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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 asthma-related 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 noncommunicable 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 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 <60 (6.1% and 0.9%). The rate of male diseases is higher than that of women (5.7% and 2.1%); The prevalence of disease in stage II accounts for 49.4%; followed by stage III accounting for 35.4% and the lowest in stage I accounted for 10.1%. 2) Some factors related to Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts of Bac Ninh province in 2015 are gender: The proportion of men with COPD is 2.90 times higher than that of women who 60 and older, the prevalence of COPD is 5.94 times higher than those under 60; smokers and pipe tobacco users have the rate of 11.16 times higher than those who do not smoke, pipe tobacco; Those who have direct contact with kitchen smoke have a 6.17 times higher incidence of COPD than those who do not have direct contact with kitchen smoke.. 3) Behavior in COPD prevention: 46.9% of patients have good knowledge; The percentage of patients who believe that the disease is preventable and believe that the disease can be treated is quite high; High rate of believing in dangerous diseases and not smoking, scientific activities is the best preventive measure; 84.6% of patients did not know about physical exercise and proper respiratory rehabilitation in disease prevention; 70.1% of patients have quit smoking, pipe tobacco; 60.8% of the patients exercised daily and 45.7% of the patients restricted their exposure to kitchen smoke; 91.5% of patients had not treated the disease 3 correctly in the exacerbation; 93.1% of patients go to the hospital for examination and counseling every year. 4) The effectiveness of some intervention measures to prevent Chronic obstructive pulmonary disease in Que Vo district, Bac Ninh province: - This district has developed 04 solutions for managing and treating diseases, including: Building a disease management unit at Que Vo general hospital; Establishment of Asthma-COPD Club; Program on respiratory rehabilitation; Outpatient treatment management. - The effectiveness of improving general knowledge about disease prevention is 630.0%, good attitude improvement is 61.0%, general practice is 1666.7%. - The effectiveness of interventions to improve the patient's health such as reducing symptoms, manifestations of the disease from 38.3% to 59.1%. Specifically, in the intervention group, dyspnea decreased from 62.8% to 23.3%; The cough persisted from 46.5% to 18.6% and sputum from 65.1% to 27.9%. The change of VC in the intervention group increased significantly. The average number of exacerbations after intervention in the intervention group changed clearly from 1.26 exacerbations/year to 0.56 exacerbations/year. In the control group, there was a decrease from 1.41 to 1.36 exacerbations/year but it was not clear. Qualitative results showed that after 24 months of intervention with 04 solutions, Knowledge, attitudes and practices (KAP) on Chronic obstructive pulmonary disease prevention of patients improved, symptoms improved markedly, health improved up, exacerbations decreased, patients achieved a high level of satisfaction ... The solution has achieved economic efficiency and high sustainability. 1.2. Factors related to Chronic obstructive pulmonary disease 1.2.1. Smoking behavior: Studies show that approximately 15.0% of smokers have COPD symptoms and between 80.0% and 90.0% of COPD patients smoke. A number of studies in Hanoi and some Northern provinces show a close relationship between smoking and COPD, among people with COPD, the proportion of smokers is 65.5%, the smokers have a risk of COPD 2-5 times higher than not smoking. 1.2.2. Air pollution: Large-scale studies in the US and Europe also show a significant link between outdoor air pollution and hospitalization for COPD, especially hospitalization due to COPD exacerbations. According to 4 GOLD, indoor air pollution from burning wood and other biofuels is estimated to kill two million women and children each year. About 15-20% of obstructive pulmonary diseases are caused by contaminants in the work environment. People who have occupational exposure to dust and chemicals are 2.6 times more likely to get COPD than other groups. 1.2.3. Bacterial infection Respiratory infections increase the severity of COPD. According to Rohde et al. (2003), about 50.0% of severe COPDs were associated with viral infections and most were due to rhinovirus. 