Control of COPD. PawełŚliwiński. Institute of Tuberculosis and Lung Diseases Warsaw, Poland

Transcription

1 Control of COPD PawełŚliwiński Institute of Tuberculosis and Lung Diseases Warsaw, Poland

2 Elements of proper control Recognition Epidemiology Prevention Smoking cessation Early detection Education Physicians Diagnosis Management Patients

3 Some facts about Poland Population: 38,18 mln GDP: USD Life expectancy: F 79y M 71y COPD prevalence: 10% in > 40y old Expenditure on health as % of OECD average: 31% (744 USD)

4 Prevalence of smoking in Poland , adults(>15 years) percentage Males Females year

5 National Program of Early Detection and Prevention of COPD Zieliński J et al., ERJ 2006

6 Target group Setting Intervention Smokers, aged> 40 y Outpatient Chest Clinics Spirometry: FEV 1, FVC Antismoking advice Financing Costs National Health Fund 7 /person screened

7 Structure Ministry of Health Institute of TB and Lung Diseases Chest Clinics National Health Fund (NFZ)

8 Program Flowchart Questionnaire Spirometry FVC, FEV 1, FEV 1 /FVC Physician: evaluation of spirometry, antismoking advice FEV 1 /FVC<0.7 Spirometry normal Referral to family physician for further evaluation and treatment Follow-up after 1 year

9 Results (1) Subjects screened 105,190 Age 54±13 years M/F 57:43 Current smokers 62% Ex-smokers 28% Non-smokers 10% Tobacco exposure 27 ± 12 packyears Airflow limitation 21%

10 Results (2) Airflow limitation mild, FEV 1 >80% N moderate, FEV 1 =80-50% N severe, FEV 1 <50% N severe 69% normal 10% restriction moderate 6.3% 6.9% mild 7.8% AFL 21%

11 Prevention of COPD program launched by NHF Primary care physicians are encouraged to perform spirometry in their patients aged years Smokers (>10 packyears) Chronic cough and/or SOB on exertion All subjects with abnormal spirometry, FEV 1 /FVC< LLN are referred to outpatient chest clinic for spirometry tests to confirm or exclude airways obstruction. Patients with FEV 1 >50% of pred. remain in primary care Patients with FEV 1 <50% of pred. are registered in chest clinic

12 ~ subjects investigated/year COPD diagnosed in ~20% Costs 7 for PCP 12 for chest clinic Detection of 1 COPD ~ 50

13 Polish Society of Phtisiopneumonology Board of PSP established Accreditation Committee in 2003 Main goals: - to work out recommendations and standards for spirometric test - to prepare accreditation criteria for labs and outpatient clinics performing spirometry - to ensure uniform method of performing and interpretation of spirometry all over the country, thus to increase a quality of provided services

14 Accreditation Committee: published standards for spirometry conducted 18 presentations of standards for 1500 physicians in 2005 and physicians were fully trained in 2006 first 5 laboratories obtained accreditation certificate in 2006

15 Association of COPD patients Building an awareness of COPD in Polish population Dissemination of knowledge about COPD Popularization of management methods in COPD Medical advices for COPD patients

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17 School for COPD patients

18 Thank you

19 GOLD 2006 Patients should be identified as early in the course of the disease as possible. However, the benefits of community based spirometric screening, of either the general population or smokers, are still unclear