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Fondazione IRCCS Policlinico San Matteo La Salute del Respiro: una attualità nazionale Ernesto Pozzi Clinica Malattie Apparato Respiratorio La Salute del.

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Presentation on theme: "Fondazione IRCCS Policlinico San Matteo La Salute del Respiro: una attualità nazionale Ernesto Pozzi Clinica Malattie Apparato Respiratorio La Salute del."— Presentation transcript:

1 Fondazione IRCCS Policlinico San Matteo La Salute del Respiro: una attualità nazionale Ernesto Pozzi Clinica Malattie Apparato Respiratorio La Salute del Respiro: una attualità nazionale Ernesto Pozzi Clinica Malattie Apparato Respiratorio Università di diPavia La Salute del Respiro, epidemiologia, costi sanitari ed implicazioni sociali delle malattie respiratorie croniche ostruttive e delle allergopatie respiratorie Milano, 26 gennaio 2007

2 2 Of the six leading causes of death in the United States, only COPD has been increasing steadily since 1970 Jemal A. et al. JAMA 2005

3 EPIDEMIOLOGICAL PERSPECTIVES Mortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006 COPD

4 EPIDEMIOLOGICAL PERSPECTIVES CHANGING GLOBAL DEMOGRAPHICS People > 60yr Mortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006

5 EPIDEMIOLOGICAL PERSPECTIVES MORTALITY IN FEMALES MORTALITY IN FEMALES Mortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006

6 COPD Mortality by Gender U.S Number Deaths x 1000 Source: US Centers for Disease Control and Prevention, 2002

7 Machado et al AJRCCM 2006 Differences in survival, men vs women, after initiating long-term oxygen terapy

8 EPIDEMIOLOGICAL PERSPECTIVES CONTINUED USE OF TOBACCO Low rates of smoking cessation (~30%) Young smokers (particularly females) Smoking in non-developed countries Mortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006

9 NET CHANGE IN ACTIVE SMOKING % PER 10 YRS ECRHS I ; ECRHS II (9053 subjects, age range years at ECRHS I) Janson, Cerveri and ECRHS group ERJ 2006

10 NET CHANGE IN PASSIVE SMOKING % PER 10 YRS ECRHS I ; ECRHS II (9053 subjects, age range years at ECRHS I) Janson, Cerveri and ECRHS group ERJ 2006

11 Global Epidemiology of Smoking

12 EPIDEMIOLOGICAL PERSPECTIVES OTHER RISK FACTORS Occupation Pollution Indoor outdoor Mortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006

13 AIR POLLUTION AND LUNG FUNCTION IN THE ECRHS Rationale: Long term effects of air pollution on lung function have not been studied across European adult populations before, and in particular evidence for effects on change in lung function among adults is weak. Gotschi, Sunyier and ECRHS group Lancet, submitted

14 Geographical distribution of ECRHS centres

15 PM 2.5 levels across ECRHS centres

16 AIR POLLUTION AND LUNG FUNCTION IN THE ECRHS Measurements and Main Results: No significant associations were found between PM2.5 and any of the lung function measures neither for lung function level nor for change in lung function. Conclusions: The heterogeneity of the studied populations in combination with limitations of the cross-community comparison approach are plausible explanations of the observed null-findings.Future studies on long term effects of air pollution on lung function should be based on within-community comparisons. Gotschi, Sunyier and ECRHS group Lancet, submitted

17 COPD PREVALENCE >10% tra la popolazione> 40 anni Prevalenza di COPD in aumento costante >10% tra la popolazione > 40 anni Chapman et al. ERJ % 0-45 years Prevalenza di COPD 3.6% tra la popolazione di eta years de Marco et al. Thorax 2004

18 INCIDENCE OF COPD ACCORDING TO THE HISTORY OF CHRONIC COUGH AND PHLEGM De Marco, Cerveri et al AJRCCM 2006

19 EPIDEMIOLOGICAL PERSPECTIVES GLOBAL BURDEN Hospitalizations Hospitalizations Number and duration Number and duration Comorbidity Comorbidity Mortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006

