Summary of Doctor of Medicine thesis: Epidemiological characteristics and effectiveness of Chronic obstructive pulmonary disease intervention in the two districts of Bac Ninh province

Describing the epidemiological characteristics of Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts, Bac Ninh province in 2015. Analyzing some factors related to Chronic obstructive pulmonary disease in the studied area. Evaluating the effectiveness of a number of intervention measures against Chronic obstructive pulmonary disease in Que Vo district, Bac Ninh province.

1 INTRODUCTION 1. The urgency of the thesis Chronic   obstructive   pulmonary   disease   (COPD)   is   a   common,  preventable   and   treatable   disease,   characterized   by   airway   obstruction,  which progresses gradually to be more serious. According to the World  Health Organization, COPD will stand by 2020. third in the causes of death  and fifth in the global burden of disease. According to Dinh Ngoc Sy in  2009, Vietnam had about 1.4 million people with COPD, the disease tends  to increase with age, related to smoking and use of organic burning fuel,  while   Phan   Thu   Phuong   studied   in   Lang   Giang   ,   Bac   Giang   in   2009  showed that the prevalence of COPD was 3.85% and the smoking, age, and  asthma­related   factors   COPD   is   becoming   a   health   concern   for   many  countries   around   the   world   In   addition   to   controlling   related   factors,  managing   COPD   patients   in   the   community,   at   the   same   time  implementing policies related to control related factors such as increasing  tobacco tax, banning smoking in public places, protecting the environment.  If   the  school   is   living    then  it   is   important   and  necessary  to  develop  COPD prevention measures in the community Bac Ninh is a northern delta province, where the land is crowded  with people. In recent years, industrial development has been hot, causing  environmental pollution, especially in the air pollution. Bac Ninh people  have a long habit of cooking with straw, later honeycomb charcoal   this  is the cause for increased COPD. The district general hospital of Bac Ninh  province  is   a  class   II   hospital   with  about   200  beds   So   far,   some   non­ communicable diseases including COPD have been treated, but the results  are modest. In order to have a scientific basis for COPD prevention in Bac  Ninh, it is necessary to conduct research on this issue. The question is how  is   the   current   situation   of   COPD   in   Bac   Ninh   province?   What   is   the  incidence   of   COPD?   And   what   is   the   appropriate   solution   to   prevent  COPD in Bac Ninh province? That's why we conducted the project titled  “Epidemiological characteristics and effectiveness of Chronic obstructive   pulmonary   disease   intervention   in   the   two   districts   of   Bac   Ninh   province” 2. Research objectives 1)   Describing   the   epidemiological   characteristics   of   Chronic  obstructive pulmonary disease in Que Vo and Thuan Thanh districts, Bac  Ninh province in 2015 2). Analyzing some factors related to Chronic obstructive pulmonary  disease in the studied area 3)   Evaluating   the   effectiveness   of   a   number   of   intervention  measures   against   Chronic   obstructive   pulmonary   disease   in   Que   Vo  district, Bac Ninh province 3. New contributions of the thesis: 1) Epidemiological characteristics of Chronic obstructive pulmonary  disease in Que Vo and Thuan Thanh districts of Bac Ninh province in 2015:  The overall prevalence of Chronic obstructive pulmonary disease in Que  Vo and Thuan Thanh districts is 3.6%, specifically in Que Vo district, it is  3.9%, Thuan Thanh district is 3.2%. The percentage of people aged  ≥60  years is higher than that of people    0.05)   The  proportion of patients with good knowledge is not high, which shows that it  is   necessary   to   strengthen   health   education   for   patients   about   COPD,  thereby helping patients gain knowledge for self­prevention and care. and  protect your health; avoid dangerous complications of the disease, and slow  down   the   progression   of   the   disease   Attitudes   of   COPD   patients:   Our  research results show that the proportion of patients who believe that COPD  is preventable and believe that COPD exacerbations can be treated in Que  Vo   and   Thuan   Thanh   districts   is   similar   same   Regarding   COPD  prevention   practice   of   research   subjects:   it   showed   that   only   15.4%   of  patients   had   proper   practice   on   physical   exercise   and   respiratory  rehabilitation   in   COPD   prevention,   the   remaining   84.6%   disease   is   not  good; Specifically, the rate of good practice of patients in Que Vo hospital  was 17.3% and Thuan Thanh district was 13.4% but the difference