease among the Global Poor, World Bank 2000

  9. DALYs, 1990 among poorest 20% of global population principal causes (% of DALYs) intentional and unintentional Injuries (13.1) Respiratory Infections (11.8) Diarrheal Diseases (11) Other (10.4) Perinatal Conditions (8.8) Childhood Cluster Diseases (8.1) • Respiratory Diseases (2.4) • Malignant Neoplasms (2.3) • Digestive Diseases (2.1) • Congenital Abnormalities (2) • Ischaemic Heart Disease (1.9) • Cerebrovascular Disease (1.5) • HIV/AIDS (1) • Inflammatory and Rheumatic Heart Diseases (0.9) • Genito-Urinary Diseases (0.7) • Diabetes (0.5) Neuropsychiatric Conditions (5.4) Nutritional Deficiencies (4.5) Maternal Conditions (3.9) Malaria (3.9) Tuberculosis (3.8) Source: The Burden of Disease among the Global Poor, World Bank 2000

  10. Distribution of causes of death in Africa, 1999 (000s) Nutritional deficiencies (180) Perinatal conditions (615) Malaria (953) Other causes (255) Injuries (776) HIV/AIDS (2154) Noncommunicable conditions (2300) Tuberculosis (357) Diarrhoeal diseases (765) Maternal Conditions (255) Respiratory infections (1086) Childhood diseases (740)

  11. Burden of disease in disability-adjusted life years (DALYs) in Africa, 1999 (000s) Other causes (23075) Injuries (36103) Perinatal conditions (24097) Nutritional deficiencies (11037) Noncommunicable conditions (63681) Malaria (36838) Maternal conditions (12525) HIV/AIDS (74449) Childhood diseases (25742) Tuberculosis (8721) Respiratory infections (32771) Diarrhoeal diseases (24321)

  12. Distribution of causes of death in Americas, 1999 (000s) Injuries (552) Respiratory infections (299) Perinatal conditions (153) Other causes (101) HIV/AIDS (81) Diarrhoeal diseases (74) Nutritional deficiencies (72) Tuberculosis (59) Childhood diseases (21) Noncommunicable conditions (4255) Maternal conditions (18) Malaria (2)

  13. Burden of disease in disability-adjusted life years (DALYs) in Americas, 1999 (000s) Injuries (17738) Other causes (4536) Perinatal conditions (5566) Respiratory infections (4204) Nutritional deficiencies (2733) HIV/AIDS (2812) Diarrhoeal diseases (2514) Maternal conditions (1207) Noncommunicable conditions (82909) Tuberculosis (1114) Childhood diseases (533) Malaria (76)

  14. Distribution of causes of death in Europe, 1999 (000s) Injuries (750) Respiratory infections (275) Perinatal conditions (62) Tuberculosis (60) Other causes (58) Diarrhoeal diseases (30) HIV/AIDS (15) Nutritional deficiencies (14) Childhood diseases (13) Maternal conditions (4) Noncommunicable conditions (7776)

  15. Distribution of causes of death in the Eastern Mediterranean, 1999 (000s) Other causes (80) Injuries (405) Perinatal conditions (313) Nutritional deficiencies (44) Malaria (44) HIV/AIDS (29) Tuberculosis (112) Diarrhoeal diseases (300) Noncommunicable conditions (2318) Respiratory infections (343) Childhood diseases (191) Maternal conditions (39)

  16. Burden of disease in disability-adjusted life years (DALYs) in Eastern Mediterranean,1999 (000s) Other causes (4931) Injuries (13214) Perinatal conditions (11755) Nutritional deficiencies (4119) Malaria (2774) HIV/AIDS (2172) Tuberculosis (2260) Diarrhoeal diseases (10123) Noncommunicable conditions (51039) Respiratory infections (10916) Childhood diseases (6560) Maternal conditions (2720)

