RISK FACTORS FOR CHRONIC RESPIRATORY …

1 37 RISK FACTORS FOR CHRONIC RESPIRATORY DISEASES9. Causes and Consequences of CHRONIC RESPIRATORY DiseasesKEY MESSAGES Many risk FACTORS for CHRONIC RESPIRATORY diseases have been identifi ed and can be risk FACTORS include:tobacco smokesecond hand tobacco smokeother indoor air pollutantsoutdoor air pollutantsallergensoccupational agents. Possible risk FACTORS include:diet and nutritionpost infectious CHRONIC RESPIRATORY diseases. Many risk FACTORS of CHRONIC RESPIRATORY diseases among those of CHRONIC diseases have been identifi ed (Table 14).The causes of the CHRONIC RESPIRATORY diseases are well known (Figure 16). The most important modifi able risk FACTORS are: tobacco use, other exposures Each million people die as a result of raised blood pressure million people die as a result of tobacco use million people die as a result of raised cholesterol levels million people die as a result of low fruit and vegetable consumption million people die as a result of being overweight or obese million people die as a result of physical inactivity million people die as a result of being exposed to solid a Includes acute RESPIRATORY infections and CHRONIC RESPIRATORY diseases.

2 Source: references 1 and 14 Risk FACTORS for CHRONIC RESPIRATORY diseases among those of CHRONIC diseases38 RISK FACTORSto indoor and outdoor air pollutants, allergens, occupational exposure, and to a lesser extent than for other CHRONIC diseases, unhealthy diet, obesity and overweight intake and physical risk FACTORS In attempting to reduce risks to health, the fi rst steps are to quantify the health risks and to assess their distribution. The risk FACTORS for CHRONIC RESPIRATORY diseases are presented in Tables 15 and accumulation with agePopulations are ageing in most low and middle income countries, against a background of many unsolved infrastructural problems. In the 1960s, people Figure 16 Causes of CHRONIC RESPIRATORY diseasesSource: reference socioeco-nomic, cultural, political and environmental determinantsGlobalizationUrbanizationPop ulation ageingWesternizationCommon modifiable risk factorsUnhealthy dietPhysical inactivityTobacco useIndoor air pollutionOutdoor air pollutionAllergensOccupational agentsNon-modifiable risk factorsAgeHeredityIntermediate risk factorsRaised blood pressureRaised blood glucoseAbnormal blood lipidsOverweight/obesityImpaired pulmonary functionAllergic sensitizationMain CHRONIC diseasesHeart diseasesStrokeCancerChronic RESPIRATORY diseasesDiabetesAllergic diseasesHigh mortality developing countryLow mortality developing countryDeveloped countryMalesFemalesMalesFemalesMalesFema lesTotal DALYs 42141222318511897 Tobacco(% of total) (% of total) (% of total) (% of total) (% of total) (% of total) smoke from solid air airborne <.

3 Reference 15 Disability-adjusted life years (DALYs) (in millions) attributable to various risk FACTORS , by level of socioeconomic development and sex, 200039aged 60 years and over constituted only a small minority, but their number is increasing rapidly. Ageing is a process associated with CHRONIC and disabling diseases (Figure 17). CHRONIC RESPIRATORY diseases are among the most frequent and severe of all, also in the low and middle income countries, those who spent a large part of their lives in an urban setting tended to have unhealthier lifestyles and therefore a higher risk of CHRONIC diseases compared with their less urbanized counterparts. An exception to this rule may arise from exposure to indoor air pollution in rural areas where solid fuels are used for cooking and general women live longer with CHRONIC diseases than men, although they are in poor health (271). The costs associated with health care, including user fees, are a barrier to women s use of services.

4 Women s income is lower than High mortality developing countryLow mortality developing countryDeveloped countryMalesFemalesMalesFemalesMalesFema lesTotal deaths (% of total)(% of total)(% of total)(% of total)(% of total)(% of total) smoke from solid air airborne < : reference 16 Mortality (in millions) attributable to various risk FACTORS , by level of socioeconomic development and sex, 2000 Figure 17 Risk accumulation: a life approach to CHRONIC diseasesSource: reference ofchronic disease risk Fetal Infancy Adolescence Adult life life and childhoodDevelopment of CHRONIC diseasesAge40 RISK FACTORS that of men, and they have less control over household resources. CHRONIC RESPIRATORY diseases require regular use of medicines. Therefore they are no exception to this low and middle income countries, the exposure of women and children to biomass fuels is of great concern. Improving the health of women in developing countries is one of the key Millennium Development Goals (272).

5 Several features related to gender constitute specifi c risk FACTORS for CHRONIC RESPIRATORY diseases. For example, in many low income countries women are more exposed to the smoke of biomass fuels used for cooking, whereas in some other regions men are more often smokers. These explain some of the differences in the prevalence of asthma, allergic diseases and CHRONIC obstructive pulmonary Tobacco Smoking: The Major Threat in High Income Countries, As Well As in Low And Middle Income CountriesKEY MESSAGES Exposure to tobacco smoke, both the active and second hand, is a major threat to people in high income countries, as well as in low and middle income countries, because of its close link with noncommunicable and communicable cumulative effect of tobacco smoke and other air pollutants increases the risk for CHRONIC RESPIRATORY diseases. The spread of the tobacco epidemic is facilitated through a variety of complex FACTORS with cross-border effects, including trade liberalization and direct foreign investment.

