INDICE

ACTIONS AGAINST CHRONIC ACTIONS AGAINST CHRONIC

RESPIRATORY DISEASES (RESPIRATORY DISEASES (CRDsCRDs) IN ) IN

ITALYITALY

STEFANO NARDINISTEFANO NARDINI

Department Pulmonary Disease Department Pulmonary Disease

VittorioVittorio Veneto Hospital (TV), Veneto Hospital (TV),

ITALYITALY

Secretary General, AIMARSecretary General, AIMAR

On behalf of the On behalf of the Centre for Centre for

Diseases Control & PreventionDiseases Control & Prevention

(CCM) of the Ministry of Health(CCM) of the Ministry of Health

CRDsCRDs, CURRENT SITUATION, CURRENT SITUATION

IN ITALYIN ITALY

SMOKING CESSATION SMOKING CESSATION NOT STANDARDISEDNOT STANDARDISED

CRDsCRDs, CURRENT SITUATION, CURRENT SITUATION

IN ITALYIN ITALY

SMOKING CESSATIO

N

SMOKING CESSATIO

N NOT STANDARDISED

NOT STANDARDISED

PRIMARY PREVENTIONPRIMARY PREVENTION

SECONDARY PREVENTIONSECONDARY PREVENTION

TERTIARY PREVENTIONTERTIARY PREVENTION

CRDsCRDs, CURRENT SITUATION, CURRENT SITUATION

IN ITALYIN ITALYPRIMARY PREVENTIONPRIMARY PREVENTION

►► goodgood protectionprotection fromfrom ETS (smoking ETS (smoking banban) and ) and pollutantspollutants (EU (EU lawslaws))

SECONDARY PREVENTIONSECONDARY PREVENTION

►► low community low community awarenessawareness on on CRDsCRDs

►► spirometryspirometry underusedunderused -- CRDsCRDs underdiagnosedunderdiagnosed

►► poorpoor integrationintegration of of primaryprimary care/care/specialistsspecialists -- CRDsCRDsundertreatedundertreated

TERTIARY PREVENTIONTERTIARY PREVENTION

►► COPD COPD diagnoseddiagnosed late in late in itsits coursecourse

►► specialistsspecialists havehave adequateadequate knowledgeknowledge of of existingexistingguidelinesguidelines butbut therethere are are insufficientinsufficient chestchest unitsunits

►► pulmonarypulmonary rehabilitationrehabilitation notnot homogeneouslyhomogeneously delivereddelivered

PRIMARY PREVENTIONPRIMARY PREVENTION

SECONDARY PREVENTIONSECONDARY PREVENTION

TERTIARY PREVENTIONTERTIARY PREVENTION

SMOKING CESSATIO

N

SMOKING CESSATIO

N NOT STANDARDISED

NOT STANDARDISED

CRDsCRDs, CURRENT SITUATION, CURRENT SITUATION

IN ITALY (2007)IN ITALY (2007)

�� National National healthhealth plan plan includesincludes CRDsCRDs asas one of one of itsits

fourfour prioritiespriorities (2006)(2006)

�� A A ““White White paperpaper”” ((““Guadagnare saluteGuadagnare salute””) )

publishedpublished byby the the GovernmentGovernment ((SpringSpring 2007) on 2007) on

howhow toto changechange lifestyleslifestyles toto preventprevent ChronicChronic

DiseasesDiseases (smoking (smoking includedincluded) )

�� RevisionRevision of the list of of the list of diseasesdiseases assistedassisted byby locallocal

healthhealth servicesservices (LEA) (LEA) maymay include smoking include smoking

((underwayunderway May 2007)May 2007)

CRDsCRDs, CURRENT SITUATION, CURRENT SITUATION

IN ITALY (NOW)IN ITALY (NOW)

�� National National healthhealth plan plan includesincludes CRDsCRDs asas one of one of itsitsfourfour prioritiespriorities (2006)(2006)

�� A A ““White White paperpaper”” ((““Guadagnare saluteGuadagnare salute””) ) toto bebepublishedpublished byby the the GovernmentGovernment on on howhow totochangechange lifestyleslifestyles toto preventprevent ChronicChronic DiseasesDiseases(smoking (smoking includedincluded) (2007)) (2007)

�� The list of The list of diseasesdiseases assistedassisted byby locallocal healthhealthservicesservices (LEA) (LEA) nownow includesincludes smoking smoking cessationcessation(DPCM 23/4/2008)(DPCM 23/4/2008)

�� COPD COPD officiallyofficially declareddeclared a a ““Social Social diseasedisease””(total (total reimbursementreimbursement fromfrom NHS NHS forfor drugsdrugs and and assistanceassistance) (DPCM 23/4/2008)) (DPCM 23/4/2008)

GARD IN ITALY (1)GARD IN ITALY (1)

COLLABORATING PARTIES IN GARDCOLLABORATING PARTIES IN GARD--ITALYITALY

►► AIMAR (2005)AIMAR (2005)

