Certificate Course in

MANAGEMENT OF COPD & ASTHMA

PUBLICHEALTHFOUNDATIONOF INDIA

agemna eM n t n oi fe Csr Ou Po DC &et Aa sci tf hit mre a

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Supported by an educational grant from

MANAGEMENT OF COPD & ASTHMA

Certificate Course in

Cycle I (November 2016 - June 2017)

Burden of Chronic Lung Diseases (COPD & Asthma)

India is the world capital for

chronic lung diseases. The

largest number of deaths due to

chronic respiratory diseases in

the world occurs in India, even

after controlling for the total

population. India leads the 1, 2world in asthma mortality and

has the second largest number

of deaths in Chronic Obstructive 1, 2Pulmonary Disease (COPD) . Chronic respiratory diseases

are the second leading cause of death in India. According to

crude estimates, about 100 million people in India suffer with

chronic respiratory diseases, predominantly those that affect

the airways. One of the largest studies conducted to 3understand what ails India reports that 50% of the patients,

who visit a primary care physician in India, do so for a

respiratory cause, with over half of them visiting a doctor for a

chronic respiratory problem. An estimated 3.5 million

patients visit a doctor every day in India for asthma or COPD

alone. The prevalence of asthma among children in certain

cities like Pune and Bangalore has doubled over the past 5-10 4, 5years . The prevalence of COPD has also been shown to be

6much higher than previously believed . A significantly large

proportion of COPD is attributable to causes other than

tobacco smoke like exposure to biomass fuel and indoor and 7outdoor air pollution

Despite knowledge of the increasing prevalence of chronic

respiratory diseases and the emerging newer risk factors that

are responsible for this exponential growth, the quality of care

that we offer to our patients with chronic respiratory diseases

remains poor. Obstructive Airways diseases are often under 8diagnosed and inappropriately managed . A study from a

tertiary undergraduate and post graduate teaching hospital

in Pune showed that up to 65% cases of obstructive airways 9diseases remained undiagnosed and therefore untreated .

Despite the fact that only clinical diagnosis without

spirometry can lead to missing more than 50% of cases of 10, 11OADs , spirometry remains poorly used by general

12, 13physicians across India . This under diagnosis coupled with

improper management of Asthma by primary care 14 physicians is leading to poorly controlled disease conditions,

leading not only to physical distress to the patient and their

families, but also loss of work days, school absenteeism, night

time awakenings, higher rates of acute exacerbations and the

growing need for hospitalization, and sometime even 15, 16, 17, 18intensive care . Not only this, it also imposes a huge and

19, 20, 21unnecessary economic burden on our country . One of

the main reasons for the under diagnosis and poor

management of chronic respiratory diseases, is inadequate

emphasis on respiratory diseases in medical schools,

References:1. http://www.worldmapper.org/display_extra.php?selected=4592. Global Burden of Diseases 2010. Heat

Maps.http://vizhub.healthdata.org/irank/heat.php3. Symptoms and medical conditions in 204912 patients visiting primary

health-care practitioners in India: a 1-day point prevalence study (the POSEIDON study). Salvi. S, Apte K, Madas S, Barne M, Chhowala S, Sethi T, Aggarwal K, Agrawal A, Gogtay J. Lancet Glob Health 2015; 3: e776–84

4. Paramesh H. Epidemiology of Asthma in India. India J Peds 2002: 69: 309-312.

5. Maria Cheraghi, AlirezaDadgarinejad, Sundeep Salvi. Increased prevalence of childhood asthma in Pune city, India. A Cross-Sectional Study to Find Prevalence and Risk Factors for Childhood Asthma in Pune City, India. International Scholarly Research Network ISRN Public Health Volume 2012, Article ID 361456, 8 pages.

6. Burney P, Jithoo A, Kato B et al. Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty—a BOLD analysis. Thorax 2014; 69:465-473.

