manila, philippines

Manila, PhilippinesManila, Philippines

BOLDManila, Philippines

COPD a growing cause of morbidity & mortality worldwide

5th leading cause of death (2001) 3rd in 2020 (WHO)


Local COPD Burden

Paucity of data and only estimates

Rural Banca- Banca (1987) 3.7%

Urban San Andres Bukid (1990) 2.3%

Estimate using a mathematical model (1999) 6.3%

Accurate estimates of the COPD prevalence using standardized methods in population-based studies:

to anticipate future burden of disease

target key risk factors plan for providing COPD-related health

services


Primary Objectives:

• Measure the prevalence of COPD and its various risk factors in the city of Manila

Secondary Objectives:

• Determine extent to which variations in risk factors contribute to variations in the prevalence of COPD

Describe the distribution of COPD according to age, sex and smoking history


Eligibility Criteria

Residents of the City of Manila

Aged 40 years and above

Signed informed consent


• Stratified, three stage cluster sampling

City of Manila (population = 1,568,092) 6 Districts of Manila

sampled zones (by random sampling) (n=27)

sampled barangays (random sampling) ( n=54)

sampled households (systematic sampling) (n= 965)

all eligible members of sampled household (n=1639)

BOLD Manila, PhilippinesStudy Design

Questionnaires

• Validated questionnaires used in multinational studies (1978 ATS/DLD Respiratory Symptom Questionnaire and questionnaires used in the European Community Respiratory Health Study and US Lung Health Study)

Linguistic validation through translation and back translation


Spirometry

• Data sent to the Pulmonary Function Quality Center in Salt Lake City

• To be deemed usable for analysis, spirometry had to meet ATS acceptability and reproducibility criteria

Data Management and Analysis

• Done at the Operating Center, Portland, Oregon


• Initial training—05/2005

• Fieldwork—10/2005-05/2006

• Participants were selected using a stratified, three-stage cluster sampling design

• 918 (58%) completed the full protocol– i.e., questionnaire & post bronchodilator spirometry

• Response rates: – Men 55%

– Women 60%


Manila, Philippines Prevalence of ever smoking in population1 ages >40 by sex

83%

31%

Ever smoked

1 Unweighted data for the sample of responders

Overall = 55%Overall = 55%

Males Females

National Nutrition Health Study Prevalence of ever smoking in population1 ages >20 years

(1999)

71%

17%Ever smoked

Overall = 45%Overall = 45%

Males Females

Manila, Philippines Population Prevalence of GOLD Stage I+, GOLD Stage II+ & Doctor

Diagnosed COPD

*Post BD FEV1/FVC<70%

** Post BD FEV1/FVC <70% and post BD FEV1 <80%

***Includes chronic bronchitis, emphysema or COPD

9%

14%

20%

12%

7%

19%

2%2%3%

0%

5%

10%

15%

20%

25%

Men Women All

*GOLD 1+

**GOLD 2+

***DoctorDiagnosed

COPD Prevalence in City of Manila

• 12% or 1 out of 8 individuals 40 years and above

• Out of 361,864 individuals (2002 census) 40 years and above, there are 45,233 COPD patients

• 2-3% doctor-diagnosed COPD highlights importance of spirometry to diagnose COPD

Manila, Philippines Estimated Population Prevalence

of GOLD Stage II+ COPD* by age and sex (NHANES)

3%

7%

47%

21%

30%

12%9%

4%

15%

24%

13%

39%

7%

19%

12%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Men Women All

40-49

50-59

60-69

70+

Total

* Post BD FEV1/FVC <70% and post BD FEV1 <80%

The prevalence of COPD that is GOLD stage II or higher increases steadily with age for men and women

BOLD Manila, Philippines

Manila, Philippines Estimated Population Prevalence of Gold Stage II+ COPD* by pack years and sex

* Post BD FEV1/FVC <70% and post BD FEV1 <80%

7% 7%

29%

4%

25%

9% 9%7%

11%

17%

8%

19%

7%

19%

12%

0%

5%

10%

15%

20%

25%

30%

35%

Men Women All

Never Smokers

0-10 pack years

10-20 pack years

20+ pack years

Total

• The relation between prevalence of GOLD stage II + COPD and pack years was evident among males but less clear with women

• The fairly high prevalence of GOLD stage II + COPD in the never smokers raise important questions about role of other risk factors

BOLD Manila, Philippines

Hannover

Guangzhou

Reykjavik

Bergen

Vancouver

Manila

Krakow

Adana

Salzburg

Sydney

Lexington

Cape Town

Site

25.00

20.00

15.00

10.00

5.00

0.00

Pre

vale

nce

Stage III+

Stage II

Cumulative Prevalence of Stages II and III+ (Males and Females)

The BOLD Study, Lancet September 2007

CONCLUSIONS

• COPD prevalence of 12% is much higher than previous estimates

• Smoking prevalence of 55% in the city of Manila may be higher than the national figure

• Prevalence of COPD among never smokers is 7% indicating other risk factors

CONCLUSIONS

• Relation between prevalence of COPD and pack years was evident in men but less clear in women

• Doctor-diagnosed COPD underestimates the true prevalence of the disease

USEFULNESS OF STUDY

It is possible to get more accurate estimates of burden of COPD & its risk factors generated from population-based studies using standardized methods

Studies like this can help assess the effectiveness of health intervention programs – preventive (anti-smoking), diagnostic (spirometry), or therapeutic (anti-inflammatory drugs) across time and even across different areas in the country

USEFULNESS OF STUDY

Assist public health officials in developing best possible primary and secondary prevention policies on COPD for their areas

PHILIPPINE BOLD STUDY

WHAT IS NEXT?

Rural study in Nueva Ecija

Other areas in the Philippines ?


Investigators:

Renato B. Dantes, MD Fernando Ayuyao, MDNorberto A. Francisco, MD Lakan U. Berratio Teresita S de Guia, MD Gerard Garcia, MDCamilo C. Roa, Jr., MD Leander P. Simpao, MDLenora C. Fernandez, MD Lourdes Amarillo, MScLuisito F. Idolor, MD Ma. Flordeliza SanchezSullian S. Naval, MD Thessa ReyesDaniel Tan, MDCecil Tady, MD


Acknowledgements:

BOLD COLLABORATIVE RESEARCH GROUP

A. Sonia Buist, MD

William M. Vollmer, PhD

Robert L. Jensen, PhD

Suzanne Gillespie, MS

Mary Ann McBurnie, PhD

SPONSORS OF THE STUDY

Philippine College of Chest Physicians

Philippine College of Physicians

Boehringer Ingelheim (Phil)

GlaxoSmithKline

United Laboratories (Phil)

Altana

Pfizer



Thank you!

manila, philippines

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