1. GARD Global Alliance against Chronic Respiratory Diseases WHO
J Bousquet, R Dahl, N Khaltaev, HJ Bekedam

2. www.who.int/chp Good afternoon.
It's my pleasure to share with you the overall messages and key findings of this new WHO global report: Preventing chronic diseases: a vital investment. Several misunderstandings about chronic diseases have contributed to their global neglect. This report dispels these misunderstandings with the strongest evidence and proposes a way forward for stopping the rising global epidemic.

3. GARD Launch Press Conference
N Zhong (China): Chronic respiratory diseases (CRD) are a major burden in China
S Hurd (USA): The burden of CRD
N Khaltaev (WHO): From the fragmented CRD programs to GARD
J Bousquet (France): The GARD action plan
M Boland (Ireland): Health promotion and CRD prevention
J Walsh (USA): The patient’s expectations

4. Suzanne S. Hurd - USA
The burden of CRD

5. Chronic Respiratory Diseases: An Increasing Global Public Health Problem
The World Health Organization estimates that over 1 billion people suffer from chronic respiratory diseases worldwide
Prevalence and severity are increasing globally
Cause substantial socioeconomic burden to individuals and societies
In all countries, chronic respiratory diseases are:
Under recognized
Under diagnosed
Under treated

6. Chronic Respiratory Diseases (CRD)
Asthma
Allergic rhinitis
Chronic obstructive pulmonary disease (COPD)
Secondary pulmonary hypertension
Occupational chronic respiratory diseases
Chronic rhinosinusitis
Post-infectious chronic respiratory diseases
Lung cancer; neoplasms of the respiratory organs
Pulmonary embolism
Cor pulmonale
Sleep apnea syndrome
Lung fibrosis

7. Global Distribution – Chronic Disease Mortality: All ages, 2005
> 4,000,000
Communicable diseases;
Maternal/perinatal,
Nutritional deficiencies 7%
Cardiovascular
Cancer
Chronic Respiratory
Diseases (CRD)
Diabetes
Other Chronic Diseases
Injuries
Source: Preventing Chronic Diseases, a vital investment, WHO, 2005

8. Increasing Burden of Diseases and Injuries:
Change in Rank Order of DALYs*
1999
2020
Acute lower respiratory
infections
2. HIV/AIDS
3. Perinatal conditions
4. Diarrhoeal diseases
5. Unipolar major depression
6. Ischemic heart disease
7. Cerebrovascular disease
8. Malaria
9. Road traffic injuries
10. COPD
11. Congenital abnormalities
12. Tuberculosis
1. Ischemic heart disease
2. Unipolar major depression
3. Road traffic injuries
4. Cerebrovascular disease
5. COPD
6. Acute lower respiratory infections
7. Tuberculosis
8. War
9. Diarrhoeal diseases
10. HIV
…….
15. Trachea, bronchus, lung cancers
*DALY = Disability-adjusted life year
Source: WHO Evidence, Information and Policy, 2000

9. Chronic Respiratory Diseases
(CRD)
Global Prevalence
Asthma > 300 million
Allergic rhinitis > 400 million
Chronic obstructive > 80 million moderate pulmonary disease to severe COPD; many millions with mild COPD

10. Burden of Asthma
Asthma is one of the most common chronic diseases in the world
Prevalence ranges from 1% to 18%
An estimated 250,000 deaths annually, many of them preventable
Direct costs (hospital, medications) account for 1-3% of total medical expenses in most countries

