9 COPD and Smoking Corlateanu

8/12/2019 9 COPD and Smoking Corlateanu

1/29

Smoking and COPD in Moldova

Alexandru Corlateanu, MD, PhD

Department of Respiratory Medicine, State University of

Medicine and Pharmacy "Nicolae Testemitanu",

Chisinau, Moldova

Conferina SntateaRespiratorie n Moldova,1 iulie, 2014, Chiinu,

Republica Moldova

REACH-4-Moldova

Research, Education And Capacity-building in

Healthcare for Moldova

(Cercetare, Educare i Fortificare de capaciti n

Sntate pentru Moldova)


2/29

2

Smoking in Moldova

COPD in Moldova SWOT


3/29


4/29

= 880 mln MDL =

47 mln Euro

n RepublicaMoldova

cheltuielile

directe i

indirecte pentrusntate, legatede maladiile

cauzate de

consumul deigri n 2012

veniturile

colectate nbugetul de stat

din vnzareaproduselor din

tutun


5/29

5


6/29

6

The European health report 2012


7/29

7


8/29

8

Moldova MICS 4, 2012

Moldova Multiple Indicator Cluster Survey 4 (MICS4)


9/29

9

STEPS 2014:

O ptrime din populaia adult din Republica Moldova fumeaz

igrile fabricate sunt principalul produs din tutun consumat,

fiecare fumtor consumnd n medie zilnic 16,7 igri pe zi (17,2

igri brbaii i 11,4 igri femeile).


10/29

10

STEPS 2014


11/29

11


12/29

12

Smoking in Moldova



13/29

13

BPOC o problem de sntate public

1.World Health Organization. World Health Report 2004. Statistical Annex - table 2 and 3: 120-131

2. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997 ; 349(9064): 1498-504.

3. The NHS Information Centre for Health and Social Care. Quality of outcomes framework 2008/09 Prevalence. http://www.ic.nhs.uk Date last accessed : July2010

4. European Respiratory Society. European Lung White Book. Huddersfield, European Respiratory Society Journals Ltd, 2003.

Pe plan mondial 210 milioane de bolnavi i 3 milioane de decese

anual (5% din mortalitatea global)1

Prevalen n continu cretere: a 6-a cauz de mortalitate la nivel

mondial n 1990, estimativ - a 3-a cauz n 20202

Boal subdiagnosticat i subtratat: Marea Britanie - 2008:

835000 de bolnavi diagnosticai cu BPOC, numr real estimat

peste 3 milioane3

Povar economic important Uniunea European: afeciunile

respiratorii - 6% din bugetul alocat sntii, din care 56% pentruBPOC4


14/29


15/29

Mortality rate for COPD

Data from World Health Organization World and Europe

Mortality Databases, November 2011 update.


16/29

Worldwide Prevalence of COPD

Adapted from the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease , Global

Initiative for Chronic Obstructive Lung Disease (GOLD) 2005.

Male/1000

Female/1000

0 2 4 6 8 10 12

Former Socialist economies

Established market economies

India

Sub-Saharan Africa

Latin America and Caribbean

Middle Eastern Crescent

Other Asia and islands


17/29

International Variation in COPD Prevalence

Reprinted from The Lancet, 370, Buist AS, et al. International variation in the prevalence of COPD (the BOLD Study):

a population-based prevalence study, 741-750, Copyright 2007, with permission from Elsevier.

0 5 10 15 20 25

Guangzhou

Adana

Manila

Salzburg

Krakow

Sydney

Vancouver

Lexington

Hannover

Bergen

Cape Town

Reykjavik

Women

Severe and very severe

(Stage III+)

Moderate (Stage II)

Prevalence (%)

0 5 10 15 20 25

Sydney

Vancouver

Salzburg

Reykjavik

Bergen

Lexington

Hannover

Krakow

Guangzhou

Adana

Manila

Cape Town

Men

Severe and very severe

(Stage III+)

Moderate (Stage II)

Prevalence (%)

Ordered by (descending) prevalence of ever-smoking

Chisinau

???????

Chisinau

???????


18/29

Proiectul reprezint partea component a unui studiu internaional BOLD

(Burden of Obstructive Lung Diseases), care deja a fost efectuat n mai

multe ri (SUA, Turcia, China, Marea Britanie, Austria, etc).

Evidenierea factorilor de risc, studierea prevalenei i particularitilor

clinico-funcionale la pacienii cu patologii pulmonare obstructive, n scopul

ameliorrii diagnosticului precoce, perfectrii opiunilor terapeutice i

elaborrii unor criterii prognostice pentru implementarea activitilor

profilactice la pacieni cu afeciunile obstructive pulmonare.

