Post on 23-Feb-2016
description
1999 Disease or Injury 2020 Disease or Injury
Increasing burden of noncommunicable diseases and injurieschange in rank order of DALYs for the 15 leading causes
(baseline scenario)
1 Acute lower respiratory infections2.HIV/AIDS3.Perinatal conditions4.Diarrhoeal diseases5.Unipolar major depression6.Ischaemic heart disease7.Cerebrovascular disease8.Malaria9.Road traffic injuries10.Chronic obstructive pulmonary
disease11.Congenital abnormalities12.Tuberculosis13.Falls 14.Measles15.Anaemias
1. Ischaemic heart disease2. Unipolar major depression3. Road traffic injuries4. Cerebrovascular disease5 .Chronic obstructive pulmonary 6. Lower respiratory infections7. Tuberculosis8. War9. Diarrhoeal diseases10.HIV11.Perinatal conditions12.Violence 13.Congenital abnormalities14.Self-inflicted injuries15.Trachea, bronchus and lung
cancers
1990 2020
8.4 million
3 million
Established Market Economies
Middle Eastern Crescent
Latin America & CaribbeanSub-Saharan AfricaOther Asia and Islands
China
India
Former Socialist Countries
Tobacco: deaths by World Bank regionsestimates for 1990 and 2020
Source: Murray CJL, Lopez AD 1996
0
5
10
15
20
25
Established MarketEconomiesFormer SocialistEconomies of EuropeIndia
China
Other Asia and Islands
Sub-Saharan Africa
Latin America and theCaribbeanMiddle Eastern Crescent
World
Developed Regions
Developing Regions0
5
10
15
20
25
Deaths (% of total) attributable to tobacco use by World Bank Region, estimates for 1990 and 2020
1990 2020
Asthma and Chronic Obstructive Airway Disease (COAD)
Control and Prevention
Objectives:You Students will be capable to understand the geographical distribution of COAD/COPD and Asthma.
identify risk factors posing the methods used in their prevention and control.
Malaria (1086)HIV/AIDS (2673)Tuberculosis (1669)
Diarrhoeal diseases (2213)
Injuries (5101)
Cardiovascular Diseases (16970)
Maternal Conditions (497)Childhood diseases (1554)
Respiratory Infections (4039)
Global distribution of causes of death,1999 (000s)
Other causes (800)Respiratory Diseases (3575)
Neuropsychiatric Disorders (911)Diabetes (777)
Malignant neoplasms (7065)
Other Noncommunicable Diseases (2137)
Digestive Diseases (2049)Perinatal conditions (2356)
Nutritional deficiences (493)
Malaria (44998)HIV/AIDS (89819)Tuberculosis (33287)
Diarrhoeal diseases (72063)
Injuries (201307)
Cardiovasculardiseases (157185)
Maternal conditions (26101)Childhood diseases (54638)
Respiratory infections (101127)
Other causes (59025)
Respiratory diseases (70017)
Neuropsychiatric disorders (158721)Diabetes (15070) Malignant neoplasms (84500)
Other Noncommunicablediseases (99420)
Digestive diseases (36829)
Global burden of diseasein disability-adjusted life years (DALYs),
1999 (000s)
Perinatal conditions (89508)Nutritional deficiences (44539)
intentional and unintentionalInjuries (9.4)
Respiratory Infections (13.4)
Respiratory Diseases (2.7)Digestive Diseases (2.5)
Perinatal Conditions (7.9)Childhood Cluster Diseases (7.8)
Source: The Burden of Disease among the Global Poor, World Bank 2000
Deaths, 1990among poorest 20%of global population
principal causes (% of deaths)Diarrheal Diseases (11.3)
Malignant Neoplasms (5.6)
Nutritional Deficiencies (1.8)
Other (8.5)
Ischaemic Heart Disease (7.3)Tuberculosis (6.2)
Cerebrovascular Diseases (4.6)
Malaria (3.6)• Maternal Conditions (1.4)• Congenital Abnormalities (1.3)• Inflammatory and Rheumatic
Heart Diseases (1.2)• Genito-Urinary Conditions (1.1)• HIV/AIDS (0.9)• Neuropsychiatric Conditions (0.8)• Diabetis Mellitus (0.7)
intentional and unintentionalInjuries (13.1)
Respiratory Infections (11.8)
Perinatal Conditions (8.8)
Source: The Burden of Disease among the Global Poor, World Bank 2000
DALYs, 1990among poorest 20%of global population
principal causes (% of DALYs)Diarrheal Diseases (11)
Nutritional Deficiencies (4.5)
Other (10.4)
• Respiratory Diseases (2.4)• Malignant Neoplasms (2.3)• Digestive Diseases (2.1)• Congenital Abnormalities (2)• Ischaemic Heart Disease (1.9)• Cerebrovascular Disease (1.5)• HIV/AIDS (1)• Inflammatory and Rheumatic
