1、,GARD action planGARD 行动计划1- Estimate population need and advocate for action1- 评估公众需求，并为行动做宣传,Estimate population needs and advocate 评估公众需求和宣传WG.1- Burden, risk factors and surveillance 负担，危险因素及监测 WG.2- Awareness and advocacy 认识和倡议,WG.1- Burden, risk factors and surveillance of CRDs and allergies 慢
2、性呼吸病与过敏的负担,危险因素及监测 chairs: G Viegi, S Buist, Y Fukuchi Goals目标To develop a standardized process to obtain data on CRD risk factors, disease burden, trends, quality and affordability of care, and the economic burden that can then be compared between all countries (developed and developing) in order t
3、o define strategies for policy-makers and to assess the impact of a CRD program,- 制定一个标准化方案,获得有关慢性呼吸病的危险因素、疾病负担、趋势、优质与可负担的照护,以及经济学问题的资料,- 以此可在发达国家和发展中国家间作比较,- 为决策者制定策略,- 评价慢性呼吸病方案的影响,WG.2- Awareness and advocay of CRDs and allergies认识和倡议chairs: C Lenfant, A Turnbull, P van Cauwenberge Very important
4、 goal of GARD 很重要的目标提高对慢性呼吸病和呼吸道过敏的认识 在政府、媒体、公众、病人、卫生服务专业人员以及学校和工厂之间进行使慢性呼吸病成为优先的公共卫生问题并列入各个国家的议程,GARD action plan1- Estimate population need and advocate for action2- Formulate and adopt policy2- 阐明与制定政策,Formulate and adopt policy阐明与制定政策WG.3- Prevention and health promotion 预防及健康促进WG.4- Diagnosis o
5、f CRD and allergy 慢性呼吸病和过敏的诊断WG.5- Control of CRD and allergies, Availability and affordability of drugs 慢性呼吸病和过敏的控制, 可用的和用得起的药WG.6- Pediatric asthma 小儿哮喘,GARD Stepwise approach 逐步推进,GARD优先目标,Step 1,Step 2,Step 3,2005,2006,2007,2008,2009,2010,GARD Stepwise approach 逐步推进,GARD优先目标,GARD综合行动计划,Step 1,St
6、ep 2,Step 3,2005,2006,2007,2008,2009,2010,GARD Stepwise approach 逐步推进,GARD优先目标,GARD综合行动计划,Step 1,Step 2,Step 3,2005,2006,2007,2008,2009,2010,各国的试点研究,GARD Stepwise approach 逐步推进,GARD优先目标,GARD综合行动计划,NCD/GARD综合行动计划,Step 1,Step 2,Step 3,2005,2006,2007,2008,2009,2010,各国的试点研究,GARD Stepwise approach 逐步推进,G
7、ARD优先目标,GARD综合行动计划,NCD/GARD综合行动计划,Step 1,Step 2,Step 3,2005,2006,2007,2008,2009,2010,各国的试点研究,各国的GARD行动计划,WG.3- Health promotion and disease prevention健康促进及疾病预防Chairs: M Boland, A CustovicKey messages: 关键宣传词Everyone has the right to live in a clean air environmentEnvironmental exposure to unhealthy e
8、nvironment causes incurable COPD, asthma, cardiovascular disease and cancer Complete elimination is the only way to remove the riskThis applies to tobacco smoke and all other at risk environments,- 人人有权生活在空气清新环境中,- 暴露于不健康的环境会引起不能治愈的慢阻肺, 哮喘，心血管病及肿瘤,- 清除它们是消除这种危险的唯一途径,- 这适用于吸烟和其他各种环境危险因素,WG.3- Health
9、promotion and disease prevention健康促进及疾病预防Goals 目标 帮助所有国家建立和推行能减少以下问题的政策 吸烟室内及室外污染职业危害其他与慢性呼吸病相关的危险因素,http:/www.worldallergy.org/professional/who_paa2003.pdf,Introduction: Definition of Prevention 预防的定义General concepts 一般概念Heredity 遗传Early environmental and immunological factorsPredictive and early d
10、iagnosis 预先及早期诊断Preventive measures 预防手段Education 教育Costs 成本 Guidelines and strength of recommendationsPrimary prevention 一级预防Secondary prevention 二级预防 Tertiary prevention 三级预防Education 教育Patient information sheets 病情登记 (mite, pollen, pet, cockroache, mould allergen avoidance; severe reactions, anap
11、hylaxis, schools, occupational)Educational programmes 教育计划Categories of evidence, strength of recommendations证据分类，强力推荐,早期环境及免疫因素,指南与强力推荐,WG.3- Health promotion and disease prevention 健康促进和疾病预防Biomass fuels 生物燃料,Times Magazine Europe, May 2005,烹饪烟火污染是非洲妇女儿童的主要杀手,WG.4- Diagnosis of CRDs and allergies
