2. Overview
Chronic respiratory diseases (CRDs) are diseases of the airways
and other structures of the lung.
Some of the most common are chronic obstructive pulmonary
disease (COPD), Asthma, Occupational lung diseases and
Pulmonary hypertension.
In addition to tobacco smoke, other risk factors include air
pollution, occupational chemicals and dusts, and frequent
lower respiratory infections during childhood.
3. Overview
CRDs are not curable, however, various forms of treatment that
help dilate major air passages and improve shortness of breath
can help control symptoms and increase the quality of life for
people with the disease.
Chronic respiratory diseases constitute a public health problem
that impose a substantial burden.
5. What is COPD?
COPD is a common, preventable, and treatable chronic lung
disease which affects men and women worldwide.
Abnormalities in the small airways of the lungs lead to
limitation of airflow in and out of the lungs.
A number of processes cause the airways to become narrow.
There may be destruction of parts of the lung, mucus blocking
the airways, and inflammation and swelling of the airway lining.
6. What is COPD?
COPD is sometimes called “emphysema” or “chronic
bronchitis”.
Emphysema usually refers to destruction of the tiny air sacs at
the end of the airways in the lungs.
Chronic bronchitis refers to a chronic cough with the
production of phlegm resulting from inflammation in the
airways.
COPD and asthma share common symptoms (cough, wheeze,
and difficulty breathing) and people may have both conditions.
7. The impact of COPD on daily life
Common symptoms of COPD develop from mid-life onwards,
including:
Breathlessness or difficulty breathing,
Chronic cough, often with phlegm,
Tiredness.
As COPD progresses, people find it more difficult to carry out
their normal daily activities, often due to breathlessness.
8. The impact of COPD on daily life
There may be a considerable financial burden due to limitation
of workplace and home productivity, and costs of medical
treatment.
During flare-ups, people with COPD find their symptoms
become much worse
Severe flare-ups can be life-threatening.
People with COPD often have other medical conditions such as
heart disease, osteoporosis, musculoskeletal disorders, lung
cancer, depression and anxiety.
9. Causes of COPD
COPD develops gradually over time, often resulting from a combination of risk
factors:
Tobacco exposure from active smoking or passive exposure to second-hand
smoke;
Occupational exposure to dusts, fumes or chemicals;
Indoor air pollution:
o Biomass fuel (wood, animal dung, crop residue) or coal is frequently used for cooking and
heating in low- and middle-income countries with high levels of smoke exposure;
Early life events
o Such as poor growth in utero, prematurity, and frequent or severe respiratory infections in
childhood that prevent maximum lung growth;
Asthma in childhood; and
A rare genetic condition called alpha-1 antitrypsin deficiency, which can
cause COPD at a young age.
10. Epidemiology of COPD
• Chronic Obstructive Pulmonary Disease (COPD) is the third
leading cause of death worldwide, causing 3.23 million deaths
in 2019.
• Over 80% of these deaths occurred in low- and middle-income
countries (LMIC).
• COPD causes persistent and progressive respiratory symptoms,
including difficulty in breathing, cough and/or phlegm
production.
11. Epidemiology of COPD
• COPD results from long-term exposure to harmful gases and
particles combined with individual factors, including events
which influence lung growth in childhood and genetics.
• Environmental exposure to tobacco smoke, indoor air pollution,
and occupational dusts, fumes, and chemicals are important
risk factors for COPD.
• Early diagnosis and treatment, including smoking cessation
support, is needed to slow the progression of symptoms and
reduce flare-ups.
12. Reducing the burden of COPD
There is no cure for COPD but early diagnosis and treatment
are important to slow the progression of symptoms and
reduce the risk of flare-ups.
COPD should be suspected if a person has typical symptoms,
and the diagnosis confirmed by a breathing test called
spirometry, which measures how the lungs are working.
In low- and middle-income countries, spirometry is often not
available and so the diagnosis may be missed.
13. Reducing the burden of COPD
There are several actions that people with COPD can take to improve their
overall health and help control their COPD:
Stop smoking: people with COPD should be offered support to quit
smoking;
Take regular exercise; and
Get vaccinated against pneumonia, influenza and coronavirus.
Flare-ups are often caused by a respiratory infection
People living with COPD must be given information about their condition,
treatment and self-care to help them to stay as active and healthy as
possible.
Inhaled medication can be used to improve symptoms and reduce flare-
ups.
15. What is asthma?
Asthma is a long-term condition affecting children and
adults.
The air passages in the lungs become narrow due to
inflammation and tightening of the muscles around the
small airways.
This causes asthma symptoms: cough, wheeze,
shortness of breath and chest tightness.
16. What is asthma?
These symptoms are intermittent and are often worse at
night or during exercise.
