Risk factors and impacts of respiratory diseases Flashcards
Define chronic respiratory diseases and identify their global, regional and
Australian prevalence across key age groups
Respiratory Disease
Any diseases or conditions affecting the
respiratory system’s key functions:
1. Pulmonary ventilation: (inflow and outflow of air between
the atmosphere and the lung alveoli);
2. Diffusion of oxygen and carbon dioxide (CO2) between
the alveoli and the blood;
3. Transport of oxygen and carbon dioxide in the blood
and body fluids to and from the body’s tissue cells; and
4. Regulation of ventilation
Respiratory Diseases can be Classified in Different ways
* Duration of respiratory condition ( acute or chronic- acute flareup of ongoing chronic )
* Broad lung zones where the condition is localized: Upper vs Lower Respiratory Tract
Majority of the diseases fall under one of three main categories: OBSTRUCTIVE, RESTRICTIVE, PULMONARY VASCULATURE
CRDs affect the airways and other structures of the lungs.
* Globally, the most common CRDs are chronic obstructive pulmonary disease (COPD), asthma,
occupational lung diseases and pulmonary hypertension.
* CRDs are not curable; the Focus of treatment is on relieving symptoms( shortness of breath, cough
etc) and preventing exacerbation(which can be life-threatening) to improve quality of life.
* Said another way, reducing the DALY associated with the diseases
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Global statistics
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CRD Morbidity(living with disease):
* Close to 545 million people in the world had a chronic
respiratory disease in 2017, an increase of 39·8%
since 1990.
* Most prevalent chronic respiratory diseases were
COPD (3·9% global prevalence-290 million) and
asthma (3·6% global prevalence 262 million people)
* More people live with CRD’s with varying impacts
based on disease/individual health status, care
access etc
CRD Mortality(deaths):
Top causes of CRD-related deaths worldwide
* COPD (3 million annual deaths / 6% of all deaths
world-wide)
* 90% of COPD deaths in <70 years in low- and middle-income countries
* Asthma
* Interstitial lung disease and pulmonary sarcoidosis
second leading cause of death in high-income(as a
group), Latin America and the Caribbean, and
central Europe, eastern Europe, and central Asia
super-regions
Usually in top 3 causes of death in low income countries
Usually top 10 in high income countries
Identify key social, biological, epidemiological, and environmental risk
factors for respiratory disorders focusing on Asthma and COPD
What do the overlapping risk factors for NCD/CRD’s tell us?
* Both often share environmental/behavioural risk factors
(e.g. tobacco, nutrition, indoor and outdoor air pollution, and
sedentary lifestyle)
* Tobacco smoking is the best-identified risk factor for many
non-communicable diseases, including chronic respiratory
disease
Comorbidities (See other q)
Although the absolute estimates of the prevalence and health burden of chronic respiratory diseases increased between 1990
and 2017, there were decreases in age-standardised estimates of prevalence (−14·3%), mortality (−42·6%), and DALYs
(−38·2%) in the same period.
* Smoking accounted for the highest proportion of disability attributable to chronic respiratory disease in all regions for men.
* However, for women, the leading risk factor for disability varied by region: household air pollution from solid fuel use in south
Asia and sub-Saharan Africa, exposure to ambient particulate matter in the southeast Asia, east Asia, and Oceania and the
north Africa and Middle East super-regions, and smoking in all other super-regions
Between 1990 and 2017, the total number of deaths due to chronic respiratory diseases increased by 18.0%, from
3.32 million in 1990 to 3.91 million in 2017.
* Regions with a low Socio-demographic index had the highest mortality and DALYs. The global trends of
mortality and DALY rates for chronic respiratory diseases varied by age, sex, region, and disease pattern
* Smoking remained the major risk factor for mortality due to COPD and asthma.
* Pollution from particulate matter was the major contributor to deaths from COPD in regions with a low Socio-
demographic index.
* Since 2013, a high body mass index has become the principal risk factor for asthma
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Key Results:
* Both socioeconomic and environmental factors impact CRD mortality rates.
* Between 2010 and 2017, approximately 21.4 million people died from chronic respiratory diseases in the
countries studied’
* 1% increase in GDP per capita results in a 20% increase in the CRD mortality rate.
* Mortality increases with greater exposure to PM2.5
* However, an extra year of schooling reduces the mortality rate by 4.79% (− 0.0479).
* Further, rate of urbanization is negatively associated with the CRD death rate (− 0.0252)*
* the impact of pollution on the risk of morbidity due to CRD is greater that its impact on mortality, since urban
areas are expected to offer better access to health care facilities and technologies
Describe chronic respiratory diseases global strategies
Health Care Approach Offers Integrated NCD and CRD care model/pathways
Integrated Care service is one that has moved away from episodic health care to a more holistic approach that puts the
requirements and experience of patients at the centre of how services are planned and provided.