1.2.4. Climate There is a link between COPD exacerbations and climate (especially temperature and humidity).. 1.2.3. Socio-economic conditions The risk of COPD is increased in people with low socioeconomic conditions. Subjects with cramped living conditions and poor nutrition are favorable conditions for increased respiratory infections. 1.2.4. Endogenous factors (factors of natural disposition) - Genetic factors: Several studies have mentioned the frequency of Serpina1 gene mutations and found that the frequency of COPD patients carrying S and Z mutant alleles is quite variable, possibly from 4.0 to 30.0%. depending on the subject of the study and the screening method. - Gender: Research by Natalie Terzikhan et al also shows that the annual incidence rate of men is 13.3/1000 higher than women (6.1/1000). - Age: In most epidemiological studies on COPD, it is found that the incidence, disability level, death rate increases with age, the incidence in men aged 70-74 is higher. 6 times higher than the age of 55-59, in women the incidence increases after the age of 55. 1.3. Prevention of Chronic obstructive pulmonary disease Such solutions are tobacco control policies, anti-environmental pollution or strengthening social advocacy activities or strengthening service delivery systems and technical expertise to prevent COPD. ... To effectively manage and monitor COPD in the community, it is necessary to coordinate drug treatment with interventions on risk factors to change lifestyle behaviors in a way that is beneficial to COPD. such as building a Clinic for chronic lung disease; Unit of chronic lung disease management; Program on respiratory rehabilitation; Asthma/COPD outpatient 5 management; Patient Club; Integrated COPD management by health facilities ... Chapter 2 RESEARCH SUBJECTS AND METHODS 2.1. Subject, place and time of the study 2.1.1 Research subjects: 1) Epidemiology: People living in the research area are from 40 years old and above; Community representatives such as Party leaders, authorities and mass organizations in the research communes; Commune Health Station staff and village health workers in studied area, COPD patients and hospital staff at Que Vo and Thuan Thanh district general hospitals in Bac Ninh province. 2) Intervention: The patient was diagnosed with COPD in the study area and was being treated at Que Vo Bac Ninh General Hospital. 2.1.2. Studied place: Two districts and two general hospitals of Que Vo and Thuan Thanh in Bac Ninh province. 2.1.3. Research time: From January 2015 to December 2018. 2.2. Research Methods 2.2.1. Research design: Designing the research in combination with quantitative and qualitative sampling methods. 2.2.2. Sample sizes and sampling methods 2.2.2.1. Sampling method for cross-sectional descriptive study * Sample size: Using the formula to calculate the sample size to estimate a percentage of the population with p, the rate of COPD in people aged 40 and older from the previous study is 0.042 (According to research by Dinh Ngoc Sy 2011). The error d = 20% of p = 0.042. Substitute the formula, we calculate 2,190 people. The actual survey was 2,221 people. * Sampling technique: Step 1: Select intentionally the districts of Que Vo and Thuan Thanh as primary sampling units Step 2: Each district selects 2 communes randomly according to the proportion of population from the list of communes in the selected districts (Total of yes The 4 selected communes are Dai Xuan and Nhan Hoa in Que Vo district, Dai Xuan Hoang and Nghia Dao communes in Thuan Thanh district. Step 3: The total number of samples divided to 04 communes, each commune surveyed 550 people. On the list of subjects aged 40 and above, selected 6 subjects interviewed and clinically examined for COPD and pulmonary ventilation. 2.2.2.2. Sampling method for investigating the actual situation of COPD patients in the hospital: Select all patients who are managing and treating COPD (including the number of patients of 4 surveyed communes) at two hospitals in Que Vo and Thuan Thanh districts, Bac Ninh province since 2014, actually surveyed 260 patients. 2.2.2.3. Sampling method for intervention research: The total number of patients diagnosed with COPD according to GOLD in 2014 of the four communes, according to the survey, estimated that according to research results of Dinh Ngoc Sy of 0.042, each district had about 40-50 patients (In fact, 43 people with COPD in Que Vo (intervention group) and 36 patients in Thuan Thanh (control group) are being managed and treated at two district general hospitals. 