6 Other FACTORS such as global marketing, transnational tobacco advertising, promotion, lobbying and sponsorship, as well as international smuggling and counterfeit cigarettes, also contribute to the explosive increase in tobacco of tobacco use among 13 15 year old school children are high. The Global Tobacco Surveillance System collaborative group has recently analysed a sample of 747 603 adolescents from different countries and continents. They report the frequency of current tobacco use to vary from in the Western Pacifi c Region, to in the Americas, for a global average of While in general girls smoke less than boys, both in the Americas and in Europe, in the leading regions in smoking youngsters, the frequency is almost the same between genders (273).Figure 18 The four stages of the tobacco epidemicSource: reference 274and female deaths%malesmokers%maledeaths%femaledeat hs010203040506070 80 90 100706050403020100403020100 Stage 1 Stage 2 Stage 3 Stage 4 Perc entage of smokers amo ng adultsPerc entage of deaths c aused by smoking Sub Saharan China Eastern Europe Western Europe Africa Japan Southern Europe USA South-East Asia Latin America Canada Latin America Australia North Africa42 RISK FACTORSS moking: the well-known killerThe report on The Millennium Development Goals and tobacco control: an opportunity for global partnership (274) summarizes the health effects of smoking.

7 Tobacco is the second risk factor causing death after high blood pressure. The annual number of deaths from tobacco, estimated at nearly > +Source: reference 19 Burden of disease attributable to selected environmental risk FACTORS (percentage of DALYs in each subregion): (a) tobacco; (b) indoor smoke from solid fuels; (c) urban air pollutionProportion of DALYs attributable to selected risk factor(a) Tobacco(b) Indoor smoke from solid fuels(c) Urban air pollution435 million in 2000, was divided almost equally between high income and low and middle income countries (275). On current trends, mortality will increase to million a year by 2030, and 80% of these deaths will occur in low and middle income countries (276) (Figures 18 and 19).The leading causes of death from smoking are cardiovascular diseases ( million deaths annually), CHRONIC obstructive pulmonary disease (1 million deaths annually) and lung cancer ( million deaths annually) (275).

8 Patterns of death and disease from tobacco vary depending on the country s level of development (Figure 20).In the United States, vascular disease and lung cancer predominate. In China, CHRONIC obstructive pulmonary disease causes more tobacco-related deaths than lung cancer. In India, with almost half the world s tuberculosis deaths, smoking exacerbates the effects of tuberculosis, and causes a greater risk of death. Tobacco is also responsible for a large portion of the disease burden in low and middle income countries and is the largest contributor to DALYs lost in high income countries (278). Manufactured cigarettes, as well as all other products of smoked tobacco ( cigars, or other traditional products like waterpipes, kreteks and bidis) are not the only form of tobacco that carries signifi cant risk (279). All tobacco products are harmful and addictive and all can cause disease and death (280, 281).Smokeless tobacco products ( chewing tobacco, snuff, Swedish snus gutkha and other oral smokeless tobacco) used by many poor people and especially Figure 20 Burden of disease attributable to tobacco and indoor smoke from solid fuelAttributable DALYs (millions)4035302520151050 Source: reference diseaseCancersChronic RESPIRATORY diseaseOther CHRONIC diseases Tobacco Solid fuels Tobacco Solid fuels TobaccoHigh mortality Low mortalityDevelopedDeveloping country country44 RISK FACTORSby women contain addictive levels of nicotine, many carcinogens, heavy metals, and other toxins and therefore carry a substantial mortality risk (282).

9 In low and middle income countries, tobacco smoking is linked with poverty and poor education (283). At the individual and household level, a lot of money is spent on tobacco. For poor people, money spent on tobacco is money not spent on basic necessities, such as food, shelter, education and health care. Tobacco users are at much higher risk of falling ill and dying prematurely of tobacco-related diseases, thus depriving families of much-needed income and imposing additional health-care costs. Those who grow tobacco suffer as well. Many tobacco farmers, rather than becoming rich from their crop, often fi nd themselves in debt to tobacco companies (283).Second-hand tobacco smokeSecond-hand tobacco smoke is the combination of smoke emitted from the burning end of a cigarette or other tobacco products and smoke exhaled by the smoker. Second-hand tobacco smoke contains thousands of known chemicals, at least 250 of which are known to be carcinogenic or otherwise toxic (284).

10 Second-hand tobacco smoke is a major constituent of air pollution in indoor environments, including the home. Scientifi c evidence has fi rmly established that there is no safe level of exposure to second-hand tobacco smoke, a pollutant that causes serious illnesses in adults and children. In light of the accumulated evidence, local and national governments worldwide are increasingly implementing smoke-free policies in workplaces and public places to protect people from the dangers of second-hand tobacco smoke. Jurisdictions that have implemented smoke-free workplaces and public places have observed an immediate drop in levels of second-hand tobacco smoke, a decline in levels of second- hand tobacco smoke components in the population as well as signifi cant and immediate health improvements in workers previously exposed to second-hand tobacco some countries, regulation on smoking in the workplace and public places has made the home the dominant unregulated source of environmental tobacco smoke.