  17. Burden of disease in disability-adjusted life years (DALYs) in Europe,1999 (000s) Injuries (19323) Respiratory infections (3509) Perinatal conditions (2370) Other causes (1921) Tuberculosis (1258) Nutritional deficiencies (1152) Diarrhoeal diseases (1131) HIV/AIDS (725) Childhood diseases (477) Maternal conditions (451) Malaria (2) Noncommunicable conditions (104032)

  18. Distribution of causes of death in South-East Asia, 1999 (000s) Injuries (1301) Other causes (236) Perinatal conditions (851) Nutritional deficiencies (159) Malaria (69) HIV/AIDS (360) Tuberculosis (723) Diarrhoeal diseases (978) Respiratory infections (1523) Noncommunicable conditions (7370) Childhood diseases (542) Maternal conditions (158)

  19. Burden of disease in disability-adjusted life years (DALYs) in South-East Asia,1999 (000s) Other causes (19693) Injuries (65289) Perinatal conditions (32715) Nutritional deficiencies (16866) Malaria (3071) HIV/AIDS (8866) Tuberculosis (14101) Diarrhoeal diseases (30017) Noncommunicable conditions (156536) Respiratory infections (38144) Childhood diseases (19449) Maternal conditions (7733)

  20. Distribution of causes of death in Western Pacific, 1999 (000s) Injuries (1317) Respiratory infections (514) Perinatal conditions (363) Tuberculosis (359) Other causes (75) Diarrhoeal diseases (67) Childhood diseases (47) HIV/AIDS (34) Noncommunicable Conditions (9462) Nutritional deficiencies (22) Maternal conditions (21) Malaria (16)

  21. Burden of disease in disability-adjusted life years (DALYs) in Western Pacific, 1999 (000s) Injuries (49641) Perinatal conditions (13005) Respiratory infections (11584) Nutritional deficiencies (8633) Tuberculosis (5832) Other causes (4872) Diarrhoeal diseases (3955) Malaria (2235) Childhood diseases (1875) Maternal conditions (1466) Noncommunicable conditions (163546) HIV/AIDS (795)

  22. ? Asthma What Is • Chronic inflammatory disorder of the airways • Usually reversible, but not yet curable • Not the same as allergies • Not contagious

  23. What Does An asthma episode ? feel like • Jog in place for 2 minutes • Place a straw in your mouth and breathe only through the straw by pinching your nose closed • How do you feel?

  24. ? What Happens During an asthma episode Airways narrow, caused by: • tightening of the muscles that surround the airways • swelling of the inner lining, and/or • increase in mucus production

  25. Two parts Two parts of asthma Noisy Quiet

  26. Asthma SYMPTOMS • Coughing • Wheezing • Chest tightness • Shortness of breath

  27. Facts Asthma • About 17 million Americans have asthma • Rate of asthma increased 75% between 1980 and 1994 • Most common chronic childhood disease, affecting about 5 million children • 14 people die each day from asthma • Nearly 2 million emergency room visits each year

  28. to suffer from asthma? Who is most at risk • Children • Low-income, urban residents • Some minorities • Allergic individuals • People with hereditary disposition for asthma

  29. Asthma Managing The patient should Consult the physician to develop an asthma management plan, which includes: • Medication • Identification of your asthma triggers & ways to reduce/avoid exposure to your asthma triggers • Peak flow monitoring • Emergency plan

  30. NAEPP Guidelines, 1997 American National Asthma Education and Prevention Program (NAEPP) • Classification of chronic asthma: • Mild intermittent asthma • Mild persistent asthma (>2 days/wk, >2 nights/mo) • Moderate persistent asthma • Severe persistent asthma • Inhaled corticosteroids (ICS) are “preferred treatment” for all patients with persistent asthma

  31. Allergens molds, dust mites, cockroaches, animal dander, pollens,foods Irritants secondhand smoke, strong odors, aerosols, volatile organic compounds, ozone, particulate matter Other Viral respiratory infections Changes in weather (cold air, wind, humidity) Exercise Medication Endocrine factors (menstrual period, pregnancy, thyroid disease) Common Triggers asthma * 5 major indoor asthma triggers

