呼吸疾病的药物干预和控制 钟南山

Interventions for prevention and control of chronic respiratory diseases in ChinaNan Shan Nan Shan ZhongZhong, M.D., M.D. National GARD Initiator, China President, Chinese Medical AssociationPresented by Professor Huahao Shen, M.D., Ph.D, FCCPGeneral informationGARD China NetworkChina Asthma AllianceChina COPD AllianceChina GARD AllianceDept of Chronic Disease Management, Ministry of Public Health, ChinaChinese Thoracic Society CountryNational GARD InitiatorContact Person in Ministry of HealthNational GARD partnersNational GARD sources of fundsP.R ChinaProf. NanSha n ZhongMs Ling-zhi Kong Vice-director Bureau of Chronic Disease Control and Prevention, Ministry of Public Health, Peoples Republic of ChinaNational COPD Alliance National Asthma Alliance Chinese Pediatrics Society Chinese Allergy Society Chinese Society of Ear, Nose and ThroatRMB 16,000,000 (2.1millions US$) From: BI,GSK, AZ, RMB 3,000,000 (400,000 US$) From: 11th National Five- year Plan ProjectGlobal Alliance against Chronic Respiratory Diseases (GARD)Summary of Information on Activities at the Country LevelWhat have we done (Apr 30 , 2006 to present)The First China COPD Alliance Meeting and Second China Asthma Alliance meeting New version of China guideline of asthma and chronic cough Training program of physicians in community level Knowledge of prevention and management of asthma in the public and mediaBiomass fuel in the pathogenesis of COPD Pilot study of early intervention of COPD management in the community level Set up a website in June 2007 (www.chinaasthma.net)What have we done (Apr 30 , 2006 to present)Official Website of China Asthma Alliancewww.chinaasthma.netThe Launch Meeting of China COPD Alliance in Guangzhou, Nov 4, 2006The Launch Meeting of China Asthma Alliance in Zhenzhou, June , 2005Activities on World Asthma Day in big city (Guangzhou)Activities on World Asthma Day in big city (Guangzhou)Activities on World Asthma Day in community(Zhejiang)Professor Nanshan Zhong introduced basic knowledge of Chronic Cough to publicPrevalence and burden of chronic respiratory diseases in China The mortality of top five diseases in some cities and counties 2006 in China8.946.1Trauma and poisoning6.132.4Trauma and poisoning513.971.8Cardiovascul ar disease13.169.3Respiratory diseases416.484.9Respiratory disease17.190.7Cardiovascula r disease320.4105.0Cerebrovasc ular disease17.793.7Cerebrovascul ar disease225.1130.2Malignant tumor27.3144.6Malignant tumor1Percentage %mortality (1/100,000)Death Cause (ICD-10)Percentage %mortality (1/100,000)Death Cause (ICD-10)In CountiesIn CitiesR a n kSurvey cities:Survey cities:Survey cities:Survey cities: 14 sites from 7 cities (Beijing, Shanghai, Tianjin, Shenyang, Xian, Chongqing, Guangzhou 2001-2002)ShanghaiTianjinShenyangXianBeijingChongqingGuangzhouThe prevalence of asthma is 0.5%2.0% in the population in mainland of China.Prevalence of Asthma in ChinaPrevalence of COPD in ChinaSubjects survey: 24,400 (>40y)Response rate: 20245/24400=83%Prevalence of COPD:Male 12.4% Female 5.1% Total 8.2%Prevalence of COPD in China by sex and age05101520253040-49years50-59years60-69years70+yearsprevalence %MaleFemaleTotalMortalityCOPD mortality rates per 10,000 population0102030405060199019911992199319941995199619971998199920002001200220032004China(M)China(M)China(M)China(M)China(F)China(F)China(F)China(F)HongKong(M)HongKong(M)HongKong(M)HongKong(M)HongKong(F)HongKong(F)HongKong(F)HongKong(F)Aus(M)Aus(M)Aus(M)Aus(M)Aus(F)Aus(F)Aus(F)Aus(F)BurdenBurden of Chronic Respiratory Diseases in ChinaA survey from 6 cities in ChinaThe burden of a patient with COPD per year:Direct medical costs: 11,000 RMB (1410 US$)Indirect medical costs: 3,400 RMB (436 US$)Days lost from work: 17 daysData from Professor Quanying He Burden of Chronic Respiratory Diseases in ChinaAverage hospitalization expenditure in 132 patients with COPD during 1998-2004YearCasesAverag hospitalization expenditure1998-1999381820 (RMB) (233 US$)2000-20014429882002-2004*504640#(RMB) (595 US$)# compared with 1998-1999, P<0.01Risk factors of COPD in ChinaEnvironmental factors leading to COPDSmokingOccupational exposureBiomass fuelsBody mass index (BMI)Respiratory infections Others(Host factors )Comparison of COPD Prevalence in Smoker And Non-smokerMale:OR=1.6(1.4Male:OR=1.6(1.4Male:OR=1.6(1.4Male:OR=1.6(1.4- - - -1.9) Female:OR=2.7(2.21.9) Female:OR=2.7(2.21.9) Female:OR=2.7(2.21.9) Female:OR=2.7(2.2- - - -3.9) Total:OR=1.9(1.73.9) Total:OR=1.9(1.73.9) Total:OR=1.9(1.73.9) Total:OR=1.9(1.7- - - -2.2)2.2)2.2)2.2)13.6 11.013.28.84.45.10.05.010.015.0male female total%smokingnever-smokingEffects of tobacco smoking on lung function in subjects with COPD-350-300-250-200-150-100-5002002.92004.32005.32006.32007.3不吸烟不吸烟不吸烟不吸烟 干预前戒烟干预前戒烟干预前戒烟干预前戒烟 干预期戒烟干预期戒烟干预期戒烟干预期戒烟 现吸烟现吸烟现吸烟现吸烟Post hoc analysis, adjusting for gender, age, childhood respiratory inf