Burden of major Respiratory Diseases WHO Survey

1

• Burden of major Respiratory DiseasesWHO
  Survey
• Ryazan region of Russia,

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RUSSIA
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Ryazan region of Russia, health care system

• 104 hospitals district hospitals 32
• rural hospitals 44
• 65 out-patient departments
• 792 feldsher's stations

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• 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.
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Protocol for assessment of prevalence of major
respiratory diseases
Number of patients
Clinical survey and lung function test

• Prevalence survey of respiratory disease in a
  household manner

Prevalence survey of respiratory disease at the
PHC level
Pilot stage
October 2004
March 2006
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Pilot stage 05.10.04-15.10.04

• Obtaining the list of PHC
• Finalize the questionnaires and the GPs, RTs
  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

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Prevalence survey of respiratory disease in a
household manner 22.11.04-28.12.04

• Population Individuals gt 5 years randomly
  selected
• Administered standardised questionnaire on
  symptoms, diseases, diagnoses, comorbidity,
  sociodemographics, risk factors

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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.
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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.
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General characteristics of the study
Region Stage Study period Number of health facilities Number of health facilities Number of patients
Scopin district PHC based 18.10.04-02.11.04 24 24 1505
Scopin district Household based 22.11.04-28.12.04 18 18 2116
Scopin district Clinical survey lung function test 08.02.05-30.03.05 8 8 812

Shilovo district PHC based 01.11.04-20.11.04 29 962 962
Shilovo district Household based 22.11.04-28.12.04 18 2030 2030
Shilovo district Clinical survey lung function test 08.02.05-30.03.05 8 725 725

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Education level of respondents, , by stages
Stage Higher Secondary Primary No edu-cation
PHC based 7,38 59,22 27,32 6,08
Household based 5,31 50.10 31.65 6.10
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Age distribution of risk factors, by stages
(self-reported by patients)
Stage Risk factor 5-14 years females/males 5-14 years females/males 15-49 years females/males 15-49 years females/males gt 50 years females/males gt 50 years females/males
PHC based Worked for a year or more in any dusty job - - 6.33 14.08 13.82 24.66
PHC based Ever smoked cigarettes 0 0.79 5.17 64.32 0.84 58.71
PHC based Now smoke cigarettes 0 1.57 4.67 60.68 0.60 45.40
PHC based Heat or cook using an open fire 46.34 35.43 85.5 67.48 90.26 72.39
Household based Worked for a year or more in any dusty job - - 4.18 11.10 8.99 24.67
Household based Ever smoked cigarettes 0 2.5 8.76 58.55 1.61 55.83
Household based Now smoke cigarettes 0 2.71 7.06 54.72 1.71 43.79
Household based Heat or cook using an open fire 48.46 39.58 83.98 72.45 88.22 78.78
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Age distribution of symptomatic respiratory
patients, by stages (self-reported by patients)
Stage Cough 5-14 years females/males 5-14 years females/males 15-49 years females/males 15-49 years females/males gt 50 years females/males gt 50 years females/males
PHC based usually have a cough 9,76 12,60 13,00 26,70 16,71 43,97
PHC based usually cough as much as 4 to 6 times a day, 4 or more days out of the week 4,88 8,66 7,83 17,72 11,78 32,17
Household based usually have a cough 0.88 1.25 4.68 14.67 9.10 28.11
Household based usually cough as much as 4 to 6 times a day, 4 or more days out of the week 0.22 0 2.09 7.91 5.67 19.89
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Age distribution of symptomatic respiratory
patients, by stages (self-reported by patients)
Stage Phlegm 5-14 years females/males 5-14 years females/males 15-49 years females/males 15-49 years females/males gt 50 years females/males gt 50 years females/males
PHC based usually bring up phlegm 8,13 6,30 7,17 18,93 9,38 33,24
PHC based usually bring up phlegm twice a day, 4 or more days out of the week 6,50 4,72 5,33 14,56 7,69 26,27
Household based usually bring up phlegm 0,44 0,21 2,29 9,06 5,35 17,59
Household based usually bring up phlegm twice a day,4 or more days out of theweek 0,22 0,21 1,00 4,97 4,28 13,19
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Age distribution of symptomatic respiratory
patients, by stages (self-reported by patients)
Stage Wheezing 5-14 years females/males 5-14 years females/males 15-49 years females/males 15-49 years females/males gt 50 years females/males gt 50 years females/males
PHC based ever had an attack of wheezing 13,82 14,96 15,17 13,59 16,59 23,59
PHC based had 2 or more such episodes 9,76 13,39 12,00 10,19 14,06 18,23
Household based ever had an attack of wheezing 2,64 3,13 3,58 2,93 7,17 9,18
Household based had 2 or more such episodes 2,42 3,33 2,89 2,68 5,57 6,69
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Age distribution of symptomatic respiratory
patients, by stages (self-reported by patients)
Stage Breathless-ness 5-14 years females/males 5-14 years females/males 15-49 years females/males 15-49 years females/males gt 50 years females/males gt 50 years females/males
PHC based MRC 1 6,50 0,79 17,17 9,71 52,04 39,95
PHC based MRC 2 2,44 0,00 9,50 5,83 43,51 34,32
PHC based MRC 3 2,44 0,00 5,17 4,13 31,13 26,01
PHC based MRC 4 2,44 0,00 3,50 1,21 19,71 15,28
PHC based MRC 5 0,00 0,00 0,67 0,97 4,93 4,56
Household based MRC 1 0,22 0,00 8,16 2,42 42,72 26,39
Household based MRC 2 0,22 0,21 5,47 1,40 33,62 20,27
Household based MRC 3 0,00 0,42 2,89 0,38 26,66 16,06
Household based MRC 4 0,00 0,21 1,29 0,51 13,81 7,07
Household based MRC 5 0,00 0,00 0,10 0,13 4,60 3,63
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Prevalence of bronchial obstruction,
Stage 5-14 years females/males 5-14 years females/males 15-49 years females/males 15-49 years females/males gt 50 years females/males gt 50 years females/males
Household based clinical survey lung function test FEV1/FVClt70 2,72 1,28 5,07 6.69 15,65 23,72
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Prevalence of smoking by Age Sex,




