Implementation of National/Regional programs

to prevent COPD

Nan Shan Zhong

Chinese Medical Association

The first five leading causes of death in China (2007)

Rank

Urban Rural

Disease(ICD-10)

Mortality(1/100,000) %

Disease (ICD-10)

Mortality (1/100,000)

%

1 Malignant tumor 176.2 28.5 Malignant tumor 114.2 24.8

2 Cerebrovascular diseases 111.5 18.0 Cerebrovascular

diseases 119.7 20.6

3Heart diseases 100.6 16.3 Respiratory Respiratory

diseasesdiseases 100.2 16.2

4 Respiratory Respiratory diseasesdiseases 80.9 13.1 Heart diseases 86.0 14.8

5Trauma/ Poisoning 37.6 6.1

Trauma/ Poisoning 52.1 9.0

Prevalence of COPD in China:

Population (>40y ): 8.2% (M-12.4% ,F-5.1% ) Total: 32.8 millions32.8 millions

8.1%-24.1% (perennial:25.6% of total)

CRD in China

Current patient

COPD 32.8 millionsCOPD 32.8 millions

Asthma 15.0 millionsAsthma 15.0 millions

Allergic rhinitis 113 millionsAllergic rhinitis 113 millions

19.30% (1.4M)19.30% (1.4M)

19.10% (1.4M)19.10% (1.4M)Cerebrovascular diseaseCerebrovascular disease

17.60% (1.28M)17.60% (1.28M)COPDCOPD

15.0% (1.0M)15.0% (1.0M)Cardiovascular diseaseCardiovascular disease

1.2% (90,000)1.2% (90,000)DiabetesDiabetes

0%0% 2%2% 4%4% 6%6% 8%8% 10%10% 12%12% 14%14% 16%16% 18%18% 20%20%

% Cause of death (2000)% Cause of death (2000)

COPD: one of the first leading causes of death in China (2000)

MOH Disease Control Department and NCDC. Report on Chronic Disease in China. 2006.MOH Disease Control Department and NCDC. Report on Chronic Disease in China. 2006.

Kong Lingzhi. 2005 Report in NCDC Annual Conference. Kong Lingzhi. 2005 Report in NCDC Annual Conference.

TumorTumor

GARD China Network

China Asthma Alliance China COPD Alliance

China GARD AllianceDept of Chronic Disease

Control, Ministry of Public Health, China

Chinese Association of Respir.

Dis

CRD listed as priority in the 15year plan of the control and prevention of chronic non communicable diseases

(MOH 2007-2022)

Hypertension

Diabetes

Heart disease

Malignant tumor

Chronic respiratory disease

National/Regional programs to manage COPD

↓Risk factors (Smoking cessation, reducti

on of indoor/outdoor air pollution)

Intervention as early as possible

Development of effective and affordable

medication

WHO Framework Convention on Tobacco Control (WHO/FCTC)

• Government ratified: Aug 28th, 2005

• Enforcement: Jan 9th, 2006

Ministry of Health

China CDC- National Tobacco Control Office

WHO Collaborating Center for Tobacco or Health

China Association On Tobacco Control

National Health Education Institute

Tobacco Control Organizations in China

11th, March 2008 22th, May 2009

Policy on Smoke Free Healthcare Facilities

Smoking forbidden in hospitals in China 50% hospitals at the end of 2010 100% hospitals at the end of 2011

MOH Document 21st May 2009

Smoking is forbidden in the following public places:1. Indoor areas of medical organizations;2. Infant institutions and kingdergartens;3. Middle schools, primary schools, mid-level vocational schools;4. Universities and other teaching areas of educational and

training organizations.5. Theatres, music halls, exhibition halls, museums, art galleries,

libraries, science and technology museums, archives, children’s palaces, memorial halls and other places for science & teaching, culture and art.

6. Business center of commerce, finance, post and tele-communications;

7. Inside buses, taxis, rail transits and other public transportation tools, related ticket offices and indoor platforms;

8. Cultural relics protection units open to the public;9. Gymnasiums;10. Contest area and seating area of stadiumThese regulations are enacted from May 1st, 2008

Regulations on No-Smoking in Public Places in Beijing

YearYear 1984 1984 1996 1996 2002 20092002 2009

Total smoking rate 33.9%Total smoking rate 33.9% 37.6% 37.6% 35.8% 35.8% (Aged>15)(Aged>15) MaleMale 66.9% 66.9% 66.0% 48%66.0% 48% FemaleFemale 4.2% 4.2% 3.08% 2.6% 3.08% 2.6% Smoking rate inSmoking rate in 60.0% 60.0% 56.8%56.8%male medical doctorsmale medical doctors