2.2.2.4. Qualitative sampling method * In 04 surveyed communes: Community leader: 01 group of 10 people representing the Commune People's Health Care Committee x 04 communes = 04 surveys; Commune health staff: 01 group of 10 people 05 commune health station staff and 05 village health workers x 04 communes = 04 surveys; People at risk of COPD: 10 people representing 40-year-old group of people and older with men and women of all ages in one commune x 04 communes = 04 surveys. * At the hospitals: Hospital COPD management staff: 01 group of 7 people including 01 representative of the Board of Directors, 01 Head of the General Planning Department, 01 Head of the Clinic and 4 health workers (medical staff) in the COPD management room of Que Vo and Thuan Thanh district general hospitals: 02 districts are 02 groups. Particularly Que Vo hospital added 01 group after the intervention. People with COPD in the hospital: 10 people representing the group of patients with men and women, with ages in two research hospitals: 02 districts are 02 groups. Particularly Que Vo hospital added 01 group after the intervention. 2.2.3. Research indicators * Epidemiology: Incidence of COPD; Prevalence by age: <60; ≥60; Prevalence by gender: Male, Female; Prevalence by district: Que Vo, Thuan Thanh; COPD rates according to the degree of airflow obstruction: GOLD 1, GOLD 2, GOLD 3, GOLD 4; Incidence of COPD according to the degree of difficulty breathing; The degree of dyspnea on the mMRC 7 scale of the patient; Ventilation disorders of the patient; The degree of airway obstruction of a patient with COPD according to GOLD; The proportion of patients with co-morbidities; Number of acute COPD cases in the year. * Group of indicators on related factors: Personal factors such as age, gender, medical history; Behavioral factors such as tobacco addiction, waterpipe tobacco; Boil wood, straw, honeycomb charcoal, sedentary; Exercise; Environmental factors: Living in places with air pollution; Working in hazardous environment, air pollution; Health care elements; Communication elements; Examination and preventive counseling for COPD. * Group of KAP indicators to prevent COPD. * Group of performance indicators for COPD preventive measures: - Building solutions: Solutions 1, 2, 3 and 4 at Que Vo General Hospital -The involvement of health workers managing COPD patients at district hospitals, hospital management, local authorities, departments, the general public and health care. - Participation of the sick people COOPD. - Acceptance of the model by the Que Vo DK hospital hospital leadership and staff. * Group of indicators to evaluate intervention effectiveness - Change the patient's KAP to prevent COPD; The index group assesses the effectiveness of improving the health of people with COPD as the manifestations of COPD; -Group of qualitative indicators on patient health, economic and social efficiency. * Classification of COPD stage according to GOLD 2011. * Assessing the degree of dyspnea: Based on the MRC questionnaire (British Medical Research Council) 2.2.4.4. Assessing the Knowledge, attitudes and practices (KAP) of COPD patients. Divide into 3 levels based on results: Score over 70%: Ranked fairly good, good; Score from 50% - 70%: Ranked average; Score <50%: Ranked Weak. 2.2.4. Research data collection techniques and tools -Directly interviewing the risk subjects in the community with COPD questionnaire in the community, combined with clinical examination and 8 respiratory function measurement. - Directly investigating the patients who are treated and treated with COPD according to the COPD case record, combined with clinical examination and respiratory function measurement. * Interview techniques: Directly interview the research subjects. The survey staff was trained on interviewing techniques and filling out forms. Investigators are also allowed to practice and assess the completeness, objectivity and interview skills. The questionnaire was developed by public health experts in collaboration with COPD experts. Cards are built according to the process. * Clinical examination: Cases with respiratory function measurements that meet the criteria identified as having obstructive hyperventilation (FEV1/FVC <70%) will be clinically examined and indepth interviewed for pathological status. After each examination day, the interviewer must verify the completeness and accuracy of the information and sum up the data according to the form. This work is done by specialized doctors in COPD. 2.3. Developing the intervention models 2.3.1 Objectives of the intervention: Manage and treat COPD patients in Que Vo General Hospital in the best way. 2.3.2 Intervention solutions - Building a COPD disease management unit at Que Vo general hospital - Establishment of COPD club - Respiratory rehabilitation program - COPD outpatient management 2.3.3. How to proceed - Training of staff involved in interventions: grassroots health workers, community leaders, hospital officials. - Conducting the health education communication for COPD patients: - For the community and the people: Mainly communication and communication against COPD in the community by integrating with other activities of the commune to communicate with the people.. 