healthy caribbean 2008 revolutionizing the prevention and management of lung disease dr. timothy...
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HEALTHY CARIBBEAN 2008
Revolutionizing the Prevention and Management of Lung Disease
Dr. Timothy Roach FRCP FACP
Head, Respiratory Unit
Queen Elizabeth Hospital
Barbados
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Lung Disease
• Which lung diseases are we talking about?
• What is the size of the problem in the Caribbean?
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Lung Diseases
• Chronic Obstructive Pulmonary Disease – COPD.- a heterogeneous group of diseases that include emphysema
and chronic bronchitis and are clinically defined by the concept of fixed airflow obstruction.
• Lung Cancer.– Primary Bronchial Carcinoma – a variety of cancer that
presents the greatest challenges in treatment as it remains largely untreatable.
• Asthma.– The commonest chronic disease of childhood but a disease
that has a myriad of forms and has a very significant impact on adults.
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COPD
• GOLD (Global Obstructive Lung Disease initiative) statistics indicate COPD prevalence of 10.1% (11.8% Male 8.5% female).
• WHO estimates 600 million COPD sufferers worldwide
• 4th leading cause of death in the US.• COPD is the only leading cause of death that
is INCREASING in prevalence • Economic costs of COPD in the USA are
>US$14 billion per annum.• No regional/local statistics.
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Causes of COPD
Cigarette smoking – 73% of cases in developed countries, 45% in underdeveloped countries.
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Causes of COPD
–Pollution – contribution of pollution unknown
–COPD higher in urban environments
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Lung Cancer
Lung Cancer is the most common fatal malignant cancer in the USA.
2nd leading cause of death amongst black males (after coronary artery disease
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Causes of Lung Cancer
– Cigarette smoking – 85% of lung cancer cases due to tobacco smoking.
– Other causes – e.g. asbestos etc – very rare.
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Action on TobaccoInternational Framework Convention on
Tobacco Control
• Urgent ratification for all signatory states.
• Legislation:– to limit or eliminate
smoking in public places.– ban the sale, advertising
and promotion of tobacco products to children (to everybody?)
– to have effective warning labels.
– To introduce fiscal measures to reduce tobacco consumption -increase taxes .
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Asthma– Commonest chronic
disease of childhood.
– International prevalence rates vary enormously.
– The International Study of Asthma and Allergies in Childhood (ISAAC): highest prevalence countries (25% of schoolchildren) were New Zealand, Australia, UK and Ireland, lowest prevalence were Indonesia, India and Eastern Europe.
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Asthma
– Barbados, Jamaica and Trinidad have all reported prevalence rates between 17-20%.
– 1 in 5 Barbadian schoolchildren suffer with symptoms of asthma
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Risk Factors for Asthma
Children exposed to cigarette smoke in utero and in infancy are more likely to suffer with asthma.
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Risk factors for Asthma
• Obesity –Increased BMI is associated with increased asthma Prevalence. Weight reduction has been demonstrated to improve lung function, symptoms, morbidity and health status
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Risk Factors for Asthma.
• Allergen sensitization and exposure: House Dust mite, cockroach, Pet allergens
• Infections – the hygiene hypothesis: Children who have frequent respiratory infections and pneumonia have a lower prevalence of asthma i.e. there is an inverse association between infectious burden in early life and the development of atopy and asthma
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Risk Factors for Asthma
• Exposure to farm animals: exposure to a farming environment confers protection against asthma. Mechanism not understood but there is strong epidemiological evidence.
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Recommendations for the prevention of Asthma.
• Breastfeeding for the first six months of life
• Avoidance of smoking during pregnancy and during infancy.
• Reducing exposure to HDM allergen in environments where HDM levels are high.
• No firm recommendations on pet allergen exposure.
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Other Concerns
• Air Quality
• Sick Buildings
• Climate Change
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Recommendations
• What is needed?– Political Commitment at the highest level– Economic justification– Legislation
• Tobacco control• Taxation on food (food baskets)
– Behavior Change– Research
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