7. Epi of Chronic respiratory diseases.ppt

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1. EPIDEMIOLOGY OF
CHRONIC
RESPIRATORY
DISEASES (CRDS)

2. Overview
Chronicrespiratorydiseases(CRDs)arediseasesoftheairways
andotherstructuresofthelung.
Someofthemostcommonarechronicobstructivepulmonary
disease(COPD),Asthma,Occupationallungdiseasesand
Pulmonaryhypertension.
Inadditiontotobaccosmoke,otherriskfactorsincludeair
pollution,occupationalchemicalsanddusts,andfrequent
lowerrespiratoryinfectionsduringchildhood.

3. Overview
CRDsarenotcurable,however,variousformsoftreatmentthat
helpdilatemajorairpassagesandimproveshortnessofbreath
canhelpcontrolsymptomsandincreasethequalityoflifefor
peoplewiththedisease.
Chronicrespiratorydiseasesconstituteapublichealthproblem
thatimposeasubstantialburden.

4. Chronic obstructive
pulmonary disease
(COPD)

5. What is COPD?
COPDisacommon,preventable,andtreatablechroniclung
diseasewhichaffectsmenandwomenworldwide.
Abnormalitiesinthesmallairwaysofthelungsleadto
limitationofairflowinandoutofthelungs.
Anumberofprocessescausetheairwaystobecomenarrow.
Theremaybedestructionofpartsofthelung,mucusblocking
theairways,andinflammationandswellingoftheairwaylining.

6. What is COPD?
COPDissometimescalled“emphysema”or“chronic
bronchitis”.
Emphysemausuallyreferstodestructionofthetinyairsacsat
theendoftheairwaysinthelungs.
Chronicbronchitisreferstoachroniccoughwiththe
productionofphlegmresultingfrominflammationinthe
airways.
COPDandasthmasharecommonsymptoms(cough,wheeze,
anddifficultybreathing)andpeoplemayhavebothconditions.

7. The impact of COPD on daily life
CommonsymptomsofCOPDdevelopfrommid-lifeonwards,
including:
Breathlessnessordifficultybreathing,
Chroniccough,oftenwithphlegm,
Tiredness.
AsCOPDprogresses,peoplefinditmoredifficulttocarryout
theirnormaldailyactivities,oftenduetobreathlessness.

8. The impact of COPD on daily life
Theremaybeaconsiderablefinancialburdenduetolimitation
ofworkplaceandhomeproductivity,andcostsofmedical
treatment.
Duringflare-ups,peoplewithCOPDfindtheirsymptoms
becomemuchworse
Severeflare-upscanbelife-threatening.
PeoplewithCOPDoftenhaveothermedicalconditionssuchas
heartdisease,osteoporosis,musculoskeletaldisorders,lung
cancer,depressionandanxiety.

9. Causes of COPD
COPDdevelopsgraduallyovertime,oftenresultingfromacombinationofrisk
factors:
Tobaccoexposurefromactivesmokingorpassiveexposuretosecond-hand
smoke;
Occupationalexposuretodusts,fumesorchemicals;
Indoorairpollution:
o Biomassfuel(wood,animaldung,cropresidue)orcoalisfrequentlyusedforcookingand
heatinginlow-andmiddle-incomecountrieswithhighlevelsofsmokeexposure;
Earlylifeevents
oSuchaspoorgrowthinutero,prematurity,andfrequentorsevererespiratoryinfectionsin
childhoodthatpreventmaximumlunggrowth;
Asthmainchildhood;and
Araregeneticconditioncalledalpha-1antitrypsindeficiency,whichcan
causeCOPDatayoungage.

10. Epidemiology of COPD
•ChronicObstructivePulmonaryDisease(COPD)isthethird
leadingcauseofdeathworldwide,causing3.23milliondeaths
in2019.
•Over80%ofthesedeathsoccurredinlow-andmiddle-income
countries(LMIC).
•COPDcausespersistentandprogressiverespiratorysymptoms,
includingdifficultyinbreathing,coughand/orphlegm
production.

11. Epidemiology of COPD
•COPDresultsfromlong-termexposuretoharmfulgasesand
particlescombinedwithindividualfactors,includingevents
whichinfluencelunggrowthinchildhoodandgenetics.
•Environmentalexposuretotobaccosmoke,indoorairpollution,
andoccupationaldusts,fumes,andchemicalsareimportant
riskfactorsforCOPD.
•Earlydiagnosisandtreatment,includingsmokingcessation
support,isneededtoslowtheprogressionofsymptomsand
reduceflare-ups.

