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Respiratory Diseases

Overview

• Breathing and our respiratory health are generally taken for granted

• Lung - vital organ vulnerable to airborne infection and injury

• Respiratory diseases are among the leading causes of death and disability in the world

• Altogether, more than 1 billion people suffer from either acute or chronic respiratory conditions

• Five of these diseases are among most common causes of severe illness and death worldwide

• About 65 million people suffer from chronic obstructive pulmonary disease (COPD) and 3 million die from it each year, making it the third leading cause of death worldwide

• About 334 million people suffer from asthma, the most common chronic disease of childhood affecting 14% of all children globally

Overview

• Pneumonia kills millions of people annually and is a leading cause of death among children under 5 years old

• Over 10 million people develop tuberculosis (TB) and 1.4 million die from it each year, making it the most common lethal infectious disease

• Lung cancer kills 1.6 million people each year and is the most deadly cancer

• At least 2 billion people are exposed to indoor toxic smoke, 1 billion inhale outdoor pollutant air and 1 billion are exposed to tobacco smoke

Overview

In addition to these five, there are several respiratory disorders whose burden is great but less well quantified

• More than 100 million people suffer from sleep- disordered breathing

• Millions live with pulmonary hypertension

• More than 50 million people struggle with occupational lung diseases

Respiratory diseases account for more than 10% of all disability-adjusted life- years (DALYs)

Respiratory Diseases and Children

• Infants and young children are particularly susceptible

• Approximately 9 million children under 5 years old die annually, and pneumonia is the world’s leading killer of these children

• In spite of its huge toll on human life, relatively few global resources are dedicated to tackling this problem

• Mortality due to childhood pneumonia is strongly linked to malnutrition, poverty and inadequate access to health care

• More than 98% of pneumonia deaths in children occur in 68 countries where progress in reducing under-five mortality is most critical

Acute Respiratory Diseases

• Influenza - Serious global health threat that impacts all countries

• Annually, an estimated 1 billion cases, 3-5 million severe cases, and 290,000-650,000 influenza- related respiratory deaths worldwide

• Respiratory tract infections caused by influenza cost between US $71 and 167 billion annually

• Coronaviruses - large family of viruses that can cause diseases in humans, ranging from the common cold to Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and the current COVID-19 pandemic

Chronic Obstructive Pulmonary Disease (COPD)

• 65 million of whom have moderate or severe airway disease

• Studies show it is underdiagnosed by 72 to 93%

• Misdiagnosis is also common

Affects more than 200 million people globally

• Direct cost is 6% of total healthcare spending (€38.6 billion annually) in the European Union

• Accounts for 56% of the total cost of treating respiratory diseases

High economic cost high

Chronic Obstructive Pulmonary Disease (COPD)

Tobacco smoking - Most important factor leading to COPD

Causes destruction of lung tissue (emphysema) and obstruction of the small airways with inflammation and mucus

Leads to the cardinal symptoms of COPD (shortness of breath and cough)

Indoor and outdoor air pollution, inhaled tobacco smoke and occupational dust, genetic syndromes, childhood, pneumonia and other diseases that involve the airways (such as chronic asthma and TB) are also factors contributing to the development of COPD

COPD Prevention

First and most important priorities to prevent COPD - Discouraging individuals

from starting to smoke tobacco and encouraging

smokers to reduce and quit smoking

Indoor pollution - Smoke from burning fuel inside

• Chimney cook stoves and other devices that decrease indoor smoke exposure lessen the risk of respiratory infections in children and potentially the incidence of COPD in nonsmokers, particularly in women

Childhood vaccines and prompt recognition and

treatment of lower respiratory tract infections will minimize airway injury that predisposes to COPD

in adulthood

Management of childhood asthma, controlling

occupational exposure to dust and fumes, avoiding outdoor air pollution, and

other environmental controls could also have substantial benefits in reducing the burden of

COPD

Asthma

• Incidence increasing for the past three decades

•Affects all ages, races and ethnicities

•Wide variation exists in different countries and in different groups within the same country