Heart Diseases (0.9)• Genito-Urinary Diseases (0.7)• Diabetes (0.5)
Childhood Cluster Diseases (8.1)
Neuropsychiatric Conditions (5.4)
Maternal Conditions (3.9)Malaria (3.9)Tuberculosis (3.8)
Malaria (953)
HIV/AIDS (2154)
Tuberculosis (357)Diarrhoeal diseases (765)
Injuries (776)
Noncommunicableconditions (2300)
Maternal Conditions (255)Childhood diseases (740) Respiratory infections (1086)
Distribution of causes of deathin Africa, 1999 (000s)
Other causes (255)Perinatal conditions (615) Nutritional deficiencies (180)
Malaria (36838)
HIV/AIDS (74449)
Tuberculosis (8721)Diarrhoeal diseases (24321)
Injuries (36103)
Noncommunicableconditions (63681)
Maternal conditions (12525)
Childhood diseases (25742)
Respiratory infections (32771)
Other causes (23075)
Burden of disease in disability-adjusted life years (DALYs) in Africa, 1999 (000s)
Perinatal conditions (24097)Nutritional deficiencies
(11037)
Malaria (2)
HIV/AIDS (81)
Tuberculosis (59)
Diarrhoeal diseases (74)
Injuries (552)
Noncommunicableconditions (4255)
Maternal conditions (18)Childhood diseases (21)
Respiratory infections (299)
Distribution of causes of deathin Americas, 1999 (000s)
Other causes (101)Perinatal conditions (153)
Nutritional deficiencies (72)
Malaria (76)
HIV/AIDS (2812)
Tuberculosis (1114)
Diarrhoeal diseases (2514)
Injuries (17738)
Noncommunicableconditions (82909)
Maternal conditions (1207)
Childhood diseases (533)
Respiratory infections (4204)
Other causes (4536)
Burden of disease in disability-adjusted life years (DALYs) in Americas, 1999 (000s)
Perinatal conditions (5566)
Nutritional deficiencies (2733)
Injuries (750)
Noncommunicableconditions (7776)
Distribution of causes of deathin Europe, 1999 (000s)
HIV/AIDS (15)
Tuberculosis (60)
Diarrhoeal diseases (30)
Maternal conditions (4)Childhood diseases (13)
Respiratory infections (275)
Other causes (58)
Perinatal conditions (62)
Nutritional deficiencies (14)
Malaria (44)HIV/AIDS (29)
Tuberculosis (112)Diarrhoeal diseases (300)
Injuries (405)
Noncommunicableconditions (2318)
Maternal conditions (39)Childhood diseases (191)
Respiratory infections (343)
Distribution of causes of deathin the Eastern Mediterranean, 1999 (000s)
Other causes (80)Perinatal conditions (313)
Nutritional deficiencies (44)
Malaria (2774)HIV/AIDS (2172)Tuberculosis (2260)
Diarrhoeal diseases (10123)
Injuries (13214)
Noncommunicableconditions (51039)
Maternal conditions (2720)Childhood diseases (6560)
Respiratory infections (10916)
Other causes (4931)
Burden of diseasein disability-adjusted life years (DALYs)
in Eastern Mediterranean,1999 (000s)
Perinatal conditions (11755)Nutritional deficiencies (4119)
Malaria (2)
HIV/AIDS (725)
Tuberculosis (1258)
Diarrhoeal diseases (1131)
Injuries (19323)
Noncommunicableconditions (104032)
Maternal conditions (451)Childhood diseases (477)
Respiratory infections (3509)
Other causes (1921)
Burden of diseasein disability-adjusted life years (DALYs)
in Europe,1999 (000s)
Perinatal conditions (2370)
Nutritional deficiencies (1152)
Malaria (69)HIV/AIDS (360)
Tuberculosis (723)Diarrhoeal diseases (978)
Injuries (1301)
Noncommunicableconditions (7370)
Maternal conditions (158)Childhood diseases (542)
Respiratory infections (1523)
Distribution of causes of deathin South-East Asia, 1999 (000s)
Other causes (236)
Nutritional deficiencies (159)Perinatal conditions (851)
Malaria (3071)HIV/AIDS (8866)Tuberculosis (14101)
Diarrhoeal diseases (30017)
Injuries (65289)
Noncommunicableconditions (156536)
Maternal conditions (7733)Childhood diseases (19449)
Respiratory infections (38144)
Other causes (19693)
Burden of diseasein disability-adjusted life years (DALYs)
in South-East Asia,1999 (000s)
Nutritional deficiencies (16866)Perinatal conditions (32715)
Injuries (1317)
NoncommunicableConditions (9462)
Distribution of causes of deathin Western Pacific, 1999 (000s)
Malaria (16)
HIV/AIDS (34)
Tuberculosis (359)
Diarrhoeal diseases (67)
Maternal conditions (21)
Childhood diseases (47)
Respiratory infections (514)
Other causes (75)
Nutritional deficiencies (22)