12. Reducing the burden of COPD
ThereisnocureforCOPDbutearlydiagnosisandtreatment
areimportanttoslowtheprogressionofsymptomsand
reducetheriskofflare-ups.
COPDshouldbesuspectedifapersonhastypicalsymptoms,
andthediagnosisconfirmedbyabreathingtestcalled
spirometry,whichmeasureshowthelungsareworking.
Inlow-andmiddle-incomecountries,spirometryisoftennot
availableandsothediagnosismaybemissed.

13. Reducing the burden of COPD
ThereareseveralactionsthatpeoplewithCOPDcantaketoimprovetheir
overallhealthandhelpcontroltheirCOPD:
Stopsmoking:peoplewithCOPDshouldbeofferedsupporttoquit
smoking;
Takeregularexercise;and
Getvaccinatedagainstpneumonia,influenzaandcoronavirus.
Flare-upsareoftencausedbyarespiratoryinfection
PeoplelivingwithCOPDmustbegiveninformationabouttheircondition,
treatmentandself-caretohelpthemtostayasactiveandhealthyas
possible.
Inhaledmedicationcanbeusedtoimprovesymptomsandreduceflare-
ups.

14. Asthma

15. What is asthma?
Asthmaisalong-termconditionaffectingchildrenand
adults.
Theairpassagesinthelungsbecomenarrowdueto
inflammationandtighteningofthemusclesaroundthe
smallairways.
Thiscausesasthmasymptoms:cough,wheeze,
shortnessofbreathandchesttightness.

16. What is asthma?
Thesesymptomsareintermittentandareoftenworseat
nightorduringexercise.
Othercommon“triggers”canmakeasthmasymptoms
worse.
Triggersvaryfrompersontoperson,butcaninclude
viralinfections(colds),dust,smoke,fumes,changesinthe
weather,grassandtreepollen,animalfurandfeathers,strong
soaps,andperfume.

17. Asthmaisoftenunder-diagnosedandunder-treated,particularlyinlow-and
middle-incomecountries.
Peoplewithunder-treatedasthmacansuffersleepdisturbance,tiredness
duringtheday,andpoorconcentration.
Asthmasufferersandtheirfamiliesmaymissschoolandwork,withfinancial
impactonthefamilyandwidercommunity.
Ifsymptomsaresevere,peoplewithasthmamayneedtoreceiveemergency
healthcareandtheymaybeadmittedtohospitalfortreatmentand
monitoring.
Inthemostseverecases,asthmacanleadtodeath.
The impact of asthma on daily life

18. Epidemiology of Asthma
Asthmaisamajornoncommunicabledisease(NCD),affectingboth
childrenandadults.
Inflammationandnarrowingofthesmallairwaysinthelungscause
asthmasymptoms,whichcanbeanycombinationofcough,wheeze,
shortnessofbreathandchesttightness.
Asthmaaffectedanestimated262millionpeoplein2019and
caused461000deaths.
Asthmaisthemostcommonchronicdiseaseamongchildren.

19. Epidemiology of Asthma
Inhaledmedicationcancontrolasthmasymptomsandallowpeople
withasthmatoleadanormal,activelife.
Avoidingasthmatriggerscanalsohelptoreduceasthmasymptoms.
Mostasthma-relateddeathsoccurinlow-andlower-middleincome
countries,whereunder-diagnosisandunder-treatmentisa
challenge.
WHOiscommittedtoimprovingthediagnosis,treatment,and
monitoringofasthma,toreducetheglobalburdenofNCDsand
makeprogresstowardsuniversalhealthcoverage.

20. Causes of asthma
Manydifferentfactorshavebeenlinkedtoanincreasedriskof
developingasthma,althoughitisoftendifficulttofindasingle,
directcause.
Asthmaismorelikelyifotherfamilymembersalsohave
asthma–particularlyacloserelative,suchasaparentor
sibling.
Asthmaismorelikelyinpeoplewhohaveotherallergic
conditions,suchaseczemaandrhinitis(hayfever).
Urbanisationisassociatedwithincreasedasthmaprevalence,
probablyduetomultiplelifestylefactors.

21. Causes of asthma
Eventsinearlylifeaffectthedevelopinglungsandcanincreasethe
riskofasthma.
Theseincludelow-birthweight,prematurity,exposuretotobacco
smokeandothersourcesofairpollution,aswellasviralrespiratory
infections.
Exposuretoarangeofenvironmentalallergensandirritantsare
alsothoughttoincreasetheriskofasthma,
Includingindoorandoutdoorairpollution,housedustmites,
moulds,andoccupationalexposuretochemicals,fumes,ordust.
Childrenandadultswhoareoverweightorobeseareatagreater
riskofasthma.