20 Aumento del numero dei ricoveri per BPCO dal 1999 al 2003 in Italia N° RICOVERI DRG 88 = malattia polmonare cronica ostruttiva DRG 87 = edema polmonare e insufficienza respiratoria DRG 475 = diagnosi relative all'apparato respiratorio con respirazione assistita

21 EXACERBATIONS AS A STARTING POINT OF PROACTIVE COPD MANAGEMENT Zoia et al, Resp Med 2005

22 Without diagnosis With diagnosis Patients with and without previous diagnosis EXACERBATIONS AS A STARTING POINT OF PROACTIVE COPD MANAGEMENT

23 Percentage of patients with and without spirometry EXACERBATIONS AS A STARTING POINT OF PROACTIVE COPD MANAGEMENT

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26 Diagnosi principalen. dimissionidegenza media Malattia polmonare cronica ostruttiva Bronchite cronica ostruttiva, riacutizzata Insufficienza respiratoria Bronchite cronica ostruttiva, non riacutizzata Bronchite, non specificata se acuta o cronica Bronchite cronica semplice Bronchite cronica non specificata Bronchite cronica mucopurulenta Epidemiologia della BPCO Ricoveri in regime ordinario SDO - Ministero della Salute, 2005

27 Hospital stay 60 days180 days1 year2 years Mortality (%) COPD Exacerbations : Mortality 11% 20% 33% 43% 49% Connors AF Jr et al. Am J Respir Crit Care Med. 1996;154: pts with severe COPD exacerbation (PaCO 2 > 50 mm Hg)

28 Total costs ( billion) of respiratory diseases in Europe in 2000

29 Piano sanitario nazionale

30 ASTHMA PREVALENCE IN ADULTS:GOOD NEWS? ASTHMA PREVALENCE IN ADULTS:GOOD NEWS? Weiland and Pearce Editorial Thorax 2004 THE EPIDEMIC HAS ENDED,OR HAS IT ? THE EPIDEMIC HAS ENDED,OR HAS IT ? Shafazand and Colice Editorial Chest 2004 THE PREVALENCE OF ASTHMA IS NO LONGER INCREASING IN SOME COUNTRIES THE PREVALENCE OF ASTHMA IS NO LONGER INCREASING IN SOME COUNTRIES Anderson Editorial BMJ 2005 Trend dellasma negli adulti non in ulteriore aumento in parecchie nazioni

31 INCREASE IN DIAGNOSED ASTHMA BUT NOT IN SYMPTOMS IN THE EUROPEAN COMMUNITY RESPIRATORY HEALTH SURVEY Chinn,Jarvis, Burney,Cerveri et al Thorax 2004

32 NET CHANGE IN IN PREVALENCE ( per 10 years of follow-up) OF SYMPTOMS, DIAGNOSED ASTHMA, AND CURRENT MEDICATION IN THE ECRHS Chinn, Cerveri and ECRHS group Thorax 2004 Net change (%) Wheeze without a cold Woken with chest tightness Woken with shortness of breath Current medication Diagnosed asthma Attack of asthma * * * * p = ** p<0.001

33 …. Either increased use of effective treatments has led to decreased morbidity among asthmatic subjects or those with mild disease have become more likely to label themselves as asthmatic Chinn, Cerveri and ECRHS group Thorax 2004 INCREASE IN DIAGNOSED ASTHMA BUT NOT IN SYMPTOMS IN THE ECRHS

34 NET CHANGE IN PREVALENCE ( per 10 years of follow-up) OF DIAGNOSED ASTHMA AND NASAL RHINITIS IN THE ECRHS (11169 subjects ) Chinn, Cerveri and ECRHS group Thorax 2004 PREVALENCE IN ECRHS I: 24% 24% PREVALENCE IN ECRHS I: PREVALENCE IN ECRHS I: 26% 26% PREVALENCE IN ECRHS I: 26% 26% PREVALENCE IN ECRHS I: 5% 5%

