WHO Strategy for prevention and control of Chronic Respiratory Diseases

6. Strategic Directions
Surveillance
To quantify and track CRDs and to improve comparability across member states, there is a need to standardize epidemiological methods and to develop a uniform set of diagnostic criteria/tools.

National surveillance systems should primarily focus on monitoring the following, bearing in mind the importance of developing and implementing simple methodologies for providing objective measures of trends:

• cause specific mortality;

• risk factor prevalence;

• certain morbidity data like hospital admissions and consultations due to common respiratory conditions, as well as therapeutic trends.

Standard indicators should be adopted. These may include lung function measurements, disease progression, absenteeism from school or work, and hospitalisations.

Elements of health care structure that can also be monitored to evaluate the quality of care include drug availability, cost and quality, existence of local guidelines and policies, and level of training of health professionals.

Primary prevention
Primary prevention of CRDs requires the reduction or avoidance of personal exposure to common risk factors, to be started during pregnancy and childhood. Avoidance of direct and indirect exposure to tobacco smoke is of primary importance not only for healthier lungs, but as a preventative measure for the other 3 priority NCDs (cardiovascular disease, cancer, and diabetes) identified in the Global Strategy for NCD prevention and control. Other shared risk factors that should be addressed include low birth weight, poor nutrition, acute respiratory infections of early childhood, indoor and outdoor air pollutants, and occupational risk factors.

For primary prevention to be effective, other sectors within a community must be actively engaged. It is beyond the scope of work and ability of any health care system to achieve changes in environmental standards, which are essential, if one intends to reduce the population's exposure to disease determinants and pollution risks. Additionally, the population must be fully informed about what constitutes a healthy lifestyle, such as healthy nutritional habits, regular exercise and avoidance of tobacco, airway irritants and allergens.

For asthma, primary prevention implies the prevention of sensitization to factors that might subsequently induce disease. In addition to those mentioned, there is increasing evidence that allergic sensitization, which is the most common precursor to the development of asthma, can occur antenatally. As such, current knowledge on primary prevention requires emphasis on the health, nutrition and environment of the pregnant woman and newborn child. However, more research is needed before effective strategies for primary prevention of asthma can be established.

Secondary and tertiary prevention
Early detection of occupational asthma is vital to prevent further progression and to ensure cost-effective management. Programmes for early detection of COPD have been suggested but their cost-effectiveness have yet to be fully evaluated. Although long term decline in lung function may not be reversible, effective management including smoking cessation, pulmonary rehabilitation and reduction of personal exposure to noxious particles and gases can reduce symptoms, improve quality of life, and increase physical fitness. Further, evidence indicates influenza vaccination is a cost-effective intervention for patients with COPD.

Asthma, although not curable, is a treatable disease with preventable morbidity. It is also a known risk factor for COPD. Secondary and tertiary prevention involves avoidance of allergens and non-specific triggers. Optimal pharmacological treatment, including the use of anti-inflammatory medication, has been shown to be cost-effective in controlling asthma, preventing the development of chronic symptoms, and reducing mortality.

Strategic directions (A)	Strategic directions (B)
Strategic directions (C)

Section 1 - Section 2 - Section 3 - Section 4 - Section 5 - Section 6- Section 7