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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 sleepdisordered 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 lifeyears (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 influenzarelated 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 middleincome countries
One of the most frequent
reasons for preventable
hospital admissions
among children in highincome 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 middleincome countries
• Countries with the lowest immunization rates account for more than two-thirds of the vaccinepreventable 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 alcoholbased 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