Perinatal conditions (363)
Malaria (2235)
HIV/AIDS (795)
Tuberculosis (5832)
Diarrhoeal diseases (3955)
Injuries (49641)
Noncommunicableconditions (163546)
Maternal conditions (1466)Childhood diseases (1875)
Respiratory infections (11584)
Other causes (4872)
Burden of diseasein disability-adjusted life years (DALYs)
in Western Pacific, 1999 (000s)
Nutritional deficiencies (8633)
Perinatal conditions (13005)
?•Chronic inflammatory disorder
of the airways•Usually reversible, but not yet
curable•Not the same as allergies•Not contagious
What Is Asthma
What Does An
?• Jog in place for 2 minutes•Place a straw in your mouth and
breathe only through the straw by pinching your nose closed
•How do you feel?
asthma episodefeel like
What Happens ?During an asthma episodeAirways narrow, caused by:
• tightening of the muscles that surround the airways
• swelling of the inner lining, and/or
• increase in mucus production
of asthmaTwo partsTwo parts
• Coughing
• Wheezing
• Chest tightness
• Shortness of breath
AsthmaSYMPTOMS
• About 17 million Americans have asthma
• Rate of asthma increased 75% between 1980 and 1994
• Most common chronic childhood disease, affecting about 5 million children
• 14 people die each day from asthma
• Nearly 2 million emergency room visits each year
FactsAsthma
• Children• Low-income, urban
residents• Some minorities• Allergic individuals• People with hereditary
disposition for asthma
most at riskto suffer from asthma?Who is
The patient should Consult the physician to develop an asthma management plan, which includes:
• Medication• Identification of your asthma triggers & ways
to reduce/avoid exposure to your asthma triggers
• Peak flow monitoring• Emergency plan
Managing Asthma
NAEPP Guidelines, 1997American National Asthma Education and Prevention Program (NAEPP)
Classification of chronic asthma:Mild intermittent asthmaMild persistent asthma (>2 days/wk, >2 nights/mo)Moderate persistent asthmaSevere persistent asthma
Inhaled corticosteroids (ICS) are “preferred treatment” for all patients with persistent asthma
• Allergens• molds, dust mites,
cockroaches, animal dander, pollens, foods
• Irritants• secondhand smoke, strong
odors, aerosols, volatile organic compounds, ozone, particulate matter
• Other• Viral respiratory infections• Changes in weather
(cold air, wind, humidity)• Exercise• Medication• Endocrine factors
(menstrual period, pregnancy, thyroid disease)
Commonasthma Triggers
* 5 major indoor asthma triggers
•All of the common asthma triggers are found indoors
•Reducing exposure to indoor allergens and irritants can reduce asthma symptoms
•Prevention is an important asthma management tool
What does theIndoor Environment Asthma?have to do with
Secondhand SmokeDust Mites
MoldPets
Cockroaches
Environmental TriggersIndoorMost common
• Contains more than 4,000 substances (over 40 are carcinogenic)
• Is particularly harmful to young children• Can trigger asthma attacks and cause
young children to develop asthma
SecondhandSmoke
Choose not to smokein your home or carand do not allow others to do so either
Avoiding Secondhand Smoke
• Found in most homes
• Live in soft bedding• Feed on skin flakes• Mites and mite
droppings can be asthma triggers
• Can cause children to develop asthma
mitesDUST
• Wash sheets and blankets once a week in hot water
• Choose washable stuffed toys, wash them often in hot water, and dry thoroughly -- keep stuffed toys off beds
• Cover mattresses and pillows in dust-proof (allergen-impermeable) zippered covers
• Vacuum often (when asthmatic is not present)• Maintain low indoor humidity, ideally between
30-50%
Avoidingdust miteTriggers
• Skin flakes, urine, and saliva of warm blooded animals can be asthma triggers
• Triggers can remain in the home for several months after a pet is removed, even with cleaning
PeTS
• Consider keeping pets outdoors or even finding a new home for your pets, if necessary
• Keep pets out of the bedroom and other sleeping areas at all times, and keep the door closed
AvoidingpetTriggers
• Keep pets away from fabric-covered furniture, carpets, and stuffed toys