Other common “triggers” can make asthma symptoms
worse.
Triggers vary from person to person, but can include
viral infections (colds), dust, smoke, fumes, changes in the
weather, grass and tree pollen, animal fur and feathers, strong
soaps, and perfume.
17. Asthma is often under-diagnosed and under-treated, particularly in low- and
middle-income countries.
People with under-treated asthma can suffer sleep disturbance, tiredness
during the day, and poor concentration.
Asthma sufferers and their families may miss school and work, with financial
impact on the family and wider community.
If symptoms are severe, people with asthma may need to receive emergency
health care and they may be admitted to hospital for treatment and
monitoring.
In the most severe cases, asthma can lead to death.
The impact of asthma on daily life
18. Epidemiology of Asthma
Asthma is a major noncommunicable disease (NCD), affecting both
children and adults.
Inflammation and narrowing of the small airways in the lungs cause
asthma symptoms, which can be any combination of cough, wheeze,
shortness of breath and chest tightness.
Asthma affected an estimated 262 million people in 2019 and
caused 461000 deaths.
Asthma is the most common chronic disease among children.
19. Epidemiology of Asthma
Inhaled medication can control asthma symptoms and allow people
with asthma to lead a normal, active life.
Avoiding asthma triggers can also help to reduce asthma symptoms.
Most asthma-related deaths occur in low- and lower-middle income
countries, where under-diagnosis and under-treatment is a
challenge.
WHO is committed to improving the diagnosis, treatment, and
monitoring of asthma, to reduce the global burden of NCDs and
make progress towards universal health coverage.
20. Causes of asthma
Many different factors have been linked to an increased risk of
developing asthma, although it is often difficult to find a single,
direct cause.
Asthma is more likely if other family members also have
asthma – particularly a close relative, such as a parent or
sibling.
Asthma is more likely in people who have other allergic
conditions, such as eczema and rhinitis (hay fever).
Urbanisation is associated with increased asthma prevalence,
probably due to multiple lifestyle factors.
21. Causes of asthma
Events in early life affect the developing lungs and can increase the
risk of asthma.
These include low-birth weight, prematurity, exposure to tobacco
smoke and other sources of air pollution, as well as viral respiratory
infections.
Exposure to a range of environmental allergens and irritants are
also thought to increase the risk of asthma,
Including indoor and outdoor air pollution, house dust mites,
moulds, and occupational exposure to chemicals, fumes, or dust.
Children and adults who are overweight or obese are at a greater
risk of asthma.
22. Reducing the burden of asthma
Asthma cannot be cured, but good management with
inhaled medications can control the disease and enable
people with asthma to enjoy a normal, active life.
There are two main types of inhaler:
Bronchodilators (such as salbutamol), that open
the air passages and relieve symptoms; and
Steroids (such as beclometasone), that reduce
inflammation in the air passages.
This improves asthma symptoms and reduces the
risk of severe asthma attacks and death.
23. Reducing the burden of asthma
Access to inhalers is a problem in many countries.
In 2019, only half of people with asthma had access to a
bronchodilator and less than one in five had access to a steroid
inhaler in public primary health-care facilities in low-income
countries.
People with asthma and their families need education to
understand more about their asthma, their treatment, triggers to
avoid, and how to manage their symptoms at home.
It is also important to raise community awareness, to reduce the
myths and stigma associated with asthma in some settings.
25. Indoor air pollution and household energy
Around 2.6 billion people still cook using solid fuels (such as wood,
crop wastes, charcoal, coal and dung) and kerosene in open fires
and inefficient stoves.
These cooking practices are inefficient, and use fuels and
technologies that produce high levels of household air pollution
In poorly ventilated dwellings, indoor smoke can be 100 times
higher than acceptable levels for fine particles.
Exposure is particularly high among women and young children,
who spend the most time near the domestic hearth.
26. Epidemiology of Household air pollution and health
Around 2.6 billion people cook using polluting open
fires or simple stoves fuelled by kerosene, biomass
(wood, animal dung and crop waste) and coal.
Each year, close to 4 million people die prematurely
from illness attributable to household air pollution
from inefficient cooking practices using polluting
stoves paired with solid fuels and kerosene.
27. Epidemiology of Household air pollution and health
Household air pollution causes noncommunicable
diseases including stroke, ischaemic heart disease,
chronic obstructive pulmonary disease (COPD) and
lung cancer.
Close to half of deaths due to pneumonia among
children under 5 years of age are caused by
particulate matter (soot) inhaled from household air
pollution.
28. Impacts on health
3.8 million people a year die prematurely from illness
attributable to the household air pollution caused by the
inefficient use of solid fuels and kerosene for cooking. Among
these 3.8 million deaths:
27% are due to pneumonia
18% from stroke
27% from ischaemic heart disease
20% from chronic obstructive pulmonary disease (COPD)
8% from lung cancer.
