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SummaryThe aim was to study epidemiology of chronic respiratory disease in populations living at different climatic and geographic regions of Russia in order to develop targeted preventive programs.Methods. This was a cross-sectional randomised epidemiological study. A comparative analysis of mortality from respiratory diseases was conducted according to the European standards in population aged 25-64 years living in Russia and certain regions of Russian Arctic. Data from a national multi-centre population-based study and of randomly selected subjects from certain climatic and geographic regions were analysed. Results. A respiratory mortality rate was much higher in most Russian Arctic regions compared to average national values. Although a death rate of chronic respiratory disease in most Arctic regions and in Russia at whole was higher than that in the EU the population in the northern regions died more often from pneumonia. Despite a significant difference in smoking prevalence there was significantly higher COPD prevalence in Arctic regions (Yakutsk) compared to other regions in the study. Among all risk factors, the Northern climate greatly contributed to morbidity of chronic respiratory disease. Conclusion: The regional difference in the prevalence and mortality from chronic respiratory disease should be considered when designing preventive programs for chronic non-infection diseases in these regions.

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Russian anti-tobacco policy is aimed at reducing long-term morbidity and mortality from smoking-related diseases.Aim. To assess the associations of tobacco control (TC) legislative measures with hospitalization rate for myocardial infarction (MI) and angina in Russia as a whole and in 10 Russian constituent entities, as well as to compare the effectiveness of anti-smoking measures in regions.Material and methods. We analyzed data on hospitalizations of patients with angina (I20) and acute (I21) and subsequent (I22) MI, as well as chronic rheumatic heart diseases (I05-I09), for 2005-2019 in Russia as a whole and in 10 Russian constituent entities. We analyzed hospital admission rates for angina and MI to compare the periods before and after introduction of Federal TC law in 2013, adjusting for possible confounders and long-term trends. We used interrupted time-series design and Poisson regression model with calculation of rate ratio (RR) and 95% CI. Regions were compared by means of original TC law implementation scale (TCIS) developed based on the results of Russian TC policy evaluation survey in 10 Russian regions (n=11625). We analyzed the relationship between the TC law measures implementation scores and RR of hospital admissions reductions for angina and MI after the TC law by means of Spearman’s rank correlation (coefficient with 95% CI) and linear regression models. Statistical package STATA 11.2 was used.Results. The actual trend of hospital admission rates for angina after TC law introduction demonstrates the greatest slope change from the predicted trend (without the law) (p=0,004); less, but still significant slope change for MI (p=0,049), and no slope change for chronic rheumatic heart disease (p=0,332). Results showed a 16,6% decrease in hospital admission rates for angina (RR, 0,83; 95% CI, 074-0,93) and 3,5% — for MI (RR, 0,96; 95% CI, 0,96-0,97) after the TC law introduction in RF and effects of various magnitude in the regions. Regions with higher TCIS scores, i.e. better enforcement of full TC package had greater reduction in hospital admission rates for angina (rsp=-0,627; 95% CI, -1,05−-0,199; p=0,004); with better enforcement of smoke-free policies — grater reduction in hospitalization rates for MI (rsp= -0,793 95%CI, -1,08−-0,506, p<0,001). Reduction of hospital admission rates for angina and MI correlated with the higher scores for help to quit tobacco use (rsp=-0,555; 95% CI, -1,098−-0,01, p=0,045), (rsp= -0,736; 95% CI, -1,12−-0,357, p=0,027). Also, hospital admission rates for angina and MI were associated with the changes in smoking cessation prevalence in 2013-2018 in the regions (β=-0,345; 95% CI, -0,67−-0,02 p=0,041) and smoking prevalence in 2019 (β=2,964; 95% CI, 1,28-5,92, p=0,049), respectively.Conclusion. TC legislation can lead not only to immediate reductions in hospital admission rates for angina and MI, but also to longer-term results. These effects may be due not only to the introduction of TC law, as such, but also to the enforcement of the law, as well as the direct results of TC measures — the decrease in smoking prevalence in the population.

Хронические респираторные заболевания (ХРЗ), и в частности хроническая обструктивная болезнь легких (ХОБЛ), представляют серьезную медико-социальную проблему во всем мире, отражая тенденции роста заболеваемости и смертности от болезней, связанных с потреблением табака. Курение табака-основной и единственный модифицируемый фактор риска развития ХРЗ, в т. ч. ХОБЛ. Современное понимание проблемы подсказывает, что ХОБЛ развивается у 50% потребителей табака, а не у 15, как считалось ранее, и что заболевание может зародиться еще до рождения и в раннем детстве индивидуума, и понимание механизмов развития заболевания исключительно важно для своевременного предупреждения этих болезней. Профилактика ХРЗ, и в частности ХОБЛ, должна быть направлена на преодоление потребления табака с учетом всех остальных факторов риска развития этих болезней. Современные программы преодоления курения включают поведенческую консультативную поддержку в сочетании с фармакотерапией такими препаратами первой линии, как НЗТ или варениклин. Пациенты с ХОБЛ нуждаются в большей помощи, чем здоровые курильщики, а вмешательства по прекращению потребления табака-самая затратно-эффективная мера для сокращения темпов падения легочной функции и снижения заболеваемости и смертности от этой болезни. Ключевые слова: хронические респираторные заболевания (ХРЗ), хроническая обструктивная болезнь легких (ХОБЛ), курение, потребление табака, профилактика ХОБЛ, лечение табачной зависимости, НЗТ, варениклин. M.G. GAMBARYAN, PhD in Medicine, National Research Center for Preventive Medicine, MoH RF CHRONIC RESPIRATORY DISEASE AND TOBACCO CONSUMPTION. Review Chronic respiratory diseases (CRD), and in particular chronic obstructive pulmonary disease (COPD), pose a relevant healthcare and social problem globally, reflecting the upward trend in the morbidity and mortality from diseases related to tobacco consumption. Tobacco smoking is the main and only modifiable risk factor for the development of CRD including COPD. The current understanding of the problem suggests that COPD develops in 50% of tobacco users and not in 15% as previously thought; that the disease may have originated even before birth or in early childhood; that capturing the mechanisms of the disease development is essential for timely prevention. Prevention of CRD, particularly COPD, should be aimed at overcoming tobacco consumption and take into account all the other risk factors for these diseases. The current smoking cessation treatments involve behavior counselling in combination with first-line pharmacotherapies such as NCT or varenicline. Patients with COPD need greater support than healthy smokers, and interventions for cessation of tobacco consumption are the most cost-effective in reducing the rates of the lung function deterioration and decreasing morbidity and mortality from the disease.