7. Salvi S, Barnes P. Chronic obstructive pulmonary disease in Non-smokers. Lancet 2009; 374:733-43.

8. R. Balakrishnan, B. Brashier, S. Salvi, et al. High prevalence of undiagnosed moderate-to-severe COPD in subjects visiting a tertiary care hospital for a routine medical check. EurRespir J 2010; P2813.

9. Salvi SS, Wagh AP, Bhutada U, Ghorpade SV, Tayade BO, Bal T, Brashier B. High prevalence and under-diagnosis of obstructive lung diseases in hospitalized patients in India. EurRespir J 2005; 26: Suppl. 49, 594s.

10. Mannino D M, Gagnon R C, Petty T L. et al. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med. 2000 Jun 12; 160(11):1683-9.

11. Pena V.S., Miravitlles M., Gabriel R., et al. Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC multicentre epidemiological study.Chest 2000; 118 : 981-989

12. Salvi SS, D’Silva L, Chhowala S, Brashier B, Bal T, Gogtay JA. Use of Spirometry in clinical practice for Obstructive Lung Diseases in India. Chest 2005; 128(4): 248S.

13. Nitin Vanjare, SushmeetaChhowala, Rahul Kodgule et al.Has the use of spirometry improved in India? Results of nationwide studies conducted among chest and primary care physicians between 2005 and 2013.EurRespir J 2013; 42: Suppl. 57,P271.

14.S. Shahid, G. S. Bhinder, J. K. Dhanjal. Knowledge Attitude and Practices (KAP) of Primary Care Physicians of Central Mumbai Suburbs about Childhood Asthma. The Internet Journal of Asthma, Allergy and Immunology; 2007; Volume 6; Number 1.

15. S. K. Jindal. Asthma Control in the first decade of 21st Century. Indian J Med Res 125, May 2007; 604-607.

16. B. Brashier, D. Kekan, A. Bamnikar et al. High prevalence of poorly controlled asthma amongst patients visiting clinics in Pune City, India. EurRespir J 2008; P221.

17. Philip J. Thompson, Sundeep Salvi, Jiangtao Lin et al. Insights, attitudes and perceptions about asthma and its treatment: Findings from a multinational survey of patients from 8 Asia-Pacific countries and Hong Kong. Respirology (2013) 18, 957-967.

18. Salvi S, Apte K, Dhar R, Shetty P, Faruqi RA, Thompson PJ, Guleria R. Asthma Insights and Management In India: lessons learnt from the Asia Pacific - Asthma Insights And Management (AP-AIM) Study. JAPI (In press).

19. Murthy K, Sastry J. Economic burden of chronic obstructive pulmonary disease. National Commission on Macroeconomics and Health. Background Papers- Burden of Disease in India, 2005.

20. Murthy KJR and J. G. Shashtry. Economic Burden of Asthma. National Commission on Macroeconomics and Health. Background Papers, 2005.

21. Jindal SK. Estimation of costs of management of smoking related COPD and CHD. Project Report, Indian Council of Medical Research, 1998.

22. S. S. Salvi, R. Kesarwani, A. Raghupathy et al. The challenges of managing asthma in primary care - Medical personnel ability to use pressurized metered dose inhaler (pMDI). EurRespir J 2006; P 3366.

including lack of training in spirometry during

undergraduate and postgraduate curriculum. A study

from a tertiary care teaching hospital in Pune identified

that less than 1% of the doctors and nurses being trained

or already trained in modern medicine knew how to use a

pressurized metered dose inhaler though most of them 22believed otherwise . More worryingly, over 50% of them

believed that inhalers were addictive. This highlights the

very poor level of knowledge that both undergraduate

and postgraduate doctors have before they start their

practice.

The quality of services provided by the PCPs are weak as

compared to specialists. Hence, there is a need for

strengthening their competencies to effectively manage

COPD and Asthma at primary and secondary level.

“Certificate Course in Management of COPD & Asthma"

(CCCA)” is an effort in this direction

normalasthma

Chest Research Foundation (CRF)(Academic Partner)

Chest Research Foundation is an autonomous academic

research institute in Pune established in Nov 2002 by

Hamied Foundation Trust. Their mission is the liberation

from suffering of patients of Obstructive Airways

Diseases through Research and Education. Chest

Research Foundation has the state of the art facilities for

research and education in the field of Obstructive

Airway Diseases.

