copd asthma workshop
TRANSCRIPT
Dr SUNDEEP SALVI MD, DNB, PhD(UK)CHEST RESEARCH FOUNDATION
Pune
WHY DO WE NEED A REFRESHER COURSE ON OBSTRUCTIVE AIRWAYS DISEASES?
www.crfindia.com
LUNGS: THE ORGAN OF RESPIRATION
420 Lts of oxygen delivered every day350 Lts of carbon dioxide removed every day
10,000 Lts air pass in and out every 24
hours
10,000 Lts blood pass every 24
hours
WHY DO WE NEED A REFRESHER COURSE ON
OBSTRUCTIVE AIRWAYS DISEASES?
• Is OAD a major health problem in India?
• A good history and a good clinical examination are enough to diagnose OAD. Or is it not?
• Are we not managing patients with OAD better in our practice?
0
10000000
20000000
30000000
40000000
50000000
60000000
70000000
Cancer IHD Stroke Diabetes Chronic respiratory disease
0.6 million
25 million
1 million
28 million
65 million
ESTIMATED MORBIDITY FOR NON COMMUNICABLE DISEASES IN INDIA
(Nongkynrih B et al, JAPI 2004 Feb; 52: 118-123)WHO, 2002 data
AsthmaCOPD
0
5
10
15
20
25
30
35
ESTIMATED NUMBER OF OBSTRUCTIVE AIRWAY DISEASE PATIENTS IN INDIA
Million
AsthmaCOPD28 million
17 million
35 million
22.2 million
25% 30%
2006 2016
( Murthy KJR, NCMH Background Papers – Burden of Diseases in India, 2005 )
PREVALENCE OF ASTHMA IN SCHOOL CHILDREN IN INDIA
(ISAAC STUDY)
(n = 15,621)
0
5
10
15
20
25
30
35
1979 1984 1989 1994 1999
Pune, Nagpur Bangalore
5 – 6%
Prevalence of asthma in Indian school children varies from 2% - 30%
TOBACCO SMOKING
5- times more harmful1 cigarette = 1 bidi
Not 15-20%, but close to 50% of smokers develop COPD
1 BILLION SMOKERS WORLD-WIDE
NON-SMOKING COPD
70% of Indian homes
50% of COPDs are non-smokers
3 BILLION PEOPLE WORLD-WIDE EXPOSED
0
1
2
3
4
5
6
7
8
Cancer IHD Stroke Diabetes Chronic Resp diseases
Injuries
2.92
1.201.02
0.21
5.77
7.49
ESTIMATED MORTALITY FOR NON COMMUNICABLE DISEASES IN INDIA
(Nongkynrih B et al, JAPI 2004 Feb; 52: 118-123)
WHO, 2002 data
Number in lacs
0.0
0.5
1.0
1.5
2.0
2.5
3.0Coronary
HeartDisease
Stroke Other CVD COPD All OtherCauses
0.5
1.0
1.5
2.0
2.5
3.0
1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998
–59% –64% –35% +163% –7%
% change in Age-Adjusted Death Rates, U.S.A., 1965-1998
OADs ARE A MAJOR AND GROWING HEALTH BURDEN
IN INDIA?
UNIQUE SET OF RISK FACTORS FOR OAD IN INDIA
HOW DO WE DIAGNOSE OBSTRUCTIVE AIRWAYS DISEASES IN
CLINICAL PRACTICE?
HOW RELIABLE IS THIS?
UNDERDIAGNOSIS OF OLD IN OUT-PATIENT CLINICS AND COMMUNITY SURVEYS
• American Study – NHANES III, >20,000 US adults underwent spirometry (1988-1994)Prevalence of OAD – 8.5%63.3% under-diagnosis(NHANES Study, Mannino et al, Arch Int Med 2000; 160: 1683-1689)
• Similar observations in UK, France, Spain and other European countries(Huchon, ERJ 2002; Pena, Am J Respir Crit Care Med 2001)
• More than 75% of patients with OAD have never had a spirometry done in their life
• Spirometry is poorly utilized in India
• Myths about of Spirometry in India –- Not really necessary for diagnosis of OAD- Expensive test for the patients- Difficult test to perform- Difficult test to interpret- Doesn’t make any difference in the management of OAD
USE OF SPIROMETRY IN INDIA
HOW GOOD ARE WE AT MANAGING ASTHMA AND COPD IN
CLINICAL PRACTICE?
• 420 cases of Obstructive Airways Disease• 43.8% Asthma; 56.2% COPD• Exacerbations - Daily: 52.6%
- Monthly: 31.2%- < 1 mthly: 16.2%
• History of hospital admissions: 52%• Usual treatment: - Antibiotics:
94.1%- Oral theophylline:
93.1%- Parenteral theophylline:
41.9%- Salbutamol Inhaler:
81.2%- Steroid Inhaler:
29.3%- Oral steroids:
23.6%
EXPERIENCE OF OADs BY A CHEST PHYSICIAN IN MUMBAI
(Kamat SR et al, Lung India, August 2006)
Tablet Salbutamol 2-4mg thrice dailyVersus
Inhaled Salbutamol 100-200mcg thrice daily
1000 excess tablets over a period of 6 months
0
10
20
30
40
50
60
UQMP QMP Specialist Institute
Use of pMDI by asthmatic subjects (Rohtak, India)
Prescribed inhaler Correct use
(n = 1400)
(Gupta PP et al, Ind J Chest Dis Allied Sci 2001; 43: 91-95 )
%
(Chest Research Foundation and B.J. Medical College Pune, 2006)
DO MEDICAL PERSONNEL KNOW HOW TO USE pMDI CORRECTLY?
1. Educate Patients2. Assess and Monitor Severity3. Avoid Exposure to Risk Factors4. Establish Medication Plans for Chronic Management: Adults and Children5. Establish Plans for Managing Exacerbations6. Provide Regular Follow-up Care
Six-Part Asthma ManagementProgram
0
2000
4000
6000
8000
10000
12000
14000
1995 2000 2005 2010 2015
Current If we follow guidelines
7641 crores
(Murthy KJR et al, NCMH Background Papers, 2005)
ECONOMIC BURDEN OF ASTHMA AND COPD IN INDIA
Am
o unt
in C
r or e
s
05000
100001500020000250003000035000400004500050000
25,209 crores
1996 2001 2006 2011 2016
SUMMARY• Obstructive Airways Diseases are a major health
burden in India.• The prevalence of OAD is only going to increase in
the future• A large number of OADs remain undiagnosed in
clinical practice because of want of use of Spirometry• Inhalation therapy is poorly used in India• Patients suffering with OAD in India remain poorly
managed• Doctors do not communicate effectively with patients
suffering with OADs• OADs contribute to a huge economic loss in India
REFRESHER COURSE ON OBSTRUCTIVE AIRWAYS DISEASE