* Integrated chronic care management in a patient-centered approach via multidisciplinary or interdisciplinarity
teams offering care continuity in a seamless manner across care settings and the community.
* Clinical pathways or care pathways: structured multidisciplinary care plans detailing essential steps in patient
care with a specific clinical problem- differ from practice guidelines as they are utilised by a multidisciplinary
team, and focus on the quality and co-ordination of care
* Promoted globally by the World Health Organisation for Low -Mid Income Countries
* HIC are refining integrated care models
In Australia:
* Priority improving access to culturally safe pulmonary
rehabilitation programs for Aboriginal and Torres Strait
Islander people with COPD, and people living in remote
areas of Australia
* Most potentially preventable hospitalisations are
acute deterioration of patients with chronic
conditions.
* Integrated care-differing definitions and integration between
organisations and across sectors(geographies/cultures) is
challenging.
ntegrated management of NCD’s
including CRD’s in Primary Health Care In Low
income Care settings
Image source: WHO PEN Report
https://www.who.int/publications/i/item/9789241598996
* Primarily for use in low-resource settings that have adopted a national
policy framework for prevention and control of NCDs.
* Represents a paradigm shift from a vertical to an integrated approach
* Focuses on proper primary health care programmes targeting vulnerable
and disadvantaged groups
Global public health intiatives for CRDs:
- SDGs targeting risk factors e.g air pollution and smoking rates/exposure (some personal/behavioural guidelines as well, despite the fact that air polllution is a country level issue)
- Lancet three steps: ramp up tobacco pollution controls at local regional global levels, promote early diagnosis and reatement to improve progrnosis, and increaseing resarch
- WHO CRD programme: reduce toll of morbidity, disability and premature mortalitiy related to CRDs especially asthma and COPD (GINA, ARIA, PAL, PEN, GARD)
Discuss the concept of comorbidities with respect to chronic diseases
People with chronic respiratory conditions often have other chronic and long-term conditions.
These ‘comorbidities’ are defined as the concurrent existence and occurrence of two or more medically diagnosed diseases in the same individual, with the diagnosis of each contributing disease based on established, widely recognized criteria.
Comorbidity is not a sequel or complication of one disease but two separate diagnosis may have common underlying risk factors.
Among people aged 45 and over with COPD:
* 55% had arthritis (compared with 33% for people without COPD)
* 43% had asthma (compared with 11% for people without COPD)
Among people aged 45 and over with asthma:
* 49% had arthritis (compared with 32% among people without asthma)
* 17% had COPD (compared with 3.1% among people without asthma)
Among people aged 45 and over with asthma:
*49% had arthritis (compared with 32% among people
without asthma)
*37% had back problems (compared with 24% among
people without asthma)
*34% had mental and behavioural conditions (compared
with 20% among people without asthma)
*17% had COPD (compared with 3.1% among people
without asthma)
Describe chronic respiratory diseases in an Australian context with key
prevention strategies
- top 10 in deaths across all ages/sexes
- in top 10 causes of DALYs across both sexes/all ages
- dropped in leading causes over time
- notably higher in indigenous australians: In 2020, COPD was the fifth leading underlying cause of death in Australia, with 6,311 deaths (3.9% of all deaths) (AIHW 2022a).; Amongst indigenous Australians most respiratory deaths due to COPD(62%), Pneumonia/Influenza (17%) and Asthma (4.6%)
- CRD’s affect almost one-third (31%) of Australians: of the estimated 7.4 million Australians with these
conditions, 4.7 million (19% of the total population) had allergic rhinitis (‘hay fever’); 2.7 million (11%) had
asthma and 2.0 million (8.4%) had chronic sinusitis. - Asthma leading cause of total burden among children aged 1–14.
In these 5% - COPD contributed 48% of the burden of the respiratory disease, and asthma contributed 36%
(together 84% of all respiratory burden due to these conditions) - At the individual disease level: COPD was the fourth leading cause of the total burden of disease;
- Asthma was ranked as the ninth leading cause of total burden overall,
- Ecobomical burden: 3.3% of total disease expenditure; copd 21% of respiratory conditions, asthma 18%
- 2/3s of total heath system spending on copd attributable to smoking alone
Australia National Plan for CRDs
The National Strategic Action Plan for Lung/Airways/respiratory Conditions (is the overarching plan to
advance lung health in Australia.
Eight priority lung condition
* Lung cancer
* Chronic Obstructive Pulmonary Disease (COPD)
* Bronchiectasis
* Respiratory infection Interstitial Lung Diseases (ILD)
* Occupational lung diseases
* Respiratory lung disease overlap (multiple lung
diseases in one person)
* Rare lung conditions, including Cystic Fibrosis (CF)
