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Burden of major
Respiratory Diseases
WHO Survey
Ryazan region of Russia,
RUSSIA
Ryazan region of Russia,
health care system:
• 104 hospitals
district hospitals – 32
rural hospitals
– 44
• 65 out-patient departments
• 792 “feldsher's” stations
Shilovo district
Population
– 60 000.
Scopin district
Population
– 40 000.
•Total area39 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%.
Protocol for assessment of
prevalence of major respiratory
diseases
Number of
patients
Prevalence
survey of
respiratory
disease in a
household
manner
Clinical survey
and lung
function test
Prevalence
survey of
respiratory
disease at the
PHC level
Pilot stage
October 2004
March 2006
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
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
Clinical survey and lung
function test
08.02.05-30.03.05
16 PHS were randomized for the
lung function test.
All patients from the household
stage were included.
Clinical survey and lung function test
08.02.05-30.03.05
16 PHS were randomized for the lung
function test.
All patients from the household stage
were included.
General characteristics of the study
Region
Stage
Scopin district PHC based
Household
based
Study period
Number of
health facilities
Number of
patients
18.10.0402.11.04
24
1505
22.11.0428.12.04
18
2116
8
812
Clinical survey 08.02.0530.03.05
& lung
function test
Shilovo district PHC based
Household
based
01.11.0420.11.04
29
962
22.11.0428.12.04
18
2030
8
725
Clinical survey 08.02.0530.03.05
& lung
function test
Education level of respondents, %,
by stages
Stage
Higher
Second Primary No eduary
cation
PHC based
7,38
59,22
27,32
6,08
Household
based
5,31
50.10
31.65
6.10
Age distribution of risk factors, by stages
(self-reported by patients)
Stage
PHC based
Household
based
Risk factor
5-14 years
15-49 years
>= 50 years
females/males
females/males
females/males
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
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
Age distribution of symptomatic respiratory
patients, by stages (self-reported by patients)
Stage
PHC
based
Household
based
Cough
5-14 years
15-49 years
>= 50 years
females/males
females/males
females/males
12,60
13,00
26,70
16,71
43,97
usually cough 4,88
as much as 4
to 6 times a
day, 4 or more
days out of the
week
8,66
7,83
17,72
11,78
32,17
0.88
1.25
4.68
14.67
9.10
28.11
0
2.09
7.91
5.67
19.89
usually have a
cough
usually have a
cough
9,76
usually cough 0.22
as much as 4
to 6 times a
day, 4 or more
days out of the
Age distribution of symptomatic respiratory
patients, by stages (self-reported by patients)
Stage
PHC
based
Household
based
Phlegm
5-14 years
15-49 years
>= 50 years
females/males
females/males
females/males
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
usually bring
up phlegm
0,44
0,21
2,29
9,06
5,35
17,59
usually bring
0,22
up phlegm
twice a day,4
or more days
out of theweek
0,21
1,00
4,97
4,28
13,19
Age distribution of symptomatic respiratory
patients, by stages (self-reported by patients)
Stage
PHC
based
Wheezing
5-14 years
15-49 years
>= 50 years
females/males
females/males
females/males
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
2,64
3,13
3,58
2,93
7,17
9,18
2,42
3,33
2,89
2,68
5,57
6,69
Househol ever had an
d based attack of
wheezing
had 2 or more
such episodes
Age distribution of symptomatic respiratory
patients, by stages (self-reported by patients)
Stage
PHC
based
Household
based
Breathlessness
5-14 years
15-49 years
>= 50 years
females/males
females/males
females/males
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
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
Prevalence of bronchial
obstruction, %
Stage
5-14 years
15-49 years
>= 50 years
females/males
females/males
females/males
Household
based
clinical
FEV1/FVC
survey &
2,72
lung
<70
function
test
1,28
5,07
6.69
15,65 23,72
Prevalence of
smoking by Age &
Sex, %
Smoking 21Рђ
70
60
50
40
30
20
10
0
Рј
f
Adult
Рј
f
Children
Bronchial obstruction
and smoking
Pack-years,
mean
Bronchial obstruction degree
Bronchial obstruction
and dyspnea
Part of patients
with dyspnea
Bronchial obstruction degree
Lung Disease and Respiratory Symptoms
Respiratory Symptoms 31%
Current or
Prior Lung Disease 11%
Low Pulmonary
Function 19%
Treatment
Only 2 from 100 patients with
respiratory symptoms and
low pulmonary function
regularly use inhalation of
bronchodilators
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
“Adequate education, should
be available,
in order to ensure correct
diagnosis and treatment, in
particular in primary care.”
Educational program
Key stones
• 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
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 6,92384Р•-17
Working population, %, by stages
Stage
5-14 years
15-49 years
>= 50 years
females/males
females/males
females/males
PHC based
-
-
72,00 59,22 16,71 24,66
Household based
-
-
45,87 45,15 12,63 17,97
Migrants, %, by stages
Stage
PHC based
3.36
Household based
3,21
Prevalence of respiratory diseases, by
stages (self-reported by patients)
Stage
PHC based
Household
based
Disease
5-14 years
15-49 years
>= 50 years
females/males
females/males
females/males
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
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
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
Main symptoms and
medical diagnosis of
chronic bronchitis
Cough
Wheezing
Phlegm
Dyspnea
Part of patients
with symptoms
Patients without
established
diagnosis
Patients with
established diagnosis
Risk factors and
chronic cough
Work
in any
dusty
job
Heat or
Smoke cook
using
an open
fire
Part of patients
with risk factors
Patients without
chronic cough
Patients with chronic
cough
Risk factors and
phlegm production
Work
in any
dusty
job
Heat or
Smoke cook
using
an open
fire
Part of patients
with risk factors
Patients without phlegm
Patients with phlegm
Risk factors and
wheezing
Work
in any
dusty
job
Heat or
Smoke cook
using
an open
fire
Part of patients
with risk factors
Patients without wheezing
Patients with wheezing
Risk factors and
dyspnea
Work
in any
dusty
job
Heat or
Smoke cook
using
an open
fire
Part of patients
with risk factors
Patients without dyspnea
Patients with dyspnea
Risk factors and
medical diagnosis of
chronic bronchitis
Work
in any
dusty
job
Heat or
Smoke cook
using
an open
fire
Part of patients
with risk factors
Patients without
with established
diagnosis
Patients with with
established diagnosis
Bronchial obstruction
and risk factors
Part of patients
with risk factors
Bronchial obstruction degree
Bronchial obstruction and medical
diagnosis of chronic bronchitis
Part of patients
with established
diagnosis
Bronchial obstruction degree
Bronchial obstruction
and chronic cough
Part of patients
with chronic
cough
Bronchial obstruction degree
Bronchial obstruction
and chronic phlegm productin
Part of patients
with phlegm
production
Bronchial obstruction degree
Bronchial obstruction
and weezing
Part of patients
with wheezing
Bronchial obstruction degree
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
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
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
Prevalence survey of
respiratory disease at
the PHC level
18.10.04-20.11.04
•Population: Individuals >= 5
years attending PHC
•Administered standardised
questionnaire on symptoms,
diseases, diagnoses, comorbidity,
sociodemographics, risk factors
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