  32. What does the Asthma? Indoor Environment have to do with • All of the common asthma triggers are found indoors • Reducing exposure to indoor allergens and irritants can reduce asthma symptoms • Prevention is an important asthma management tool

  33. Indoor Environmental Triggers Most common Secondhand Smoke Dust Mites Mold Pets Cockroaches

  34. Smoke Secondhand • Contains more than 4,000 substances (over 40 are carcinogenic) • Is particularly harmful to young children • Can trigger asthma attacks and cause young children to develop asthma

  35. Avoiding Secondhand Smoke Choose not to smoke in your home or car and do not allow others to do so either

  36. DUST mites • Found in most homes • Live in soft bedding • Feed on skin flakes • Mites and mite droppings can be asthma triggers • Can cause children to develop asthma

  37. Avoiding Triggers dust mite • Wash sheets and blankets once a week in hot water • Choose washable stuffed toys, wash them often in hot water, and dry thoroughly -- keep stuffed toys off beds • Cover mattresses and pillows in dust-proof (allergen-impermeable) zippered covers • Vacuum often (when asthmatic is not present) • Maintain low indoor humidity, ideally between 30-50% 

  38. PeTS • Skin flakes, urine, and saliva of warm blooded animals can be asthma triggers • Triggers can remain in the home for several months after a pet is removed, even with cleaning

  39. pet Triggers Avoiding • Consider keeping pets outdoors or even finding a new home for your pets, if necessary • Keep pets out of the bedroom and other sleeping areas at all times, and keep the door closed • Keep pets away from fabric-covered furniture, carpets, and stuffed toys • If you remove an animal from the home, clean the home thoroughly

  40. Molds • Can be found almost anywhere and can grow on virtually any damp substance • Key to mold control is moisture control • Clean up the mold and get rid of excess water or moisture • Reducing moisture also helps reduce other triggers, such as dust mites and cockroaches

  41. Avoiding Mold Triggers • Wash mold off hard surfaces and dry completely • Absorbent materials (ceiling tiles and carpet) may need to be replaced • Fix leaky plumbing or other sources of water • Keep drip pans in your air conditioner, refrigerator, and dehumidifier clean and dry • Use exhaust fans or open windows in kitchens and bathrooms when showering, cooking, or using the dishwasher • Vent clothes dryers to the outside • Maintain low indoor humidity (between 30-50% relative humidity)

  42. Cockroaches • Droppings or body parts of cockroaches can be asthma triggers • Cockroaches likely contribute significantly to asthma problems in inner city area • Free your home of places for pests to hide and sources of food and water

  43. Avoiding Cockroaches • Do not leave food or garbage out • Store food in airtight containers • Clean all food crumbs or spilled liquids right away

  44. Cockroaches (cont) • Try using poison baits, boric acid, or traps first before using pesticide sprays • If sprays are used: • Limit the spray to infested area • Carefully follow instructions on the label • Make sure there is plenty of fresh air when you spray, and keep the person with asthma out of the room

  45. COAD (COPD) Or Chronic Bronchitis That Was

  46. COPD • Chronic bronchitis • Emphysema • COAD • Chronic airflow restriction • Some cases of chronic asthma

  47. COAD: Definition • Chronic slowly progressive airways obstruction, not fully reversible • FEV1 <80% predicted • FEV1/FVC ratio <70% • Impairment largely fixed

  48. COAD: Prevalence • Depends on where you work! • Male:Female = 4:1 ?????? • Urban:Rural = 2:1 • 5-25% of population • Declining, or being redefined! • 1-4 consultations per GP per week • Strongly social class related • Increases with age

  49. COAD: Risk Factors • Smoking • Asthma • Genetic • Social class (Independent ? Of other factors)

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