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Burden of major Respiratory Diseases
WHO Survey
Ryazan region of Russia,
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RUSSIA
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Ryazan region of Russia, health care system:
• 104 hospitals district hospitals – 32
rural hospitals – 44
• 65 out-patient departments
• 792 “feldsher's” stations
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•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.
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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
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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
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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
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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.
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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.
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General characteristics of the study
Region Stage Study period Number of health facilities
Number 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
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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
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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
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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
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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
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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
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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
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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
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Prevalence of smoking by Age &
Sex, %
0
10
20
30
40
50
60
70
м f м f
Adult Children
Smoking 21А
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Bronchial obstruction degree
Pack-years, mean
Bronchial obstruction and smoking
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Bronchial obstruction degree
Part of patients with dyspnea
Bronchial obstruction and dyspnea
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Lung Disease and Respiratory Symptoms
Respiratory Symptoms 31%
Low Pulmonary Function 19%
Current or Prior Lung Disease 11%
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Treatment
Only 2 from 100 patients with respiratory symptoms and low pulmonary function regularly use inhalation of bronchodilators
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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
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“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
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• 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
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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
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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
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Migrants, %, by stages
Stage
PHC based 3.36
Household based 3,21
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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
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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
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Main symptoms and medical diagnosis of
chronic bronchitis
Patients without established diagnosis
Patients with established diagnosis
Part of patients with symptoms
Cough Wheezing
Phlegm Dyspnea
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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
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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
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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
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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
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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
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Bronchial obstruction degree
Part of patients with risk factors
Bronchial obstruction and risk factors
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Bronchial obstruction degree
Part of patients with established diagnosis
Bronchial obstruction and medical diagnosis of chronic bronchitis
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Bronchial obstruction degree
Part of patients with chronic cough
Bronchial obstruction and chronic cough
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Bronchial obstruction degree
Part of patients with phlegm production
Bronchial obstruction and chronic phlegm productin
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Bronchial obstruction degree
Part of patients with wheezing
Bronchial obstruction and weezing
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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
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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
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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
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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