Interventionsfor prevention and control of chronic …...Presented by Professor Huahao Shen, M.D.,...
Transcript of Interventionsfor prevention and control of chronic …...Presented by Professor Huahao Shen, M.D.,...
Interventions for prevention and control of chronic
respiratory diseases in China
Nan Shan Nan Shan ZhongZhong, M.D., M.D.National GARD Initiator, China
President, Chinese Medical Association
Presented by Professor Huahao Shen, M.D., Ph.D, FCCP
General information
GARD China Network
China Asthma Alliance China COPD Alliance
China GARD AllianceDept of Chronic Disease Management, Ministry of Public Health, China
Chinese Thoracic Society
Country National GARD Initiator
Contact Person in Ministry of Health
National GARD partners National GARD sources of funds
P.R China
Prof. NanShan Zhong
Ms Ling-zhi KongVice-director
Bureau of Chronic Disease Control and Prevention, Ministry of Public Health, People’s Republic
of China
National COPD Alliance
National Asthma Alliance
Chinese PediatricsSociety
Chinese Allergy Society
Chinese Society of Ear, Nose and Throat
RMB 16,000,000(2.1millions US$)
From:BI,GSK, AZ,
RMB 3,000,000(400,000 US$)
From:11th National Five-year Plan Project
Global Alliance against Chronic Respiratory Diseases (GARD)
Summary of Information on Activities at the Country Level
What have we done(Apr 30 , 2006 to present)
• The First China COPD Alliance Meeting and
Second China Asthma Alliance meeting
• New version of China guideline of asthma and
chronic cough
• Training program of physicians in community level
• Knowledge of prevention and management of asthma in the public and media
• Biomass fuel in the pathogenesis of COPD
• Pilot study of early intervention of COPD
management in the community level
• Set up a website in June 2007
(www.chinaasthma.net)
What have we done(Apr 30 , 2006 to present)
Official Website of China Asthma Alliance
www.chinaasthma.net
The Launch Meeting of China COPD Alliance in Guangzhou,
Nov 4, 2006
The Launch Meeting of China Asthma Alliance in Zhenzhou,
June , 2005
Activities on World Asthma Day in big city (Guangzhou)
Activities on World Asthma Day in big city (Guangzhou)
Activities on World Asthma Day in community(Zhejiang)
Professor Nanshan Zhong introduced basic knowledge of Chronic Cough to public
Prevalence and burden of
chronic respiratory diseases
in China
The mortality of top five diseases in some cities and counties 2006 in China
8.946.1Trauma and
poisoning6.132.4Trauma and
poisoning5
13.971.8Cardiovascul
ar disease13.169.3Respiratory diseases
4
16.484.9Respiratory disease17.190.7
Cardiovascula
r disease3
20.4105.0Cerebrovasc
ular disease17.793.7Cerebrovascul
ar disease2
25.1130.2Malignant
tumor27.3144.6Malignant
tumor1
Percentage
%
mortality(1/100,000)
Death Cause
(ICD-10)
Percentage
%
mortality(1/100,000)
Death Cause
(ICD-10)
In CountiesIn CitiesRank
Survey cities:Survey cities:Survey cities:Survey cities: 14 sites from 7 cities (Beijing,
Shanghai, Tianjin, Shenyang, Xi’an, Chongqing,
Guangzhou 2001-2002)
Shanghai
Tianjin
Shenyang
Xi’an
Beijing
Chongqing
Guangzhou
The prevalence of asthma is 0.5%~~~~2.0% in the population in mainland of China.
