1. Chronic respiratory diseases: burden, population and interventions,
focus on LMIC
(Dr. Eugene Zheleznyakov, Technical Officer, Chronic Disease Prevention and Management, WHO, Geneva)

2. 4 000 000 PEOPLE DIED FROM CHRONIC RESPIRATORY DISEASES
Did you know??
PEOPLE DIED FROM CHRONIC RESPIRATORY DISEASES
IN 2005

3. Chronic respiratory diseases worldwide
Main NCDs include:
Cardiovascular diseases mainly heart disease and stroke
Cancer
Chronic respiratory diseases
Diabetes

4. Projected disease deaths and burden. 2005
Preventing Chronic Diseases, a vital investment, WHO, 2005
Main causes of
global burden of
disease (DALYs)
Main causes
of death
Communicable diseases
Maternal/perinatal
Nutrional deficiencies 7%
Cardiovascular
Cancer 4%
CRD
Diabetes
Other chronic diseases
Injuries

5. Chronic respiratory diseases worldwide
Hundreds of millions of people have
chronic respiratory diseases
including 300 million people with
asthma
210 million people with chronic obstructive pulmonary disease (COPD)
Millions of people with allergic rhinitis, sleep apnoea syndrome and other chronic respiratory diseases

6. Chronic Respiratory Diseases
Year of estimate
Prevalence
Asthma
2007
300 million
COPD
210 million
Allergic rhinitis
400 million
Sleep apnea
>100 million
Others
2006
>50 million 8

7. Lower Respiratory Infections
Burden of Major Respiratory Conditions
Condition
Deaths
DALYs* % %
Lower Respiratory Infections
COPD
Tuberculosis
Lung/
Bronchus
/Trachea Cancer
Asthma
Respiratory conditions impose an enormous burden on society.
According to the WHO World Health Report 2000, the top five respiratory disease account for 17.4% of all deaths and 13.3% of all disability-Adjusted Life Years (DALYs).
Total
*DALYs = Disability-Adjusted Life-Years
Source: World Health Report 2003

8. Chronic respiratory diseases
4 million people die each year from CRD
And in 2030:
COPD: 4th cause of death (Plos Med 2006)
Tobacco > 8 million deaths (Plos Med 2006)
Biomass fuel combustion > 10 million deaths (Ezzatti, Science 2005)
> 50% of the world population will be allergic

9. What are DALYs? DALY = YLD + YLL Disability Adjusted Life Years YLL
One DALY: one lost year of “healthy” life
DALY = YLD + YLL 55 65 75
COPD
onset
death
expected
YLL
Years of Life Lost
Years of Life
with Disability
YLD 50
Respiratory conditions impose an enormous burden on society.
According to the WHO World Health Report 2000, the top five respiratory disease account for 17.4% of all deaths and 13.3% of all disability-Adjusted Life Years (DALYs).
age (years)

10. Increasing Burden of Diseases and Injuries:
Change in Rank Order of DALYs*
*DALYs = Disability-Adjusted Life-Years
Source: WHO Evidence, Information and Policy, 2005
*DALYs: Disability Adjusted Life Years

11. Age-standardized disability-adjusted life year (DALY) rates from respiratory diseases by country (per 100,000)
Canuckguy et al. 2009

12. WHO global approach to control Chronic Respiratory Diseases

13. 16

15. The aim of the WHO chronic respiratory diseases programme as a part of NCD programme is to support member states in their efforts to reduce the toll of morbidity, disability and premature mortality related to chronic respiratory diseases, and specifically, asthma and chronic obstructive pulmonary disease (COPD).
Objectives:
Better surveillance to map the magnitude of chronic respiratory diseases and analyze their determinants with particular reference to poor and disadvantaged populations, and to monitor future trends.
Primary prevention to reduce the level of exposure of individuals and populations to common risk factors, particularly tobacco, poor nutrition, frequent lower respiratory infections during childhood, and environmental air pollution (indoor, outdoor, and occupational).
Secondary and tertiary prevention to strengthen health care for people with chronic respiratory diseases by identifying cost-effective interventions, upgrading standards and accessibility of care at different levels of the health care system.

16. May 2010

20. Framework Convention on Tobacco Control (FCTC)
As for 1As for 17 December 2004: 47 countries have
ratified the treaAs for 17 December 2004: 47 countries have
ratified the treaty. On 27 February 2005:
the FCTC has entered into force and has become
an International law.
ty. On 27 February 2005:
the FCTC hasAs for 17 December 2004: 47 countries have
entered into force and has become
7 December 2004: 47 countries have
Today the FCTC has 140 parties
(16 November 2006)

21. 
Reducing NCD risk factors

22. 
Reducing NCD risk factors

23. 
Reducing NCD risk factors

24. Source: World Health Report, 2002

25. Source: World Health Report, 2002

26. EUROPE versus AFRICA The relative importance of Tobacco Smoke
and other risk factors relevant for COPD
Opposite patterns in different geographic areas
EUROPE versus AFRICA
Source: World Health Report 2002

27. EUROPE
Disease burden (DALYs) in 2000 attributable to selected risk factors
Indoor smoke from solid fuels
Unsafe water, sanitation, and hygiene
Underweight
Childhood sexual abuse
Urban air pollution
Occupational risk factors for injury
Iron deficiency
Unsafe sex
Lead exposure
Illicit drugs
Physical inactivity
Fruit and vegetable intake
High Body Mass Index
Cholesterol
Alcohol
Tobacco
Blood pressure
Number of Disability-Adjusted Life Years (000s)
Urban air
pollution
5000
10000
15000
20000

28. Indoor pollution AFRICA
Disease burden (DALYs) in 2000 attributable to selected risk factors
10000
20000
30000
40000
50000
60000
70000
Fruit and vegetable intake
Occupational risk factors for injury
Global climate change
Unsafe health care injections
Cholesterol
Tobacco
Lack of contraception
Blood pressure
Alcohol
Iron deficiency
Indoor smoke from solid fuels
Zinc deficiency
Vitamin A deficiency
Unsafe water, sanitation, and hygiene
Underweight
Unsafe sex
Number of Disability-Adjusted Life Years (000s)
Indoor pollution
Lead exposure

29. Multisectoral collaboration
Multilateral Bilateral Agencies
Educational Sector
Professional Associations
Communities, churches, religious leaders
Multisectoral collaboration
Patient Groups
Private sector, media
CRD and public health experts
Related Ministries
NGOs

30. Global Alliance against Chronic Respiratory Diseases
Web site: