1. Burden of major Respiratory Diseases WHO Survey Ryazan region of Russia,

2. RUSSIA

3. Ryazan region of Russia, health care system: 104 hospitals district hospitals – 32 rural hospitals – 44 65 out-patient departments 792 “feldsher's” stations

4. Total area- 39 600 square kilometres. Density of population– 32 per square kilometre. Total population 1 mlln. 230 thousand people, 600 000 live in Ryazan. 96% - Russians. Rural population – 31%. Shilovo district Population – 60 000. Scopin district Population – 40 000.

5. Protocol for assessment of prevalence of major respiratory diseases Prevalence survey of respiratory disease at the PHC level Prevalence survey of respiratory disease in a household manner Clinical survey and lung function test Pilot stage Number of patients October 2004March 2006

6. Pilot stage 05.10.04-15.10.04 Obtaining the list of PHC Finalize the questionnaires and the GP’s, RT’s and LFT forms Training of the personnel Design, plan and execute pilot prevalence survey Determine whether the “cookbook” (protocol & manual of procedures) works Test communications

7. Prevalence survey of respiratory disease in a household manner 22.11.04-28.12.04 Population: Individuals >= 5 years randomly selected Administered standardised questionnaire on symptoms, diseases, diagnoses, comorbidity, sociodemographics, risk factors

8. Clinical survey and lung function test 08.02.05-30.03.05 16 PHS were randomized for the lung function test. All patients from the household stage were included.

9. Clinical survey and lung function test 08.02.05-30.03.05 16 PHS were randomized for the lung function test. All patients from the household stage were included.

10. General characteristics of the study RegionStageStudy periodNumber of health facilities Number of patients Scopin districtPHC based18.10.04- 02.11.04 241505 Household based 22.11.04- 28.12.04 182116 Clinical survey & lung function test 08.02.05- 30.03.05 8812 Shilovo districtPHC based01.11.04- 20.11.04 29962 Household based 22.11.04- 28.12.04 182030 Clinical survey & lung function test 08.02.05- 30.03.05 8725

11. Education level of respondents, %, by stages StageHigherSecond ary PrimaryNo edu- cation PHC based7,3859,2227,326,08 Household based 5,3150.1031.656.10

12. Age distribution of risk factors, by stages (self-reported by patients) StageRisk factor5-14 years females/males 15-49 years females/males >= 50 years females/males PHC based Worked for a year or more in any dusty job --6.3314.0813.8224.66 Ever smoked cigarettes 00.795.1764.320.8458.71 Now smoke cigarettes 01.574.6760.680.6045.40 Heat or cook using an open fire 46.3435.4385.567.4890.2672.39 Household based Worked for a year or more in any dusty job --4.1811.108.9924.67 Ever smoked cigarettes 02.58.7658.551.6155.83 Now smoke cigarettes 02.717.0654.721.7143.79 Heat or cook using an open fire 48.4639.5883.9872.4588.2278.78

13. Age distribution of symptomatic respiratory patients, by stages (self-reported by patients) StageCough5-14 years females/males 15-49 years females/males >= 50 years females/males PHC based usually have a cough 9,7612,6013,0026,7016,7143,97 usually cough as much as 4 to 6 times a day, 4 or more days out of the week 4,888,667,8317,7211,7832,17 Household based usually have a cough 0.881.254.6814.679.1028.11 usually cough as much as 4 to 6 times a day, 4 or more days out of the week 0.2202.097.915.6719.89

14. Age distribution of symptomatic respiratory patients, by stages (self-reported by patients) StagePhlegm5-14 years females/males 15-49 years females/males >= 50 years females/males PHC based usually bring up phlegm 8,136,307,1718,939,3833,24 usually bring up phlegm twice a day, 4 or more days out of the week 6,504,725,3314,567,6926,27 Household based usually bring up phlegm 0,440,212,299,065,3517,59 usually bring up phlegm twice a day,4 or more days out of theweek 0,220,211,004,974,2813,19

15. Age distribution of symptomatic respiratory patients, by stages (self-reported by patients) StageWheezing5-14 years females/males 15-49 years females/males >= 50 years females/males PHC based ever had an attack of wheezing 13,8214,9615,1713,5916,5923,59 had 2 or more such episodes 9,7613,3912,0010,1914,0618,23 Househol d based ever had an attack of wheezing 2,643,133,582,937,179,18 had 2 or more such episodes 2,423,332,892,685,576,69

16. Age distribution of symptomatic respiratory patients, by stages (self-reported by patients) StageBreathless- ness 5-14 years females/males 15-49 years females/males >= 50 years females/males PHC based MRC 16,500,7917,179,7152,0439,95 MRC 22,440,009,505,8343,5134,32 MRC 32,440,005,174,1331,1326,01 MRC 42,440,003,501,2119,7115,28 MRC 50,00 0,670,974,934,56 Household based MRC 10,220,008,162,4242,7226,39 MRC 20,220,215,471,4033,6220,27 MRC 30,000,422,890,3826,6616,06 MRC 40,000,211,290,5113,817,07 MRC 50,00 0,100,134,603,63

17. Prevalence of bronchial obstruction, % Stage5-14 years females/males 15-49 years females/males >= 50 years females/males Household based clinical survey & lung function test FEV1/FVC <70 2,721,285,076.6915,6523,72

18. Prevalence of smoking by Age & Sex, %

19. Bronchial obstruction degree Pack-years, mean Bronchial obstruction and smoking

20. Bronchial obstruction degree Part of patients with dyspnea Bronchial obstruction and dyspnea

21. Lung Disease and Respiratory Symptoms

22. Treatment Only 2 from 100 patients with respiratory symptoms and low pulmonary function regularly use inhalation of bronchodilators

23. Among the patients with bronchial asthma: –regularly use inhalation of glucocorticoids – less than 1% –regularly use inhalation of bronchodilators – 1,5% –regularly use theophylline – 15 % Treatment

24. “ Adequate education, should be available, in order to ensure correct diagnosis and treatment, in particular in primary care.”