Prevalence of Asthma in China
Prevalence of COPD in China
• Subjects survey: 24,400 (>40y)
• Response rate: 20245/24400=83%
• Prevalence of COPD:
Male 12.4%
Female 5.1%
Total 8.2%
Prevalence of COPD in China by sex and age
0
5
10
15
20
25
30
40-49years 50-59years 60-69years 70+years
prevalence %
Male Female Total
Mortality
COPD mortality rates per 10,000 population
0
10
20
30
40
50
60
1
9
9
0
1
9
9
1
1
9
9
2
1
9
9
3
1
9
9
4
1
9
9
5
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
China(M)China(M)China(M)China(M) China(F)China(F)China(F)China(F) HongKong(M)HongKong(M)HongKong(M)HongKong(M) HongKong(F)HongKong(F)HongKong(F)HongKong(F) Aus(M)Aus(M)Aus(M)Aus(M) Aus(F)Aus(F)Aus(F)Aus(F)
Burden
Burden of Chronic Respiratory Diseases in China
A survey from 6 cities in China
The burden of a patient with COPD per year:
Direct medical costs: 11,000 RMB (1410 US$)
Indirect medical costs: 3,400 RMB (436 US$)
Days lost from work: 17 days
Data from Professor Quanying He
Burden of Chronic Respiratory Diseases in China
Average hospitalization expenditure in 132 patients with COPD
during 1998-2004
Year Cases Averag hospitalization expenditure
1998-1999 38 1820 (RMB)
(233 US$)
2000-2001 44 2988
2002-2004* 50 4640#(RMB)
(595 US$)
# compared with 1998-1999, P<0.01
Risk factors of COPD in China
Environmental factors leading to COPD
• Smoking
• Occupational exposure
• Biomass fuels
• Body mass index (BMI)
• Respiratory infections
• Others(Host factors )
Comparison of COPD Prevalence in
Smoker And Non-smoker
Male:OR=1.6(1.4Male:OR=1.6(1.4Male:OR=1.6(1.4Male:OR=1.6(1.4----1.9) Female:OR=2.7(2.21.9) Female:OR=2.7(2.21.9) Female:OR=2.7(2.21.9) Female:OR=2.7(2.2----3.9) Total:OR=1.9(1.73.9) Total:OR=1.9(1.73.9) Total:OR=1.9(1.73.9) Total:OR=1.9(1.7----2.2)2.2)2.2)2.2)
13.6
11.0
13.2
8.8
4.4
5.1
0.0
5.0
10.0
15.0
male female total
%
smoking never-smoking
Effects of tobacco smoking on lung function in subjects with COPD
-350
-300
-250
-200
-150
-100
-50
0
2002.9 2004.3 2005.3 2006.3 2007.3
不吸烟不吸烟不吸烟不吸烟
干预前戒烟干预前戒烟干预前戒烟干预前戒烟
干预期戒烟干预期戒烟干预期戒烟干预期戒烟
现吸烟现吸烟现吸烟现吸烟
• Post hoc analysis, adjusting for gender, age, childhood
respiratory infection, family history and body mass index
P=0.001
年月
Accumulative decline
in FEV1(ml)
non-smokers
ex-smokers before in
Ex- smokers after in
Current smokers
Y,M
Mean annual decline in FEV1((((ml/yr))))
COPD and Smoking (2005)
Liwang (Guangzhou) Yunyan (Shaoguan)
(n=1818) (n=1468)
38.4%38.4%38.4%38.4%35.1%35.1%35.1%35.1%Total
0.5%0.5%87.5%9.5%73.4%Smoker
12.0%7.4%Total
7.1%7.1%18.3%3.0%13.8%COPD
F(n=828)
M(n=640)
F(n=1088)
M(n=730)
Liu SM, Zhong NS, et al. Thorax 2007, on line
Fuel For Cooking in the last two Decade
69.3%0.7%Biomass
18.1%-
Biomass
+
Coal
10.9%0.7%Coal
-2.8%Electric
0.1%95.5%Gas
Yunyan (Shaoguan)Liwan (Guangzhou)
Liu SM, Zhong NS, et al. Thorax 2007, on line
Indoor Biomass Combustion
Liu SM, Zhong NS, et al. Thorax 2007, on line
Only SO2 was significantly associated with the prevalence of non-smoking female COPD subjects (p=0.036)
Conclusion• Prevalence of COPD in females in the rural area was
significantly correlated with family history, childhood respiratory
infection and biomass combustion.