2.3.3.4. Contents of evaluation: - Comparing the changes of knowledge, attitudes and practices of COPD prevention of patients after the intervention. 9 - Comparing the changes in health status of patients before intervention - Evaluating the intervention results based on effectiveness index and intervention effectiveness: + Efficiency index % = In which: p1 is the pre-intervention rate and p2 is the postintervention ratio. + Intervention effectiveness = intervention effectiveness index control effect index 2.5. Data processing methods: Data were entered and analyzed in SPSS version 13.0 program. 2.6. Ethical issues in research: The research proposal was approved by the scientific council of Thai Nguyen University of Medicine and Pharmacy. Chapter 3. RESEARCH RESULTS 3.1. Epidemiological characteristics of COPD 3.1.1. General information about the studied subjects 3.1.2. Epidemiological characteristics of COPD Chart 3.2 shows the prevalence: Among 2221 surveyed people, 79 people were found with COPD, accounting for 3.6%. Chart 3.3 shows the distribution of COPD by age, gender and occupation: The proportion of people aged ≥60 years with COPD is higher than people <60 years old (6.1% and 0.9%). The proportion of men with COPD is higher than that of women (5.7% and 2.1%); Farmers have a higher incidence of COPD than other people with other occupations (3.6% and 2.9%). Chart 3.4 shows the prevalence of COPD in Que Vo district is 3.9%, Thuan Thanh is 3.2%, but the difference is not statistically significant (p> 0.05). Chart 3.5 shows that COPD rate by airway obstruction level mainly in stage GOLD 2 accounted for 49.4%; followed by GOLD 3 accounted for 35.4% and the lowest in GOLD 1 accounted for 10.1%. 10 Box 3.1. Current situation of COPD in communes of two surveyed districts Opinions of some community leaders: - In the past, there was little talk about chronic obstructive pulmonary disease but now it is more talkative and increasing number of patients. - Most people with the disease are aged 40 years or older. -The majority of infected people are men. Opinions of commune health officials: - Patients visiting and managing chronic obstructive pulmonary disease in the hospital are increasing month by month. - About age shows that the majority of people infected are aged over 40 years old. - About gender, the majority of patients are men. 3.2. Several factors related to COPD 3.2.1. Several factors related to COPD through community surveys Table 3.7. shows the relationship between factors such as age, gender of the subjects with COPD (p <0.05). Table 3.8. shows the relationship between the history of bronchial asthma, tuberculosis of subjects with COPD (p <0.05). Table 3.9. shows a link between some living habits of subjects such as tobacco, pipe tobacco addiction; boil firewood and straw; lives in air pollution and is sedentary with COPD (p <0.05). Table 3.10. Shows the relationship between some exercise habits of subjects with COPD such as sport and other physical activities (p <0.05). Table 3.11. shows that the only correlation between communication is the role of health workers and COPD (p <0.05). Table 3.12. shows a correlation between medical examination and counseling for prevention of COPD and COPD (p <0.05). The results of logistic regression analysis show that the rate of men with COPD is 2.9 times higher than that of women, people from 60 years and older have 5.94 times higher incidence of COPD than those with people under 60 years of age; smokers and pipe tobacco users have the rate of 11.16 times higher than those who do not smoke, pipe tobacco; Those who have direct contact with kitchen smoke have a 6.17 times higher incidence of COPD than those who do not have direct contact with kitchen smoke. 