1. G GARD Nan Shan Zhong C China

2. The first ten leading causes of death in urban China (2003) RankDiseaseMortality(per 10 5 ) 1Malignant tumor134.5 2Cerebrovascular diseases105.4 3 Respiratory diseases 77.3 4Heart diseases76.2 5Trauma/Poisoning32.6 6Digestive diseases19.3 7Endocrinal, Nutritional & Metabolic Disorders 14.1 8Genitourinary diseases7.1 9Neurological diseases4.8 10Perinatal diseases162.1

3. The first ten leading causes of death in rural China (2003) RankDiseaseMortality (per 10 5 ) 1Malignant tumor95.7 2Cerebrovascular diseases89.9 3 Respiratory diseases 70.9 4Heart diseases45.5 5Trauma/Poisoning21.5 6Endocrinal, Nutritional & Metabolic Disorders 14.5 7Digestive diseases10.5 8Genitourinary diseases7.2 9Perinatal diseases372.2 10Pulmonary TB4.2

5. Survey cities: 14 sites from 7 cities (Beijing, Shanghai, Tianjin, Shenyang, Xian, Chongqing, Guangzhou) Shanghai Tianjin Chongqing Shenyang Xian Beijing Guangzhou Ren PX et al 2005

6. Overall prevalence of COPD in China * Male VS Female: P<0.01;# Urban VS Rural: P<0.01

7. COPD mortality rates per 100,000 population

8. Exacerbations days in last 6 months Base: 752 patients

9. Number of Times Hospitalised for COPD in the last year Base: 752 patients

10. Association Between Prevalence of COPD And Smoke-index # tests for trend : P<0.000 # # #

11. Prevalence of Smoking in China (Chinese Academy of Preventive Medicine 1996) Population ( 15yrs) 130,657 Current smoker 35.3% Male 63.0% Female 3.8%

13. Shaoguan Guangzhou Shaoguan rural (northern part of Guangdong province) and Guangzhou city (the capital city of Guangdong province) of China was selected to be studied. Total 3449 subjects investigated, response rate 81.3%.

15. Comparison of COPD prevalence in smoker and non-smoker in Guangdong province P<0.01, compared with Guangzhou; * P<0.01, compared with Non- smoke; P<0.05, compared with Non-smoke.; ** P<0.01, compared with Non-smoke; OR=2.723(2.145-3.456). GuangzhouShaoguanTotal male female total Male female total male female total male female total Non- smoker smoker 13.8 7.2 7.8 6.1 10.7 2.7 4.9 13.8 7.2 7.8 11.3 4.9 6.1 18.9 0 18.8 * 15.1 ** 16.4 4.2 11.9 * 18.9 0 18.8 * 17.9 * 4.1 15.1 **

16. +:with biomass or cigarette exposure; – without biomass or cigarette exposure compared with (4) p 0.017, compared with (4) p 0.000 ** compared with (3) p 0.003, * compared with (4) p 0.000 compared with (3) P 0.000, compared with (2) P 0.001 Exposure factor biomass / cigarette smoking Prevalence in corresponding exposure factor (1) Biomass(+)/cigarette smoking(+) 19.3 * (2) Biomass(-)/cigarette smoking(+) 12.3 ** (3) Biomass(+)/cigarette smoking(-) 7.7 (4) Biomass(-)/cigarette smoking(-) 5.1 Association between COPD prevalence and exposure to biomass and cigarette smoking

17. (432500 population in 31 cities) National Cooperative Group of Children Asthma Current Asthma Prevalence of Children (0-14yrs) in China

18. 1 GINA Treatment Guideline No (or minimal) need for emergency hospital visit/hospitalization China Survey Findings 33% had visited the emergency room at hospital in the past year 16% of these patients had been hospitalized during the previous year Summary of Hospital and Emergency Visits for Asthma in Past Year

19. Have Lost Work/School Days in the Past Year Due to Asthma GINA Treatment Guidelines No missed school or work China Survey Findings Up to 25%(20%) missed work (school) because of asthma in the past year

20. CRD in China Current patients COPD 32.8 millions Asthma 39.0 millions Deaths 1.6 millions

21. Chronic Respiratory Diseases (CRD) Are a Major Burden in China

22. Distribution of economic status areas depending on the global country income Luxembourg ($69056/ 1) U.S. U.S.($42076/7) Japan Japan($36486/10) Korea($14649/34) Brazil($3311/77) Turkey($4437/66) Thailand($2807/84) China($1352/112) Burundi($123/179) Burma($135/176) Russia($4750/63) India($652/133) The International Monetary Fund IMF(2005) Country (GDP per capita/rank)