• Indoor biomass combustion was an important risk factor of
COPD in females in the rural area
• Biomass combustion (or occupational exposure) and smoking
possess a synergistic effect on COPD prevalence
Liu SM, Zhong NS, et al. Thorax 2007, on line
Interventions for prevention
and control of chronic
respiratory diseases
in China
Community intervention for COPD
• 1410 patients (aged above 40) with confirmed COPD in Liwan, Guangzhou
P=0.121Χ
2=7.292
36.1%40.0%% lost to follow
up
436 cases436 casesMar 2007
683 cases727 casesSept 2002
Control Intervened
Zhou YM, Zhong NS, et al. AJRCCM 2007, in pres
Community intervention
• Health education
• Consultation
• Archives
management
• Routine therapy
• Tobacco cessation
• Knowledge on
prevention &
treatment
• Reduction of indoor
and outdoor air
pollution
• Sabutamol +
Ipratropin Inhalation
• Hazards of tobacco
• Quitting steps
(nicotine replacement)
• Helps to set up
ventilating facilities
• Voluntary consultation
• TV, broadcasts
• Bulletins
• Lectures
Zhou YM, Zhong NS, et al. AJRCCM 2007, in pres
Intervention outcomes
0.11711.1%2.1%% COPD mortality
0.0038.3%21.8%% tobacco cessation
0.0193.2%5.7%% improvement of occupation environment
0.00219.1%26.6%% improvement of outdoor environment
<0.00182.2%92.3%% awareness of tobacco hazards
<0.00121.8%77.1%% COPD awareness
<0.00126.1%78.9%% attendance to health education
P valueControlIntervened
Zhou YM, Zhong NS, et al. AJRCCM 2007, in pres
Overall outcome of community intervention(FEV1)
-350
-300
-250
-200
-150
-100
-50
0
2002.9 2004.3 2005.3 2006.3 2007.3
干预社区干预社区干预社区干预社区
对照社区对照社区对照社区对照社区
Y,M
P<0.001
Zhou YM, Zhong NS, et al. AJRCCM 2007, in pres
Intervened
Control
Accumulative decline
in FEV1(ml)
Overall outcome of community intervention(FVC)
-350
-300
-250
-200
-150
-100
-50
0
2002.9 2004.3 2005.3 2006.3 2007.3
干预社区干预社区干预社区干预社区
对照社区对照社区对照社区对照社区
Y,M
P=0.017
Zhou YM, Zhong NS, et al. AJRCCM 2007, in pres
Intervened
Control
Accumulative decline
in FVC(ml)
Overall outcome of community intervention(FEV1/FVC)
-5
-4.5
-4
-3.5
-3
-2.5
-2
-1.5
-1
-0.5
0
2002.9 2004.3 2005.3 2006.3 2007.3
干预社区干预社区干预社区干预社区
对照社区对照社区对照社区对照社区
Y,M
P<0.001
Zhou YM, Zhong NS, et al. AJRCCM 2007, in pres
Intervened
Control
Accumulative decline
in FEV1/FVC(%)
Conclusion
•Community intervention may lead to:
−Effective reduction of COPD risk factors
−Significantly less decline in lung function
Zhou YM, Zhong NS, et al. AJRCCM 2007, in pres
Zhou et al Respirology 2006; 11: 603
A study of low-dose, slow-release theophylline in
the treatment of COPD for 1 year
• 110 COPD patients(61.0±10.5yrs) in
Guangdong.
• 100 mg slow release theophylline bd versus
placebo in a parallel design for one year.
• 85 (77 %) completed the study.
Mean changes from baseline in pre-bronchodilator and post-bronchodilator lung functions in ITT and PP population
Zhou et al Respirology 2006; 11: 603
Time to first exacerbation
theophylline
placebo
Time of the first acute exacerbation
Conclusion
Low-dose, slow release oral theophylline is
effective and well-tolerated in long-term treatment
of stable COPD.
Recent plans (Asthma)
• A second ARIA survey on asthma control in China
• A survey of common allergen in patients with asthma and allergic rhinitis
• Dissemination of GINA Guidelines
• Training program of physicians in community level
• Knowledge of prevention and management of asthma in the public and media
• Development of a simplified guideline available for the rural area (cost-effective)
• Boycott false medicine
Recent plans (COPD)
• Review the China Guidelines for management of
COPD
• Complete the nationwide survey of COPD
prevalence
• Nationwide study of normal lung function values
• To sum up a pilot study of early intervention of
COPD (a 13-year study)