General Meeting of the Global Alliance against Chronic

General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD) and GARD Launch 28 -29 March 2006 – Beijing, People’s Republic of China Wednesday, 29 March 2006 Session 2: Working Groups. Chairmanship, composition, 2005 annual report, 2006 action plan and indicators

The Lancet 2005; 366: 1514

Horton, The Lancet 2005

Strong et al, Lancet 2005

Epping-Jordan et al, Lancet 2005

Reddy et al, Lancet 2005

Fan Wu et al, Lancet 2005

Presidents of respiratory societies participating in FIRS

Chapman et al, ERJ 2006

Lopez et al, ERJ 2006

Mannino et al, ERJ 2006

Menezes, Lancet 2005

Respir Med. 2003 Feb; 97(2): 115 -22. Not 15 but 50% of smokers develop COPD? --Report from the Obstructive Lung Disease in Northern Sweden Studies. Lundback B, Lindberg A, Lindstrom M, Ronmark E, Jonsson AC, Jonsson E, Larsson LG, Andersson S, Sandstrom T, Larsson K; Obstructive Lung Disease in Northern Sweden Studies. In 1996, 5892 of the Obstructive Lung Disease in Northern Sweden (OLIN) Study's first cohort could be traced to a third follow-up survey, and 5189 completed responses (88%) were received corresponding to 79% of the original cohort from December 1985. Of the responders, a random sample of 1500 subjects were invited to a structured interview and a lung function test, and 1237 of the invited completed a lung function test with acceptable quality. In ages >45 years, the prevalence of COPD according to the BTS guidelines was 8%, while it was 14% according to the GOLD criteria and approximately a half of elderly smokers fulfilled the criteria for COPD according to both the BTS and the GOLD criteria. Of those fulfilling the BTS criteria for COPD, 94% were symptomatics, 69% had chronic productive cough, but only 31% had prior to the study been diagnosed as having either chronic bronchitis, emphysema, or COPD. The corresponding figures for COPD according GOLD were 88, 51, and 18%.

CHEST 2005

Lindberg et al, CHEST 2005

2005

Johannessen, IJTLD 2005

WG-1: Epidemiology and Surveillance (G Viegi): Chair: G. Viegi, Italy (ERS); Co-Chairs: S. Buist, USA (GOLD), Y. Fukuchi (APSR). WHO-Liaison Officers: E. Mantsouranis. Proposed initial composition: I. Annesi (ERS), R. Beasley (? ), P. Burney (GA 2 LEN), W. Canonica (WAO), B. Chipps (ACAAI), E. Duran (ERS), J. Jardim (ALAT), D. S. Kim (APSR), A. Kocabas (TTS), C. Lai (AAAF), Lee Todd (BOLD), B. Lundback (ERS), J. Mallol (? ), D. Mannino (ATS? ), D. Nugmanova (WONCA), J. A. Odhiambo (IUATLD? ), R Pawankar (ARIA? ), J Vestbo (ERS).

2005 Annual report The WG chairpersons have participated in the preparatory meetings held in Geneva and Copenhagen and have indicated the major needs in terms of epidemiology and surveillance of CRD and allergies. They have discussed the Terms of References of GARD. They have also identified the human resources needed to carry out the action plan, once the GARD budget has been established.

General Objective The goal of this WG is to develop a standardized process to obtain data risk factors, disease burden, trends, quality and affordability of care and the economic burden of chronic respiratory diseases (CRD) and allergies that can then be compared across countries.

Aims: 1. Use WHO programmes and non-WHO programmes to make an inventory of existing studies/reports that have collected data on prevalence, risk factors, severity, and economic burden of chronic respiratory diseases. 2. Collect these data at a country-based level. 3. Expand WHO internal initiatives (routine statistics, information systems, projection models) to cover respiratory and allergic diseases.

Plan of work (I): 1. Develop the methodology and selection of key words. 2. Review the literature published in the last 10 years. 3. Calculate the PAR (Population Attributable Risk) for host and environmental factors. 4. Include these data in the Info base of WHO.

Plan of work (II): 5. Develop and test methods for estimating the economic burden of chronic respiratory diseases. 6. Validate the existing models aimed at forecasting disease prevalence and economic burden. 7. Identify standardized methods for prevalence surveys for the CRD of interest and establish standards for carrying out these surveys. 8. Develop risk charts for educational purposes.

Action Plan Year 1 (I) Once the WG is fully established and the necessary work force recruited, the first activity will be a full description of the epidemiology of COPD This is motivated by the COPD epidemic that is largely unrecognized at governmental level and challenged by the misuse of common indicators such as death certificates. The first work to be carried out will be: 1. Definition of the methodology and selection of key words.

