1. GARD - Country Initiatives BRAZIL Alvaro A. Cruz, M.D. Associate Professor of Universidade Federal da Bahia Scientist of CNPq - National Research Council Co-chairman of ARIA Brazil

2. GARD - Brazil p Pop. 180 million p Area 8,511,965 sq km p GDP per capita $7,762 p Life expect. 70 years p Child mortality 36/1000 p Health exp. per capita $611, 7% of GDP AA Cruz, 2006.

3. GARD - Brazil obstacles and advantages p Poverty / unemployment p Limited education p Poor transportation system p Inadequate health care Low wages Poor facilities Unsatisfactory training p Poverty / unemployment p Limited education p Poor transportation system p Inadequate health care Low wages Poor facilities Unsatisfactory training p Universal coverage of PHS p National health database p Primary care priority p Growing family health program p Qualified reference and research centres p Active NGOs p National telecommunication networks p Universal coverage of PHS p National health database p Primary care priority p Growing family health program p Qualified reference and research centres p Active NGOs p National telecommunication networks AA Cruz, 2006.

4. Recife Salvador Uberlândia Itabira São Paulo Curitiba 05101520253035 AsthmaRhinitis Prevalence of Asthma and Rhinitis Brazil - ISAAC Phase I, 13 -14 years old Prevalence of Asthma and Rhinitis Brazil - ISAAC Phase I, 13 -14 years old Solé et al, 2002. %

5. GARD - Brazil countrywide approach p Asthma/Rhinitis: Prevalence may be > 20% 4th. cause of hospitalizations Over 2,000 deaths a year p COPD: Prevalence of 14.9% (S. Paulo) 5th. cause of death p Asthma/Rhinitis: Prevalence may be > 20% 4th. cause of hospitalizations Over 2,000 deaths a year p COPD: Prevalence of 14.9% (S. Paulo) 5th. cause of death p Meeting of national CRD leaders to discuss GARD proposal in Rio, 2005 p GARD Brazil Working group: AA Cruz (asthma and rhinitis) JR Jardim (COPD) PA Camargos (pediatrics) ML Barreto (epidemiology) p Meeting of national CRD leaders to discuss GARD proposal in Rio, 2005 p GARD Brazil Working group: AA Cruz (asthma and rhinitis) JR Jardim (COPD) PA Camargos (pediatrics) ML Barreto (epidemiology) AA Cruz, 2006.

6. GARD - Brazil Ministry of Health and WHO Recent actions, Brazilian Ministry p Ban on tobacco advertisement p Free pharmaceutical assistance to severe asthma/rhinitis, 2002 p Publication of Asthma/Rhinitis Guidelines, 2005 p Free medication for asthma/rhinitis in primary care, 2006 Recent actions, Brazilian Ministry p Ban on tobacco advertisement p Free pharmaceutical assistance to severe asthma/rhinitis, 2002 p Publication of Asthma/Rhinitis Guidelines, 2005 p Free medication for asthma/rhinitis in primary care, 2006 Preliminary contacts p GARD Working group have consulted for Ministries of Health, Education and National Research Council p GARD Working group offered advisory collaboration p Meeting with Head of Primary Health Department scheduled Preliminary contacts p GARD Working group have consulted for Ministries of Health, Education and National Research Council p GARD Working group offered advisory collaboration p Meeting with Head of Primary Health Department scheduled AA Cruz, 2006.

7. GARD - Brazil role of primary health care Decentralization of management p each city may control its health budget in agreement with Ministry of Health p example: Salvador (Pop. 2.5 million) will receive US$ 1.2 million specifically for asthma and rhinitis medication in primary care in 2006 Decentralization of management p each city may control its health budget in agreement with Ministry of Health p example: Salvador (Pop. 2.5 million) will receive US$ 1.2 million specifically for asthma and rhinitis medication in primary care in 2006 Primary Care, a Priority in Brazil p A Family Medicine approach recently developed already covers 45% of population Guidance and means p The Asthma and Rhinitis Guidelines was developed for the primary care professional Primary Care, a Priority in Brazil p A Family Medicine approach recently developed already covers 45% of population Guidance and means p The Asthma and Rhinitis Guidelines was developed for the primary care professional AA Cruz, 2006.

8. GARD - Brazil role of NGOs CRD NGOs and Ministry of Health p Medical associations: Pulmonary, Allergy, Pediatrics p ARIA, GOLD p Patient associations: asthma, COPD Collaboration for the Asthma and Rhinitis Guideline and training CRD NGOs and Ministry of Health p Medical associations: Pulmonary, Allergy, Pediatrics p ARIA, GOLD p Patient associations: asthma, COPD Collaboration for the Asthma and Rhinitis Guideline and training Tradition of NGOs p Hospital care p Health professional associations New perspectives for NGOs p Patient associations p “Problem based” NGOs Tradition of NGOs p Hospital care p Health professional associations New perspectives for NGOs p Patient associations p “Problem based” NGOs AA Cruz, 2006.

9. GARD - Brazil successful experiences in CRD control A research project intervention in Salvador City (ProAR) focusing on severe asthmatics (n=1405): p reduction of admissions by 90% p reduction of family expenses with asthma by 86% p reduction of public expenses with asthma by US$566.00 per patient/year A research project intervention in Salvador City (ProAR) focusing on severe asthmatics (n=1405): p reduction of admissions by 90% p reduction of family expenses with asthma by 86% p reduction of public expenses with asthma by US$566.00 per patient/year Various local asthma programs p Care by specialists, education and... medication? p Some city programs with free medication available in multiple facilities, from 1997 (as in Belo Horizonte) Various local asthma programs p Care by specialists, education and... medication? p Some city programs with free medication available in multiple facilities, from 1997 (as in Belo Horizonte) AA Cruz, 2006.

10. GARD - Brazil hospitalizations in public health system, Salvador AA Cruz, 2006. 0 1000 2000 3000 4000 5000 6000 200020012002200320042005 pneumonia asthma acute m. infarction ProAR

11. GARD Global Alliance against Chronic Respiratory Diseases

12. GARD Global Alliance against Chronic Respiratory Diseases