Affects up to 334 million people worldwide

•Results in consistent burden on health system Most common chronic

disease in children

•Underdiagnosis and under-treatment are common, and effective medicines may not be available or affordable

More severe in children living in poor countries

•Less information is available from low- and middle- income countries

One of the most frequent reasons for preventable

hospital admissions among children in high-

income countries

Asthma

Accounts for more than 30% of all pediatric hospitalizations and nearly 12% of readmissions within 180 days of discharge

Asthma causes about 489,000 deaths per year or more than 1,300 deaths per day

Recent evidence indicates that children with asthma may have abnormal lung growth and are at risk for developing lifelong respiratory compromise and COPD

Asthma Causes

• The causes of the increase in global prevalence of asthma are not well understood

• Genetic predisposition, exposure to environmental allergens, indoor and outdoor air pollution, lower respiratory tract infection early in life, airway microbiome makeup, dietary factors and abnormal immunological responses may promote the development of asthma

• The timing and level of exposure to allergens, infection or irritants may be major factors leading to the development of disease

• Early viral infections and passive tobacco smoke exposure have been associated with the development of asthma in young children

• Airborne allergens and irritants associated with asthma occur in the workplace and can lead to chronic and debilitating disease among workers if the exposure persists.

Asthma Prevention

The cause of most asthma cases are unknown

No effective strategy for primary prevention

Potentially modifiable risk factors for development of asthma include:

• Avoiding smoking during pregnancy and avoidance of passive smoke exposure after birth can reduce asthma severity in children.

• Early removal of allergens or irritants may lead to better control of the disease

Little evidence for effective single-strategy indoor allergen avoidance interventions in adults outside the occupational context except for:

• Remediation of dampness and mold

Use of maintenance controller medication can effectively prevent recurrent asthma attacks with a resultant decline in lung function and has been clearly shown to reduce mortality and hospitalizations

Asthma Control and Elimination

Additional research is needed to better understand the earliest origins of asthma, causes of exacerbations and reasons for its rising prevalence in many countries

Making quality-assured inhaled corticosteroids, bronchodilators and spacer devices widely available at an affordable price, and educating people with asthma about the disease and its management are key steps in improving outcomes for people with asthma

Strategies to reduce indoor air pollution, smoke exposure and respiratory infections will improve asthma control and reduce the need for healthcare utilization.

Acute Respiratory Tract Infection

• Lower respiratory tract infection and pneumonia are two of the leading causes of death

• Accounts for more than 4 million fatalities annually

• Important cause of death in low- and middle-income countries

• Kills more people than human immunodeficiency virus (HIV), TB and malaria combined

• Leading cause of death in children under 5 years of age outside the neonatal period

• Pneumonia killed 739,000 children aged under 5 years in 2019,

• Accounts for 15% of the deaths in this age group

• Also the second leading cause of years of life lost due to premature mortality and one of the most frequent reasons for hospitalization

Pneumonia

Risk factors include being very young or elderly, crowded living conditions, malnutrition, HIV infection, lack of breastfeeding in infants, lack of immunization, chronic health conditions and exposure to tobacco smoke or indoor air pollutants

Streptococcus pneumoniae – most frequent bacterial cause of pneumonia

• Kills more than 300,000 children aged under 5 years annually

• HIV infection increases the risk of pneumonia caused by this organism twentyfold

• Incidence of severe disease has declined with better immunization and the use of antiretroviral therapy.

Can also lead to other chronic respiratory diseases

Viral Respiratory Infections

Viral respiratory infections can occur in epidemics and spread rapidly within communities across the globe

Annually, influenza leads to respiratory tract infections in 5–15% of the population and severe illness in 3–5 million people

Respiratory syncytial virus (RSV) is the most common cause of acute respiratory infection in children, causing almost 34 million episodes annually

More than 90% of deaths from RSV respiratory infection in children occur in low- and middle-income countries

Childhood Viral Respiratory Infection Prevention

• Childhood respiratory disease can be prevented or ameliorated by several measures:

