COPD Asthma

1. Dr SUNDEEP SALVI MD, DNB, PhD(UK)
CHEST RESEARCH FOUNDATION
Pune
WHY DO WE NEED A REFRESHER COURSE
ON OBSTRUCTIVE AIRWAYS DISEASES?
www.crfindia.com

2. LUNGS: THE ORGAN OF RESPIRATION
420 Lts of oxygen delivered every day
350 Lts of carbon dioxide removed every day
10,000 Lts air pass
in and out every 24
hours
10,000 Lts blood
pass every 24
hours

3. WHY DO WE NEED A REFRESHER
COURSE ON
OBSTRUCTIVE AIRWAYS DISEASES?
• Is OAD a major health problem in
India?
• A good history and a good clinical
examination are enough to diagnose
OAD. Or is it not?
• Are we not managing patients with
OAD better in our practice?

4. 0
10000000
20000000
30000000
40000000
50000000
60000000
70000000
Cancer IHD Stroke Diabetes Chronic respiratory
disease
0.6 million
25 million
1 million
28 million
65 million
ESTIMATED MORBIDITY FOR NON COMMUNICABLE
DISEASES IN INDIA
(Nongkynrih B et al, JAPI 2004 Feb; 52: 118-123)
WHO, 2002 data
Asthma
COPD

5. 0
5
10
15
20
25
30
35
ESTIMATED NUMBER OF OBSTRUCTIVE
AIRWAY DISEASE PATIENTS IN INDIA
Million
Asthma
COPD28 million
17 million
35 million
22.2 million
25% 30%
2006 2016
( Murthy KJR, NCMH Background Papers – Burden of Diseases in India, 2005 )

6. PREVALENCE OF ASTHMA IN SCHOOL
CHILDREN IN INDIA
(ISAAC STUDY)
(n = 15,621)
0
5
10
15
20
25
30
35
1979 1984 1989 1994 1999
Pune, Nagpur Bangalore
5 – 6%
Prevalence of asthma in Indian school children
varies from 2% - 30%

7. TOBACCO SMOKING
5- times more harmful
1 cigarette = 1 bidi
Not 15-20%, but close to 50% of smokers develop COPD
1 BILLION SMOKERS WORLD-WIDE

8. NON-SMOKING COPD
70% of Indian homes
50% of COPDs are non-smokers
3 BILLION PEOPLE WORLD-WIDE EXPOSED

9. 0
1
2
3
4
5
6
7
8
Cancer IHD Stroke Diabetes Chronic Resp
diseases
Injuries
2.92
1.20
1.02
0.21
5.77
7.49
ESTIMATED MORTALITY FOR NON COMMUNICABLE
DISEASES IN INDIA
(Nongkynrih B et al, JAPI 2004 Feb; 52: 118-123)
WHO, 2002 data
Number in
lacs

10. 0.0
0.5
1.0
1.5
2.0
2.5
3.0
Coronary
Heart
Disease
Stroke Other CVD COPD All Other
Causes
0.5
1.0
1.5
2.0
2.5
3.0
1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998
–59% –64% –35% +163% –7%
% change in Age-Adjusted Death
Rates, U.S.A., 1965-1998

11. OADs ARE A MAJOR AND
GROWING HEALTH BURDEN
IN INDIA?

12. UNIQUE SET OF RISK FACTORS FOR
OAD IN INDIA

13. HOW DO WE DIAGNOSE
OBSTRUCTIVE AIRWAYS DISEASES IN
CLINICAL PRACTICE?
HOW RELIABLE IS THIS?

14. UNDERDIAGNOSIS OF OLD IN OUT-PATIENT
CLINICS AND COMMUNITY SURVEYS
• American Study – NHANES III, >20,000 US
adults underwent spirometry (1988-1994)
Prevalence of OAD – 8.5%
63.3% under-diagnosis
(NHANES Study, Mannino et al, Arch Int Med 2000; 160: 1683-1689)
• Similar observations in UK, France, Spain and
other European countries
(Huchon, ERJ 2002; Pena, Am J Respir Crit Care Med 2001)

15. • More than 75% of patients with OAD have never
had a spirometry done in their life
• Spirometry is poorly utilized in India
• Myths about of Spirometry in India –
- Not really necessary for diagnosis of OAD
- Expensive test for the patients
- Difficult test to perform
- Difficult test to interpret
- Doesn’t make any difference in the management
of OAD
USE OF SPIROMETRY IN INDIA

16. HOW GOOD ARE WE AT
MANAGING ASTHMA AND COPD IN
CLINICAL PRACTICE?

17. • 420 cases of Obstructive Airways Disease
• 43.8% Asthma; 56.2% COPD
• Exacerbations - Daily: 52.6%
- Monthly: 31.2%
- < 1 mthly: 16.2%
• History of hospital admissions: 52%
• Usual treatment: - Antibiotics: 94.1%
- Oral theophylline: 93.1%
- Parenteral theophylline: 41.9%
- Salbutamol Inhaler: 81.2%
- Steroid Inhaler: 29.3%
- Oral steroids: 23.6%
EXPERIENCE OF OADs BY A CHEST
PHYSICIAN IN MUMBAI
(Kamat SR et al, Lung India, August 2006)

18. Tablet Salbutamol 2-4mg thrice daily
Versus
Inhaled Salbutamol 100-200mcg thrice daily
1000 excess tablets over a period of 6 months

19. 0
10
20
30
40
50
60
UQMP QMP Specialist Institute
Use of pMDI by asthmatic subjects
(Rohtak, India)
Prescribed inhaler Correct use
(n = 1400)
(Gupta PP et al, Ind J Chest Dis Allied Sci 2001; 43: 91-95 )
%

20. (Chest Research Foundation and B.J. Medical College Pune, 2006)
DO MEDICAL PERSONNEL KNOW HOW TO USE
pMDI CORRECTLY?

21. 1. Educate Patients
2. Assess and Monitor Severity
3. Avoid Exposure to Risk Factors
4. Establish Medication Plans for Chronic
Management: Adults and Children
5. Establish Plans for Managing Exacerbations
6. Provide Regular Follow-up Care
Six-Part Asthma Management
Program

22. 0
2000
4000
6000
8000
10000
12000
14000
1995 2000 2005 2010 2015
Current If we follow guidelines
7641 crores
(Murthy KJR et al, NCMH Background Papers, 2005)
ECONOMIC BURDEN OF ASTHMA AND COPD
IN INDIA
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
25,209 crores
1996 2001 2006 2011 2016

23. SUMMARY
• Obstructive Airways Diseases are a major health
burden in India.
• The prevalence of OAD is only going to increase in
the future
• A large number of OADs remain undiagnosed in
clinical practice because of want of use of Spirometry
• Inhalation therapy is poorly used in India
• Patients suffering with OAD in India remain poorly
managed
• Doctors do not communicate effectively with patients
suffering with OADs
• OADs contribute to a huge economic loss in India

24. REFRESHER COURSE ON OBSTRUCTIVE AIRWAYS DISEASE