AB 94. Burden of COPD and SDB

Most of the informations available on COPD prevalence, morbidity and mortality comes from high-income countries. Even in those countries, accurate epidemiologic data on COPD are difficult and expensive to collect. It is known that almost 90% of COPD deaths occur in low and middle-income countries. WHO recognizes that chronic obstructive pulmonary disease (COPD) is of major public health importance. Unfortunately, there is no accurate epidemiological data for Serbia, but from everyday situation, we note the dominance of these patients in ambulatory and hospital work. By far the largest number of hospital admissions during the pulmonologist duty are exacerbations of COPD. We are preparing COPD register, which would improve our work.

Untreated obstructive sleep apnea (OSA) and other similar sleep breathing disorders (SDB) increases healthcare utilization and is associated with reduced work performance and occupational injuries. The economic burden related to untreated OSA is substantial, accounting for billions of euros per year. Furthermore, therapy of OSA is an extremely cost-efficient use of healthcare resources, comparing highly favorably with other commonly funded medical therapies. Governments need to be better informed concerning the economic impact of untreated OSA and the benefits of therapy. In Serbia, health insurance covers the cost of polysomnography, but devices for non-invasive ventilation, which treat respiratory disorders during sleep, are not covered.

The coexistence of SDB and COPD is associated with a definite increase in morbidity and a probable reduction in survival. Successful treatment of SDB through the application of positive pressure to the upper airway via nasal mask has led to the application of nocturnal positive-pressure ventilation as therapy for chronic respiratory failure due to multiple causes, including COPD. Clearly, more studies are required before valid conclusions can be made about the efficacy of noninvasive ventilation in patients with advanced COPD. In theory, noninvasive ventilation could have a role in the treatment of patients with the overlap syndrome by eliminating both upper-airway obstruction and nocturnal hypoventilation.

We hope that some kind of regional cooperation will be implemented in the future, especially at projects linked with respiratory disorders during sleep.