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									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
Horton, The Lancet 2005
Horton, The Lancet 2005
Strong et al, Lancet 2005
Strong et al, Lancet 2005
Strong et al, 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
Chapman et al, ERJ 2006
Chapman et al, ERJ 2006
Chapman et al, ERJ 2006
Chapman et al, ERJ 2006
Lopez et al, ERJ 2006
Lopez et al, ERJ 2006
Lopez et al, ERJ 2006
Lopez et al, ERJ 2006
Lopez et al, ERJ 2006
Lopez et al, ERJ 2006
Mannino 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
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 (GA2LEN), 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
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.

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

The first work to be carried out will be:

1. Definition of the methodology and selection of key
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
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).

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.
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.
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-
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.
10. Mannino DM, Watt G, Hole D, Gillis C, Hart C, McConnachie 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
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

                      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
                                     FEV1/FVC <70%

                                     Lower limit of normal $


             Celli et al, ERJ 2003
NHANES III                           $ = 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 PhD in Epidemiology.
One half-time PhD in Biostatistics.
One part-time PhD in Economics.
One part-time expert in Information system.

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