• If you remove an animal from the home, clean the home thoroughly
• Can be found almost anywhere and can grow on virtually any damp substance
• Key to mold control is moisture control
• Clean up the mold and get rid of excess water or moisture
• Reducing moisture also helps reduce other triggers, such as dust mites and cockroaches
Molds
• Wash mold off hard surfaces and dry completely
• Absorbent materials (ceiling tiles and carpet) may need to be replaced
• Fix leaky plumbing or other sources of water
• Keep drip pans in your air conditioner, refrigerator, and dehumidifier clean and dry
Avoiding Mold Triggers
• Use exhaust fans or open windows in kitchens and bathrooms when showering, cooking, or using the dishwasher
• Vent clothes dryers to the outside
• Maintain low indoor humidity (between 30-50% relative humidity)
• Droppings or body parts of cockroaches can be asthma triggers
• Cockroaches likely contribute significantly to asthma problems in inner city area
• Free your home of places for pests to hide and sources of food and water
Cockroaches
•Do not leave food or garbage out
•Store food in airtight containers
•Clean all food crumbs or spilled liquids right away
Avoiding
Cockroaches
Cockroaches (cont)• Try using poison baits, boric acid, or
traps first before using pesticide sprays• If sprays are used:Limit the spray to infested areaCarefully follow instructions on the
labelMake sure there is plenty of fresh air
when you spray, and keep the person with asthma out of the room
COAD (COPD) Or Chronic Bronchitis That Was
COPD
•Chronic bronchitis•Emphysema•COAD•Chronic airflow restriction•Some cases of chronic asthma
COAD: Definition
•Chronic slowly progressive airways obstruction, not fully reversible
•FEV1 <80% predicted•FEV1/FVC ratio <70%•Impairment largely fixed
COAD: Prevalence• Depends on where you work!• Male:Female = 4:1 ??????• Urban:Rural = 2:1• 5-25% of population• Declining, or being redefined!• 1-4 consultations per GP per week• Strongly social class related• Increases with age
COAD: Risk Factors
•Smoking•Asthma•Genetic•Social class (Independent ? Of other factors)
COAD: Risk Factors (Cont)
•Pollution•Occupational dust exposure
•Recurrent infection
COAD: Symptoms
•“Smokers cough” - Mild•Breathlessness on exertion - Moderate
•Cough +/- sputum - Moderate
COAD: Symptoms (cont)
•Breathlessness on any exertion - Severe
•Peripheral edema - Severe
COAD: Diagnosis
•Spirometry preferred to PEFR•If PEFR used then it needs to be
done over several weeks to confirm lack of variability
•CXR to exclude other problems•Bronchodilators only give limited
improvement of PEF
Management Plans
Essential at all stagesQuit rates improved
by:I. Active cessation
programmesII. NRT
Management PlansExercise.
Encouraged where at all possible, evidence that graded programmes are beneficial is growing.
Management Plans
•Obesity and poor nutrition make things worse
Management PlansDepression•Common concurrent problem
Social problems•Also common
Management Plans
Vaccination
Influenza for all
? Pneumococcal
Management Plansi. Short acting bronchodilator
Anticholinergic ii.Regular use of aboveii.Combination of two
Prevention• Fags (Poor)• Fags• Fags• Pollution• Occupational factors• ? Housing
1990 2020
8.4 million
3 million
Established Market Economies
Middle Eastern Crescent
Latin America & CaribbeanSub-Saharan AfricaOther Asia and Islands
China
India
Former Socialist Countries
Tobacco: deaths by World Bank regionsestimates for 1990 and 2020
Source: Murray CJL, Lopez AD 1996
0
5
10
15
20
25
Established MarketEconomiesFormer SocialistEconomies of EuropeIndia
China
Other Asia and Islands
Sub-Saharan Africa
Latin America and theCaribbeanMiddle Eastern Crescent
World
Developed Regions
Developing Regions0
5
10
15
20
25
Deaths (% of total) attributable to tobacco use by World Bank Region, estimates for 1990 and 2020
1990 2020
Objectives:You Students will be capable to understand the geographical distribution of COAD/COPD and Asthma.
identify risk factors posing the methods used in their prevention and control.