Narayana Health formerly known as Narayana Hrudyalaya, is a

multi-specialty hospital chain in India, headquartered in

Bengaluru. The hospital chain has 6498 beds spread across 32

hospitals in 20 locations (as of April 2015). The company won

the "Good Company" award for its quality, affordability and

scale. The business model of Narayana Health became a Global

Healthcare and Harvard Business School case study. The

hospital chain is among the largest telemedicine networks in

the world. The group was founded in 2000 by Dr. Devi Shetty

under the guidance of the Asian Heart Foundation (AHF). In

2013, Narayana Hrudayalaya Pvt. Ltd. changed its brand name

to Narayana Health. Narayana Health’s vision is "To provide

high quality health care, with care and compassion, at an

affordable cost, on a large scale. An average of 150 surgeries are

performed every day and an average of around 80,000

outpatients are seen every month. The chain caters to the super

specialty tertiary care services of the Indian populace. Though

started as a hospital devoted to cardiovascular disease, it was

soon recognised that these patients often had co-morbidities

which needed care. Hence the service was expanded to include

other specialities, including Pulmonology, which is now one of

the largest departments offering a wide range of services in

management of airway disease, interstitial lung disease,

pulmonary vascular disease, interventional pulmonology and

sleep medicine. In addition, the department has an active

academic program, offering the DNB in Pulmonology. The

success of the program is attested to by the 100% pass rate

since inception.

For more information visit: www.narayanahealth.org

Narayana Health (NH) (Academic Partner)

Public Health Foundation of India

The Public Health Foundation of India (PHFI) is a

public private initiative that has collaboratively

evolved through consultations with multiple

constituencies including Indian and International

academia, state and central governments, multi & bi-

lateral agencies and civil society groups. PHFI is a

response to redress the limited institutional capacity

in India for strengthening training, research and policy

development in the area of Public Health.

Structured as an independent foundation, PHFI

adopts a broad, integrative approach to public health,

tailoring its endeavours to Indian conditions and

bearing relevance to countries facing similar

challenges and concerns. The PHFI focuses on broad

dimensions of public health that encompass

promotive, preventive and therapeutic services, many

of which are frequently lost sight during policy

planning as well as in popular understanding.

thHonourable 14 Prime Minister of India Dr. th Manmohan Singh, launched PHFI on 28 March, 2006

at New Delhi. PHFI recognizes the fact that meeting

the shortfall of health professionals is imperative to a

sustained and holistic response to the public health

concerns in the country which in turn requires health

care to be addressed not only from the scientific

perspective of what works, but also from the social

perspective of, who needs it the most.

For more information visit: www.phfi.org

The objectives of CRF are as follows:

Research

• To study airways diseases in India, especially asthma and

COPD, with focus on India specific variations in

epidemiology, risk factors, lung physiology and molecular

studies.

• Clinical evaluation of drugs for the treatment of these

diseases.

Education

• Updating knowledge and practice of respiratory disease,

diagnosis and management through certificate courses for

physicians, paediatricians, chest physicians and general

practitioners.

• Training programmes for technicians and paramedical

personnel to improve diagnosis and management of

airways diseases.

• Patient education programmes to improve understanding

of disease management, overcome stigmas and scale

boundaries of language and culture.

• Training modules for postgraduate students.

• Basic and advanced pulmonary function test.

• Distance learning and online programmes.

For more information visit: www.crfindia.com

The Course: CCCA

CCCA is a joint certificate program designed,

implemented and delivered by Public Health

Foundation of India (PHFI), Chest Research

Foundation (CRF), Pune and Narayana Health (NH),

Bengaluru. The educational grant for the same has

been provided by GlaxoSmithKline Pharmaceuticals

Limited to train PCPs across the country with an

ultimate objective to improve patient outcomes by

enabling early diagnosis and evidence based

treatment and establishing a robust referral linkage.

