Smoking and COPD in Moldova

Alexandru Corlateanu, MD, PhD

Department of Respiratory Medicine, State University of
Medicine and Pharmacy "Nicolae Testemitanu",
Chisinau, Moldova
Conferina Sntatea
Respiratorie n Moldova,
1 iulie, 2014, Chiinu,
Republica Moldova
REACH-4-Moldova
Research, Education And Capacity-building in
Healthcare for Moldova
(Cercetare, Educare i Fortificare de capaciti n
Sntate pentru Moldova)
2
Smoking in Moldova
COPD in Moldova
SWOT
= 880 mln MDL =
47 mln Euro
n Republica
Moldova
cheltuielile
directe i
indirecte pentru
sntate, legate
de maladiile
cauzate de
consumul de
igri n 2012
veniturile
colectate n
bugetul de stat
din vnzarea
produselor din
tutun
5
6
The European health report 2012

7
8
Moldova MICS 4, 2012
Moldova Multiple Indicator Cluster Survey 4 (MICS4)
9
STEPS 2014:
O ptrime din populaia adult din Republica Moldova fumeaz
igrile fabricate sunt principalul produs din tutun consumat,
fiecare fumtor consumnd n medie zilnic 16,7 igri pe zi (17,2
igri brbaii i 11,4 igri femeile).
10
STEPS 2014
11
12
Smoking in Moldova
COPD in Moldova
SWOT
13
BPOC o problem de sntate public
1.World Health Organization. World Health Report 2004. Statistical Annex - table 2 and 3: 120-131
2. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997 ; 349(9064): 1498-504.
3. The NHS Information Centre for Health and Social Care. Quality of outcomes framework 2008/09 Prevalence. http://www.ic.nhs.uk Date last accessed : July
2010
4. European Respiratory Society. European Lung White Book. Huddersfield, European Respiratory Society Journals Ltd, 2003.
Pe plan mondial 210 milioane de bolnavi i 3 milioane de decese
anual (5% din mortalitatea global)
1
Prevalen n continu cretere: a 6-a cauz de mortalitate la nivel
mondial n 1990, estimativ - a 3-a cauz n 2020
2
Boal subdiagnosticat i subtratat: Marea Britanie - 2008:
835000 de bolnavi diagnosticai cu BPOC, numr real estimat
peste 3 milioane
3
Povar economic important Uniunea European: afeciunile
respiratorii - 6% din bugetul alocat sntii, din care 56% pentru
BPOC
4
Mortality rate for COPD
Data from World Health Organization World and Europe
Mortality Databases, November 2011 update.
Worldwide Prevalence of COPD
Adapted from the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global
Initiative for Chronic Obstructive Lung Disease (GOLD) 2005.
Male/1000
Female/1000
0 2 4 6 8 10 12
Former Socialist economies
Established market economies
India
Sub-Saharan Africa
Latin America and Caribbean
Middle Eastern Crescent
Other Asia and islands
International Variation in COPD Prevalence
Reprinted from The Lancet, 370, Buist AS, et al. International variation in the prevalence of COPD (the BOLD Study):
a population-based prevalence study, 741-750, Copyright 2007, with permission from Elsevier.
0 5 10 15 20
25
Guangzhou
Adana
Manila
Salzburg
Krakow
Sydney
Vancouver
Lexington
Hannover
Bergen
Cape Town
Reykjavik
Women
Severe and very severe
(Stage III+)
Moderate (Stage II)
Prevalence (%)
0 5 10 15 20 25
Sydney
Vancouver
Salzburg
Reykjavik
Bergen
Lexington
Hannover
Krakow
Guangzhou
Adana
Manila
Cape Town
Men
Severe and very severe
(Stage III+)
Moderate (Stage II)
Prevalence (%)
Ordered by (descending) prevalence of ever-smoking
Chisinau
???????
Chisinau
???????
Proiectul reprezint partea component a unui studiu internaional BOLD
(Burden of Obstructive Lung Diseases), care deja a fost efectuat n mai
multe ri (SUA, Turcia, China, Marea Britanie, Austria, etc).
Evidenierea factorilor de risc, studierea prevalenei i particularitilor
clinico-funcionale la pacienii cu patologii pulmonare obstructive, n scopul
ameliorrii diagnosticului precoce, perfectrii opiunilor terapeutice i
elaborrii unor criterii prognostice pentru implementarea activitilor
profilactice la pacieni cu afeciunile obstructive pulmonare.
18
Problemele prioritare
la nivelul national
OBIECTIVELE PRIMARE:
Evaluarea prevalenei i factorilor de risc a BPCO n funcie de vrst i sex,
n comparaie cu alte ri
Evaluarea prevalenei comorbiditilor la pacienii cu BPCO
Estimarea impactului BPCO asupra calitii vieii, limitrii activitii fizice,
simptomelor respiratorii
Elaborarea unui model validat pentru a prognoza impactul BPCO
Elaborarea n baza datelor obinute n studiu a recomandrilor practice de
perfectare a diagnosticului BPCO la diferite etape de acordare a asistenei
medicale
19
Obiectivele primare ale strategiei naionale
Prevenirea apariiei i progresiei bolilor respiratorii cronice
Identificarea i diagnosticarea corect a cazurilor
