burden of major respiratory diseases who survey ryazan region of russia,

Burden of major Respiratory Diseases

WHO Survey

Ryazan region of Russia,

RUSSIA

Ryazan region of Russia, health care system:

• 104 hospitals district hospitals – 32

rural hospitals – 44• 65 out-patient departments• 792 “feldsher's” stations

•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 districtPopulation – 60 000.

Scopin districtPopulation – 40 000.

Protocol for assessment of prevalence of major respiratory

diseases

Prevalence survey of respiratory disease at the PHC level

Prevalence survey of respiratory disease in a household manner

Clinical survey and lung function test

Pilot stage

Number ofpatients

October 2004 March 2006

Pilot stage 05.10.04-15.10.04

•Obtaining the list of PHC•Finalize the questionnaires and the GP’s, RT’s 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

Prevalence survey of respiratory disease in a household manner

22.11.04-28.12.04

•Population: Individuals >= 5 years randomly selected

•Administered standardised questionnaire on symptoms, diseases, diagnoses, comorbidity, sociodemographics, risk factors

Clinical survey and lung function test08.02.05-30.03.05

16 PHS were randomized for the lung function test.

All patients from the household stage were included.

Clinical survey and lung function test08.02.05-30.03.05

16 PHS were randomized for the lung function test.

All patients from the household stage were included.

General characteristics of the studyRegion Stage Study period Number of

health facilitiesNumber of patients

Scopin district PHC based 18.10.04-02.11.04

24 1505

Household based

22.11.04-28.12.04

18 2116

Clinical survey & lung function test

08.02.05-30.03.05

8 812

Shilovo district PHC based 01.11.04-20.11.04

29 962

Household based

22.11.04-28.12.04

18 2030

Clinical survey & lung function test

08.02.05-30.03.05

8 725

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

Age distribution of risk factors, by stages (self-reported by patients)

Stage Risk factor 5-14 years females/males

15-49 years females/males

>= 50 years females/males

PHC based Worked for a year or more in any dusty job

- - 6.33 14.08 13.82 24.66

Ever smoked cigarettes

0 0.79 5.17 64.32 0.84 58.71

Now smoke cigarettes 0 1.57 4.67 60.68 0.60 45.40

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

Ever smoked cigarettes

0 2.5 8.76 58.55 1.61 55.83

Now smoke cigarettes 0 2.71 7.06 54.72 1.71 43.79

Heat or cook using an open fire

48.46 39.58 83.98 72.45 88.22 78.78

Age distribution of symptomatic respiratory patients, by stages (self-reported by patients)

Stage Cough 5-14 years females/males

15-49 years females/males

>= 50 years females/males

PHC based

usually have a cough

9,76 12,60 13,00 26,70 16,71 43,97

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

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

Age distribution of symptomatic respiratory patients, by stages (self-reported by patients)

Stage Phlegm 5-14 years females/males

15-49 years females/males

>= 50 years females/males

PHC based

usually bring up phlegm

8,13 6,30 7,17 18,93 9,38 33,24

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

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

Age distribution of symptomatic respiratory patients, by stages (self-reported by patients)

Stage Wheezing 5-14 years females/males

15-49 years females/males

>= 50 years females/males

PHC based

ever had an attack of wheezing

13,82 14,96 15,17 13,59 16,59 23,59

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

had 2 or more such episodes

2,42 3,33 2,89 2,68 5,57 6,69

Age distribution of symptomatic respiratory patients, by stages (self-reported by patients)

Stage Breathless-ness

5-14 years females/males

15-49 years females/males

>= 50 years females/males

PHC based

MRC 1 6,50 0,79 17,17 9,71 52,04 39,95

MRC 2 2,44 0,00 9,50 5,83 43,51 34,32

MRC 3 2,44 0,00 5,17 4,13 31,13 26,01

MRC 4 2,44 0,00 3,50 1,21 19,71 15,28

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

MRC 2 0,22 0,21 5,47 1,40 33,62 20,27

MRC 3 0,00 0,42 2,89 0,38 26,66 16,06

MRC 4 0,00 0,21 1,29 0,51 13,81 7,07

MRC 5 0,00 0,00 0,10 0,13 4,60 3,63

Prevalence of bronchial obstruction, %

Stage 5-14 years females/males

15-49 years females/males

>= 50 years females/males

Household based clinical survey & lung function test

FEV1/FVC<70 2,72 1,28 5,07 6.69 15,65 23,72

Prevalence of smoking by Age &

Sex, %

0

10

20

30

40

50

60

70

м f м f

Adult Children

Smoking 21А

Bronchial obstruction degree

Pack-years, mean

Bronchial obstruction and smoking

Bronchial obstruction degree

Part of patients with dyspnea

Bronchial obstruction and dyspnea

Lung Disease and Respiratory Symptoms

Respiratory Symptoms 31%

Low Pulmonary Function 19%

Current or Prior Lung Disease 11%

Treatment

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

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 %

Treatment

“Adequate education, should be available,

in order to ensure correct diagnosis and treatment, in particular in primary care.”

ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ МИНИСТЕРСТВО ЗДРАВООХРАНЕНИЯ РОССИЙСКОЙ ФЕДЕРАЦИИ

НИИ ПУЛЬМОНОЛОГИИ МЗ РФ РЯЗАНСКИЙ ГОСУДАРСТВЕННЫЙ

МЕДИЦИНСКИЙ УНИВЕРСИТЕТ

ПРАКТИЧЕСКИЙ ПОДХОД К ДИАГНОСТИКЕ

И ЛЕЧЕНИЮ БОЛЕЗНЕЙ ОРГАНОВ ДЫХАНИЯ

РУКОВОДСТВО ДЛЯ РАБОТНИКОВ УЧРЕЖДЕНИЙ

ЗДРАВООХРАНЕНИЯ ПЕРВИЧНОГО ЗВЕНА

World Health Organization Noncommunicable Diseases and Mental Health Department of Chronic Diseases and Health Promotion Chronic Respiratory Diseases and Arthritis

2005

• 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

Educational programKey stones

Comparison of age distribution, in years, by stages between sexes

Stage Mean age (+/- SD) in females

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 6,92384Е-17

Working population, %, by stages

Stage 5-14 years females/males

15-49 years females/males

>= 50 years females/males

PHC based - - 72,00 59,22 16,71 24,66

Household based - - 45,87 45,15 12,63 17,97

Migrants, %, by stages

Stage

PHC based 3.36

Household based 3,21

Prevalence of respiratory diseases, by stages (self-reported by patients)

Stage Disease 5-14 years females/males

15-49 years females/males

>= 50 years females/males

PHC based Emphysema 0,00 0,00 0,50 1,46 2,76 8,58

Asthma 4,07 6,30 3,83 4,13 4,33 4,29

Chronic bronchitis 2,44 5,51 8,17 9,95 15,14 26,01

Tuberculosis 0,00 0,00 0,17 1,94 0,36 2,95

Current pneumonia 4,07 2,36 0,67 1,46 1,32 2,14

Allergic rhinitis 5,69 1,57 3,50 3,88 2,40 1,07

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

Asthma 0,22 0,21 0,40 1,02 1,82 1,15

Chronic bronchitis 0,22 1,46 4,78 5,99 10,06 16,06

Tuberculosis 0,00 0,42 0,40 0,64 1,07 1,72

Current pneumonia 0,00 0,00 0,40 0,64 0,32 1,15

Allergic rhinitis 0,88 0,63 1,00 0,77 0,54 0,00

Another respiratory disease*

20,04 22,50 22,99 20,41 15,10 13,19

Prevalence of respiratory diseases (reported by medics)

Stage Disease 5-14 years 15-49 years >= 50 years

Household based clinical survey & lung function test

Emphysema 0,00 0,17 0,89

Asthma 0,33 0,84 1,33

Chronic bronchitis

0,33 2,19 7,33

Tuberculosis 0,00 0,34 0,22

Current pneumonia

2,00 2,02 4,00

Allergic rhinitis 0,33 1,18 0,00

Main symptoms and medical diagnosis of

chronic bronchitis

Patients without established diagnosis

Patients with established diagnosis

Part of patients with symptoms

Cough WheezingPhlegm Dyspnea

Risk factors and chronic cough

Patients without chronic cough

Patients with chronic cough

Part of patients with risk factors

Work in any dusty job

Heat or cook using an open fire

Smoke

Risk factors and phlegm production

Patients without phlegm Patients with phlegm

Part of patients with risk factors

Work in any dusty job

Heat or cook using an open fire

Smoke

Risk factors and wheezing

Patients without wheezing Patients with wheezing

Part of patients with risk factors

Work in any dusty job

Heat or cook using an open fire

Smoke

Risk factors and dyspnea

Patients without dyspnea Patients with dyspnea

Part of patients with risk factors

Work in any dusty job

Heat or cook using an open fire

Smoke

Risk factors and medical diagnosis of

chronic bronchitis

Patients without with established diagnosis

Patients with with established diagnosis

Part of patients with risk factors

Work in any dusty job

Heat or cook using an open fire

Smoke

Bronchial obstruction degree

Part of patients with risk factors

Bronchial obstruction and risk factors

Bronchial obstruction degree

Part of patients with established diagnosis

Bronchial obstruction and medical diagnosis of chronic bronchitis

Bronchial obstruction degree

Part of patients with chronic cough

Bronchial obstruction and chronic cough

Bronchial obstruction degree

Part of patients with phlegm production

Bronchial obstruction and chronic phlegm productin

Bronchial obstruction degree

Part of patients with wheezing

Bronchial obstruction and weezing

Have ever taken drug for respiratory diseases

Stage Drug category 5-14 years 15-49 years >= 50 years

Household based clinical survey & lung function test

Antibiotics 13.71 11.99 14.03

Inhalation bronchodilators

0.33 1.37 1.11

Theophylline 1.00 2.57 4.68

Mucolitics 2.34 5.31 6.90

Inhalation glucocorticoids

0.33 0.34 0.22

Oral steroids 0 0.68 0.22

Pilot stage 05.10.04-15.10.04 •Obtaining the list of PHC

•Finalize the questionnaires and the GP’s, RT’s 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

Prevalence survey of respiratory disease in a household manner

22.11.04-28.12.04 •Population: Individuals >= 5 years randomly selected

•Administered standardised questionnaire on symptoms, diseases, diagnoses, comorbidity, sociodemographics, risk factors

Prevalence survey of respiratory disease at

the PHC level18.10.04-20.11.04

•Population: Individuals >= 5 years attending PHC

•Administered standardised questionnaire on symptoms, diseases, diagnoses, comorbidity, sociodemographics, risk factors