22. Reducing the burden of asthma
Asthmacannotbecured,butgoodmanagementwith
inhaledmedicationscancontrolthediseaseandenable
peoplewithasthmatoenjoyanormal,activelife.
Therearetwomaintypesofinhaler:
Bronchodilators(suchassalbutamol),thatopen
theairpassagesandrelievesymptoms;and
Steroids(suchasbeclometasone),thatreduce
inflammationintheairpassages.
Thisimprovesasthmasymptomsandreducesthe
riskofsevereasthmaattacksanddeath.

23. Reducing the burden of asthma
Accesstoinhalersisaprobleminmanycountries.
In2019,onlyhalfofpeoplewithasthmahadaccesstoa
bronchodilatorandlessthanoneinfivehadaccesstoasteroid
inhalerinpublicprimaryhealth-carefacilitiesinlow-income
countries.
Peoplewithasthmaandtheirfamiliesneededucationto
understandmoreabouttheirasthma,theirtreatment,triggersto
avoid,andhowtomanagetheirsymptomsathome.
Itisalsoimportanttoraisecommunityawareness,toreducethe
mythsandstigmaassociatedwithasthmainsomesettings.

24. Household air
pollution and
health

25. Indoor air pollution and household energy
Around2.6billionpeoplestillcookusingsolidfuels(suchaswood,
cropwastes,charcoal,coalanddung)andkeroseneinopenfires
andinefficientstoves.
Thesecookingpracticesareinefficient,andusefuelsand
technologiesthatproducehighlevelsofhouseholdairpollution
Inpoorlyventilateddwellings,indoorsmokecanbe100times
higherthanacceptablelevelsforfineparticles.
Exposureisparticularlyhighamongwomenandyoungchildren,
whospendthemosttimenearthedomestichearth.

26. Epidemiology of Household air pollution and health
Around2.6billionpeoplecookusingpollutingopen
firesorsimplestovesfuelledbykerosene,biomass
(wood,animaldungandcropwaste)andcoal.
Eachyear,closeto4millionpeopledieprematurely
fromillnessattributabletohouseholdairpollution
frominefficientcookingpracticesusingpolluting
stovespairedwithsolidfuelsandkerosene.

27. Epidemiology of Household air pollution and health
Householdairpollutioncausesnoncommunicable
diseasesincludingstroke,ischaemicheartdisease,
chronicobstructivepulmonarydisease(COPD)and
lungcancer.
Closetohalfofdeathsduetopneumoniaamong
childrenunder5yearsofagearecausedby
particulatematter(soot)inhaledfromhouseholdair
pollution.

28. Impacts on health
3.8millionpeopleayeardieprematurelyfromillness
attributabletothehouseholdairpollutioncausedbythe
inefficientuseofsolidfuelsandkeroseneforcooking.Among
these3.8milliondeaths:
27%areduetopneumonia
18%fromstroke
27%fromischaemicheartdisease
20%fromchronicobstructivepulmonarydisease(COPD)
8%fromlungcancer.

29. Impacts on health
Pneumonia
Exposuretohouseholdairpollutionalmostdoublesthe
riskforchildhoodpneumoniaandisresponsiblefor45%
ofallpneumoniadeathsinchildrenlessthan5yearsold.
Householdairpollutionisalsoriskforacutelower
respiratoryinfections(pneumonia)inadults,and
contributesto28%ofalladultdeathstopneumonia.

30. Impacts on health
Chronicobstructivepulmonarydisease
Oneinfouror25%ofdeathsfromCOPDinadultsinlow-
andmiddle-incomecountriesareduetoexposureto
householdairpollution.
Womenexposedtohighlevelsofindoorsmokearemore
thantwiceaslikelytosufferfromCOPDthanwomenwho
usecleanerfuelsandtechnologies.
Amongmen(whoalreadyhaveaheightenedriskofCOPD
duetotheirhigherratesofsmoking),exposureto
householdairpollutionnearlydoublesthatrisk.

31. Impacts on health
Stroke
12%ofalldeathsduetostrokecanbeattributedtothe
dailyexposuretohouseholdairpollutionarisingfrom
cookingwithsolidfuelsandkerosene.
Ischaemicheartdisease
Approximately11%ofalldeathsdueto
ischaemicheartdisease,accountingforovera
millionprematuredeathsannually,canbe
attributedtoexposuretohouseholdair
pollution.

