GARDGARD inin RussiaRussia AndreyAndrey BelevskiyBelevskiy
MD,MD, PhD,PhD, ProfessorProfessor RussianRussian StateState MedicalMedical UniversityUniversity RussianRussian RespiratoryRespiratory SocietySociety GARDGARD inin RussiaRussia
•• PrevalencePrevalence •• GPGP andand SpecialistsSpecialists •• EducationEducation •• ResourcesResources •• NextNext stepssteps Figure 1-1. Asthma Prevalence and Mortality
Permission for use of this figure obtained from J. Bousquet. 2. Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004;59(5):469-78.
3. Beasley R. The Global Burden of Asthma Report, Global Initiative for Asthma (GINA). Available from http://www.ginasthma.org 2004.
Bronchial asthma prevalence in children
City Year Prevalence Novosibirsk 1996 11,1 Novosibirsk 2002 10,8 Irkutsk 1997 10,6 Vladivostok 1998 7,2 Nalchik 1998 9,8 Kazan 1999 8,1 Ulan -Ude 1999 7,6 Tomsk 1999 7,6 Moscow 2000 10,8 Cheboxary 2000 5,6 Yakutsk 2001 12,1 Novokuznetsk 2001 10,7 Kirov 2004 9,0
National program “Bronchial asthma in children”, 2006 BronchialBronchial asthmaasthma prevalenceprevalence inin adultsadults
Ekaterinburg 6,1% SanktSankt---- Peterburg 7,3 %
Moscow Irkutsk 6,3% 5,6% РРО.RRS Руководство….,National guidelines, М.,2005 2005 AsthmaAsthma mortalitymortality
Hospital mortality,% 0.4 0,2 0.3 0,1 0.2 0,4 0.1 0,3 0 96 97 98 99 0 1 2 3 Mortality per 100000
10 8 Ural Region 6 4 8.9 3,1 Ekaterinburg 2 5,5 1,9 0 96 97 98 99 0 1 2 3 Leshchenko, 2006 Hospital mortality in Moscow
5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 1996 2001 2003 2004 2005 2006 COPDCOPD (Moscow)(Moscow)
•• RegistrationRegistration –– 2,2%2,2% •• PrevalencePrevalence (epidemiologic(epidemiologic studies)studies) –– 6,76,7 %%
Shmeleva,Belevskiy, 2005 PrevalencePrevalence summarysummary
•• AsthmaAsthma –– 66--8%8% (children(children upup toto 12%)12%) •• COPDCOPD –– 66--7%7% •• MiscellaniesMiscellanies –– 2%2%
Chronic respiratory diseases: 17-21% 2005 2005 March March - - 2004 2004 Ryazan region of Russia, of region Ryazan Ryazan region of Russia, of region Ryazan October October
Respiratory Diseases Respiratory Diseases WHO Survey WHO Survey Burden Burden of major Burden of major PrevalencePrevalence ofof smokingsmoking byby AgeAge && SexSex ,, %%
Smoking 21А
70 60 50 40 30 20 10 0 м f м f
Adult Children Lung Disease and Respiratory Symptoms Respiratory Symptoms 31%
Current or Low Pulmonary Prior Lung Disease 11% Function 14% EmergenciesEmergencies duedue toto asthmaasthma
7000 140 118 6000 5754 120
5000 100
4000 80
3000 60 1876 2000 40 Emergincesperyear Status asthmaticus Status 1000 21 20
0 0 1997 2005 1997 2005
Emergency station report 1997, 2005. Irkutsk Emergencies due to asthma in Moscow
Year Total Asthma %
2001 2302578 41918 1,8
2002 2341012 41143 1,7
2003 2389775 39777 1,6
2004 2436033 33609 1,4
2005 2322752 29259 1,3 Number of nebulizers in emergency cars in Moscow
140
120
100
80
60
40
20
0 2000 2002 2004 2006 NATIONAL PROJECT “IKAR” (2002-2006) HRQLHRQL inin Asthma,Asthma, COPDCOPD andand PopulationPopulation
80
70
60
50 COPD 40 Asthma Population 30
20
10
0 FA RF P GH V SA RE MH GPGP prioritiespriorities
•• ArterialArterial hypertensionhypertension •• HeartHeart diseasedisease •• StrokeStroke •• GastrointestinalGastrointestinal diseasedisease •• ProblemsProblems ofof oldold ageage •• RespiratoryRespiratory diseasedisease
Belevskiy, 2006 GPGP knowledgeknowledge
CorrectCorrect answersanswers CardiologyCardiology RespiratoryRespiratory medicinemedicine 19981998 67%67% 18%18% 20062006 7373 %% 6262 %%
Novikov, Belevskiy 2006 EducationEducation
•• VeryVery broadbroad spectrumspectrum ofof educationaleducational activityactivity forfor GPsGPs andand respiratoryrespiratory specialistsspecialists •• RussianRussian ResearchResearch InstituteInstitute ofof PulmonologyPulmonology •• RussianRussian StateState MedicalMedical UniversityUniversity •• StandardStandard educationaleducational programprogram forfor GPsGPs andand specialists.specialists.
NumberNumber ofof chestchest specialistsspecialists differsdiffers veryvery muchmuch
•• MoscowMoscow -- 265265 •• SanktSankt --PeterburgPeterburg –– 5656 •• EkaterinburgEkaterinburg –– 1010 •• KazanKazan -- 22 ResourcesResources
•• ReimbursementReimbursement listlist forfor respiratoryrespiratory medicinemedicine isis avaiavailablelable •• FinancialFinancial situationsituation forfor itit isis unstableunstable andand differsdiffers dependingdepending ofof regionregion •• VeryVery weakweak linkslinks withwith MinistryMinistry ofof HealthHealth andand ParliameParliamentnt •• RespiratoryRespiratory medicinemedicine isis notnot includedincluded inin NationalNational ProjectsProjects NextNext stepssteps
•• NationalNational GARDGARD BoardBoard launchlaunch -- 20072007 (?)(?) •• NationalNational GARDGARD programprogram developmentdevelopment –– 20072007 --20082008 •• CooperationCooperation withwith GovernmentGovernment andand ParliamentParliament -- immediatelyimmediately