CCCA is an eight modular course (November 2016 –

June 2017) spread across 25 regional training

centers in India. The core groups involved in the

course are 15 National Experts, 25 Regional Faculty

and group of Observers. The trainer – trainee ratio

for each centre would be 1:20.

The course follows a continuous Monitoring and

Evaluation system throughout the cycle to ensure

quality assurance and standardized course delivery

pattern on all India level.

Inhaler devices is absolutely essential for proper

management of Asthma and COPD. COPD is a

systemic disease and the systemic manifestations

are a major cause of morbidity and poor quality of

life. These are discussed as is long term oxygen

therapy. Not all patients of Asthma have similar

presentations. The course discusses the various

avatars of Asthma and also the common co-

morbidities like Allergic Rhinitis and Gastro

Esophageal Reflux Disease associated with it.

Smoking Cessation and Pulmonary Rehabilitation

are essential yet neglected aspects of COPD

management. The course emphasizes on the need

and ways to address these issues to gain good

control of symptoms. However, no matter how well

we manage asthma and COPD, exacerbations may

still happen and the course covers how to manage

these exacerbations. It also tackles the difficult issue

of end of life communication as it is best to discuss

with the patient and family of patients with end

stage COPD what their preferences and resources

are like.

Certificate Course in Management of COPD & Asthma is

a unique, on the job training course with a primary

objective to enhance knowledge, skills and core

competencies of PCPs in management of chronic lung

disease (COPD & Asthma).

The total duration of the course is eight months

(November 2016 to June 2017), with once a month

contact session, scheduled on designated weekend at

Regional Centers, across India.

Course Design and Duration:

Course Administration and Language

CCCA is a joint certificate program designed and delivered by

Public Health Foundation of India (PHFI) and its academic

partner; Chest Research Foundation (CRF) and Narayana

Health (NH).th The last date for enrolment is: 30 September 2016

The language of instruction is English

Minimum eligibility:

MD/DNB (Medicine of Internal Medicine or Family Medicine)

Or

MBBS with minimum 3 years of clinical experience

Contents

The Certificate course begins with making the practicing

physician realize the need to focus on respiratory diseases and

the fact that our country is losing precious man days and

money because we as practitioners are still following the age

old methods for diagnosis and management of Asthma and

COPD. Understanding investigations like Spirometry and Peak

Expiratory Flow Meter which are standard of care

investigations for obstructive airways diseases is made

extremely simplified. Management aspects are covered in

detail with emphasis on patient counselling which forms the

backbone of management of all chronic diseases.

Teaching and Training Methodology

The course utilizes a variety of teaching/learning

techniques. Training is imparted through direct

teaching complemented by various informative case

studies, interactive group activities, assignments

and didactic lectures. The use of videos to highlight

certain points is a distinctive feature of the course.

The complete and comprehensive learning package

includes printed modules along with the CD which

will be provided to all the participants by the

organizers. The course content will be delivered by

renowned Pulmonologists; Regional Faculty.

Evaluation System & Certification Criteria

Participant evaluation will be through a continuous

internal evaluation, course work and performance in

written examination. The criteria for successful

completion of the course shall be as follows:

· Participation in at least 7 monthly contact sessions

(Including the pre-test and post-test of each

module)

· Submission of two interim assignments at the end

of module III and module VI to the respective

Regional Faculty

· Appearance and clearance of final written

examination in the form of 50 MCQs with min. 50%

score along with Module VIII

The candidate completing the certificate course

successfully as per the above mentioned criteria shall

be awarded certificate, jointly issued by PHFI, CRF, NH

and respective Regional Faculty.

