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News from GARD Syria

In 2009-2010, Tishreen University and the Health Ministry conducted a multi-center Survey on the Prevalence and risk factors of chronic respiratory diseases (CRD) and co-morbidities in patients presenting to primary care: in health centers, general outpatients clinics and Emergency rooms in hospitals. In collaboration with WHO-Global alliance against chronic respiratory diseases (GARD). The protocol of this survey has been established and validated by the WHO-GARD experts. This survey is the first multi-center survey on CRD in primary care in the Eastern Mediterranean Region. The strongest point is the use of lung function measurement for diagnosis of CRD.

Objective: Improve teaching and training curriculum in Universities, through a new approach on long term management of CRD and co- morbidities. Improve Ministry of Health (MOH) programs on CRD and co-morbid chronic diseases, by evidence-based strategies.

We surveyed 22 centers in six departments of Syria:1599 patients 6 years and older. 51% are women. Median age for women (30.87±17.84), and for men (32.08±20.37). Men are cigarette smokers in 34.24%, women in 13.4%. Narguile smokers in 11.11%, 9.42% for in women. 4.6% of 6-20 years old are Narguile smokers. 35.5% of patients have respiratory complaint: Chronic cough in 36.8%, chronic sputum 31.68 %, dyspnea in 14.75%. Respiratory symptoms are associated with FEV1 <80%, P=0.001.

Lung functions
• FEV1 <80% predicted in 36.23%.
• FEV1/FVC <70%after bronchodilators in 16.67%. It is 15% in women.
• Dr. Diagnosed COPD reported only 3.39% COPD. 10% in older than 44 years.
• Mean FEV1, which is the marker of severity of COPD correlates with age, it is 70.77% in patients >44 years old. This highlights the burden of COPD.
• Asthma in 13.12%, but wheezing in 31% ,and reversibility in 27% , this point to the under- diagnosis of asthma. Another important issue is 56% of asthma patients have FEV1 <80% at baseline, 25% of asthma patients have FEV1/FVC <70% after bronchodilators, which points to poor control and inadequate treatment.

As for co-morbidities: hypertension in 9.6%, diabetes in 7.8%, cardiac ischemia in 3.88%, cardiac failure in 2.61%, allergic rhinitis in 5.64%, Cancer in 1.4%, Tuberculosis in2.75%. Hypertension, heart failure and diabetes are associated with FEV1 <80%, P=0.0001.

Risk factors associated with abnormal FEV1 (FEV1 <80% predicted): active and passive smoking, illiteracy, body mass index, P=0.0001. It is important to stress on the impact of passive smoking of both cigarette and Narguile on FEV1 reduction , especially in females 0.0001.

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