►► SIMeRSIMeR (2006)(2006)

►► CCM (MINISTRY OF HEALTH) (2006)CCM (MINISTRY OF HEALTH) (2006)

►► AIPO (2007)AIPO (2007)

►► LIBRA PROJECT (2007)LIBRA PROJECT (2007)

CCMCCM HAS ASSUMED THE ROLE OF COORDINATOR HAS ASSUMED THE ROLE OF COORDINATOR OF GARD IN ITALY, UNDER THE DIRECTION OF OF GARD IN ITALY, UNDER THE DIRECTION OF DONATO GRECO; PAOLO DDONATO GRECO; PAOLO D’’ ARGENIO, GIOVANNA ARGENIO, GIOVANNA LAURENDI LAURENDI COORDINATORSCOORDINATORS

GARD IN ITALY (2)GARD IN ITALY (2)

CCM IS ACTING AS INITIATOR:CCM IS ACTING AS INITIATOR:

►► A MEETING ORGANISED IN ROME WITH MANY A MEETING ORGANISED IN ROME WITH MANY RESPIRATORY SOCIETIES AND PATIENTS RESPIRATORY SOCIETIES AND PATIENTS ORGANISATIONS TO INTRODUCE GARDORGANISATIONS TO INTRODUCE GARD--ITALY (J. ITALY (J. BOUSQUET CHAIRED THE MEETING) (JUNE, BOUSQUET CHAIRED THE MEETING) (JUNE, 2007)2007)

►► A SESSION ON GARD DURING THE AIMAR A SESSION ON GARD DURING THE AIMAR CONSENSUS CONFERENCE IN RESPIRATORY CONSENSUS CONFERENCE IN RESPIRATORY MEDICINE (JOINTLY ORGANISED BY CCMMEDICINE (JOINTLY ORGANISED BY CCM--AIMAR) AIMAR) (N. KALTHAEV CHAIRED THE SESSION) (N. KALTHAEV CHAIRED THE SESSION) (OCTOBER, 2007)(OCTOBER, 2007)

GARD IN ITALY (3)GARD IN ITALY (3)►► EACH SESSION OF EACH SESSION OF

THE C.C. PRODUCED THE C.C. PRODUCED (BY VOTING) A (BY VOTING) A SERIES OF SERIES OF EVIDENCEEVIDENCE--BASED BASED STATEMENTS STATEMENTS ABOUT THE MOST ABOUT THE MOST RELEVANT RELEVANT RESPIRATORY RESPIRATORY MEDICINE MEDICINE ISSUESISSUES……

►► …….WHICH.WHICH WERE PUBLISHED WERE PUBLISHED

IN ISSUE # 2 OF AIMARIN ISSUE # 2 OF AIMAR’’s INDEXED s INDEXED

OFFICIAL JOURNAL, OFFICIAL JOURNAL, MULTIDISCIPLINARY MULTIDISCIPLINARY

RESPIRATORY MEDICINE (MRM) RESPIRATORY MEDICINE (MRM) →→→→→→→→

GARD IN ITALY (4)GARD IN ITALY (4)

►► CCMCCM CALLED FOR AN EXPERT GROUP OF PHYSICIANS CALLED FOR AN EXPERT GROUP OF PHYSICIANS (INCLUDING (INCLUDING G.W.G.W. CANONICA, CANONICA, G.G. VIEGIVIEGI) TO PRODUCE A ) TO PRODUCE A ““WHITE PAPERWHITE PAPER”” ON ON CRDsCRDs IN ITALY (NOVEMBER, 2007)IN ITALY (NOVEMBER, 2007)

►► ON APRIL, 12 2008 ON APRIL, 12 2008 AIMARAIMAR ORGANISED 17 ORGANISED 17 SIMULTANEOUS REGIONAL CONSENSUS CONFERENCES SIMULTANEOUS REGIONAL CONSENSUS CONFERENCES ((““PRIMAVERA AIMARPRIMAVERA AIMAR””-- ““AIMAR SPRINGAIMAR SPRING””) TO ) TO DISSEMINATE THE STATEMENTS ON DISSEMINATE THE STATEMENTS ON CRDsCRDs..

�� THE FIRST PART OF THESE REGIONAL CONFERENCES WAS THE FIRST PART OF THESE REGIONAL CONFERENCES WAS BROADCAST FROM ROME THROUGH VIDEOBROADCAST FROM ROME THROUGH VIDEO--CONFERENCE: CONFERENCE: IT PRESENTED GARD (N. KALTHAEV, SPEAKER) AND ITS IT PRESENTED GARD (N. KALTHAEV, SPEAKER) AND ITS ACTIONS IN ITALYACTIONS IN ITALY

�� THEN DISCUSSION AND VOTING FOLLOWED AT THE LOCAL THEN DISCUSSION AND VOTING FOLLOWED AT THE LOCAL LEVEL. TO STIMULATE THE DISCUSSION:LEVEL. TO STIMULATE THE DISCUSSION:

