Chronic respiratory diseases: burden, population and interventions, focus on LMIC (Dr. Eugene Zheleznyakov, Technical Officer, Chronic Disease Prevention and Management, WHO, Geneva)

4 000 000 PEOPLE DIED FROM CHRONIC RESPIRATORY DISEASES Did you know?? 4 000 000 PEOPLE DIED FROM CHRONIC RESPIRATORY DISEASES IN 2005

Chronic respiratory diseases worldwide Main NCDs include: Cardiovascular diseases mainly heart disease and stroke Cancer Chronic respiratory diseases Diabetes

Projected disease deaths and burden. 2005 Preventing Chronic Diseases, a vital investment, WHO, 2005 Main causes of global burden of disease (DALYs) Main causes of death Communicable diseases Maternal/perinatal Nutrional deficiencies 7% Cardiovascular Cancer 4% CRD Diabetes Other chronic diseases Injuries

Chronic respiratory diseases worldwide Hundreds of millions of people have chronic respiratory diseases including 300 million people with asthma 210 million people with chronic obstructive pulmonary disease (COPD) Millions of people with allergic rhinitis, sleep apnoea syndrome and other chronic respiratory diseases

Chronic Respiratory Diseases Year of estimate Prevalence Asthma 2007 300 million COPD 210 million Allergic rhinitis 1996 - 2006 400 million Sleep apnea 1986 - 2002 >100 million Others 2006 >50 million 8

Lower Respiratory Infections Burden of Major Respiratory Conditions Condition Deaths DALYs* % % Lower Respiratory Infections 6.6 5.8 COPD 4.8 1.9 Tuberculosis 2.8 2.4 Lung/ Bronchus /Trachea Cancer 2.2 0.8 Asthma 0.4 1.0 Respiratory conditions impose an enormous burden on society. According to the WHO World Health Report 2000, the top five respiratory disease account for 17.4% of all deaths and 13.3% of all disability-Adjusted Life Years (DALYs). Total 16.8 11.9 *DALYs = Disability-Adjusted Life-Years Source: World Health Report 2003

Chronic respiratory diseases 4 million people die each year from CRD And in 2030: COPD: 4th cause of death (Plos Med 2006) Tobacco > 8 million deaths (Plos Med 2006) Biomass fuel combustion > 10 million deaths (Ezzatti, Science 2005) > 50% of the world population will be allergic

What are DALYs? DALY = YLD + YLL Disability Adjusted Life Years YLL One DALY: one lost year of “healthy” life DALY = YLD + YLL 55 65 75 COPD onset death expected YLL Years of Life Lost Years of Life with Disability YLD 50 Respiratory conditions impose an enormous burden on society. According to the WHO World Health Report 2000, the top five respiratory disease account for 17.4% of all deaths and 13.3% of all disability-Adjusted Life Years (DALYs). age (years)

Increasing Burden of Diseases and Injuries: Change in Rank Order of DALYs* *DALYs = Disability-Adjusted Life-Years Source: WHO Evidence, Information and Policy, 2005 *DALYs: Disability Adjusted Life Years

Age-standardized disability-adjusted life year (DALY) rates from respiratory diseases by country (per 100,000) Canuckguy et al. 2009

WHO global approach to control Chronic Respiratory Diseases

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The aim of the WHO chronic respiratory diseases programme as a part of NCD programme is to support member states in their efforts to reduce the toll of morbidity, disability and premature mortality related to chronic respiratory diseases, and specifically, asthma and chronic obstructive pulmonary disease (COPD). Objectives: Better surveillance to map the magnitude of chronic respiratory diseases and analyze their determinants with particular reference to poor and disadvantaged populations, and to monitor future trends. Primary prevention to reduce the level of exposure of individuals and populations to common risk factors, particularly tobacco, poor nutrition, frequent lower respiratory infections during childhood, and environmental air pollution (indoor, outdoor, and occupational). Secondary and tertiary prevention to strengthen health care for people with chronic respiratory diseases by identifying cost-effective interventions, upgrading standards and accessibility of care at different levels of the health care system.

May 2010

Framework Convention on Tobacco Control (FCTC) As for 1As for 17 December 2004: 47 countries have ratified the treaAs for 17 December 2004: 47 countries have ratified the treaty. On 27 February 2005: the FCTC has entered into force and has become an International law. ty. On 27 February 2005: the FCTC hasAs for 17 December 2004: 47 countries have entered into force and has become 7 December 2004: 47 countries have Today the FCTC has 140 parties (16 November 2006)

 Reducing NCD risk factors

 Reducing NCD risk factors

 Reducing NCD risk factors

Source: World Health Report, 2002

Source: World Health Report, 2002

EUROPE versus AFRICA The relative importance of Tobacco Smoke and other risk factors relevant for COPD Opposite patterns in different geographic areas EUROPE versus AFRICA Source: World Health Report 2002

EUROPE Disease burden (DALYs) in 2000 attributable to selected risk factors Indoor smoke from solid fuels Unsafe water, sanitation, and hygiene Underweight Childhood sexual abuse Urban air pollution Occupational risk factors for injury Iron deficiency Unsafe sex Lead exposure Illicit drugs Physical inactivity Fruit and vegetable intake High Body Mass Index Cholesterol Alcohol Tobacco Blood pressure Number of Disability-Adjusted Life Years (000s) Urban air pollution 5000 10000 15000 20000

Indoor pollution AFRICA Disease burden (DALYs) in 2000 attributable to selected risk factors 10000 20000 30000 40000 50000 60000 70000 Fruit and vegetable intake Occupational risk factors for injury Global climate change Unsafe health care injections Cholesterol Tobacco Lack of contraception Blood pressure Alcohol Iron deficiency Indoor smoke from solid fuels Zinc deficiency Vitamin A deficiency Unsafe water, sanitation, and hygiene Underweight Unsafe sex Number of Disability-Adjusted Life Years (000s) Indoor pollution Lead exposure

Multisectoral collaboration Multilateral Bilateral Agencies Educational Sector Professional Associations Communities, churches, religious leaders Multisectoral collaboration Patient Groups Private sector, media CRD and public health experts Related Ministries NGOs

Global Alliance against Chronic Respiratory Diseases Web site: www.who.int/gard E-mail: gard@who.int