Control of COPDControl of COPD

Paweł Śliwiński

Institute of Tuberculosis and Lung Diseases

Warsaw, Poland

Paweł Śliwiński

Institute of Tuberculosis and Lung Diseases

Warsaw, Poland

Elements of proper controlElements of proper control

• Recognition– Epidemiology

• Prevention– Smoking cessation

• Early detection

• Education– Physicians

• Diagnosis

• Management

– Patients

• Recognition– Epidemiology

• Prevention– Smoking cessation

• Early detection

• Education– Physicians

• Diagnosis

• Management

– Patients

• Population: 38,18 mln

• GDP: 12.647 USD

• Life expectancy: F – 79y

M – 71y

• COPD prevalence:

10% in > 40y old

• Expenditure on health

as % of OECD average:

31% (744 USD)

Some facts about PolandSome facts about Poland

Prevalence of smoking in Poland

1974-2004, adults(>15 years)

Prevalence of smoking in Poland

1974-2004, adults(>15 years)

0

10

20

30

40

50

60

70

1974 1978 1982 1986 1990 1994 1998 2002 2006

yearyear

MalesMales

FemalesFemales

percentage

percentage

National Program of Early Detection

and Prevention of COPD

National Program of Early Detection

and Prevention of COPD

Zieliński J et al., ERJ 2006

Target group Smokers, aged> 40 y

Setting Outpatient Chest Clinics

Intervention ���� Spirometry: FEV1, FVC

���� Antismoking advice

Financing National Health Fund

Costs 7 €/person screened

Target group Smokers, aged> 40 y

Setting Outpatient Chest Clinics

Intervention ���� Spirometry: FEV1, FVC

���� Antismoking advice

Financing National Health Fund

Costs 7 €/person screened

2000-20022000-2002

StructureStructure

Ministry of Health

Institute of TB and Lung Diseases

Chest Clinics

National Health Fund (NFZ)

Program FlowchartProgram Flowchart

Questionnaire

SpirometryFVC, FEV1, FEV1/FVC

Physician: evaluation of spirometry,antismoking advice

Spirometry normalFEV1/FVC<0.7

Referral to family physicianfor further

evaluation and treatmentFollow-up after 1 year

Subjects screened 105,190

Age 54±±±±13 years

M/F 57:43

Current smokers 62%

Ex-smokers 28%

Non-smokers 10%

Tobacco exposure 27 ±±±± 12 packyears

Airflow limitation 21%

Subjects screened 105,190

Age 54±±±±13 years

M/F 57:43

Current smokers 62%

Ex-smokers 28%

Non-smokers 10%

Tobacco exposure 27 ±±±± 12 packyears

Airflow limitation 21%

Results (1)Results (1)

Airflow limitation

• mild, FEV1>80% N

• moderate, FEV1=80-50% N

• severe, FEV1<50% N

Airflow limitation

• mild, FEV1>80% N

• moderate, FEV1=80-50% N

• severe, FEV1<50% N

Results (2)Results (2)

AFL 21%AFL 21%

69% normal

10% restriction

mild

7.8%

moderatesevere

6.3% 6.9%

”Prevention of COPD”

program launched by NHF

”Prevention of COPD”

program launched by NHF

� Primary care physicians are encouraged to perform spirometry in

their patients aged 40-65 years

� Smokers (>10 packyears)

� Chronic cough and/or SOB on exertion

� All subjects with abnormal spirometry, FEV1/FVC< LLN

are referred to outpatient chest clinic for spirometry tests

to confirm or exclude airways obstruction.

� Patients with FEV1>50% of pred. remain in primary care

� Patients with FEV1<50% of pred. are registered in chest clinic

� Primary care physicians are encouraged to perform spirometry in

their patients aged 40-65 years

� Smokers (>10 packyears)

� Chronic cough and/or SOB on exertion

� All subjects with abnormal spirometry, FEV1/FVC< LLN

are referred to outpatient chest clinic for spirometry tests

to confirm or exclude airways obstruction.

� Patients with FEV1>50% of pred. remain in primary care

� Patients with FEV1<50% of pred. are registered in chest clinic

2004-20062004-2006

~200 000 subjects investigated/year

COPD diagnosed in ~20%

� Costs 7 € for PCP

12 € for chest clinic

� Detection of 1 COPD ~ 50 €

~200 000 subjects investigated/year

COPD diagnosed in ~20%

� Costs 7 € for PCP

12 € for chest clinic

� Detection of 1 COPD ~ 50 €

Board of PSP

established Accreditation Committee in 2003

Main goals:

- to work out recommendations and standards

for spirometric test

- to prepare accreditation criteria for labs and

outpatient clinics performing spirometry

- to ensure uniform method of performing and

interpretation of spirometry all over the country,

thus to increase a quality of provided services

Board of PSP

established Accreditation Committee in 2003

Main goals:

- to work out recommendations and standards

for spirometric test

- to prepare accreditation criteria for labs and

outpatient clinics performing spirometry

- to ensure uniform method of performing and

interpretation of spirometry all over the country,

thus to increase a quality of provided services

Polish

Society of

Phtisiopneumonology

Polish

Society of

Phtisiopneumonology

� published standards for spirometry

� conducted 18 presentations of standards

for 1500 physicians in 2005 and 2006

� 200 physicians were fully trained in 2006

� first 5 laboratories obtained accreditation

certificate in 2006

� published standards for spirometry

� conducted 18 presentations of standards

for 1500 physicians in 2005 and 2006

� 200 physicians were fully trained in 2006

� first 5 laboratories obtained accreditation

certificate in 2006

Accreditation Committee:Accreditation Committee:

Association of COPD patients

Building an awareness of COPD in Polish population

� Dissemination of knowledge about COPD

� Popularization of management methods in COPD

� Medical advices for COPD patients

AssociationAssociation ofof COPD COPD patientspatients

BuildingBuilding anan awarenessawareness ofof COPD COPD inin PolishPolish populationpopulation

�� DisseminationDissemination ofof knowledgeknowledge aboutabout COPDCOPD

�� PopularizationPopularization ofof managementmanagement methodsmethods inin COPDCOPD

�� MedicalMedical advicesadvices for COPD for COPD patientspatients

School for COPD patientsSchoolSchool for COPD for COPD patientspatients

Thank youThank you

GOLD 2006GOLD 2006

„Patients should be identified as early in the

course of the disease as possible.

However, the benefits of community – based

spirometric screening, of either the general

population or smokers, are still unclear”

„Patients should be identified as early in the

course of the disease as possible.

However, the benefits of community – based

spirometric screening, of either the general

population or smokers, are still unclear”