18

Problemele prioritare

la nivelul national


19/29

OBIECTIVELE PRIMARE:

Evaluarea prevalenei i factorilor de risc a BPCO n funcie de vrst i sex,

n comparaie cu alte ri

Evaluarea prevalenei comorbiditilor la pacienii cu BPCO

Estimarea impactului BPCO asupra calitii vieii, limitrii activitii fizice,simptomelor respiratorii

Elaborarea unui model validat pentru a prognoza impactul BPCO

Elaborarea n baza datelor obinute n studiu a recomandrilor practice de

perfectare a diagnosticului BPCO la diferite etape de acordare a asistenei

medicale

19


20/29

Obiectivele primare ale strategiei naionale

Prevenirea apariiei i progresiei bolilor respiratorii cronice

Identificarea i diagnosticarea corect a cazurilor

Asigurarea accesului pacientului la ngrijiri medicale de calitate

Informarea bolnavilor i educarea pentru auto-ngrijire

Implementarea unei strategii naionale


21/29

21

Prevenirea apariiei i progresiei bolilor respiratorii

Informarea populaiei Campanii de informare i promovare a sntii respiraiei

Politici i campanii de marketing social anti-fumat

Limitarea aciunii factorilor de risc Suport de specialitate pentru renunarea la fumat

Norme de calitatea aerului n mediul de via i profesional

Screening populaional pentru bolile respiratorii Identificarea grupurilor populaionale la risc

Chestionare pentru evaluarea simptomelor clinice

Teste funcionale respiratorii


22/29

22

Identificarea cazurilor i diagnosticarea NCD

Diagnosticarea corect a cazurilor de NCD

Spirometria de calitate stabilire diagnostic i stadializare

Evaluare clinic: tolerana efort, dispnee (MRC), gaze

arteriale, deficit de -1-Antitripsina, stare de nutriie, etc.

Managementul anticipat al bolii cronice re-evaluareperiodic clinic i funcional respiratorie cu revizuirea

terapiei n funcie de stadiul de severitate

Evaluare i re-evaluare periodic din punct de vedere al

prezenei comorbiditilor (boli coronariene, diabet,

depresie, osteoperoz, etc.)


23/29

23

Smoking in Moldova



24/29

24

1. Range of staff expertise

2. A highly integrated team that is able to adapt quickly and efficiently

3. In-depth knowledge of our patient population

4. Emphasis on a patient centric approach to problem solving approach5. Dedication and commitment

6. Links with and active involvement in the Community and with International Scientific

Societies

7. The ongoing development of effective local solutions for our local population

Strengths


25/29

25

1. Obstructive Respiratory diseases are underdiagnosed, underestimated and undertreated2. A general lack of awareness of medical community and general population for COPD,

asthma and sleep apnea

3. Lack of interaction with specialists in related fields

4. Evidence based COPD, asthma guidelines are available, but not implemented

5. No access to COPD, asthma and sleep apnea education for patients

6. Smoking cessation programs are unavailable7. Bad access to spirometry and sleep testing and CPAP/BiPAP therapy

8. Care Pathways are fragmented and not integrated, both across organizations and between

health care professionals, resulting in fragmented access to services

9. Patients are not being referred to specialist care in a timely manner

10. Due to a lack of service coordination there are inconsistency issues in terms of provider

COPD, asthma, sleep apnea knowledge, education and management of the diseases11. Need for more electronic outcome based care

Weaknesses


26/29

26

1. A need of Impact of Obstructive Respiratory Diseases study to identify the unapproached

needs in the chronic respiratory disease management

2. A need for more evidence-based care of COPD, asthma, sleep apnea

3. A need for better standardization of COPD, asthma, sleep apnea assessment processes and

formats

4. A need for improved collaboration with primary health care providers

5. A need for better follow-up COPD, asthma, sleep apnea population on the management of

their disease

6. The population that does not have a primary care provider continue to receive episodic

care through the emergency department

7. Need more emphasis on prevention in primary care setting

8. Provision of more evidence-based COPD care across the health care system

Opportunities


27/29

27

1. Access to medications financial impacts2. Potential changes in government and funding models

3. Any changes in government policies

4. An ageing population with changing patient demographics which will require increased

funding to support their care

5. Recruitment, growth and staff retention issues

Threats


28/29

Realitatea subdiagnosticate

subestimate

subtratate

Sperana

Realizare studiului BOLD (Impactul Bolilor Obstructive Respiratorii) pentru

identificarea necesitatilor neatinse in managementul bolilor respiratorii

cronice

Dezvoltare strategiei intersectoriale nationale de abordare a bolilorrespiratorii cronice mai ales la nivelul asistenei medicale primare i printr-

un abord integrator cu celelalte boli cronice

Participarea activ n elaborare i realizare European Respiratory

RoadMap i strategiei globale OMSmpotriva NCD


29/29

29

Documents

9 COPD and Smoking Corlateanu