29. Impacts on health
Pneumonia
Exposure to household air pollution almost doubles the
risk for childhood pneumonia and is responsible for 45%
of all pneumonia deaths in children less than 5 years old.
Household air pollution is also risk for acute lower
respiratory infections (pneumonia) in adults, and
contributes to 28% of all adult deaths to pneumonia.
30. Impacts on health
Chronic obstructive pulmonary disease
One in four or 25% of deaths from COPD in adults in low-
and middle-income countries are due to exposure to
household air pollution.
Women exposed to high levels of indoor smoke are more
than twice as likely to suffer from COPD than women who
use cleaner fuels and technologies.
Among men (who already have a heightened risk of COPD
due to their higher rates of smoking), exposure to
household air pollution nearly doubles that risk.
31. Impacts on health
Stroke
12% of all deaths due to stroke can be attributed to the
daily exposure to household air pollution arising from
cooking with solid fuels and kerosene.
Ischaemic heart disease
Approximately 11% of all deaths due to
ischaemic heart disease, accounting for over a
million premature deaths annually, can be
attributed to exposure to household air
pollution.
32. Impacts on health
Lung cancer
Approximately 17% of lung cancer deaths in adults are
attributable to exposure to carcinogens from household
air pollution caused by cooking with kerosene or solid
fuels like wood, charcoal or coal.
The risk for women is higher, due to their role in food
preparation.
34. Ambient (outdoor) air pollution
Outdoor air pollution is a major environmental health problem
affecting everyone in low-, middle-, and high-income
countries.
Ambient (outdoor) air pollution in both cities and rural areas
was estimated to cause 4.2 million premature deaths
worldwide per year in 2016;
This mortality is due to exposure to fine particulate matter of
2.5 microns or less in diameter, which cause cardiovascular
and respiratory disease, and cancers.
35. Ambient (outdoor) air pollution
Air pollution is one of the greatest environmental risk to
health.
By reducing air pollution levels, countries can reduce the
burden of disease from stroke, heart disease, lung cancer, and
both chronic and acute respiratory diseases, including asthma.
The lower the levels of air pollution, the better the
cardiovascular and respiratory health of the population will
be, both long- and short-term.
In 2019, 99% of the world population was living in places
where the WHO air quality guidelines levels were not met.
36. Ambient (outdoor) air pollution
Ambient (outdoor air pollution) in both cities and rural areas was
estimated to cause 4.2 million premature deaths worldwide in 2016.
Some 91% of those premature deaths occurred in low- and middle-income
countries, and the greatest number in the WHO South-East Asia and
Western Pacific regions.
Policies and investments supporting cleaner transport, energy-efficient
homes, power generation, industry and better municipal waste
management would reduce key sources of outdoor air pollution.
In addition to outdoor air pollution, indoor smoke is a serious health risk
for some 2.6 billion people who cook and heat their homes with biomass,
kerosene fuels and coal.
37. Primary Prevention Cont.
There are many examples of successful policies in transport, urban
planning, power generation and industry that reduce air pollution:
for industry:
clean technologies that reduce industrial smokestack emissions;
improved management of urban and agricultural waste, including
capture of methane gas emitted from waste sites as an alternative
to incineration (for use as biogas);
for energy:
ensuring access to affordable clean household energy solutions for
cooking, heating and lighting;
for transport:
shifting to clean modes of power generation; prioritizing rapid
urban transit, walking and cycling networks in cities as well as rail
interurban freight and passenger travel; shifting to cleaner heavy-
duty diesel vehicles and low-emissions vehicles and fuels, including
fuels with reduced sulfur content;
38. Primary Prevention Cont.
for urban planning:
improving the energy efficiency of buildings and making cities more green
and compact, and thus energy efficient;
for power generation:
increased use of low-emissions fuels and renewable combustion-free
power sources (like solar, wind or hydropower); co-generation of heat and
power; and distributed energy generation (e.g. mini-grids and rooftop solar
power generation);
for municipal and agricultural waste management:
strategies for waste reduction, waste separation, recycling and reuse or
waste reprocessing; as well as improved methods of biological waste
management such as anaerobic waste digestion to produce biogas, are
feasible, low cost alternatives to the open incineration of solid waste.
Where incineration is unavoidable, then combustion technologies with
strict emission controls are critical
39. WHO Global air quality guidelines
Limits for key air pollutants that pose health risks.
The Guidelines apply worldwide to both outdoor and indoor
environments and are based on expert evaluation of current
scientific evidence for:
Particulate matter (PM)
Ozone (O3)
Nitrogen dioxide (NO2)
Sulfur dioxide (SO2).