►►THE THE C.C.C.C. STATEMENTS STATEMENTS

►►DATA FROM THE DATA FROM THE ““SOSSOS--BREATHBREATH”” STUDYSTUDY

SOS BREATHSOS BREATH: THE FIRST STUDY IN ITALY ON : THE FIRST STUDY IN ITALY ON

THE GARD APPROACH TO THE GARD APPROACH TO CRDsCRDs (2006(2006--2007)2007)

►► HealthHealth educationeducation on CRD on CRD

symptomssymptoms

�� TV TV spotsspots (M. Lippi, coach of (M. Lippi, coach of

the National soccer team, the National soccer team,

testimonial)testimonial)

�� LeafletsLeaflets in GP in GP clinicsclinics

►► Professional Professional educationeducation on on

diagnosisdiagnosis and treatment of and treatment of

CRDsCRDs

�� toto GPsGPs

�� toto PulmonologistsPulmonologists

►► SpirometrySpirometry carriedcarried outout

RESULTS RESULTS

►► 414 people 414 people carriedcarried out out spirometryspirometry�� No No CRDsCRDs = 58= 58

�� Asthma=Asthma= 7474

�� COPD= 221COPD= 221

�� CB= 61CB= 61

►► Out of 221 COPD Out of 221 COPD casescases, 208 , 208 (94%) (94%) werewere notnot previouslypreviouslydiagnoseddiagnosed

►► Out of Out of thesethese 208 208 previouslypreviouslyundiagnosedundiagnosed COPD, 175 (84%) COPD, 175 (84%) werewere led led toto spirometryspirometry after the after the campaigncampaign

CONCLUSIONSCONCLUSIONS

►► The GARD The GARD approachapproach isisfeasiblefeasible and and effectiveeffective

►► A A substantialsubstantial underdiagnosisunderdiagnosisof COPD of COPD isis confirmedconfirmed in Italyin Italy

►► OurOur budget budget waswas tootoo low low totoreachreach a a greatgreat numbernumber of of citizenscitizens: : wewe suggestsuggest thatthat --accordingaccording toto NHP NHP -- the the MoHMoHstartsstarts a a campaigncampaign of of preventionprevention/appropriate /appropriate treatment of treatment of CRDsCRDs, , supportedsupported byby scientificscientificsocietiessocieties: :

►► GARD can GARD can bebe of helpof help

GARDGARD--ITALYITALY

A LOOK TO THE FUTUREA LOOK TO THE FUTURECCMCCM

AIMARAIMAR

GARDGARD--ITALYITALY

A LOOK TO THE FUTUREA LOOK TO THE FUTURECCM/RESPIRATORY SOCIETIESCCM/RESPIRATORY SOCIETIES

►► WHITE PAPER ON WHITE PAPER ON CRDsCRDs IN ITALY DUE FOR PUBLICATION IN ITALY DUE FOR PUBLICATION AT END OF 2008. IT WILL BE THE BASIS FOR:AT END OF 2008. IT WILL BE THE BASIS FOR:

►► 20092009--YEAR OF THE BREATHYEAR OF THE BREATH�� ADVOCACYADVOCACY

�� HEALTH EDUCATIONHEALTH EDUCATION

�� PROFESSIONAL EDUCATIONPROFESSIONAL EDUCATION

�� OFFICIAL LAUNCHING OF GARDOFFICIAL LAUNCHING OF GARD--ITALYITALY

AIMARAIMAR

►► AN ANALYSIS OF THE RESULTS OF THE 17 AN ANALYSIS OF THE RESULTS OF THE 17 SIMULTANEOUS REGIONAL CONFERENCESSIMULTANEOUS REGIONAL CONFERENCES

►► AN AUDIT AMONG CHEST PHYSICIANS ON AN AUDIT AMONG CHEST PHYSICIANS ON IMPLEMENTATION OF ERS GUIDELINES ON SMOKING IMPLEMENTATION OF ERS GUIDELINES ON SMOKING CESSATION IN RESPIRATORY PATIENTSCESSATION IN RESPIRATORY PATIENTS

]] On On CRDsCRDs

CONCLUSIONCONCLUSION

In Italy, the GARD model is being implemented by In Italy, the GARD model is being implemented by

CCM with the collaboration of scientific societies. CCM with the collaboration of scientific societies.

We can now develop a We can now develop a comprehensive strategy of comprehensive strategy of

primary and secondary prevention of primary and secondary prevention of CRDsCRDs

gathering all the interventionsgathering all the interventions already carried out already carried out

by the government on specific risks (e.g. tobacco by the government on specific risks (e.g. tobacco

smoking, indoor and outdoor pollution) smoking, indoor and outdoor pollution) that so far that so far

have remained fragmented.have remained fragmented.

We hope that our experience in Italy may be of help We hope that our experience in Italy may be of help

to other European Countries.to other European Countries.

THANK THANK

YOUYOU

Stefano NardiniStefano Nardini