25. Optimization of prophylactic programs for primary care settings to reduce risk factors Diagnostic algorithm for primary care settings based on the main symptoms and risk factors Using spirometry like routine method in primary care Optimization of rehabilitation program for primary care settings to reduce patients disability Educational program Key stones

26. Comparison of age distribution, in years, by stages between sexes StageMean age (+/- SD) in females Mean age (+/- SD) in males p PHC based49,5721,2942,4721,806,67535E-16 Household based41,0324,0434,8922,606,92384Е-17

27. Working population, %, by stages Stage5-14 years females/males 15-49 years females/males >= 50 years females/males PHC based--72,0059,2216,7124,66 Household based--45,8745,1512,6317,97

28. Migrants, %, by stages Stage PHC based3.36 Household based3,21

29. Prevalence of respiratory diseases, by stages (self-reported by patients) StageDisease5-14 years females/males 15-49 years females/males >= 50 years females/males PHC basedEmphysema0,00 0,501,462,768,58 Asthma4,076,303,834,134,334,29 Chronic bronchitis2,445,518,179,9515,1426,01 Tuberculosis0,00 0,171,940,362,95 Current pneumonia4,072,360,671,461,322,14 Allergic rhinitis5,691,573,503,882,401,07 Another respiratory disease* 45,5348,0327,6719,6614,7811,80 Household based Emphysema0,00 0,260,430,38 Asthma0,220,210,401,021,821,15 Chronic bronchitis0,221,464,785,9910,0616,06 Tuberculosis0,000,420,400,641,071,72 Current pneumonia0,00 0,400,640,321,15 Allergic rhinitis0,880,631,000,770,540,00 Another respiratory disease* 20,0422,5022,9920,4115,1013,19

30. Prevalence of respiratory diseases (reported by medics) StageDisease5-14 years15-49 years>= 50 years Household based clinical survey & lung function test Emphysema0,000,170,89 Asthma0,330,841,33 Chronic bronchitis 0,332,197,33 Tuberculosis0,000,340,22 Current pneumonia 2,002,024,00 Allergic rhinitis0,331,180,00

31. Main symptoms and medical diagnosis of chronic bronchitis Patients without established diagnosis Patients with established diagnosis Part of patients with symptoms CoughWheezing PhlegmDyspnea

32. Risk factors and chronic cough Patients without chronic cough Patients with chronic cough Part of patients with risk factors Work in any dusty job Heat or cook using an open fire Smoke

33. Risk factors and phlegm production Patients without phlegmPatients with phlegm Part of patients with risk factors Work in any dusty job Heat or cook using an open fire Smoke

34. Risk factors and wheezing Patients without wheezingPatients with wheezing Part of patients with risk factors Work in any dusty job Heat or cook using an open fire Smoke

35. Risk factors and dyspnea Patients without dyspneaPatients with dyspnea Part of patients with risk factors Work in any dusty job Heat or cook using an open fire Smoke

36. Risk factors and medical diagnosis of chronic bronchitis Patients without with established diagnosis Patients with with established diagnosis Part of patients with risk factors Work in any dusty job Heat or cook using an open fire Smoke

37. Bronchial obstruction degree Part of patients with risk factors Bronchial obstruction and risk factors

38. Bronchial obstruction degree Part of patients with established diagnosis Bronchial obstruction and medical diagnosis of chronic bronchitis

39. Bronchial obstruction degree Part of patients with chronic cough Bronchial obstruction and chronic cough

40. Bronchial obstruction degree Part of patients with phlegm production Bronchial obstruction and chronic phlegm productin

41. Bronchial obstruction degree Part of patients with wheezing Bronchial obstruction and weezing

42. Have ever taken drug for respiratory diseases StageDrug category5-14 years15-49 years>= 50 years Household based clinical survey & lung function test Antibiotics13.7111.9914.03 Inhalation bronchodilators 0.331.371.11 Theophylline1.002.574.68 Mucolitics2.345.316.90 Inhalation glucocorticoids 0.330.340.22 Oral steroids00.680.22

43. Pilot stage 05.10.04-15.10.04 Obtaining the list of PHC Finalize the questionnaires and the GP’s, RT’s and LFT forms Training of the personnel Design, plan and execute pilot prevalence survey Determine whether the “cookbook” (protocol & manual of procedures) works Test communications

44. Prevalence survey of respiratory disease in a household manner 22.11.04-28.12.04 Population: Individuals >= 5 years randomly selected Administered standardised questionnaire on symptoms, diseases, diagnoses, comorbidity, sociodemographics, risk factors

45. Prevalence survey of respiratory disease at the PHC level 18.10.04-20.11.04 Population: Individuals >= 5 years attending PHC Administered standardised questionnaire on symptoms, diseases, diagnoses, comorbidity, sociodemographics, risk factors