GARD - Czech Experience Burden of Chronic Respiratory Diseases Initiatives for Their Control
V.Kolek Czech Pneumological and Phthiseological Society
Epidemiological burden of respiratory diseases in the Czech Republic (10.2 mil) Tuberculosis: incidence 9.5/100 000 COPD: prevalence 7.78 % (780 000), mortality in men 19.1/100 000, in women 4.9/100 000 Asthma bronchiale: prevalence 8% (800 000), incidence 40 000/y Lung cancer: mortality in men 89/100 000, in women 24/100 000 ILD: incidence of IPF 1.2/100 000, sarcoidosis 2.6/100 000 Pneumonia: hospitalization: 23 000, mortality 22.3/100 000 Bronchiectasis, primary pulmonary hypertension: data not known Cystic fibrosis: 33/100 000 inborns
Notification of TB in CR 1958 - 2005 20000
15000
10000
5000
0 1958 1962 1966 1970 1974 1978 1982 1986 1990 1994 1998 2002
TB according age cohorts /100 000 inhabitants, CR 2005 men
40
20
0 0-4
5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
TB according age cohorts /100 000 inhabitants, CR 2005 women 40
20
0 0-4
5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
Prevalence of COPD stages CR – 2005 8% 0% 31% 23%
38% st.1
st.2
st.3
st.4 231 000 pat.
Prevalence of asthma stages CR - 2005 9% 25%
31%
35% IA
MiPA
MoPA
SA
Number of hospitalized for asthma in the Czech Republic 1995-2004 12000 Total no. of persons
10000 8000
- 34 %
6000 4000 2000 0
Linear (Total no. of persons) 1995 – 9 870 1997 – 8 934 1999 – 8 841 2001 – 8 195
19 95 19 97 19 99 20 01 20 02 20 03 20 04
2002 – 7 234
ÚZIS
2003 – 7 029 2004 – 6 503
Lung cancer mortality in CR year
men
women
1950
1 083
252
1960
3 152
386
1970
4 641
511
1980
5 100
638
1986
5 124
767
1990
4 979
851
1995
4 704
1 091
2000
4 480
1 246
Medical societies and civic associations medical societies ČLS JEP Czech Medical Society of Jan Evangelista Purkyně 34 636 physicians, 102 specialized medical societies, 43 regional associations (360 alergologists, 565 pneumologists) Specialized societies (doctors, health care only) are not independent legislative subjects, they organize medical meetings, postgraduate education, take part in reimbrusment procedures civic associations and patient inciatives ČOPN Czech Civic Association against COPD ČIPA Czech Inciative for AB Being independent legislative subjects (doctors, own administration), they can more effectively educate patients, organize courses, print books, teach self monitoring…
Societies and associations potencially cooperating with GARD Česká společnost pneumologie a ftizeologie ČLS JEP Česká společnost alergologie a klinické imunologie ČLS JEP Pracovní skupina pediatrické pneumologie České pediatrické společnosti ČLS JEP Společnost pro léčbu závislosti na tabáku ČLS JEP Společnost všeobecného lékařství ČLS JEP Odborná společnost praktických dětských lékařů ČLS JEP ---------Národní centrum pro těžké astma (NTA) Správní rada České iniciativy pro astma o.p.s. (ČIPA) České občanské sdružení proti chronické obstrukční plicní nemoci (ČOPN) ----------Klub pro cystickou fibrózu Sdružení pro alergické a astmatické dětí (SAAD), Brno Sdružení na pomoc chronicky nemocným dětem, Praha Nadace ASTMA Sdružení respiriků, Hradec Králové Klub astmatiků, Olomouc
Czech Iniciative for Asthma ČIPA, o.p.s. ČIPA – was founded and established in 1996 as a non-profit NGO by three medical societies – – –
Czech Society of Allergology and Clinical Immunology Czech Society of Pneumology ant Phthiseology Czech Society of Respiratory Physiology and Pathophysiology
Activities – Implementations and acceptance of GINA and ARIA documents in local medical practice – National Guidelines for Asthma Management – Courses: „Asthma Management“ for GPs and for nurses
Czech Association against COPD- ČOPN ČOPN – was founded and established in 2000 as a non-profit NGO by Czech Society of Pneumology and Phthiseology
Activities – ContinuaI implementations and acceptance of GOLD documents in local medical practice – National Guidelines for COPD – Weekend courses: „COPD“ for GPs and for nurses – Fighting for nonsmokers´ rights
Consumption of antiasthmatic medication in the CR in 1999-2005 (DOT – days of treatment) Antiastmatika v ČR 1999 - 2005 v DOT 100% 90% 80%
Theophyllines
70%
Cromoglycates Antileukotrienes
DOT
60%
SABA
50%
Anticholinergics
40%
LABA
30%
ICS
20%
Fixed combination
10%
IMS
DO
T
Ye ar /0 5
Ye ar /0 4
DO
T
Ye ar /0 3 T
DO
DO
T
Ye ar /0 2
Ye ar /0 1
DO
T
Ye ar /0 0 T
DO
DO
T
Ye ar /9 9
0%
Role of pneumologists in GARD We understand GARD activity as an integrated approach, which should be extended to all chronic respiratory diseases, particularly since many of them share similar risk factors. Pneumologists should be reponsible for assessing all respiratory diseases and risk factors globally and to determine the major problems for our society. Information needs to be provided to educate people about risk factors and their effects
Strategy of the Czech GARD To find a cooperating partners from the govermental environment (after the period of political hesitations) To join all medical and civic subjects dealing with CRD To improve the level of respiratory medicine and increase its power in the Czech Republic To inform the public institutions about the huge social burden of respiratory diseases
Visions of Czech pneumologists Continual inovation of respiratory medicine Entering research programmes of national agencies, EU funds, frame programmes Up grading of interventional pneumology Establishing national programme of COPD Co-organisation of national oncological centres Better equipment of therapeutic bronchology centres Discussing changes of the BCG vaccination system Realize a continual care of respiratory diseases
freely breathing society
patients
doctors
political lobbying mass media sponsors
partners