COURSE MODULES

Module No. 1

Introduction and overview of Asthma and Chronic Obstructive Airways Diseases

Module No. 2

Module No. 3

Module No. 5

Module No. 7

Module No. 4

Module No. 6

Module No. 8

Diagnosis of Asthma and COPD

Management of COPD

Management of Asthma

Good inhalation practices and Patient counselling

Asthma Phenotypes and Co-Morbids associated with Asthma

Pulmonary Rehabilitation and Smoking Cessation

Management of an acute exacerbation and End of Life Issues

Course Fee

For enrolment in the CCCA course the completed

application form with a Demand Draft for

INR 10,000/- in favour of ‘Public Health

Foundation of India’ payable at New Delhi,

can be submitted to:

Program Secretariat- CCCA

Public Health Foundation of India

Plot No. 47, Sector - 44, Gurgaon, Haryana -

122002, India

Tel: +91 124 4781400; 0124 4781582, Fax: +91 124

472297, Mobile: +91 8527578090/ 9599051984

Website: www.phfi.org; www.ccca.org.in;

Email: ccca@phfi.org

This module elaborates the

pathogenesis and pathophysiology of

Asthma and COPD.

The salient features of this module are clinical diagnosis of Asthma and COPD,

differentiating between the two diseases, Pulmonary Function Tests (Spirometry and

Peak Flow Meter) and an introduction to Advanced Pulmonary Function Tests.

This module takes in detail

pharmacotherapy, systemic manifestations

and principles of management of COPD.

This module takes in detail

pharmacotherapy, systemic manifestations

and principles of management of Asthma.

This module gives an insight on; advantages of inhalation therapy

over systemic therapy; different types of inhaler devices along

with their technical details important for a practising physician;

correct technique of using different devices; hands on session on

devices and patient counselling in Asthma and COPD.

The following module describes about; the

phenotypes of Asthma; concept of Unified Airways

Disease; allergy testing and immunotherapy and

association of GERD with Asthma.

This module covers both clinic based and home

based pulmonary rehabilitation.

The last module covers management of an

acute exacerbation and end of life issues in

detail.

For Application Forms and Course Brochure, please contact:

Program Secretariat- CCCA

Public Health Foundation of India

Plot No. 47, Sector - 44, Gurgaon, Haryana - 122002, India

Tel: +91 124 4781400; 0124 4781582, Fax: +91 124 4722971

Mobile: +91 8527578090/ 9599051984

Website: www.phfi.org; www.ccca.org.in;

Email: ccca@phfi.org

agemna enM t n oi fe Csr Ou Po DC &et Aa sci tf hit mre a

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Disclaimer: PHFI, CRF & NH hereby declare that, this jointly designed “Certificate Course in Management of COPD & Asthma” is not recognized medical

qualification, under section 11(1) of Indian Medical Council Act, 1956. PHFI,CRF & NH offering this course hereby declare that it is not a medical college

or a university and not offering this course in accordance with the provisions of the Indian Medical Council Act/University Grants Commission Act.

*Decision taken by PHFI for selection and enrolment of participants will be final.

**Course Fee to be paid in the form of Demand Draft (DD) for INR 10,000/- drawn in favour of Public Health Foundation of India, payable at New Delhi.

Map of India* Not to Scale

Delhi

LucknowGuwahati

Kolkata

Jaipur

Bengaluru

Mysore

Mangalore

Calicut

TrivandrumCoimbatore

Chennai

Hyderabad

Aurangabad

Nagpur

Ahmedabad

PuneMumbai

Thane

Bhubaneswar

Ranchi

Patna

Gurgaon

State City

Assam Guwahati

Bihar Patna

Jharkhand Ranchi

Odisha Bhubaneswar

West Bengal Kolkata*

Delhi Delhi

Haryana Gurgaon

Rajasthan Jaipur

Uttar Pradesh Lucknow

Karnataka Bengaluru

Karnataka Mysore

Karnataka Mangalore

Regional Training Centres across India:

State City

Kerala Trivandrum

Kerala Calicut

Tamil Nadu Coimbatore

Tamil Nadu Chennai

Tamil Nadu Madurai

Telangana Hyderabad

Maharashtra Aurangabad

Gujarat Ahmedabad

Maharashtra Pune

Maharashtra Mumbai

Maharashtra Thane

Maharashtra Nagpur

Madurai

* 2 Centres in Kolkata