3.2.2. Several factors related to COPD through hospital investigations Researching 260 patients who are managed the treatment at the Que Vo and Thuan Thanh Hospitals, we have obtained some results as follows: 11 * Knowledge, attitude and practice of preventing COPD: The results in Table 3.14 show that the rate of patients who know about dyspnea accounts for the highest proportion (71.9%), the lowest is the rate of knowing about fatigue (36.4%). In the two district hospitals, there was no significant difference in the proportion of patients who knew about the symptoms (p> 0.05). The results in Table 3.16. show that the attitude about COPD, 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 are similar; The proportion of people who believe that COPD is a dangerous disease and do not smoke, scientific activities is the best preventive measure in Thuan Thanh district is higher than Que Vo district, but it is not statistically significant (p> 0). , 05). The results in Chart 3.9. show that 91.5% of the patients have not practiced the correct treatment of acute COPD, of which Que Vo district has only 6.8% lower treatment rate than the district. Thuan Thanh (10.2%); However, it is not statistically significant (p> 0.05). The results in Table 3.19. show that 84.6% of patients do not practice proper exercise and respiratory rehabilitation in COPD prevention. There is no difference between the two districts (p> 0.05). * The basic signs of disease Table 3.20. shows the degree of dyspnea of 260 patients. The proportion of patients with signs of dyspnea is quite high (70.0%); The level of difficulty breathing is highest in Grade 2 (34.1%), followed by Grade 3 (33.5%), Grade 4 is 26.9% and the lowest is Grade 1 accounting for 2.2%. There was no difference in the rates of dyspnea and the levels of dyspnea in the two districts. Table 3.22. Distribution of the degree of airflow obstruction according to GOLD Stages Que Vo Thuan Thanh General according Quantity % Quantity % Quantity % p to GOLD Stage 1 11 8,3 19 15, 30 11,5 >0,05 Stage 2 36 27,1 40 31,5 76 29,2 >0,05 Stage 3 45 33,8 34 26,8 79 30,4 >0,05 Stage 4 41 30,8 34 26,8 75 28,8 >0,05 12 Patients mainly in GOLD stages 2,3,4 (29,2%; 30,4%, 28,8%), the rate of GOLD 1 is the lowest (11.5%). There is no difference in the proportion of COPD stages according to GOLD between the two districts (p> 0.05). Figure 3.10 shows that the proportion of patients with comorbidities accounts for 12.3%. There is no difference in the incidence of co-morbidity between the two districts (p> 0.05). Table 3.23. Number of exacerbations in the year (n = 260) District Average p Que Vo 1.79±0.817 >0.05 Thuan Thanh 1.84±0.877 1.82±0.845 General In the last 01 year, the average number of hospitalizations of patients with COPD is 1.82 times. There is no difference in the average number of hospitalizations between the two districts (p> 0.05). Place of detecting COPD: All patients with COPD were found to be hospitalized (100%). Table 3.24. shows that the proportion of patients hospitalized 2 or more times for COPD exacerbations during the year in the age group 60 years and older and in men is higher than the age group under 60 years and women; however the difference is not clear (p> 0.05). Table 3.25. Relationship between smoking history and direct exposure to kitchen smoke and number of exacerbations during the year Number of ≤ 1 time/year ≥ 2 times/year p exacerbations Rate Rate Quantity Quantity (%) (%) History Yes 59 33.3 118 66.7 Smoking <0.05 No 50 60.2 33 39.8 Yes 54 37.2 91 62.8 Kitchen >0.05 smoke No 55 47.8 60 52.2 The rate of hospitalization with 2 times or more of COPD exacerbations during the year in the group with a history of smoking was 66.7% higher than the group without smoking history and the difference was statistically significant (p <0.001 ); In the group exposed to kitchen smoke, the hospitalization rate of 2 or more times was 62.8% higher than the group who did not have direct contact with kitchen smoke, but the difference was not clear (p> 0 , 05). 13 Table 3.26. shows that there is no relationship between co-morbidity and the number of exacerbations in the year: The rate of hospitalization of 2 or more episodes for COPD exacerbations in the group with Comorbidity is 62.5% higher than No co-morbidity group (57.5%), however the difference is not clear (p> 0.05). Qualitative research results: Box 3.3. Several factors are involved in COPD Comments from some community leaders: - Those who are addicted to tobacco and pipe tobacco are susceptible to COPD. - Smoke caused by burning honeycomb charcoal in families makes COPD increase. - Currently, environmental pollution, especially the smoke in polluted air, makes COPD of people increasing - The disease is related to gender, the more men suffer than the woman, the older one gets. - COPD is common in people who have had some illnesses such as asthma, chronic bronchitis or tuberculosis ... - The disease often occurs in people who are sedentary. Comments from grassroots health officials: - Those who smoke, pipe tobacco are at high risk of developing COPD. - The smog factor in families caused by boiling straw, the honeycomb charcoal in families, causes COPD to increase. - Currently, due to the increasing environment of dust and smoke, air pollution contributes to the increase of COPD in the community. - Gender factors are related to the disease, the more men get infected, the older the disease is. - People with a history of a number of diseases such as asthma, chronic bronchitis or tuberculosis ... or COPD. - People who are sedentary often get sick - If there is less chance of being examined and consulted by health staff. 