• Improving childhood nutrition and promoting breastfeeding (both of which improve immune status); ensuring comprehensive immunization; improving living conditions to prevent crowding; avoiding tobacco smoke exposure from the time of conception through childhood; reducing indoor air pollution; treating or preventing HIV infection; giving prophylactic antibiotics in immunosuppressed children; and preventing mother-to-child HIV transmission

• Several of these measures are also appropriate for respiratory disease prevention in adults

• Vaccination is one of the greatest achievements of modern public health

• Many children are not immunized against preventable infections particularly in low- and middle- income countries

• Countries with the lowest immunization rates account for more than two-thirds of the vaccine- preventable disease burden and have the highest childhood mortality

Preventing Respiratory Diseases Through Vaccines

• Essential for the control and elimination of many of these respiratory diseases

• The development of new vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b have been important advances in preventing pneumonia

• Vaccines against bacteria, such as S. pneumoniae, H. influenzae type b and whooping cough (pertussis) are highly effective for preventing lower respiratory tract infections

• The influenza vaccine is effective in preventing influenza viruses currently circulating within communities

Emerging respiratory pathogens

Ominously, new respiratory pathogens are emerging

These events can stress national healthcare systems, leading to widespread disaster

Respiratory viruses can spread quickly because of the ease of transmission, as has been seen in past influenza pandemics

In 2003, severe acute respiratory syndrome (SARS), caused by a previously unrecognized coronavirus, rapidly spread throughout the world

• Due to its lethality, mobilized international efforts that rapidly identified the cause and the method of spread

• Stringent infection control measures reduced its spread effectively and no further cases were identified

Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (Middle East Respiratory Syndrome coronavirus, or MERS‐CoV) that was first identified in Saudi Arabia in 2012

• 27 countries reported cases of MERS

• 80% of human cases were reported by Saudi Arabia

• Approximately 34% of reported patients with MERS-CoV died

Novel Coronavirus Disease (2019) COVID-19

• COVID-19 is the infectious disease caused by the most recently discovered coronavirus

• This new virus was unknown before the outbreak began in Wuhan, China, in December 2019

• COVID-19 is now a pandemic affecting practically all countries globally

Current COVID-19 Situation (As of Sept 18, 2022) • Please note that these numbers change on a daily basis. For the latest

numbers, please access the following link. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html# /bda7594740fd40299423467b48e9ecf6

• Total Cases (Global) – ~612 million

• Total Deaths (Global) – ~6.5 million (1.1% mortality rate) • Has declined from a peak of 6.9% since the vaccine’s introduction

• Total Cases (U.S.) – ~95.6 million

• Total Deaths (U.S.) – ~1.05 million (1.1% mortality rate)

Symptoms and Transmission

• The most common symptoms of COVID-19 are fever, dry cough, and fatigue

• Some patients may have aches and pains, nasal congestion, sore throat or diarrhea

• These symptoms are usually mild and begin gradually

• Some people become infected but only have very mild symptoms

• Most people (about 80%) recover from the disease without needing hospital treatment

• Around 1 out of every 5 people who gets COVID-19 becomes seriously ill and develops difficulty breathing

• Older people, and those with underlying medical problems like high blood pressure, heart and lung problems, diabetes, or cancer , are at higher risk of developing serious illness

• However anyone can catch COVID-19 and become seriously ill

• Even people with very mild symptoms of COVID-19 can transmit the virus

• People of all ages who experience fever, cough and difficulty breathing should seek medical attention

COVID-19 Transmission

• People can catch COVID-19 from others who have the virus

• The disease spreads primarily from person to person through small droplets from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes, or speaks

• These droplets are relatively heavy, do not travel far and quickly sink to the ground

• People can catch COVID-19 if they breathe in these droplets from a person infected with the virus • It is why it is important to stay at least 2 meters (6 feet) away from others

• These droplets can land on objects and surfaces around the person such as tables, doorknobs and handrails • People can become infected by touching these objects or surfaces, then touching their eyes, nose

or mouth • It is why it is important to wash your hands regularly with soap and water or clean with alcohol-

based hand rub

COVID-19 Transmission

• COVID-19 is mainly spread through respiratory droplets expelled by someone who is coughing or has other symptoms such as fever or tiredness

• Many people with COVID-19 experience only mild symptoms

• This is particularly true in the early stages of the disease

• It is possible to catch COVID-19 from someone who has just a mild cough and does not feel ill

• Some reports have indicated that people with no symptoms can transmit the virus • It is not yet known how often it happens.