12、慢性呼吸病和过敏的诊断Chair: K Rabe, S Wenzel Goals: 目标:推荐简单、有用、价廉的诊断方法 - 逐步进行 - 适应不同的卫生需求、服务及资源 对专业卫生人员提供适当的培训WHO有关GARD的第一步策略,在所有国家的基层卫生保健中开展低价肺活量测定及慢阻肺早期诊断（与FIRS合作） WHO过敏诊断的策略,WG.5- Control of CRDs and allergy and drug accessibility慢性呼吸病和过敏的控制及可用的药物Chairs: J Bousquet, E Bateman, L Fabbri, C van Weel, N Ait-K
13、haledGoals:目标：,改善慢性呼吸病和相关过敏的控制，依靠： 开发、确认与推行简单、价廉的手段 对卫生专业人员进行适当的培训对所有人提供可接受的廉价药,WG.5- Control of CRDs and allergy and drug accessibilityChairs: J Bousquet, E Bateman, L Fabbri, C van Weel, N Ait-Khaled分步骤进行 GARD列入公共卫生计划在适当的地方在当地基层保健中应用PAL 和 PALSA GIFT WHO计划将用于一种可及性、可用性最佳的抗慢性呼吸病药物ADF (哮喘药物工具): 联合使用？,
14、Projected main causes of burden ofdisease (DALYs). All ages, 2005 疾病负担主要原因Preventing Chronic Diseases, a vital investment, WHO, 2005WHO, 2005 慢性病预防，一种生命投资,0,2000,4000,6000,8000,10000,12000,14000,低收入,中低收入,中高收入,高收入,外伤,慢性病,孕产期传染病，营养缺乏,标化年龄 DALYs 100,000,High income,Middle income,Lowincome,In high incom
15、e countries在高收入国家病人可接受适当诊断治疗但诊断治疗不足需要做与病情相应的研究本目标实用于诊断治疗及文化较高的患者 In upper-middle income countries上中等收入少数病人可接受适当诊断治疗本第一目标可减少不够诊断者第二目标可为所有患者提纲可用的廉价药 a syndromic approach (PAL) is needed in many placesIn lower-middle and low income countries very few patients can receive adequate diagnosis and treatmen
16、t the first goals of GARD are to reduce unde-rdiagnosis the second goals of GARD are to provide accessible and affordable treatment for all patients a syndromic approach (PAL) is needed in most placesIn all countries: Health promotion and prevention control by disease-specific approach control by sy
17、ndromic approach no control,GARD policy 政策,High income高收入,Middle income,Lowincome,The arrows indicate the goals of GARD,In high income countries在高收入国家病人可接受适当诊断治疗但诊断治疗不足-需要做与病情相应的研究-GARD目标是更好地诊断治疗及教育患者 In upper-middle income countries few patients can receive adequate diagnosis and treatment the firs
18、t goals of GARD are to reduce under-diagnosis the second goals of GARD are to provide accessible and affordable treatment for all patients a syndromic approach (PAL) is needed in many placesIn lower-middle and low income countries very few patients can receive adequate diagnosis and treatment the fi
19、rst goals of GARD are to reduce unde-rdiagnosis the second goals of GARD are to provide accessible and affordable treatment for all patients a syndromic approach (PAL) is needed in most placesIn all countries: Health promotion and prevention control by disease-specific approach control by syndromic
20、approach no control,GARD policy 政策,High income,Middle income中收入,Lowincome,The arrows indicate the goals of GARD,In high income countries在高收入国家-病人可接受适当诊断治疗-但诊断治疗不足-需要做与病情相应的研究-GARD目标是更好地诊断治疗及教育患者 In upper-middle income countries在中上收入国家 少数病人可接受适当诊断治疗-GARD第一目标是减少漏诊者-第二目标是为所有患者提供可用的廉价药-在很多地方须做对症处理In low
21、er-middle and low income countries very few patients can receive adequate diagnosis and treatment the first goals of GARD are to reduce unde-rdiagnosis the second goals of GARD are to provide accessible and affordable treatment for all patients a syndromic approach (PAL) is needed in most placesIn a
22、ll countries: Health promotion and prevention control by disease-specific approach control by syndromic approach no control,GARD policy 政策,High income,Middle income,Lowincome,The arrows indicate the goals of GARD,In high income countries在高收入国家-病人可接受适当诊断治疗-但诊断治疗不足-需要做与病情相应的研究-GARD目标是更好地诊断治疗及教育患者 In u
23、pper-middle income countries在上中等收入国家少数病人可接受适当诊断治疗-GARD第一目标是减少漏诊者-第二目标是为所有患者提供可用的廉价药-在很多地方须做对症处理In lower-middle and low income countries very few patients can receive adequate diagnosis and treatment the first goals of GARD are to reduce unde-rdiagnosis the second goals of GARD are to provide accessi