3.3. Results of community intervention activities 3.3.1. The basis for developing intervention solutions Due to limited resources, we focused on hospital interventions. After discussing with hospital managers and health workers to directly examine and treat patients with COPD, we selected 04 main solutions: 1) Building a COPD disease management unit at Da Nang Hospital. Faculty of Que Vo. 14 2) Building COPD Club. 3) Develop a respiratory rehabilitation program. 4) Managing COPD outpatient treatment. 3.3.2. Effectiveness of intervention models Table 3.34. shows the effectiveness of improving general knowledge about COPD prevention is very high up to 630.0%. In particular, in the intervention group this rate increased from 9.3% to 69.8%. In the control group 13.9% up to 16.7%. Table 3.35. shows the effectiveness of improving the overall attitude on COPD prevention After the intervention, the percentage of patients in the intervention group with the rate of good attitude in COPD prevention increased from 60.5 to 100.0%; In the control group increased from 63.9% to 66.7%. Effectiveness of intervention is 61.0%. Table 3.36. The effectiveness of interventions to improve the proportion of patients who implement COPD prevention measures Time Before After Efficiency intervention intervention index (%) Subject Quantity % Quantity % 3 7.0 25 58.1 733.3 Que Vo (n = 43) Thuan Thanh 2 5.6 4 11.1 100.0 (n = 36) Effectiveness of 633.3 intervention (%) The effectiveness of practice improvement on implementation of COPD preventive measures is very high, up to 633.3%. In which, in the intervention group, the rate increased from 7.0% to 58.1%. In the control group 5.6% up to 11.1%. Table 3.37. Effectiveness of intervention the general practice rate of the studied subjects Time Before After Efficiency intervention intervention index (%) Subject Quantity % Quantity % 1 2.3 18 41.9 1700.0 Que Vo (n = 43) Thuan Thanh 3 8.3 4 11.1 33.3 (n = 36) Effectiveness of 1666.7 intervention (%) 15 After the intervention, the proportion of patients in the intervention group who have good general practice in COPD prevention and control increased from 2.3 to 41.9%; In the control group, it increased from 8.3% to 11.1%. Effectiveness of intervention is 1666.7%. Table 3.38. Effectiveness of COPD manifestations Time Before After Efficiency intervention intervention index (%) manifestations Quantity % Quantity % Dyspnea Que Vo (n = 43) 27 62.8 10 23.3 63.0 Thuan Thanh 26 72.2 25 69.4 3.8 (n = 36) Effectiveness of 59.1 intervention (%) The effectiveness of intervention to improve the health of patients is quite high in the intervention group showing difficulty in breathing reduced from 62.8% to 23.3%. Table 3.40. Number of exacerbations in the year Place Districts p Time Que Vo Thuan Thanh Before intervention 1.26 ± 0.82 1.41 ± 0.84 > 0.05 After intervention 0.56 ± 0.55 1.36 ± 0.64 <0.05 p <0.05 > 0.05 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. In the control group, there was a decrease from 1.41 to 1.36 exacerbations/year but the change was not statistically significant, with p> 0.05. Qualitative research results: Box 3.6. The effectiveness of COPD management and treatment solutions Opinion of COPD management and treatment staff about the outcome of the intervention: - Knowledge of behavioral attitudes about management and treatment of patients with COPD is much better, the number of weaknesses is reduced. 