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Manila, PhilippinesManila, Philippines
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BOLDManila, Philippines
COPD a growing cause of morbidity & mortality worldwide
5th leading cause of death (2001) 3rd in 2020 (WHO)
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BOLDManila, Philippines
Local COPD Burden
Paucity of data and only estimates
Rural Banca- Banca (1987) 3.7%
Urban San Andres Bukid (1990) 2.3%
Estimate using a mathematical model (1999) 6.3%
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Accurate estimates of the COPD prevalence using standardized methods in population-based studies:
to anticipate future burden of disease
target key risk factors plan for providing COPD-related health
services
BOLDManila, Philippines
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Primary Objectives:
• Measure the prevalence of COPD and its various risk factors in the city of Manila
Secondary Objectives:
• Determine extent to which variations in risk factors contribute to variations in the prevalence of COPD
Describe the distribution of COPD according to age, sex and smoking history
BOLDManila, Philippines
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Eligibility Criteria
Residents of the City of Manila
Aged 40 years and above
Signed informed consent
BOLDManila, Philippines
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• Stratified, three stage cluster sampling
City of Manila (population = 1,568,092) 6 Districts of Manila
sampled zones (by random sampling) (n=27)
sampled barangays (random sampling) ( n=54)
sampled households (systematic sampling) (n= 965)
all eligible members of sampled household (n=1639)
BOLD Manila, PhilippinesStudy Design
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Questionnaires
• Validated questionnaires used in multinational studies (1978 ATS/DLD Respiratory Symptom Questionnaire and questionnaires used in the European Community Respiratory Health Study and US Lung Health Study)
Linguistic validation through translation and back translation
BOLDManila, Philippines
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Spirometry
• Data sent to the Pulmonary Function Quality Center in Salt Lake City
• To be deemed usable for analysis, spirometry had to meet ATS acceptability and reproducibility criteria
Data Management and Analysis
• Done at the Operating Center, Portland, Oregon
BOLDManila, Philippines
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• Initial training—05/2005
• Fieldwork—10/2005-05/2006
• Participants were selected using a stratified, three-stage cluster sampling design
• 918 (58%) completed the full protocol– i.e., questionnaire & post bronchodilator spirometry
• Response rates: – Men 55%
– Women 60%
BOLDManila, Philippines
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Manila, Philippines Prevalence of ever smoking in population1 ages >40 by sex
83%
31%
Ever smoked
1 Unweighted data for the sample of responders
Overall = 55%Overall = 55%
Males Females
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National Nutrition Health Study Prevalence of ever smoking in population1 ages >20 years
(1999)
71%
17%Ever smoked
Overall = 45%Overall = 45%
Males Females
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Manila, Philippines Population Prevalence of GOLD Stage I+, GOLD Stage II+ & Doctor
Diagnosed COPD
*Post BD FEV1/FVC<70%
** Post BD FEV1/FVC <70% and post BD FEV1 <80%
***Includes chronic bronchitis, emphysema or COPD
9%
14%
20%
12%
7%
19%
2%2%3%
0%
5%
10%
15%
20%
25%
Men Women All
*GOLD 1+
**GOLD 2+
***DoctorDiagnosed
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COPD Prevalence in City of Manila
• 12% or 1 out of 8 individuals 40 years and above
• Out of 361,864 individuals (2002 census) 40 years and above, there are 45,233 COPD patients
• 2-3% doctor-diagnosed COPD highlights importance of spirometry to diagnose COPD
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Manila, Philippines Estimated Population Prevalence
of GOLD Stage II+ COPD* by age and sex (NHANES)
3%
7%
47%
21%
30%
12%9%
4%
15%
24%
13%
39%
7%
19%
12%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Men Women All
40-49
50-59
60-69
70+
Total
* Post BD FEV1/FVC <70% and post BD FEV1 <80%
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The prevalence of COPD that is GOLD stage II or higher increases steadily with age for men and women
BOLD Manila, Philippines
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Manila, Philippines Estimated Population Prevalence of Gold Stage II+ COPD* by pack years and sex
* Post BD FEV1/FVC <70% and post BD FEV1 <80%
7% 7%
29%
4%
25%
9% 9%7%
11%
17%
8%
19%
7%
19%
12%
0%
5%
10%
15%
20%
25%
30%
35%
Men Women All
Never Smokers
0-10 pack years
10-20 pack years
20+ pack years
Total
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• The relation between prevalence of GOLD stage II + COPD and pack years was evident among males but less clear with women
• The fairly high prevalence of GOLD stage II + COPD in the never smokers raise important questions about role of other risk factors
BOLD Manila, Philippines
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Hannover
Guangzhou
Reykjavik
Bergen
Vancouver
Manila
Krakow
Adana
Salzburg
Sydney
Lexington
Cape Town
Site
25.00
20.00
15.00
10.00
5.00
0.00
Pre
vale
nce
Stage III+
Stage II
Cumulative Prevalence of Stages II and III+ (Males and Females)
The BOLD Study, Lancet September 2007
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CONCLUSIONS
• COPD prevalence of 12% is much higher than previous estimates
• Smoking prevalence of 55% in the city of Manila may be higher than the national figure
• Prevalence of COPD among never smokers is 7% indicating other risk factors
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CONCLUSIONS
• Relation between prevalence of COPD and pack years was evident in men but less clear in women
• Doctor-diagnosed COPD underestimates the true prevalence of the disease
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USEFULNESS OF STUDY
It is possible to get more accurate estimates of burden of COPD & its risk factors generated from population-based studies using standardized methods
Studies like this can help assess the effectiveness of health intervention programs – preventive (anti-smoking), diagnostic (spirometry), or therapeutic (anti-inflammatory drugs) across time and even across different areas in the country
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USEFULNESS OF STUDY
Assist public health officials in developing best possible primary and secondary prevention policies on COPD for their areas
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PHILIPPINE BOLD STUDY
WHAT IS NEXT?
Rural study in Nueva Ecija
Other areas in the Philippines ?
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BOLDManila, Philippines
Investigators:
Renato B. Dantes, MD Fernando Ayuyao, MDNorberto A. Francisco, MD Lakan U. Berratio Teresita S de Guia, MD Gerard Garcia, MDCamilo C. Roa, Jr., MD Leander P. Simpao, MDLenora C. Fernandez, MD Lourdes Amarillo, MScLuisito F. Idolor, MD Ma. Flordeliza SanchezSullian S. Naval, MD Thessa ReyesDaniel Tan, MDCecil Tady, MD
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BOLDManila, Philippines
Acknowledgements:
BOLD COLLABORATIVE RESEARCH GROUP
A. Sonia Buist, MD
William M. Vollmer, PhD
Robert L. Jensen, PhD
Suzanne Gillespie, MS
Mary Ann McBurnie, PhD
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SPONSORS OF THE STUDY
Philippine College of Chest Physicians
Philippine College of Physicians
Boehringer Ingelheim (Phil)
GlaxoSmithKline
United Laboratories (Phil)
Altana
Pfizer
BOLDManila, Philippines
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BOLDManila, Philippines
Thank you!