Asigurarea accesului pacientului la ngrijiri medicale de calitate
Informarea bolnavilor i educarea pentru auto-ngrijire
Implementarea unei strategii naionale
21
Prevenirea apariiei i progresiei bolilor respiratorii
Informarea populaiei
Campanii de informare i promovare a sntii respiraiei
Politici i campanii de marketing social anti-fumat
Limitarea aciunii factorilor de risc
Suport de specialitate pentru renunarea la fumat
Norme de calitatea aerului n mediul de via i profesional
Screening populaional pentru bolile respiratorii
Identificarea grupurilor populaionale la risc
Chestionare pentru evaluarea simptomelor clinice
Teste funcionale respiratorii
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Identificarea cazurilor i diagnosticarea NCD
Diagnosticarea corect a cazurilor de NCD
Spirometria de calitate stabilire diagnostic i stadializare
Evaluare clinic: tolerana efort, dispnee (MRC), gaze
arteriale, deficit de -1-Antitripsina, stare de nutriie, etc.
Managementul anticipat al bolii cronice re-evaluare
periodic clinic i funcional respiratorie cu revizuirea
terapiei n funcie de stadiul de severitate
Evaluare i re-evaluare periodic din punct de vedere al
prezenei comorbiditilor (boli coronariene, diabet,
depresie, osteoperoz, etc.)
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Smoking in Moldova
COPD in Moldova
SWOT
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1. Range of staff expertise
2. A highly integrated team that is able to adapt quickly and efficiently
3. In-depth knowledge of our patient population
4. Emphasis on a patient centric approach to problem solving approach
5. Dedication and commitment
6. Links with and active involvement in the Community and with International Scientific
Societies
7. The ongoing development of effective local solutions for our local population
Strengths
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1. Obstructive Respiratory diseases are underdiagnosed, underestimated and undertreated
2. A general lack of awareness of medical community and general population for COPD,
asthma and sleep apnea
3. Lack of interaction with specialists in related fields
4. Evidence based COPD, asthma guidelines are available, but not implemented
5. No access to COPD, asthma and sleep apnea education for patients
6. Smoking cessation programs are unavailable
7. Bad access to spirometry and sleep testing and CPAP/BiPAP therapy
8. Care Pathways are fragmented and not integrated, both across organizations and between
health care professionals, resulting in fragmented access to services
9. Patients are not being referred to specialist care in a timely manner
10. Due to a lack of service coordination there are inconsistency issues in terms of provider
COPD, asthma, sleep apnea knowledge, education and management of the diseases
11. Need for more electronic outcome based care
Weaknesses
26
1. A need of Impact of Obstructive Respiratory Diseases study to identify the unapproached
needs in the chronic respiratory disease management
2. A need for more evidence-based care of COPD, asthma, sleep apnea
3. A need for better standardization of COPD, asthma, sleep apnea assessment processes and
formats
4. A need for improved collaboration with primary health care providers
5. A need for better follow-up COPD, asthma, sleep apnea population on the management of
their disease
6. The population that does not have a primary care provider continue to receive episodic
care through the emergency department
7. Need more emphasis on prevention in primary care setting
8. Provision of more evidence-based COPD care across the health care system
Opportunities
27
1. Access to medications financial impacts
2. Potential changes in government and funding models
3. Any changes in government policies
4. An ageing population with changing patient demographics which will require increased
funding to support their care
5. Recruitment, growth and staff retention issues
Threats
Realitatea
subdiagnosticate
subestimate
subtratate
Sperana
Realizare studiului BOLD (Impactul Bolilor Obstructive Respiratorii) pentru
identificarea necesitatilor neatinse in managementul bolilor respiratorii
cronice
Dezvoltare strategiei intersectoriale nationale de abordare a bolilor
respiratorii cronice mai ales la nivelul asistenei medicale primare i printr-
un abord integrator cu celelalte boli cronice
Participarea activ n elaborare i realizare European Respiratory
RoadMap i strategiei globale OMS mpotriva NCD
29