Korea Asthma Allergy Foundation

You - Young Kim, MD. PhD.

Presented at WHO GARD meeting March 28-29, 2006

Overview

• Name of Organization : Korea Asthma Allergy Foundation (KAF)

• Number of members : 286

• Year of establishment : 2003

• Category : National NGO

• Countries mostly represented : Republic of Korea

• Areas of Respiratory Medicine and Allergy covered : Asthma/Allergy

Map of the countries where the organization has ongoing activities : South Korea nationwide

ContentsContents1.1. Surveillance/Epidemiology Surveillance/Epidemiology

2.2. Health Promotion and Disease Prevention Health Promotion and Disease Prevention

3.3. Diagnosis, Control and Drug Accessibility Diagnosis, Control and Drug Accessibility

4.4. Pediatric Chronic Respiratory (CRD) and Pediatric Chronic Respiratory (CRD) and

Allergic Diseases Allergic Diseases

5. Awareness of CRD and Allergic Diseases5. Awareness of CRD and Allergic Diseases

6. Health Professional and Public Education6. Health Professional and Public Education

7.7%9.1%

2.7%

5.3%

0

10

20

Elementary schoolchildren(6-12 yr olds)

Middle schoolchildren (12-15 yr olds)

(%)(%)

p<0.05

p<0.05

Prevalence of asthma in Korean children

1995

2000

0

5

10

15

20

20 30 40 50 60 70

Ages

Pre

vale

nce,

%

Total

Male

Female

Prevalence of current asthma in Korean adults

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

19831984

19851986

19871988

19891990

19911992

19931994

19951996

19971998

19992000

20012002

5 to 34 yrs oldover 60 yrs oldAll age

Asthma Mortality in Korea

Burden of Asthma Project in South KoreaBurden of Asthma Project in South Korea

A research, conducted by KAF and Graduated school of Public Health of Seoul National University to estimate the prevalence and the economic impact of asthma in South Korea

• Methods

Collecting and analyzing data sources from

- Health Insurance Review Agency (HIRA)

- National Survey on Health and Nutrition (NSHN) - National Health Insurance Corporation (NHIC) - Ministry of Health and Welfare (MOHW) - Patient cost survey

1. Surveillance/Epidemiology

total male female total male female

0~1 35,750 21,651 14,099 8.04% 9.29% 6.66%

1~4 541,369 302,454 238,915 22.42% 23.96% 20.74%

5~9 352,547 192,912 159,635 10.35% 10.69% 9.96%

10~14 112,465 66,106 46,359 3.51% 3.90% 3.08%

15~19 36,957 19,650 17,307 1.18% 1.20% 1.15%

20~24 37,317 12,916 24,401 0.94% 0.63% 1.26%

25~29 56,453 18,135 38,318 1.39% 0.88% 1.91%

30~34 82,985 27,552 55,433 1.81% 1.18% 2.47%

35~39 79,311 29,202 50,109 1.93% 1.38% 2.51%

40~44 88,175 32,509 55,666 2.05% 1.48% 2.64%

45~49 76,601 28,546 48,055 2.29% 1.69% 2.92%

50~54 67,708 25,910 41,798 2.77% 2.11% 3.44%

55~59 70,344 27,342 43,002 3.58% 2.84% 4.30%

60~64 87,814 35,722 52,092 4.56% 3.90% 5.16%

65~69 81,132 34,590 46,542 5.80% 5.53% 6.02%

70~74 63,311 25,666 37,645 7.08% 7.35% 6.90%

75+ 82,355 30,988 51,367 7.83% 8.86% 7.32%

total 1,952,594 931,851 1,020,743 4.18% 3.96% 4.41%

no of patient estimated prevalence rate

• Prevalence rate : 4.18 % (NHIC)• Number of patients : 1,952,594

1. Surveillance/Epidemiology

HIRA data NHIC data

direct cost 573 880

indirect cost 417 901

direct + indirect 990 1,781

intangible cost 146 331

total 1,136 2,112

Intangible cost in this table is just WTP(willingness to pay) for a month (not a year); WTP is usually evaluated higher than true value, but still not decided how much is appropriate

Cost of Asthma • 990 ~ 1,781 million US Dollar (direct+indirect cost)

• 1,136~ 2,112 million US Dollar (including intangible cost)

1. Surveillance/Epidemiology

Million dollar

Burden of Asthma

• 0.15~0.28 % of GDP (including intangible cost)

1. Surveillance/Epidemiology

Million dollar

HIRA data NHIC data

2004 GDP 754,245 0.15% 0.28%

2003 Ministry of health andwelfare budget

8,175 13.99% 25.84%

2003 medical security budget 4,616 24.77% 45.76%

amount% of

The Ceremony of the 6th & 7th World Asthma Day Date : April 11, 2004 and April 24,2005

Place : Olympic Park, Seoul No. of participants : About 1,200 persons including patients and their family, consumer each year

Main Program- The Turtle Marathon Contest (famous prowrestler,Mr.Wang Pyo Lee who is a asthmatic)- Entrusting the Asthma Representative: Asthma Ambassador- Clean Car Campaign: Campaign of No Smoking in a Car

2. Health promotion and Disease Prevention

2004, 2005 Korea Asthma/Allergy/Atopy Seminar and Exhibition

Period: July 8-11,2004 and May 3-6, 2005

Place: Convention and Exhibitor Center (COEX), Seoul

No. of participants: 30,150 persons in 2004 and 29,043 persons in 2005

Main Program

- Seminar for experts and general participants

- Event on diagnosing atopy and the lungs age

- Exhibition of environmental management goods

2. Health promotion and Disease Prevention

GINA Goals AIRIAP in Korea Survey

Minimal or no symptoms, including night-time symptoms

42% of patients report night-time symptoms in the last 4 weeks

52% report daytime symptoms in the last 4 weeks

No limitations on physical activities and exercise

56% of respondents reported “some” or “a lot” of limitation to sport or other vigorous physical activity