35 biological changes factors ….An increase in reported nasal allergies was observed that was greater in the youngest age group. It is not possible to be certain whether it is explained by biological changes occurring at particular ages or by factors occurring earlier in life that make this younger cohort more suceptible.. Chinn, Cerveri and ECRHS group Thorax 2004 INCREASE IN DIAGNOSED ASTHMA BUT NOT IN SYMPTOMS IN THE ECRHS

36 Asthma attacks Anti- asthmatic treatment % 3.2% 1.9% 2.5% ASTHMA ATTACKS AND ANTI-ASTHMATIC TREATMENT IN ITALY (1993 AND 2000) Verlato,Cerveri et al, J Allergy Clin Immunol 2003

37 NASAL ALLERGIES IN ITALY (1993 AND 2000) Nasal allergies P < % 18.3 %

38 Non aumento in Italia di attacchi di asma negli anni 90 Nuovi farmaci, miglior strategia globale di trattamento, di accesso alle strutture sanitarie e di controllo degli allergeni indoor determinanti di una minore espressione della malattia Ancora attenzione particolarmente focalizzata alla rinite allergica CONCLUSIONI

39 EPIDEMIOLOGIA DELLASMA Stabilizzazione dovuta al miglioramento dei trattamenti antiasmatici Plateau per raggiunto sviluppo della patologia in tutti i soggetti suscettibili (Saturation: massimo effetto del cambiamento dellesposizione ambientale negli individui suscettibili)

40 ALLERGIC RHINITIS AND ASTHMA COMORBIDITY IN A SURVEY OF YOUNG ADULTS IN ITALY About 60 % of asthmatics reported AR Subjects with AR had eightfold risk of having asthma compared to subjects without AR Bugiani and ECRHS group, Allergy 2005

41 ECRHSSAPALDIA Age All ages Subjects(number) Gender(% males)4850 Mean age(years ± SD)34±733±841±11 Asthma Symptoms(%) Physician diagnosed asthma (%) Atopy(%) Tumor necrosis factor polymorphisms and asthma in two international population-based cohorts ( ECRHS and SAPALDIA studies) Castro Giner, ECRHS and Sapaldia groups AJRCCM, submitted

42 ASTHMA SEVERITY IN THE GENERAL POPULATION According to GINA 2006 Classification (ECRHS II; ) de Marco ECRHS group JACI 2006

43 13.2% Light burden 14% Heavy burden 72.8% No burden No burden no productivity losses no use of hospital services Light burden up to 12 lost working days or up to 3 days per months limited no use of hospital services Heavy burden > 12 lost working days or > 3 days per months limited or use of hospital services THE BURDEN OF ASTHMA REMAINS SUBSTANTIAL IN EUROPE A DECADE AFTER THE GINA GUIDELINES (ECRHS II; ) Accordini, Cerveri and ECRHS group Allergy 2007

44 THE BURDEN OF ASTHMA REMAINS SUBSTANTIAL IN EUROPE A DECADE AFTER THE GINA GUIDELINES (ECRHS II; ) Accordini, Cerveri and ECRHS group Allergy 2007 Light burdenLight burden up to 12 lost working days or up to 3 days per months limited no use of hospital services Heavy burdenHeavy burden > 12 lost working days or > 3 days per months limited or use of hospital services FEV1 % predicted

45 REAL-WORLD EVALUATION OF ASTHMA CONTROL AND TREATMENT(REACT): Findings from a national Web-based survey (1812 patients with moderate to severe asthma using standard asthma medications) 45% Controlled asthma 55% Uncontrolled asthma Peters et al JACI 2007

46 PREVALENCE OF ASTHMA TREATMENT ADHERENCE AT ECRHS I AND II ECRHS I ECRHS II Corsico,Cerveri and ECRHS group Resp Med 2007

47 Utilizzo farmaci R03 (antiasmatici) Bisogno terapeutico teorico ITALIA CAMPANIAEMILIALOMBARDIA DDD = dose media mantenimento giornaliera Dati Fondazione SKF

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