11. Affordability of Asthma Drugs Moderate persistent asthma, 1998
SETTING: The cost and availability of the medications required for the treatment of asthma may represent potential barriers to effective management. METHOD: A survey of prices and policies for components of asthma treatment in 1998, in Algeria, Burkina Faso, Ivory Coast, Guinea, Mali, Syria, Turkey and Vietnam. RESULTS: Medications were consistently available in only four of the eight countries studied. The cost of essential medications for standard case management varied by over five times for beclomethasone and by over three times for inhaled salbutamol. In all but two countries, the cost of one year of drugs for treatment of a moderate, persistent case exceeded the monthly salary of a nurse in that country. The essential drugs list included inhaled salbutamol in five of eight countries and beclomethasone in three of eight. The costs of medications were lower where generic preparations were available and, to a lesser extent, where the medications are on the essential drugs list. CONCLUSIONS: The cost and availability of medications vary widely, and may represent an important barrier to effective management in some low and middle income countries.
Cost in US$
N. Ait-Khaled and al Int J Tuberc Lung Dis 2000; 4, 3:

12. Burden of COPD
COPD is a major cause of morbidity, mortality and disability
High prevalence, morbidity and mortality of COPD present challenges for healthcare systems
Despite its ease of diagnosis, COPD remains an under-diagnosed disease, chiefly in its milder and more treatable form

13. COPD Mortality by Gender, USA, 1980-2000
Number Deaths x 1000
Recent data from the US Centers for Disease Control and Prevention shows that while the mortality rates for COPD in men continue to rise in the US, a startling finding was the steep rise in mortality in women.
Year
Source: Mannino D, US CDC, August 2002

14. Risk Factors for COPD Occupational dusts Cigarette Smoke Environmental
tobacco smoke
Fumes/gases
Indoor/outdoor
pollution
Occupational
dusts
Risk Factors for COPD
Nutrition
Socio-economic status
Infections

15. Chronic Respiratory Diseases Global Public Health Problem
are a
Global Public Health Problem

16. From the fragmented CRD programs
N Khaltaev - WHO
From the fragmented CRD programs
to GARD

17. WHA resolution 53.17 The 53rd World Health Assembly
recognized the enormous human suffering caused by chronic respiratory diseases (CRDs)
and requested the WHO Director General to continue
giving priority to the prevention and control of CRDs
with special emphasis on developing countries and other deprived populations
WHA resolution 53.17, May 2000
endorsed by all 191 WHO Member States

18. GARD WHO calls for a global and coordinated effort
to fight chronic respiratory diseases
GARD

19. A world where all people can breathe freely:
GARD
The Global Alliance against Chronic Respiratory Diseases (GARD) is a voluntary alliance of organizations, institutions, and agencies working towards a common vision to improve global lung health according to the local needs.
Vision:
A world where all people can breathe freely:
Breath for all.

20. Fragmented success stories
Asthma and COPD plans:
Brasil
China
Finland
France
Portugal
USA

21. Experience from Brazil
In Brazil since 2002 the ministry of health provides free pharmaceutical assistance for severe asthmatics.
In the province of Salvador this lead to the reduction of 55% of hospital submissions. The mean annual income of families of severe asthmatics increased by 10 %.
The public health system has saved 566 US$ per patient per year.

22. A Success Story: France
Increase awareness on asthma (patients and public)
Improve
management of acute severe asthma
follow-up of asthmatics
diagnosis and management of childhood asthma in schools
Increase patient education
Better manage and prevent occupational asthma
Surveillance of asthma and risk factors

23. Healthcare benefits from asthma intervention
350
Reimbursement asthma
Hospitalization days
Death rate
300
250
(base 100 in 1981)
Asthma Indices
200
150
100 50
1981
1983
1985
1987
1989
1991
1993
1995
Year
Haahtela et al, Thorax 1998

24. J Bousquet - France
The GARD Action Plan

25. Specific Objectives of GARD
Build a stepwise and integrated program of prevention and control of CRD.
Improve collaboration between the fragmented WHO and non-WHO programs.
Increase awareness of CRD.
Reduce the burden of CRD, and foster country-specific initiatives appropriate to local needs.
Focus on developing countries and deprived populations.

26. Specific Objectives of GARD
Availability and affordability of medications
Provide appropriate training for health care personnel.
Provide education to patients, care givers and families.