Action Plan Year 1 (II) 2. Review of the literature published in the last 10 years. An important basis for enlisting existing data on COPD prevalence will be the article of Halbert RJ et al (Chest 2003), and an updated systematic review and meta analysis, also by Halbert et al (in Press in ERJ) A review and updating of this paper, if necessary, will be the first task of WG 1.

Action Plan Year 1 (III) 3. Review of existing and ongoing initiatives and projects, e. g. : BOLD, ERS White Book, GINA Global Burden of Asthma, Healthy people 2010 goals for respiratory diseases (NHLBI), IMCA (Indicators for monitoring COPD and asthma in the EU), ISAAC, PLATINO, 2003 NHLBI Fact Book, 2003 NHLBI Chart Book, South African Thoracic Society plan to develop an “African White Book”.

Action Plan Year 1 (IV) 4. Dissemination of the outcome of the Task Force on Simple Spirometry, carried out by the Forum of International Respiratory Societies (FIRS) (due to finish in the fall of 2006).

Deliverables: 1. 1. An inventory of recent studies (published in the last ten years) with COPD prevalence data. 1. 2. Definition of standardized methods needed to carry out comparable epidemiological surveys on CRD and allergic diseases of interest.

References: 1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990 -2020: Global Burden of Disease Study. Lancet 1997 May 24; 349(9064): 1498 -504. 2. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet 2003 Sep 13; 362 (9387) : 847 -52. 3. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, Schmid V, Buist S. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006 Feb; 27(2): 397 -412. 4. He J, Gu D, Wu X, Reynolds K, Duan X, Yao C, Wang J, Chen CS, Chen J, Wildman RP, Klag MJ, Whelton PK. Major causes of death among men and women in China. N Engl J Med 2005 Sep 15; 353(11): 1124 -34.

References: 5. Wagner PD, Viegi G, Luna CM, Fukuchi Y, Kvale PA, El Sony A. Major causes of death in China. N Engl J Med 2006 Feb 23; 354(8): 874 -6; author reply 874 -6. 6. Halbert RJ, Isonaka S, George D, Iqbal A. Interpreting COPD prevalence estimates: what is the true burden of disease? Chest 2003 May; 123(5): 1684 -92. 7. Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? A multiple cause coding analysis. Eur Respir J 2003 Nov; 22(5): 809 -14. 8. Viegi G, Matteelli G, Angino A, Scognamiglio A, Baldacci S, Soriano JB, Carrozzi L. The proportional Venn diagram of obstructive lung disease in the Italian general population. Chest 2004 Oct; 126(4): 1093 -101. 9. Celli BR, Halbert RJ, Isonaka S, Schau B. Population impact of different definitions of airway obstruction. Eur Respir J 2003 Aug; 22(2): 268 -73.

References: 10. Mannino DM, Watt G, Hole D, Gillis C, Hart C, Mc. Connachie A, Davey Smith G, Upton M, Hawthorne V, Sin DD, Man SF, Van Eeden S, Mapel DW, Vestbo J. The natural history of chronic obstructive pulmonary disease. Eur Respir J 2006 Mar; 27(3): 627 -43. 11. Fukuchi Y, Nishimura M, Ichinose M, Adachi M, Nagai A, Kuriyama T, Takahashi K, Nishimura K, Ishioka S, Aizawa H, Zaher C. COPD in Japan: the Nippon COPD Epidemiology study. Respirology 2004 Nov; 9(4): 458 -65. 12. Menezes AM, Perez-Padilla R, Jardim JR, Muino A, Lopez MV, Valdivia G, Montes de Oca M, Talamo C, Hallal PC, Victora CG; PLATINO Team. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet 2005 Nov 26; 366(9500): 1875 -81 - Halber RJ, Natoli JL, Gano A, Badamgarav E, Buist AS and Mannino DM. Global Burden of COPD : Systematic review and meta-analysis Eur Resp J 2006, in Press

CHEST 2003; 123: 1684 - 1692

1 -2 digits TO BE CONTINUED 1/3 CHEST 2003; 123: 1684 - 1692

1 -2 digits TO BE CONTINUED 2/3 CHEST 2003; 123: 1684 - 1692

1 -2 digits <1 digit CHEST 2003; 123: 1684 - 1692

CHEST 2003; 123: 1684 - 1692

Eur Respir J 2003; 22: 268 -273

FEV 1/FVC <70% (GOLD) Lower limit of normal $ Self-report NHANES III Study Celli et al, ERJ 2003 $ = ERS/ATS 2005

2° edition: in preparation

Needed human resources 1. Job description: Consultants in epidemiology: selection of usable prevalence studies and countries for new surveys. Consultants in biostatistics: PAR and risk charts calculations and models verification. Consultants in health economics: burden calculations. Consultant in information system: liaison with in-house WHO initiatives. 2. Work-force needed (to be budgeted): One full-time Ph. D in Epidemiology. One half-time Ph. D in Biostatistics. One part-time Ph. D in Economics. One part-time expert in Information system.