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Bronchial obstruction and smoking
Pack-years, mean
Bronchial obstruction degree
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Bronchial obstruction and dyspnea
Part of patients with dyspnea
Bronchial obstruction degree
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Lung Disease and Respiratory Symptoms
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Treatment

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

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Treatment

• 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

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Adequate education, should be available,in
order to ensure correct diagnosis and treatment,
in particular in primary care.
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Educational programKey stones

• 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

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Comparison of age distribution, in years, by
stages between sexes
Stage Mean age (/- SD) in females Mean age (/- SD) in females Mean age (/- SD) in males Mean age (/- SD) in males p
PHC based 49,57 21,29 42,47 21,80 6,67535E-16
Household based 41,03 24,04 34,89 22,60 6,92384?-17
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Working population, , by stages
Stage 5-14 years females/males 5-14 years females/males 15-49 years females/males 15-49 years females/males gt 50 years females/males gt 50 years females/males
PHC based - - 72,00 59,22 16,71 24,66
Household based - - 45,87 45,15 12,63 17,97
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Migrants, , by stages
Stage
PHC based 3.36
Household based 3,21
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Prevalence of respiratory diseases, by stages
(self-reported by patients)
Stage Disease 5-14 years females/males 5-14 years females/males 15-49 years females/males 15-49 years females/males gt 50 years females/males gt 50 years females/males
PHC based Emphysema 0,00 0,00 0,50 1,46 2,76 8,58
PHC based Asthma 4,07 6,30 3,83 4,13 4,33 4,29
PHC based Chronic bronchitis 2,44 5,51 8,17 9,95 15,14 26,01
PHC based Tuberculosis 0,00 0,00 0,17 1,94 0,36 2,95
PHC based Current pneumonia 4,07 2,36 0,67 1,46 1,32 2,14
PHC based Allergic rhinitis 5,69 1,57 3,50 3,88 2,40 1,07
PHC based Another respiratory disease 45,53 48,03 27,67 19,66 14,78 11,80

Household based Emphysema 0,00 0,00 0,00 0,26 0,43 0,38
Household based Asthma 0,22 0,21 0,40 1,02 1,82 1,15
Household based Chronic bronchitis 0,22 1,46 4,78 5,99 10,06 16,06
Household based Tuberculosis 0,00 0,42 0,40 0,64 1,07 1,72
Household based Current pneumonia 0,00 0,00 0,40 0,64 0,32 1,15
Household based Allergic rhinitis 0,88 0,63 1,00 0,77 0,54 0,00
Household based Another respiratory disease 20,04 22,50 22,99 20,41 15,10 13,19

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Prevalence of respiratory diseases (reported by
medics)
Stage Disease 5-14 years 15-49 years gt 50 years
Household based clinical survey lung function test Emphysema 0,00 0,17 0,89
Household based clinical survey lung function test Asthma 0,33 0,84 1,33
Household based clinical survey lung function test Chronic bronchitis 0,33 2,19 7,33
Household based clinical survey lung function test Tuberculosis 0,00 0,34 0,22
Household based clinical survey lung function test Current pneumonia 2,00 2,02 4,00
Household based clinical survey lung function test Allergic rhinitis 0,33 1,18 0,00
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Main symptoms and medical diagnosis of chronic
bronchitis
Cough
Wheezing
Phlegm
Dyspnea
Part of patients with symptoms
Patients without established diagnosis
Patients with established diagnosis
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Risk factors and chronic cough
Heat or cook using an open fire
Work in any dusty job
Smoke
Part of patients with risk factors
Patients without chronic cough
Patients with chronic cough
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Risk factors and phlegm production
Heat or cook using an open fire
Work in any dusty job
Smoke
Part of patients with risk factors
Patients without phlegm
Patients with phlegm
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Risk factors and wheezing
Heat or cook using an open fire
Work in any dusty job
Smoke
Part of patients with risk factors
Patients without wheezing
Patients with wheezing
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Risk factors and dyspnea
Heat or cook using an open fire
Work in any dusty job
Smoke
Part of patients with risk factors
Patients without dyspnea
Patients with dyspnea
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Risk factors and medical diagnosis of chronic
bronchitis
Heat or cook using an open fire
Work in any dusty job
Smoke
Part of patients with risk factors
Patients without with established diagnosis
Patients with with established diagnosis
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Bronchial obstruction and risk factors
Part of patients with risk factors
Bronchial obstruction degree
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Bronchial obstruction and medical diagnosis of
chronic bronchitis
Part of patients with established diagnosis
Bronchial obstruction degree
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Bronchial obstruction and chronic cough
Part of patients with chronic cough
Bronchial obstruction degree
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Bronchial obstruction and chronic phlegm
productin
Part of patients with phlegm production
Bronchial obstruction degree
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Bronchial obstruction and weezing
Part of patients with wheezing
Bronchial obstruction degree
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Have ever taken drug for respiratory diseases
Stage Drug category 5-14 years 15-49 years gt 50 years
Household based clinical survey lung function test Antibiotics 13.71 11.99 14.03
Household based clinical survey lung function test Inhalation bronchodilators 0.33 1.37 1.11
Household based clinical survey lung function test Theophylline 1.00 2.57 4.68
Household based clinical survey lung function test Mucolitics 2.34 5.31 6.90
Household based clinical survey lung function test Inhalation glucocorticoids 0.33 0.34 0.22
Household based clinical survey lung function test Oral steroids 0 0.68 0.22
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Pilot stage 05.10.04-15.10.04

• Obtaining the list of PHC
• Finalize the questionnaires and the GPs, RTs
  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 gt 5 years randomly
  selected
• Administered standardised questionnaire on
  symptoms, diseases, diagnoses, comorbidity,
  sociodemographics, risk factors

45
Prevalence survey of respiratory disease at the
PHC level18.10.04-20.11.04

• Population Individuals gt 5 years attending PHC
• Administered standardised questionnaire on
  symptoms, diseases, diagnoses, comorbidity,
  sociodemographics, risk factors