Manila Philippines BOLD Manila Philippines COPD a growing
Manila, Philippines
BOLD Manila, Philippines COPD a growing cause of morbidity & mortality worldwide 5 th leading cause of death (2001) 3 rd in 2020 (WHO)
BOLD Manila, Philippines Local COPD Burden Paucity of data and only estimates Rural Banca- Banca (1987) 3. 7% Urban San Andres Bukid (1990) 2. 3% Estimate using a mathematical model (1999) 6. 3%
BOLD Manila, Philippines Accurate estimates of the COPD prevalence using standardized methods in population-based studies: to anticipate future burden of disease target key risk factors plan for providing COPD-related health services
BOLD Manila, Philippines Primary Objectives: • Measure the prevalence of COPD and its various risk factors in the city of Manila Secondary Objectives: • Determine extent to which variations in risk factors contribute to variations in the prevalence of COPD Describe the distribution of COPD according to age, sex and smoking history
BOLD Manila, Philippines Eligibility Criteria Residents of the City of Manila Aged 40 years and above Signed informed consent
BOLD Manila, Philippines Study Design • Stratified, three stage cluster sampling City of Manila (population = 1, 568, 092) 6 Districts of Manila sampled zones (by random sampling) (n=27) sampled barangays (random sampling) ( n=54) sampled households (systematic sampling) (n= 965) all eligible members of sampled household (n=1639)
BOLD Manila, Philippines Questionnaires • Validated questionnaires used in multinational studies (1978 ATS/DLD Respiratory Symptom Questionnaire and questionnaires used in the European Community Respiratory Health Study and US Lung Health Study) Linguistic validation through translation and back translation
BOLD Manila, Philippines Spirometry • Data sent to the Pulmonary Function Quality Center in Salt Lake City • To be deemed usable for analysis, spirometry had to meet ATS acceptability and reproducibility criteria Data Management and Analysis • Done at the Operating Center, Portland, Oregon
BOLD Manila, Philippines • Initial training— 05/2005 • Fieldwork— 10/2005 -05/2006 • Participants were selected using a stratified, three -stage cluster sampling design • 918 (58%) completed the full protocol – i. e. , questionnaire & post bronchodilator spirometry • Response rates: – Men 55% – Women 60%
Manila, Philippines Prevalence of ever smoking in population 1 ages >40 by sex Ever smoked 31% 83% Males Females Overall = 55% 1 Unweighted data for the sample of responders
National Nutrition Health Study Prevalence of ever smoking in population 1 ages >20 years (1999) 17% 71% Males Females Overall = 45% Ever smoked
Manila, Philippines Population Prevalence of GOLD Stage I+, GOLD Stage II+ & Doctor Diagnosed COPD *Post BD FEV 1/FVC<70% ** Post BD FEV 1/FVC <70% and post BD FEV 1 <80% ***Includes chronic bronchitis, emphysema or COPD
COPD Prevalence in City of Manila • 12% or 1 out of 8 individuals 40 years and above • Out of 361, 864 individuals (2002 census) 40 years and above, there are 45, 233 COPD patients • 2 -3% doctor-diagnosed COPD highlights importance of spirometry to diagnose COPD
Manila, Philippines Estimated Population Prevalence of GOLD Stage II+ COPD* by age and sex (NHANES) * Post BD FEV 1/FVC <70% and post BD FEV 1 <80%
BOLD Manila, Philippines The prevalence of COPD that is GOLD stage II or higher increases steadily with age for men and women
Manila, Philippines Estimated Population Prevalence of Gold Stage II+ COPD* by pack years and sex * Post BD FEV 1/FVC <70% and post BD FEV 1 <80%
BOLD Manila, Philippines • The relation between prevalence of GOLD stage II + COPD and pack years was evident among males but less clear with women • The fairly high prevalence of GOLD stage II + COPD in the never smokers raise important questions about role of other risk factors
The BOLD Study, Lancet September 2007
CONCLUSIONS • COPD prevalence of 12% is much higher than previous estimates • Smoking prevalence of 55% in the city of Manila may be higher than the national figure • Prevalence of COPD among never smokers is 7% indicating other risk factors
CONCLUSIONS • Relation between prevalence of COPD and pack years was evident in men but less clear in women • Doctor-diagnosed COPD underestimates the true prevalence of the disease
USEFULNESS OF STUDY It is possible to get more accurate estimates of burden of COPD & its risk factors generated from population-based studies using standardized methods Studies like this can help assess the effectiveness of health intervention programs – preventive (anti-smoking), diagnostic (spirometry), or therapeutic (anti-inflammatory drugs) across time and even across different areas in the country
USEFULNESS OF STUDY Assist public health officials in developing best possible primary and secondary prevention policies on COPD for their areas
PHILIPPINE BOLD STUDY WHAT IS NEXT? Rural study in Nueva Ecija Other areas in the Philippines ?
BOLD Manila, Philippines Investigators: Renato B. Dantes, MD Norberto A. Francisco, MD Teresita S de Guia, MD Camilo C. Roa, Jr. , MD Lenora C. Fernandez, MD Luisito F. Idolor, MD Sullian S. Naval, MD Daniel Tan, MD Cecil Tady, MD Fernando Ayuyao, MD Lakan U. Berratio Gerard Garcia, MD Leander P. Simpao, MD Lourdes Amarillo, MSc Ma. Flordeliza Sanchez Thessa Reyes
BOLD Manila, Philippines Acknowledgements: BOLD COLLABORATIVE RESEARCH GROUP A. Sonia Buist, MD William M. Vollmer, Ph. D Robert L. Jensen, Ph. D Suzanne Gillespie, MS Mary Ann Mc. Burnie, Ph. D
BOLD Manila, Philippines SPONSORS OF THE STUDY Philippine College of Chest Physicians Philippine College of Physicians Boehringer Ingelheim (Phil) Glaxo. Smith. Kline United Laboratories (Phil) Altana Pfizer
BOLD Manila, Philippines Thank you!
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