7 work or school days per year, on average, lost due to asthma

No emergency visits to doctors or hospitals

30% patients had emergency visits and 14% patients had been hospitalized in the past year

Nearly normal lung function

65% of patients had never been given a lung function test

Gap Between Treatment Status in Korea and GINA Goals

Easy Asthma Management Project

To create an easily acceptable practical simplified protocol focusing on the diagnosis, treatment, monitoring of asthma for clinician to fill the gap between guidelines and real practice and achieve more successful clinical outcome in asthma management

3. Diagnosis, Control and Drug accessibility

symptoms based severity classification using electronic CRF

fixed and easily remembered drug usage program

simplified monitoring tools

Diagnosis

Treatment

Monitoring

Easy Asthma Management

EAM WORK SHOP

before

after

EAM Pilot

analysis

EAM beta

version

EAM nationalversion

feedback

EAM Pilot Study

HIRA Data Analysis

Prescription pattern

Doctor Survey KAF

feedback

Prescription pattern

3. Diagnosis, Control and Drug accessibility

1. Within recent 1 yearYes

NoScor

eHave you had wheezing associated with dyspnea? V 2

Provoking factors

Nocturnal aggravation 1

Cold air v 1

Exercise V 1

Upper respiratory infection 1

Smoke or air pollution 1

Concurrently with coughing 1

Paroxysmal coughing 1

Dyspnea without wheezing 1

Wheezing without dyspnea. 1

Fluctuation of Above mentioned symptoms 2

Total 4

Screening by SymptomGive scores for each symptoms Symptom Based

Diagnosis

Differential check points

COPD

Endo TB /

Lung Ca

HF / MI

No or minimal reversibility of airway obstruction

Mainly exertional dyspnea

Smokers common, Chest PA

Consider endobronchial lesion in case of monotonous wheeze

No or minimal reversibility of airway obstruction

Chest PA, sputum exam

Edema, DOE, chest pain

Underlying CV disease

Chest PA, EKG, Cardiac enzyme

Differentiate other possible cardiopulmonary diseases

Sensitivity Specificity Positive Predictabili

ty

Negative Predictabili

ty

26.2 87.0 82.1 34.0

Diagnose and prescribe upon severity

Shows Prescriptive Drugs

Defines Patient’s severity

Diagnosis & treatmentDiagnosis & treatment

3. Diagnosis, Control and Drug accessibility

•Dr. Training Material

•Nurse Training Material

•Patient Book for Adults

•Patient Book for Children

•Patient Survey Form

• e-CRF

Material developmentMaterial development

3. Diagnosis, Control and Drug accessibility

Easy Asthma Management Workshop 10 region 25 workshop 1,939 Drs attended

Korea Asthma Allergy FoundationOrganize Workshop

Workshop registration Introduction

e-CRF education e-CRF Practice e-CRF Role play

3. Diagnosis, Control and Drug accessibility

25 workshops36 General hospitals

6,193 patients

EAM Pilot Study To verify Easy Asthma Management protocol

598 clinics

3. Diagnosis, Control and Drug accessibility

Nursing teacher education and asthma care support

To facilitate the improvement of asthma care in school for pediatric asthma patients •Conducting research for investigating the reality of asthma care in school - 1,405 samples among 5,000 elementary, middle and high schools

Concept of nursing teacher :

1. Pediatric asthma is not common disease for student (86%)

2. Pediatric asthma is allergic disease and it need long term management (92%)

3. Patients with asthma has limitation of their school life & must not do exercise (52%)

Understanding asthma & its medication

1. Only 5 % of nursing teachers keep rescue medication ready

2. Only 31% know existence of control medication for asthma and how to use

4. Pediatric Chronic Respiratory (CRD) and Allergic Diseases

4. Pediatric Chronic Respiratory (CRD) and Allergic Diseases

•Education and asthma care support (2005)

- Only 5% of nursing teachers have conducted asthma education in school - 84% of nursing teachers want asthma educational course - Develop and provide asthma management manuals

5. Awareness of CRD and Allergic Diseases Activities through various media, including TV and newspapers to increase public awareness of Asthma

TV Period : 2004. 09 ~ 2004. 12 (4 months)

Contents : messaging effectively the seriousness of asthma by showing

the episode in the case of street, theater, home, respectively, in which

people can suffer from the asthma in daily life.

Expected effects: Arousing the awareness of the public on the importance

of the management and prevention of asthma

5. Awareness of CRD and Allergic Diseases

Newspaper

over 670 press release about asthma and information in 2004 and 2005

Korea Economic Daily Maeil Business NewspaperDonga Weekly

5. Awareness of CRD and Allergic Diseases

Newspaper

Asthma Experience Event

Yonhap news Maeil Business Newspaper

Cho sun daily

6. Health professional and public education

Providing asthma education, information, research to health professional,

and patients to improve better health outcome Health profession Post Graduate Asthma (PGA) school - providing the latest information on asthma to young asthma doctors directed to improving their quality of care

• Period: July 3-4, 2004 and June 18-19, 2005• Place: Busan• No. of Participants: 119 doctors in 2004 134 doctors in 2005

6. Health professional and public education

For Public Information Homepage :www. Kaaf.org