32. Impacts on health
Lungcancer
Approximately17%oflungcancerdeathsinadultsare
attributabletoexposuretocarcinogensfromhousehold
airpollutioncausedbycookingwithkeroseneorsolid
fuelslikewood,charcoalorcoal.
Theriskforwomenishigher,duetotheirroleinfood
preparation.

33. Ambient (outdoor) air pollution

34. Ambient (outdoor) air pollution
Outdoorairpollutionisamajorenvironmentalhealthproblem
affectingeveryoneinlow-,middle-,andhigh-income
countries.
Ambient(outdoor)airpollutioninbothcitiesandruralareas
wasestimatedtocause4.2millionprematuredeaths
worldwideperyearin2016;
Thismortalityisduetoexposuretofineparticulatematterof
2.5micronsorlessindiameter,whichcausecardiovascular
andrespiratorydisease,andcancers.

35. Ambient (outdoor) air pollution
Airpollutionisoneofthegreatestenvironmentalriskto
health.
Byreducingairpollutionlevels,countriescanreducethe
burdenofdiseasefromstroke,heartdisease,lungcancer,and
bothchronicandacuterespiratorydiseases,includingasthma.
Thelowerthelevelsofairpollution,thebetterthe
cardiovascularandrespiratoryhealthofthepopulationwill
be,bothlong-andshort-term.
In2019,99%oftheworldpopulationwaslivinginplaces
wheretheWHOairqualityguidelineslevelswerenotmet.

36. Ambient (outdoor) air pollution
Ambient(outdoorairpollution)inbothcitiesandruralareaswas
estimatedtocause4.2millionprematuredeathsworldwidein2016.
Some91%ofthoseprematuredeathsoccurredinlow-andmiddle-income
countries,andthegreatestnumberintheWHOSouth-EastAsiaand
WesternPacificregions.
Policiesandinvestmentssupportingcleanertransport,energy-efficient
homes,powergeneration,industryandbettermunicipalwaste
managementwouldreducekeysourcesofoutdoorairpollution.
Inadditiontooutdoorairpollution,indoorsmokeisaserioushealthrisk
forsome2.6billionpeoplewhocookandheattheirhomeswithbiomass,
kerosenefuelsandcoal.

37. Primary Prevention Cont.
Therearemanyexamplesofsuccessfulpoliciesintransport,urban
planning,powergenerationandindustrythatreduceairpollution:
forindustry:
cleantechnologiesthatreduceindustrialsmokestackemissions;
improvedmanagementofurbanandagriculturalwaste,including
captureofmethanegasemittedfromwastesitesasanalternative
toincineration(foruseasbiogas);
forenergy:
ensuringaccesstoaffordablecleanhouseholdenergysolutionsfor
cooking,heatingandlighting;
fortransport:
shiftingtocleanmodesofpowergeneration;prioritizingrapid
urbantransit,walkingandcyclingnetworksincitiesaswellasrail
interurbanfreightandpassengertravel;shiftingtocleanerheavy-
dutydieselvehiclesandlow-emissionsvehiclesandfuels,including
fuelswithreducedsulfurcontent;

38. Primary Prevention Cont.
forurbanplanning:
improvingtheenergyefficiencyofbuildingsandmakingcitiesmoregreen
andcompact,andthusenergyefficient;
forpowergeneration:
increaseduseoflow-emissionsfuelsandrenewablecombustion-free
powersources(likesolar,windorhydropower);co-generationofheatand
power;anddistributedenergygeneration(e.g.mini-gridsandrooftopsolar
powergeneration);
formunicipalandagriculturalwastemanagement:
strategiesforwastereduction,wasteseparation,recyclingandreuseor
wastereprocessing;aswellasimprovedmethodsofbiologicalwaste
managementsuchasanaerobicwastedigestiontoproducebiogas,are
feasible,lowcostalternativestotheopenincinerationofsolidwaste.
Whereincinerationisunavoidable,thencombustiontechnologieswith
strictemissioncontrolsarecritical

39. WHO Global air quality guidelines
Limitsforkeyairpollutantsthatposehealthrisks.
TheGuidelinesapplyworldwidetobothoutdoorandindoor
environmentsandarebasedonexpertevaluationofcurrent
scientificevidencefor:
Particulatematter(PM)
Ozone(O3)
Nitrogendioxide(NO2)
Sulfurdioxide(SO2).