was not  statistically significant between the two districts. About the manifestations  and related factors: among the symptoms, shortness of breath is the most  important   symptom   for   prognosis,   indicating   a   decrease   in   respiratory  function 4.3   Efficacy   of   some   intervention   measures   to   prevent   Chronic  obstructive pulmonary disease in Que Vo district, Bac Ninh province 4.3.1   The   effectiveness   of   some   communication   solutions   to   prevent   Chronic   obstructive   pulmonary   disease   in   Que   Vo   district,   Bac   Ninh   province The results of our study show that, during the outpatient treatment at  the Que Vo district general hospital, patients are constantly changing their  behavior about preventing Chronic obstructive pulmonary disease such as  quitting   smoking,   practicing   exercise   regularly   with   your   own   strength,  limit contact with charcoal smoke, honeycomb stoves and straw. Regarding  general practice in COPD prevention, the intervention effect is very clear  with   the   intervention   effect   up   to   1666.7%   The   proportion   of   research  subjects who practiced well before the intervention was only 2.3% ­ a very  low rate, which is a risk factor for aggravating the disease but after the  intervention reached up to 41.9%. The control group also increased but not  23 significantly from 8.3% to 11.1% In our intervention program, including health counseling, health talk  is   integrated   into   the   activities   of   the   COPD   club   at   Que   Vo   General  Hospital   Health  communication  and   education   activities   are   specifically  planned and carried out regularly. Thanks to that, the intervention effect is   very high  With activities  such as  how to  make  the  Chronic  obstructive  pulmonary   disease   a   better   living   survey;   overlap   between   asthma   and  COPD   in   the   same   patient,   Chronic   obstructive   pulmonary   disease   and  travel,   identify   when   there   is   an   acute   Chronic   obstructive   pulmonary  disease,   initial   treatment,   Chronic   obstructive   pulmonary   disease   and  cardiovascular disease, Some problems when using the drug in the elderly;  how to use aerosol and inhalers for asthma and COPD treatment, benefits of  influenza   vaccination,   pneumococcal   disease   for   people   with   Chronic  obstructive pulmonary disease   together with questions and answers when  club members need advice and in addition organize medical examinations  and   measurements   of   respiratory   function   for   club   members   The   club  model is very helpful for the sick, giving the person the opportunity to share  his or her condition, and to better understand his or her condition in a spirit  of comfort, without fear or pressure. Help with doctors who are sick. The  pulmonary   rehabilitation   program   in   the   UK   provided   knowledge   to  patients during rehabilitation. The communication sessions were based on  focus groups, conducted in 11 hospital and community programs with 25  health professionals and 57 patients with COPD. Results showed that the  knowledge and ability to manage COPD of patients was very good Self­management interventions are related to helping patients acquire  and practice the skills necessary to implement specific treatment regimens,  change health behaviors to adjust the patient's own roles for a The optimal way  for   improving  and  managing  daily  disease   Self­management   also  includes  assessing   progress,   problems,   setting   goals,   and   solving   problems   While  guidance, training the patient is necessary, as it is essential for the patient to  develop   Knowledge   Patient   education   and   training   is   meant   to   provide  patients with information (documents and instructions) on the characteristics,  circumstances of their illness and how to manage their disease 4.3.2   Efficacy   of   some   solutions   to   improve   the   health   of   Chronic   obstructive pulmonary disease in Que Vo district, Bac Ninh province Our   research   results   show   that,   after   implementing   measures   to  24 improve and improve the health of  people with COPD, such as guiding  patients to self­manage the disease, communication, distributing leaflets on  minimizing   risk   factors   muscles,   strengthen   and   choose   the   form   of  exercise, reasonable sports, rehabilitation (breathing, improving ventilation,  coughing   sputum   )   has   been   quite   effective   with   a   knife   intervention  effect from 38.3 to 59.1% on the reduction of symptoms of shortness of  breath, persistent cough and sputum. Specifically, in the group of outpatient  patients   at   Que   Vo   district   general   hospital,   the   rate   of   dyspnea   after  intervention decreased from 62.8% to 23.3% with a statistically significant  change