GARD

Global Alliance against Chronic

Respiratory Diseases

WHO

J Bousquet, R Dahl, N Khaltaev, HJ Bekedam

www.who.int/chp

GARD Launch Press Conference

N Zhong (China): Chronic respiratory diseases (CRD) are a major burden in

China

S Hurd (USA): The burden of CRD

N Khaltaev (WHO): From the fragmented CRD programs to GARD

J Bousquet (France): The GARD action plan

M Boland (Ireland): Health promotion and CRD prevention

J Walsh (USA): The patient’s expectations

Suzanne S. Hurd - USA

The burden of CRD

• The World Health Organization estimates that over 1 billion people suffer from chronic respiratory diseases worldwide

• Prevalence and severity are increasing globally

• Cause substantial socioeconomic burden to individuals and societies

• In all countries, chronic respiratory diseases are:

– Under recognized

– Under diagnosed

– Under treated

Chronic Respiratory Diseases: An Increasing Global Public Health

Problem

Chronic Respiratory Diseases (CRD)

• Asthma• Allergic rhinitis• Chronic obstructive

pulmonary disease (COPD)

• Secondary pulmonary hypertension

• Occupational chronic respiratory diseases

• Chronic rhinosinusitis

• Post-infectious chronic respiratory diseases

• Lung cancer; neoplasms of the respiratory organs

• Pulmonary embolism• Cor pulmonale• Sleep apnea syndrome• Lung fibrosis

Injuries

Other Chronic Diseases

Diabetes

Chronic RespiratoryDiseases (CRD)

Cancer

Cardiovascular

Communicable diseases; Maternal/perinatal,Nutritional deficiencies

Source: Preventing Chronic Diseases, a vital investment, WHO, 2005

7%

> 4,000,000

Global Distribution – Chronic Disease Mortality: All ages,

2005

19991999 20202020

Increasing Burden of Diseases and Injuries:Change in Rank Order of DALYs*

*DALY = Disability-adjusted life year

1. Acute lower respiratory infections2. HIV/AIDS3. Perinatal conditions4. Diarrhoeal diseases5. Unipolar major depression6. Ischemic heart disease7. Cerebrovascular disease8. Malaria9. Road traffic injuries10. COPD10. COPD11. Congenital abnormalities12. Tuberculosis

1. Ischemic heart disease2. Unipolar major depression3. Road traffic injuries4. Cerebrovascular disease5. COPD5. COPD6. Acute lower respiratory

infections7. Tuberculosis8. War9. Diarrhoeal diseases10. HIV ……. 15. Trachea, bronchus, lung

cancers

Source: WHO Evidence, Information and Policy, 2000

Chronic Respiratory Diseases

(CRD)

Global Prevalence

Asthma > 300 million

Allergic rhinitis > 400 million

Chronic obstructive > 80 million moderate pulmonary disease to severe COPD; many millions with mild COPD

Burden of Asthma

• Asthma is one of the most common chronic diseases in the world

• Prevalence ranges from 1% to 18%

• An estimated 250,000 deaths annually, many of them preventable

• Direct costs (hospital, medications) account for 1-3% of total medical expenses in most countries

Affordability of Asthma DrugsModerate persistent asthma, 1998

0 100 200 300 400

Turkey

Burkina Faso

Ivory Coast

Mali

Guinea

Syria

Vietnam

Algeria

Drug cost (per year) Nurse's salary (per year)

N. Ait-Khaled and al Int J Tuberc Lung Dis 2000; 4, 3: 268-271

Cost in US$

Burden of COPD

• COPD is a major cause of morbidity, mortality and disability

• High prevalence, morbidity and mortality of COPD present challenges for healthcare systems

• Despite its ease of diagnosis, COPD remains an under-diagnosed disease, chiefly in its milder and more treatable form

COPD Mortality by Gender, USA, 1980-2000

0

10

20

30

40

50

60

70

1980 1985 1990 1995 2000

Men

Women

YearYear

Number Deaths x 1000Number Deaths x 1000Number Deaths x 1000Number Deaths x 1000

Source: Mannino D, US CDC, August 2002

Cigarette Smoke

Environmental tobacco smoke

Fumes/gases

Indoor/outdoor pollution

Occupational

dusts

Risk Factors for COPD

Nutrition

Socio-economic status

Infections

Chronic Respiratory Diseases

are a

Global Public Health Problem

N Khaltaev - WHO

From the fragmented CRD programs to GARD

WHA resolution 53.17The 53rd World Health Assembly

• recognized the enormous human suffering caused by chronic respiratory diseases (CRDs)

• and requestedrequested the WHO Director General to continue

giving priority to the prevention and control of CRDs

• with special emphasis on developing countries and other deprived populations

WHA resolution 53.17, May 2000

endorsed by all 191 WHO Member States

WHO calls for a global and coordinated effortto fight chronic respiratory diseases

GARDGARD

GARD

• The Global Alliance against Chronic Respiratory Diseases (GARD) is a voluntary alliance of organizations, institutions, and agencies working towards a common vision to improve global lung health according to the local needs.

Vision:

A world where all people can breathe freely:A world where all people can breathe freely:

Breath for all.Breath for all.

