Public Health Aspect in

Respiratory Health
Problem (COPD case)

Department of Public Health & Preventive Medicine

Faculty of Medicine Universitas Brawijaya
2018
DEFINITION

a disease state characterized by airflow limitation

Progressive and associated with an abnormal

inflammatory response of the lungs to noxious particles
and gases
OVERVIEW

is one of the leading causes of morbidity &

mortalitas worldwide

Prevalence of COPD cases in several countries

such as America and Europe ranges from 5-9 % in
2000

Southeast Asia  the highest cases are in the

country of Vietnam (6.7%)

Indonesia  no accurate data. However, based

on research conducted in 2002, estimated the
prevalence of COPD in Indonesia of 5.6 %.
Indentify Hazard

• Age
• Gender
Hereditery • Genetic

• Smoking
Behaviour
 • Occupational exposure
(textile, mine)
Environment • Air pollution (indoor /outdoor)

• Programs to prevent COPD <<

Health • Screening
service
Faktor Risiko
 Prevention of COPD
Approximately 75% of COPD cases are
attributed to cigarette smoking.
Occupation-related exposures may
account for another 15% of COPD cases
and genetic factors, asthma,
respiratory infections, and indoor and
outdoor exposures to air pollutants also
play a role.
Thus, COPD largely can be prevented.

CDC, 2011
 Prevention of COPD
Avoidance of environmental factors
 Environmental tobacco smoke (ETS) /
passive exposure to cigarette smoke
 Smoking bans and restrictions
 Community education to reduce ETS in home
 Occupational dusts and chemicals
 Organic and inorganic dusts and chemical
agents and fumes—use of masks/respirators in
high-exposure occupations
 Indoor air pollution
 Burning of other biomass fuels such as wood,
animal dung, crop residues, and coal in open
fires or poorly functioning stoves
 Outdoor air pollution
 Ozone, particulate matter
Jindal, 2006
Secondary Prevention

Secondary prevention focuses on

prevention of acute exacerbations

An acute exacerbation is defined as …

“an event in the natural course of the

disease characterized by a change in the
patient’s baseline dyspnea, cough, and /or
sputum that is beyond normal day-to-day
variations, is acute in onset and may
warrant a change in regular medication”

Rabe 2007
Secondary Prevention
Exacerbations are thought to be related to
an interaction of host factors, bacteria,
viruses, and changes in air quality,
leading to increased inflammation of the
lower respiratory tract.

Early recognition and treatment of acute

exacerbations can significantly reduce:
 Morbidity
 Poor health-related quality of life
 Health care expenditures
 Mortality related to this disease

White, 2003; Rohde, 2003

Secondary Prevention
Risk factors for exacerbation
 Age: older than 65 years
 FEV1 ≤ 50% of predicted
 ≥ 3 exacerbations in past 12 months
 Poor physical activity
 Poor social support
 Comorbidities
 Coronary disease
 Heart failure
 Diabetes
 Renal failure
 Hepatic failure

 Low body weight: body mass index (BMI) ≤ 20 kg/m2

Garcia-Aymerich, 2001
Secondary Prevention
Methods for secondary prevention
 Avoidance of environmental factors
 Lowering risks for exacerbation
 Immunization strategies
 Pulmonary rehabilitation
 Long-term oxygen therapy and other
pharmacologic interventions
 Screening
Secondary Prevention:
Environmental Factors
 Ozone, sulphur dioxide, nitrogen dioxide, and
particulate matter including diesel particulates
 Increase airway inflammation
 Stimulate production of pro-inflammatory cytokines,
neutrophil production, and methylhistamine
 Potentially lead to exacerbations

 Epidemiologic studies have shown …

 Increased hospitalization rates when atmospheric
pollution high
 Increased risk of death in COPD patients with
increased urban particle air pollution

White, 2003; Laumbach, 2010

Secondary Prevention
Improvement in certain modifiable risks
associated with COPD exacerbations
may serve to prevent evere
exacerbations
 Better control of comorbidities
 Heart failure
 Cardiac ischemia
 Diabetes
 Renal and hepatic failure

 Physical activity and improved fitness

 Maintain body weight (BMI > 20 kg/m2)
McCrory, 2001
Secondary Prevention
Immunization strategies
 Influenza vaccine
 Annual vaccination reduces total number of
exacerbations, outpatient visits, and
hospitalizations (SOR: A)
 Pneumococcal vaccine
 Vaccination recommended for all patients
with COPD, and those with FEV1 < 40% (SOR:
C)

Poole, 2008; Menon, 2008; Granger, 2007

THANK YOU