1. My conflicts of interest during the last two years GSK has supported my participation in ERS congress 2010 Utrecht, September the 23th 2011

2. Best Practice Finland: COPD Action Programme – 10 year results Anne Pietinalho, Ass. Prof., Dr, FCCP Chief physician, Raasepori Health Care center and a specialist in Filha (Finnish Lung Health Association) Utrecht, September the 23th 2011

3. Backgrounds and goals Utrecht, September the 23th 2011

4. Key points and figures at the start of the program Population: 5.2 million inhabitants Smokers: > 1 million COPD: 200 000 patients Tobacco Legislation : 1977 - Ban on advertising 1995 - Ban on smoking in public places and at work 4 important authorities on the respiratory field gave a proposal to the Ministry of Social Afairs and Health in 1996 COPD Program 1998–2007 Utrecht, September the 23th 2011

5. Goals of prevention and treatment 1. To decrease the incidence of chronic bronchitis. 2. To achieve recovery of as many chronic bronchitis patients as possible. 3. COPD patients feel well, and their capacity for work and function remains good. good. 4. To decrease the proportion of severe and moderate COPD. 5. To decrease the number of bed-days of COPD patients by 25%. 6. To decrease the annual costs per patient. Utrecht, September the 23th 2011

6. Implementation – to whom, how, what and how much? Information for all health care workers & population Multidiciplinary education/training in good collaboration together with Filha, specialized health care, occupational health care and primary health care but also private doctors and nurses were invited training events publications internet based information Training consisted of presentations concerning COPD as a disease, diagnosis (spirometry), treatment, smoking cessation and rehabilitation Totally 900 events for 25 000 health care workers Utrecht, September the 23th 2011

7. What else was ongoing during the time of the program? Asthma Program 1994-2004 EB guide lines 1999 for COPD 2000 for asthma 2002 for smoking cessation 2006 for Non Invasive Ventilation Changes in the health care organization fewer hospital places more outpatient based treatment Stronger tobacco legislation 2003 - tobacco smoke carcinogenic 2007 - ban on smoking in restaurants Utrecht, September the 23th 2011

8. Results (Kinnula V et al Prim Care Resp J 2011;20(2):178-183) Utrecht, September the 23th 2011

9. Knowledges, skills and resources Health care personnel has improved knowledges and skills on COPD improved attitudes towards smokers and COPD patients Population has now better knowledge on COPD Primary health care has improved resources: 700 asthma nurses in primary health care take also care of COPD and smoking cessation tools: PEF-meters and spirometry equipments in all healt care stations Pharmacies have 700 asthma contact persons taking care of COPD and smoking cessation as well Utrecht, September the 23th 2011

10. COPD prevalence among the adults has not risen 1978-1980: males 4.7%, females 2.2% 2000-2001: males 4.3 %, females 3.1% Utrecht, September the 23th 2011 Vasankari TM et al. ERJ 2010

11. Quality of spirometry in the health care – use of recommended reference values and calibration of the equipments Utrecht, September the 23th 2011

12. Hospital days due to COPD in 1997–2007 Utrecht, September the 23th 2011 Number/100 000 Hospital days per 100 000 Men 35-64 years National Institute for Health and Welfare

13. Smoking among adults in Finland Utrecht, September the 23th 2011 p<0.001 Y 2010 M 23% F 16% National Institute for Health and Welfare

14. Retirements due to COPD Social Insurance Institution Utrecht, September the 23th 2011 Retirements due to all

15. Mortality due to COPD YearAllMen% of all 1997105579575 20071 09480674 Utrecht, September the 23th 2011 Statistic Finland

16. Costs due to COPD in Finland milj eur Medicines + Hosp.treat.+ Out patient Tynkkynen et al 2009 Utrecht, September the 23th 2011 88%

17. Costs due to COPD in Finland milj eur Medicines + Hosp.treat.+ Out patient Tynkkynen et al 2009 Utrecht, September the 23th 2011 88%

18. Conclusions The implementation was a hard work but anyhow: COPD is now a relatively well known disease among the population The attitudes, knowledge and skills for COPD, spirometry and smoking cessation among health care personnel have improved and the resources have increased The Program in combination with many other efforts had several positive consequences: stopping increase of COPD prevalence reduction of smoking improving quality of diagnosis reduction of hospitalisations and costs for COPD stopping increase of COPD costs Utrecht, September the 23th 2011

19. Thank you for your attention! Utrecht, September the 23th 2011