GARD in RussiaGARD in RussiaAndreyAndrey BelevskiyBelevskiy

MD, PhD, ProfessorMD, PhD, ProfessorRussian State Medical UniversityRussian State Medical University

Russian Respiratory SocietyRussian Respiratory Society

GARD in RussiaGARD in Russia

•• PrevalencePrevalence

•• GP and SpecialistsGP and Specialists

•• EducationEducation

•• Resources Resources

•• Next stepsNext steps

Figure 1-1. Asthma Prevalence and Mortality

Permission for use of this figure obtained from J. Bousquet.

2. Masoli M, Fabian D, Holt S, Beasley R. The global burden of

asthma: executive summary of the GINA Dissemination

Committee report. Allergy 2004;59(5):469-78.

3. Beasley R. The Global Burden of Asthma Report, Global Initiative

for Asthma (GINA). Available from http://www.ginasthma.org 2004.

9,09,020042004KirovKirov

7,67,619991999TomskTomsk

7,67,619991999UlanUlan--UdeUde

10,710,720012001NovokuznetskNovokuznetsk

12,112,1

5,65,6

10,810,8

8,18,1

9,89,8

7,27,2

10,610,6

10,810,8

11,111,1

PrevalencePrevalence

20012001

20002000

20002000

19991999

19981998

19981998

19971997

20022002

19961996

YearYear

YakutskYakutsk

CheboxaryCheboxary

MoscowMoscow

KazanKazan

NalchikNalchik

VladivostokVladivostok

IrkutskIrkutsk

NovosibirskNovosibirsk

NovosibirskNovosibirsk

CityCity

Bronchial asthma prevalence in children

National program “Bronchial asthma in children”, 2006

Bronchial asthma prevalence in adultsBronchial asthma prevalence in adults

MoscowMoscowMoscowMoscow6,3%6,3%6,3%6,3%

SanktSanktSanktSankt----PeterburgPeterburgPeterburgPeterburg

7,3 %7,3 %7,3 %7,3 %

IrkutskIrkutskIrkutskIrkutsk5,6%5,6%5,6%5,6%

EkaterinburgEkaterinburgEkaterinburgEkaterinburg6,1%6,1%6,1%6,1%

РРО. Руководство…., М.,2005RRS National guidelines, 2005

Hospital mortality,%

0

0.1

0.2

0.3

0.4

96 97 98 99 0 1 2 3

0

2

4

6

8

10

96 97 98 99 0 1 2 3

Mortality per 100000

Ural Region

Ekaterinburg8.9

5,5

3,1

1,9

0,4

0,3

0,2

0,1

Leshchenko, 2006

Asthma mortalityAsthma mortality

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

1996 2001 2003 2004 2005 2006

Hospital mortality in Moscow

COPD COPD (Moscow)(Moscow)

•• Registration Registration –– 2,2% 2,2%

•• Prevalence (epidemiologic studies) Prevalence (epidemiologic studies) –– 6,76,7%%

Shmeleva,Belevskiy, 2005

Prevalence summary Prevalence summary

•• Asthma Asthma –– 66--8% (children up to 12%)8% (children up to 12%)

•• COPD COPD –– 66--7%7%

•• Miscellanies Miscellanies –– 2%2%

Chronic respiratory diseases: 17-21%

Burden of major Burden of major

Respiratory DiseasesRespiratory Diseases

WHO SurveyWHO Survey

Ryazan region of Russia,Ryazan region of Russia,

OctoberOctober 2004 2004 -- MarchMarch 2005 2005

Prevalence of Prevalence of

smoking by Age & smoking by Age &

SexSex, % , %

0

10

20

30

40

50

60

70

м f м f

Adult Children

Smoking 21А

Lung Disease and Respiratory SymptomsRespiratory Symptoms 31%

Low Pulmonary Function 14%

Current or Prior Lung Disease 11%

Emergencies due to asthmaEmergencies due to asthma

5754

1876

0

1000

2000

3000

4000

5000

6000

7000

1997 2005

Emerginces per year

118

21

0

20

40

60

80

100

120

140

1997 2005

Status asthmaticus

Emergency station report 1997, 2005. Irkutsk

Emergencies due to asthma in Moscow

1,31,329259292592322752232275220052005

1,41,433609336092436033243603320042004

1,61,639777397772389775238977520032003

1,71,741143411432341012234101220022002

1,81,841918419182302578230257820012001

%%AsthmaAsthmaTotalTotalYearYear

0

20

40

60

80

100

120

140

2000 2002 2004 2006

Number of nebulizers in emergency cars

in Moscow

NATIONAL PROJECT “IKAR”(2002-2006)

HRQL in Asthma, COPD and PopulationHRQL in Asthma, COPD and Population

0

10

20

30

40

50

60

70

80

FA RF P GH V SA RE MH

COPD

Asthma

Population

GP priorities GP priorities

•• Arterial hypertensionArterial hypertension

•• Heart diseaseHeart disease

•• StrokeStroke

•• Gastrointestinal diseaseGastrointestinal disease

•• Problems of old ageProblems of old age

•• Respiratory diseaseRespiratory disease

Belevskiy, 2006

GP knowledgeGP knowledge

7373%%

67%67%

CardiologyCardiology

Correct answersCorrect answers

6262%%20062006

18%18%19981998

Respiratory Respiratory

medicinemedicine

Novikov, Belevskiy 2006

EducationEducation

•• Very broad spectrum of educational activity for Very broad spectrum of educational activity for

GPs and respiratory specialistsGPs and respiratory specialists

•• Russian Research Institute of Russian Research Institute of PulmonologyPulmonology

•• Russian State Medical UniversityRussian State Medical University

•• Standard educational program for GPs and Standard educational program for GPs and

specialists.specialists.

Number of chest specialists Number of chest specialists

differs very muchdiffers very much

•• Moscow Moscow -- 265265

•• SanktSankt--PeterburgPeterburg –– 5656

•• EkaterinburgEkaterinburg –– 1010

•• Kazan Kazan -- 22

ResourcesResources

•• Reimbursement list for respiratory medicine is available Reimbursement list for respiratory medicine is available

•• Financial situation for it is unstable and differs Financial situation for it is unstable and differs

depending of region depending of region

•• Very weak links with Ministry of Health and Parliament Very weak links with Ministry of Health and Parliament

•• Respiratory medicine is not included in National Respiratory medicine is not included in National

ProjectsProjects

Next stepsNext steps

•• National GARD Board National GARD Board

launch launch -- 20072007 (?)(?)

•• National GARD program National GARD program

development development –– 20072007--20082008

•• Cooperation with Government Cooperation with Government

and Parliament and Parliament -- immediatelyimmediately