with p  0.05. Preventing and reducing the degree of dyspnea  also enhances the quality of the patient's living survey and is one of the  important   goals   of   the   respiratory   rehabilitation   program   According   to  Dinh Ngoc Sy in 2009, after 8 weeks of treatment and rehabilitation of the  intervention group: there were no more patients at mMRC5, mMRC4 also  decreased to 33.0%, over 50.0% at the point level. mMRC3 and mMRC2  have 4 cases. Meanwhile, the control group did not change any statistically  significant   prolonged   cough   manifestations   in   the   intervention   group  decreased from 46.5% to 18.6% with p    0.05   With   expectoration,   this   rate   in   the  intervention group decreased from 65.1% to 27.9% with p  0.05. Our research results are also consistent with the  goals   of   COPD   treatment   according   to   GOLD   2017,   which   is   symptom  relief   including:   reducing   symptoms,   improving   exercise   capacity   and  improving   health   status   At   the   same   time,   the   risk   reduction   includes  prophylaxis   of   progressive   disease,   prevention   and   treatment   of  exacerbations and mortality Our research results show that the number of exacerbations in the  intervention   group   significantly   improved,   the   average   number   of  exacerbations after intervention in the intervention group changed clearly  from 1.26 exacerbations/year to 0.56 exacerbations/year with p  0.05. Chronic  obstructive pulmonary disease exacerbated exacerbation or exacerbation of  COPD is determined to be a change in the patient's difficulty breathing,  25 coughing,   and/or   sputum   beyond   the   usual   daily   level   and   acute   onset.  Inpatient or outpatient treatment, depending on the severity of symptoms  and   coordinated   diseases   The   research   results   also   showed   that   the  intervention effect to improve the health of patients was quite high, up to  73.7%. One of the goals of GOLD 2017 is to continue to adhere to treatment  while   combining   non­pharmacological   treatments   such   as   stopping  exposure to risk factors, rehabilitating and being able to get a flu shot. Once  again   our   research   confirms   the   role,   importance   and   effectiveness   of  interventions that minimize symptoms, limit risk factors and improve the  quality of life surveys for patient. From health education communication  measures, to establishing patient clubs to help patients share and encourage  themselves; at the same time to improve the capacity of health workers at  grassroots levels, timely advice and timely detection at an early stage. Self­ management interventions involve helping the patient acquire and practice  the   skills   necessary   to   implement   specific   treatment   regimens,   change  health behaviors to adjust the patient's own role for a The optimal way for  improving and managing daily disease 4.4. Limitations of the project  If favorable conditions and good resources are available, we have to  conduct   community   intervention   That   is,   there   must   be   intervention  activities on prevention of COPD in the intervention communes. This is a  primary prevention prophylactic intervention, that is, a room for healthy  people at risk, not just a secondary prevention for patients as in the study. If  level 1 prophylaxis is to enhance communication and prevention. Although  we have conducted capacity building training for key community members  such as community leaders, commune health workers, and village health  workers. Behavior change of COPD risk subjects changes after 2 years of  intervention. In addition to the resources to intervene in communication,  KAP assessments for inputs and KAP outputs for the community are very  expensive,   and   the   research   is   not   very   cost   effective   With   better  conditions, we should intervene for the whole group of patients treated and  managed at Que Vo General Hospital, and then have to evaluate the impact  of the interventions on this whole patient population. This is an intervention  for 133 patients, not just 43 patients at Que Vo Hospital. This limitation is  partly due to our calculations that want to impact primarily on the group of  patients screened in cross­sectional surveys in the development of research  plans. These limitations appear to be partly due to the initial orientation of  26 the research proposal but in large part to the resources of the researcher CONCLUSION 1) Epidemiological characteristics of Chronic obstructive pulmonary  disease in Que Vo and Thuan Thanh districts of Bac Ninh province in 2015:  The overall prevalence of Chronic obstructive pulmonary disease in Que  Vo and Thuan Thanh districts was 3.6%, specifically in the district. Que Vo  is 3.9%, Thuan Thanh district is 3.2%. The percentage of people aged ≥60  years is higher than that of people