Fragmented success stories

• Asthma and COPD plans:

- Brasil

- China

- Finland

- France

- Portugal

- USA

Experience from Brazil

• In Brazil since 2002 the ministry of health provides free pharmaceutical assistance for severe asthmatics.

• In the province of Salvador this lead to the reduction of 55% of hospital submissions. The mean annual income of families of severe asthmatics increased by 10 %.

• The public health system has saved 566 US$ per patient per year.

A Success Story: France

• Increase awareness on asthma (patients and public)

• Improve

– management of acute severe asthma

– follow-up of asthmatics

– diagnosis and management of childhood asthma in schools

• Increase patient education

• Better manage and prevent occupational asthma

• Surveillance of asthma and risk factors

Healthcare benefits from asthma intervention

As

thm

a In

dic

es(b

ase

10

0 in

198

1)

Reimbursement asthmaHospitalization daysDeath rate

Year

350

300

250

200

150

100

50

0

1981 1983 1985 1987 1989 1991 1993 1995

Haahtela et al, Thorax 1998

J Bousquet - France

The GARD Action Plan

Specific Objectives of GARD

Build a stepwise and integrated program of prevention and control of CRD.

Improve collaboration between the fragmented WHO and non-WHO programs.

Increase awareness of CRD.

Reduce the burden of CRD, and foster country-specific initiatives appropriate to local needs.

Focus on developing countries and deprived populations.

Specific Objectives of GARD

Availability and affordability of medications

Provide appropriate training for health care personnel.

Provide education to patients, care givers and families.

Comprehensive and integrated action is the means to prevent and control chronic diseases

Estimate population needs and advocate

• WG.1- Burden, risk factors and surveillance

(G Viegi, S Buist, Y Fukuchi)

• WG.2- Awareness and advocacy

(C Lenfant, A Turnbull, P van Cauwenberge)

Formulate and adopt policy

• WG.3- Prevention and health promotion

(M Boland, A Custovic)

• WG.4- Diagnosis of CRD and allergy

(K Rabe, S Wenzel)

• WG.5- Control of CRD and allergies, availability and affordability of drugs

(J Bousquet, E Bateman, L Fabbri, C van Weel)

• WG.6- Pediatric asthma

(C Baena-Cagnani, E Mantzouranis, FER Simons,

E Valovirta)

Identify Policy Implementation Steps

• The GARD action plan should be applied at the country level.

• A national coordination group will:– Provide existing national statistics on CRD – Assess the specific needs for the given

country – Review the GARD action plan – Determine the relevant issues for the country action plan – Develop a country-specific action plan

M Boland - Ireland

Health promotion and CRD prevention

Health promotion and disease prevention

Key messages:

• Everyone has the right to live in a clean air environment

• Environmental exposure to unhealthy environment causes incurable COPD, asthma, cardiovascular disease and cancer

• Complete elimination is the only way to remove the risk

• This applies to tobacco smoke and all other at risk environments

WG.3- Health promotion and disease prevention

Goals:

• Help all countries to build and implement policies to reduce the burden of – tobacco smoke, – indoor and outdoor pollution, – occupational hazards – and other risk factors of relevance for CRD

WG.3- Health promotion and disease prevention

Some WHO programs are already available:

– FCTC (Framework Convention on Tobacco Control)

– Healthy Environment for Children Alliance – WHO program on prevention of allergy and

asthma– Environment– Occupational diseases

Tobacco Cessation

0

5

10

15

20

25

30

35

1992 2000 2002 2004 2005

% Smoking

No. of Smokers fallen by 25%

‘Slan’ SurveysOTC/MRBI Tracker

Smoking Ban

WG.3- Health promotion and disease prevention

• Biomass fuels

– Over 2 billion people in the developing world burn traditional biomass fuels indoor for cooking and heating.

– Resulting in an estimated 1.6 million deaths each year, largely among women and children.

– Acute respiratory infections and COPD (700,000 deaths/yr)

J Walsh - USA

The patient’s expectations

Personal History of J. Walsh

• When did the disease start• Symptoms• Effects on daily life• Treatment• Expectations• Future

Patient’s Expectations from GARD

• Health care professionals should be able to recognize CRD at an early phase and introduce early management

• The patient must be taken more seriously about his/her symptoms

• Health care systems should be structured to manage patients with chronic disease, including regular and long term follow up

….continued

Patient’s Expectations from GARD (continued)

• Health care systems should develop a structured patient education, information and training programs

• General public should become more informed of CRDs problems and take a more positive attitude toward the needs of CRD patients

• Societies should be more receptive to the value of environmental changes

Doctors and Patients Doctors and Patients

must be must be

Partners in Care of Partners in Care of

CRDs.CRDs.

Doctors and Patients Doctors and Patients

must be must be

Partners in Care of Partners in Care of

CRDs.CRDs.

Conclusions• Hundreds of millions of people suffer from

chronic respiratory diseases

• Over 4 million people die prematurely each year

• Huge economic burden

• In all countries, and particularly in developing countries

• In all age groups

• Prevalence and mortality are increasing

www.who.int/chp