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) Rank UrbanRural Disease (ICD-10) Mortality (1/100,000) % Disease (ICD-10) Mortality (1/ 100,000) % 1 Malignant tumor 176.228.5 Malignant tumor 114.224.8 2 Cerebrovascul ar diseases 111.518.0 Cerebrovascular diseases 119.720.6 3 Heart diseases 100.616.3 Respiratory diseases 100.216.2 4 Respiratory diseases 80.913.1 Heart diseases 86.014.8 5 Trauma/ Poisoning 37.66.1 Trauma/ Poisoning 52.19.0

3. Prevalence of COPD in China: 32.8 millions 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 COPD 32.8 millions Asthma 15.0 millions Asthma 15.0 millions Allergic rhinitis 113 millions Allergic rhinitis 113 millions

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

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

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

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

13.  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 Tobacco Control Organizations in China

14. 11th, March 2008 22th, May 2009 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

15. 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 Regulations on No-Smoking in Public Places in Beijing

16. Year 1984 19962002 2009 Total smoking rate 33.9% 37.6%35.8% (Aged>15) (Aged>15) Male 66.9%66.0% 48% Male 66.9%66.0% 48% Female 4.2%3.08% 2.6% Female 4.2%3.08% 2.6% Smoking rate in 60.0%56.8% male medical doctors Year 1984 19962002 2009 Total smoking rate 33.9% 37.6%35.8% (Aged>15) (Aged>15) Male 66.9%66.0% 48% Male 66.9%66.0% 48% Female 4.2%3.08% 2.6% Female 4.2%3.08% 2.6% Smoking rate in 60.0%56.8% male medical doctors Three National Prevalence Surveys

17. Haze in large cities

18. “Hazy sky” (NO VOC O 3 etc) firstly listed in the category of air pollution in the Pearl River Delta Region Document of Guangdong Government 1 th May 2009

19. 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

20. ——Early prevention and intervention 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

21. Earlyprevention Earlymanagement Clinical management Rescue EarlypreventionEarlymanagement Clinicalmanagement Rescue Medical costs

22. 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

23. 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)

24. 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

25. Routine (regular) lung function test in the community Health care system

26. 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

27. 2007;175

28. Diagnosed Rate of COPD Before Epidemiologic Survey

29. Usage of Lung Function Test

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

31. 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

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

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

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

36. 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

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

38. THANKS