27. Comprehensive and integrated action is the means to prevent and control chronic diseases
Good afternoon.
It's my pleasure to share with you the overall messages and key findings of this new WHO global report: Preventing chronic diseases: a vital investment. Several misunderstandings about chronic diseases have contributed to their global neglect. This report dispels these misunderstandings with the strongest evidence and proposes a way forward for stopping the rising global epidemic.

28. Estimate population needs and advocate
WG.1- Burden, risk factors and surveillance
(G Viegi, S Buist, Y Fukuchi)
WG.2- Awareness and advocacy
(C Lenfant, A Turnbull, P van Cauwenberge)

29. Formulate and adopt policy
WG.3- Prevention and health promotion
(M Boland, A Custovic)
WG.4- Diagnosis of CRD and allergy
(K Rabe, S Wenzel)
WG.5- Control of CRD and allergies, availability and affordability of drugs
(J Bousquet, E Bateman, L Fabbri, C van Weel)
WG.6- Pediatric asthma
(C Baena-Cagnani, E Mantzouranis, FER Simons,
E Valovirta)

30. Identify Policy Implementation Steps
The GARD action plan should be applied at the country level.
A national coordination group will:
Provide existing national statistics on CRD
Assess the specific needs for the given country
Review the GARD action plan
Determine the relevant issues for the country
action plan
Develop a country-specific action plan

31. Health promotion and CRD prevention
M Boland - Ireland
Health promotion and CRD prevention

32. Health promotion and disease prevention
Key messages:
Everyone has the right to live in a clean air environment
Environmental exposure to unhealthy environment causes incurable COPD, asthma, cardiovascular disease and cancer
Complete elimination is the only way to remove the risk
This applies to tobacco smoke and all other at risk environments

33. WG.3- Health promotion and disease prevention
Goals:
Help all countries to build and implement policies to reduce the burden of
tobacco smoke,
indoor and outdoor pollution,
occupational hazards
and other risk factors of relevance for CRD

34. WG.3- Health promotion and disease prevention
Some WHO programs are already available:
FCTC (Framework Convention on Tobacco Control)
Healthy Environment for Children Alliance
WHO program on prevention of allergy and asthma
Environment
Occupational diseases

35. Tobacco Cessation No. of Smokers fallen by 25% Smoking Ban
‘Slan’ Surveys
OTC/MRBI Tracker
Smoking Ban

37. WG.3- Health promotion and disease prevention
Biomass fuels
Over 2 billion people in the developing world burn traditional biomass fuels indoor for cooking and heating.
Resulting in an estimated 1.6 million deaths each year, largely among women and children.
Acute respiratory infections and COPD (700,000 deaths/yr)

38. The patient’s expectations
J Walsh - USA
The patient’s expectations

39. Personal History of J. Walsh
When did the disease start
Symptoms
Effects on daily life
Treatment
Expectations
Future

40. Patient’s Expectations from GARD
Health care professionals should be able to recognize CRD at an early phase and introduce early management
The patient must be taken more seriously about his/her symptoms
Health care systems should be structured to manage patients with chronic disease, including regular and long term follow up
….continued

41. Patient’s Expectations from GARD (continued)
Health care systems should develop a structured patient education, information and training programs
General public should become more informed of CRDs problems and take a more positive attitude toward the needs of CRD patients
Societies should be more receptive to the value of environmental changes

42. Partners in Care of CRDs.
Doctors and Patients
must be
Partners in Care of CRDs.

43. Conclusions
Hundreds of millions of people suffer from chronic respiratory diseases
Over 4 million people die prematurely each year
Huge economic burden
In all countries, and particularly in developing
countries
In all age groups
Prevalence and mortality are increasing

44. www.who.int/chp Good afternoon.
It's my pleasure to share with you the overall messages and key findings of this new WHO global report: Preventing chronic diseases: a vital investment. Several misunderstandings about chronic diseases have contributed to their global neglect. This report dispels these misunderstandings with the strongest evidence and proposes a way forward for stopping the rising global epidemic.