Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach.
Chronic respiratory diseases (CRY)) are major public health problems worldwide. Realizing the urgency of the health related problems of chronic respiratory diseases, a voluntary alliance of national and international organizations, institutions and agencies has been established and named as the Global Alliance against Chronic Respiratory Diseases (GARD). This alliance is part of the World Health Organization's global activities to prevent and control chronic diseases. The GARD was started with a vision of a world where all people breathe freely, a goal to reduce the global burden of chronic respiratory diseases and an objective to initiate a comprehensive approach to fight chronic respiratory diseases; and it was launched in Beijing, China on March 28, 2006. The WHO advocates an integrated approach that combines chronic respiratory disease prevention and management with a similar approach for heart diseases, stroke, diabetes mellitus and other chronic diseases, as this approach has been found to be cost-effective.
This publication provides an insight into the global problems of chronic respiratory diseases, and the salient features described for the prevention and management of CRD are of great value to public health experts, physicians and policy makers. The first chapter gives an overview of the burden of chronic diseases, discusses the chronic respiratory diseases as a major global health problem and suggests mechanisms of action for the prevention and management. The second chapter deals with epidemiology of chronic respiratory diseases. The third chapter is devoted to the risk factors for chronic respiratory diseases.
The CRDs included bronchial asthma, chronic obstructive pulmonary disease (COPD), occupational lung diseases, obstructive sleep apnoea syndrome (OSAS) and pulmonary hypertension. These diseases are major preventable diseases that affect people of all ages particularly in low and middle income counties. The health care systems especially in developing countries, focus mainly on communicable diseases and serious attention is not paid to the diagnosis and management of chronic respiratory diseases. Though many national programmes exist for the control of communicable diseases, such programmes for the prevention of chronic respiratory diseases are often absent or insufficient. As a result, these diseases have major adverse effects on the quality of life and disability of affected individuals. It has been estimated that CRDs account for 4 per cent of the global burden and 8.3 per cent of the burden of chronic diseases measured in disability adjusted life years (DALYs); and that annually four million of deaths occur globally due to chronic respiratory diseases.
About 300 million people of all ages worldwide suffer from bronchial asthma. It is a misfortune that about 250,000 annual deaths which are preventable, occur worldwide due to asthma. The morbidity associated with asthma is often severe in poor people and minorities. There are evidences that asthma intervention programmes have health care benefits leading to a reduction in death rates and hospitalizations. COPD affects 210 million people worldwide and it is projected to be the fourth cause of mortality by 2030. It has been reported that 12 million people are affected with COPD in India. Acute exacerbations of COPD are major causes of morbidity and mortality in COPD. Obstructive sleep apnoea syndrome that affects children and adults both, is a neglected disease especially in developing countries. Excessive day time sleepiness and loud snoring are major consequences of OSAS. It has been estimated that 4 per cent of men and 2 per cent of women suffer from OSAS. Increased frequency of accidents and cardiovascular diseases (hypertension, congestive cardiac failure and coronary artery diseases) have been seen in patients with OSAS.
Many risk factors for CRD have been identified and can be prevented. The major risk factors of CRD especially for COPD are tobacco smoke including environment tobacco smoke, indoor and outdoor pollutants, allergies, and occupational agents. Ageing of the population and urbanization are other factors that can influence CRD. It has been predicted that annual number of deaths from tobacco will increase to 8.3 millions by 2030 and 80 per cent of these deaths will occur in low and middle income countries. Tobacco smoking especially in low and middle income countries is linked with poverty and education. Solid fuels in the form of wood, dung and crop residues used in low and middle income countries for domestic energy are important indoor air pollutants that are associated with asthma and COPD. Other indoor and outdoor pollutants including allergens have adverse effects on respiratory health. Occupational respiratory diseases are caused by the inhalation of both organic and inorganic materials in the workplace. The occupational diseases are not adequately addressed and diagnosed in low and middle income countries. The epidemiological features and the risk factors discussed in this publication should be an eye opener to everybody involved in health care especially from Indian subcontinent and the time has come to launch national chronic respiratory disease control programmes in India.
The last chapter deals with a step-wise framework for action and this framework has identified three steps. Step one includes estimation of disease burden and population needs, identification of risk factors for chronic respiratory diseases and respiratory allergies and undertaking surveillance on chronic respiratory disease risk factors and trends in disease burden. Step two will formulate and adopt policy and GARD will provide the basis for action in the field of chronic respiratory diseases with plans for the implementations of policies. It has been emphasised that there is a need for comprehensive and integrated policies and plans for prevention to minimize overlap and fragmentation of the health system. Step three identifies policy implementation steps. It has been emphasised that these recommendations should be adapted locally to ensure their appropriateness to the community in which these will be applied.
Overall, this is a timely publication and a reminder to everybody to be aware of the problem of chronic respiratory diseases which are preventable and can be treated. The public, medical profession and the government should join together to fight these diseases to save millions of people from death.
Vallabhbhai Patel Chest Institute
University of Delhi
Delhi 110 007, India
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|Publication:||Indian Journal of Medical Research|
|Article Type:||Book review|
|Date:||Sep 1, 2008|
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