24、ble and affordable treatment for all patients a syndromic approach (PAL) is needed in most placesIn all countries: Health promotion and prevention control by disease-specific approach control by syndromic approach no control,GARD policy 政策,High income,Middle income,Lowincome,The arrows indicate the
25、goals of GARD,在高收入国家-病人可接受适当诊断治疗-但诊断治疗不足-需要做与病情相应的研究-GARD目标是更好地诊断治疗及教育患者 在上中等收入国家少数病人可接受适当诊断治疗-GARD第一目标是减少漏诊者-第二目标是为所有患者提供可用的廉价药-在很多地方须做对症处理在中下及低收入国家很少病人可接受适当诊断治疗-GARD第一目标是减少漏诊者-第二目标是为所有患者提供可用的廉价药-在大多数地方须做对症处理In all countries: Health promotion and prevention control by disease-specific approach cont
26、rol by syndromic approach no control,GARD policy 政策,High income,Middle income,Lowincome,The arrows indicate the goals of GARD,在高收入国家-病人可接受适当诊断治疗-但诊断治疗不足-需要做与病情相应的研究-GARD目标是更好地诊断治疗及教育患者 在上中等收入国家很少病人可接受适当诊断治疗-GARD第一目标是减少漏诊者-第二目标是为所有患者提供可用的廉价药-在很多地方须做对症处理在中下及低收入国家-很少病人能接受适当诊断治疗-第一目标是减少漏诊-第二目标是提纲有效价廉药-大
27、多数地方需对症处理In all countries: Health promotion and prevention在所有国家：健康促进和预防 control by disease-specific approach control by syndromic approach no control,GARD policy 政策,在高收入国家病人可接受适当诊断治疗-但诊断治疗不足-需要做与病情相应的研究-GARD目标是更好地诊断治疗及教育患者在上中等收入国家很少病人可接受适当诊断治疗-GARD第一目标是减少漏诊者-第二目标是为所有患者提供可用的廉价药-在很多地方须做对症处理在中下及低收入国家-很
28、少病人能接受适当诊断治疗-第一目标是减少漏诊-第二目标是提纲有效价廉药-大多数地方需对症处理在所有国家首要的是健康促进和预防,High income,Middle income,Lowincome,The arrows indicate the goals of GARD,GARD policy 政策,疾病针对性管理症状针对性管理无管理,Disease management of CRDs慢性呼吸病的处理First list of diseases:一线疾病 asthma / rhinitis 哮喘/鼻炎 COPD 慢阻肺 infections in COPD 慢阻肺继发感染 occupati
29、onal lung diseases 职业性肺病 pulmonary hypertension 肺动脉高压Other diseases: 其他疾病 others to be added 应加入的其他疾病 country-specific requests 某国特有的病,1- increase awareness on asthma (patients and public) 2- improve 改善 management of acute severe asthma 急性重症哮喘的处理 follow-up of asthmatics 哮喘随访 diagnosis and management
30、 of childhood asthma in schools 在学校内对儿童哮喘的诊断和治疗3- increase patient education增加病人教育4- better manage and prevent occupational asthma 改善职业性哮喘的防治5- surveillance of asthma and risk factors 对哮喘及危险因素的监测,加强（病人及公众）对哮喘的认识,WG.6- Pediatric CRDs and allergies儿童慢性呼吸病及过敏Chairs: C Baena-Cagnani, FER Simons, E Valov
31、irtaChildren should be studied separately对儿童应分别研究A major worldwide problem is Childhood Asthma with specificities for each age group 全球的主要问题是各年龄组儿童哮喘的特殊性,GARD action plan1- Estimate population need and advocate for action2- Formulate and adopt policy3- Identify policy implementation steps3- 确认政策实施步骤
32、,Identify policy implementation stepsNational coordination: 政府协调 政府的工作组应：Assess the specific needs for the given country Review the GARD action plan Determine the relevant issues for the country action plan Develop a country-specific action plan,行动计划应与国家的水平相一致,需要建立政府的工作组和政府的协调人,提供目前关于慢性呼吸病和过敏的官方统计数据
33、,对本国的特殊需要作出评估,回顾GARD行动计划,确定与本国行动计划有关的问题,做出本国专用的行动计划,GARD行动计划,政府协调,政府/社团成员呼吸科过敏科五官科全科医生药师其他非政府成员病人卫生部其他可能需要者,Disease management of CRDs慢性呼吸病的疾病管理,12-05,政府行动计划,GARD行动计划,政府协调,政府/社团成员呼吸科过敏科五官科全科医生药师其他非政府成员病人卫生部其他可能需要者,Disease management of CRDs慢性呼吸病的疾病管理,12-05,06-06,卫生部对本计划的签署,政府行动计划,GARD行动计划,政府协调,政府/社团
34、成员呼吸科过敏科五官科全科医生药师其他非政府成员病人卫生部其他可能需要者,Disease management of CRDs,12-05,06-06,12-06,卫生部对本计划的签署,政府行动计划,行动计划,政府协调,政府/社团成员呼吸科过敏科五官科全科医生药师其他非政府成员病人卫生部其他可能需要者,Disease management of CRDs,用成功的指标在选定国试验,12-05,06-06,12-06,Starting 06 to 12-06,患慢性呼吸病和哮喘者达数亿人 每年因而早死者超过4百万人 在所有国家，特别是发展中国家如此 各年龄组都有 患病率与严重性正在增加,Conclusions 结论,Thecost of inaction is clear and unacceptable不采取行动的代价显然是不能接受的,Conclusions结论,