YearYear 1984 1984 1996 1996 2002 20092002 2009

Total smoking rate 33.9%Total smoking rate 33.9% 37.6% 37.6% 35.8% 35.8% (Aged>15)(Aged>15) MaleMale 66.9% 66.9% 66.0% 48%66.0% 48% FemaleFemale 4.2% 4.2% 3.08% 2.6% 3.08% 2.6% Smoking rate inSmoking rate in 60.0% 60.0% 56.8%56.8%male medical doctorsmale medical doctors

Three National Prevalence Surveys

Three National Prevalence Surveys

Haze in large cities

“Hazy sky” (NO VOC O3 etc) firstly listed in the category of air pollution in the Pearl River Delta Region

Document of Guangdong Government 1th May 2009

National/Regional programs to manage CRD

↓Risk factors (Smoking cessation reducti

on of indoor/outdoor air pollution)

Intervention as early as possible

Development of effective and affordable

medication

The trend towards development of medicine

——Early prevention and intervention——Early prevention and intervention

A 3P modality Predictive

Preventive

Personalized

Strategy of COPD management : moving to the community level

Early Early preventionprevention

Early Early managementmanagement

Clinical

management

Rescue

Early Early preventionprevention

Early Early managementmanagement

ClinicalClinicalmanagementmanagement RescueRescue

Medical costs

Medical costsMedical costs

How to improve COPD management at the community level

Increase government investment

Education among medical staff at the

community medical system

Research to early implement

intervention ;to develop “effective,

affordable, simple and safe” medications

China’s total health expenditure takes up only 17% of government’s budget, compared with a mean of

40% in developing countries

0

10

20

30

40

50

60

70

80

1980 1990 1995 2000 2002 2003 2004 2005

Government budget

Soci al securi ti es

Out of pocket

Data from MoH China (2006)

Increased government investment

More investment in the community health care system (in the next 3 years) Additional healthcare budget

850 billion Yuan Wen Jiabao

National People’s Congress 2009

Routine (regular) lung function test in the community

Health care system

How to improve community health-care

Increase government investment

Education among medical staff at the

community medical system

Research to early implement

intervention ;to develop “effective,

affordable, simple and safe” medications

2007;175

Diagnosed Rate of COPD Before Epidemiologic Survey

0. 0

5. 0

10. 0

15. 0

20. 0

25. 0

30. 0

35. 0

40. 0

total popul at i on COPD popul at i on

prev

alen

ce o

f do

ctor

-dia

gnos

is chroni c bronchi t i s

emphysema

bronchi al asthma

COPD

one of above

Usage of Lung Function Test

1. 52. 4

6. 7

10. 6

4. 3

6. 5

0. 0

2. 0

4. 0

6. 0

8. 0

10. 0

12. 0

total popul at i on COPD popul at i on

Perc

enta

ge o

f us

age

ofPF

Trural

urban

toatal

The Launch Meeting of China COPD Alliance in Guangzhou, Nov 4, 2006

Program of COPD Prevention & Management

Awareness: burden ,smoking hazards, air pollu

tion (including biomas fuels)Smoking cessation campaignReduction of outdoor/indoor pollutionPublic education (TV newspaper)Research work:

a/ Early intervention-more treatable and reversible b/ Develop effective and affordable medication

Beijing Feb 25Beijing Feb 25

Tianjin Feb 26Tianjin Feb 26

Shanghai Mar 4Shanghai Mar 4Chongqing Mar 5Chongqing Mar 5

Haerbin Mar 19Haerbin Mar 19

Guangzhou Mar 11Guangzhou Mar 11

Wuhan Mar 12Wuhan Mar 12Nanjing Mar 25Nanjing Mar 25

Shenyang Mar 26Shenyang Mar 26

Jinan Apr 1Jinan Apr 1

Hangzhou Mar 18Hangzhou Mar 18

1st turn

2nd turn

Training programme of the medical staff in the community health care system (Early 2007)

Beijing Sep 10Beijing Sep 10

Shanghai Sep 23Shanghai Sep 23Chendu Sep 16Chendu Sep 16

Haerbin Sep 9Haerbin Sep 9

Guangzhou Oct 8Guangzhou Oct 8

Wuhan Oct 21Wuhan Oct 21Nanjing Sep 17Nanjing Sep 17

Shenyang Oct 14Shenyang Oct 14

Jinan Sep 24Jinan Sep 24

Hangzhou Oct 15Hangzhou Oct 15

1st turn

2nd turn

Training programme of the medical staff in the community health care system (late 2008)

The Launch Meeting of China Asthma Alliance in Zhengzhou, June , 2005

Asthma AllianceImplementation of 2008 GINA Guidelines

Training program of physicians in community level

Knowledge of prevention and management of asthma in the public and media

Development of a simplified guideline available for the rural area (cost-effective)

Boycott fake medicine

Effective and affordable

Carbocisteine, theophylline in COPD

Half of GINA recommended dose in ast

hma

Chinese traditional medicine

THANKS