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

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. www.who.int/chp

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

Suzanne S. Hurd - USA The burden of CRD

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

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

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

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

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

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

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: 268-271

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

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

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

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

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

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

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

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.

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

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.

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

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

J Bousquet - France The GARD Action Plan

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.

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

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.

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)

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)

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

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

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

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

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

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

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)

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

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

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

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

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

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

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. www.who.int/chp