Close Contact

• If you have been in close contact with someone with COVID-19, you may be infected

• Close contact means being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case

• If you have close contact with someone recently diagnosed with COVID-19, it is best to stay at home

• If you or someone you know tested positive for COVID-19, self-isolate for 5 days even after symptoms have disappeared as a precautionary measure

Additional COVID-19 Information

• For additional information and resources visit https://www.cdc.gov/coronavirus/2019-ncov/index.html

• Global COVID-19 Dashboard https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html# /bda7594740fd40299423467b48e9ecf6

Tuberculosis (TB)

• In 2020 – 9.9 million new cases of TB.

• 1 million were children

• Likely to be an underestimate because the diagnosis of pediatric TB is challenging

• In 2020 – An estimated 157,000 new cases of multidrug-resistant TB

• Among new cases of TB, 11% of people also had coinfection with HIV

• In 2020, TB killed 1.5 million people

• Greatest single infectious agent cause of death and a leading cause of overall deaths globally

• When combined with HIV, another 400,000 people were killed

• Twenty countries accounted for 84% of the cases of TB

TB Prevention

In no disease is the phrase “treatment is prevention” truer than with TB

Factors promoting the spread of infection relate to the chance that an uninfected individual is exposed to a person with infectious TB

• The more cases in the community, the more likely it is that an individual will become infected

Factors promoting the development of disease in infected individuals generally relate to the function of the immune system

• The most potent factor causing an exposed person to develop active tuberculosis is infection with HIV, but other conditions that affect immunity, such as certain medications and the presence of poorly controlled diabetes, also increase the risk of developing active disease

TB Prevention

By identifying persons who either have or highly likely to have latent infection and treating those who have conditions that

increase the risk of disease, the likelihood of developing active TB can be substantially reduced

TB lies dormant because the infection is contained by the body’s immune system, but it can become active at any point in a

person’s lifetime

Inhaling only a few tuberculous bacteria can result in infection

Only about one in 10 people infected with Mycobacterium tuberculosis will develop active disease

•Rate is much higher in young children and people with immunodeficiency conditions

Lung Cancer

Remains the most common type of cancer globally

• An estimated 2.2 million new cases in 2020

• Most (58%) cases occurred in less developed regions

Also the most fatal cancer globally

• In 2020, 1.8 million people died from lung cancer

• Accounts for nearly a fifth of the total cancer deaths

If lung cancer has spread to other organs, the 5-year survival is only about 13%

Lung Cancer

Tobacco smoke causes most cases of lung cancer

• Damages DNA and mutating protective genes.

• Risk correlates with the amount and duration of smoking

• Since DNA-damaged genes accumulate over time, lung cancer may occur years after people begin or quit smoking

Currently, more former smokers than smokers worldwide, but former smokers are not free from cancer risk

Lung cancer can also occur in people who have never smoked

• Other non-smoking risk factors include passive exposure to tobacco smoke (second-hand smoking), biomass fuel, diesel exhaust, radon, asbestos, and other environmental and workplace carcinogens

Lung Cancer Prevention

Largely preventable through tobacco control

Public programs that reduce smoking are effective, but more are urgently needed, especially in countries where smoking is increasing because the incidence of lung cancer follows increased smoking

Environmental causes of lung cancer, such as radon and asbestos, can be monitored and reduced

Producers of asbestiform materials should have increased regulations to minimize or eliminate exports of their carcinogenic material

Countries must not be allowed to export asbestos to poorer countries

Other known modifiable risk factors, such as biomass fuels, diesel exhaust and air pollution, must also be addressed

Additional research is also needed to determine other causes of lung cancer and how to translate this knowledge into effective health policy