16 - The main symptoms of the patient such as shortness of breath, cough, sputum ... are reduced. - The number of exacerbations of COPD patients is also greatly reduced. - The research intervention measures are easy to implement, high economic efficiency and easy to maintain. Opinions of patients who are under management and treatment of COPD: - After a period of management and treatment of patients with COPD, the main symptoms such as difficulty breathing, cough, sputum ... are reduced. - The number of exacerbations of COPD is also greatly reduced. Chapter 4. DISCUSSION 4.1. Epidemiological characteristics of Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts of Bac Ninh province in 2015 * Incidence of Chronic obstructive pulmonary disease: Our research results show that the prevalence of COPD is 3.6%. Our research results are in accordance with the research results in Vietnam which range from 2.0 to 7.0%. According to a study by Ngo Quy Chau in Hai Phong in 2005, the prevalence of COPD was 4.7% and 6.89%, respectively, in people over 40 years old. Compared with research results in the world, according to the 2011 CDC study at ILLINOIS, the prevalence of COPD in adults is about 6.1%. Recent studies on COPD in Asia-Pacific show that the overall COPD rate is about 6.2%; ranging from 4.5% in Indonesia to 9.5% in Taiwan in 2012. Our research results show that the prevalence of COPD mainly in the GOLD 2 period accounted for 49.4%; followed by GOLD 3 accounted for 35.4% and the lowest in GOLD 4 accounted for 5.1%. * Incidence of COPD and a number of related factors: About gender, research results show that among COPD patients, men account for a high proportion (64.6%); The percentage of women is 35.4%. The study of Nguyen Mai Huong among 100 patients also showed that 89.0% were male and 11.0% were female. In the study of Phan Thu Phuong et al, the overall prevalence of COPD for both sexes was 2.3 % (the prevalence in men is 3% and in women is 1.7%. About the age of people with COPD in the study, the average age is 60.8 years old. In the study of Ngo Quy Chau in 2011 , the average age is 68.1, of Phan Thu Phương in 2013 was 69.25 ± 10.08. 17 Our research results show that people with some of the leading behaviors of COPD are working in hazardous environment, polluted air (85.6%), living in air pollution. (78.6%), burning wood, straw, honeycomb ... accounts for 31.7%, at least sedentary (1.5%). The percentage of people who are addicted to tobacco and pipe tobacco is high (13, 5%) ... Smoking is the most important cause of COPD, according to WHO statistics, about 80-90% of patients with COPD are smoking. On the other hand, regular exposure to kitchen smoke can Due to economic conditions and the habit of using charcoal, firewood or honeycomb for cooking, changing their bad habits requires a process. However, today this habit has been replaced by another habit of cooking a gas stove which is much less toxic. On the other hand, there are no specific health education programs to guide patients to practice self-rehabilitation and proper exercise. The practice of leading research subjects is another activity. (in fact, manufacturing workers) account for the highest proportion (39.4%), while physical training is the first to walk (20.4%), or to nourish (10.5%). A number of recent studies have shown that in people with COPD who have appropriate exercise and rehabilitation programs, they can reduce up to 50% of patients' hospitalization rates due to exacerbations. Physical exercise is the most important factor in the rehabilitation process in people with COPD. The history of chronic illnesses of the study subjects is also quite high, including some high-risk diseases with COPD, it was bronchitis (55.6%), low as tuberculosis (2%) or bronchial asthma (1.4%). Regarding the consultation consultations for COPD prevention of research subjects, the results showed that The percentage of people consulted for COPD prophylaxis is very low (14.0%), the majority is not. This shows that the provision of health services for patients is not well implemented. However, our research results are higher than the results of COPD prevention project in 2011 when only 5% of patients were regularly examined. Therefore, improving the knowledge and attitudes of patients has a great influence on this process. Research results at the hospital show that exacerbation of COPD is a worsening of the previous stable COPD stage that needs to change in daily treatment. The results also showed that the average number of hospital admissions in the past year was 1.82, lower than that of Khổng Thục Chinh with the average number of exacerbations per year of 139 COPD patients being 3.47±1.27 exemptions/year. Our research results are similar to those of Chu Thi Hanh in 2013 conducted on patients with stable stage COPD, 18 which was monitored at COPD management room - Bach Mai Hospital from January 1, 2013 to September 30, 2013 showed the average number of exacerbations/year to be 1.9. Exacerbation of COPD quickly reduces the respiratory function of the patient.After each exacerbation, the airway of the patient will become more inflamed, the lung function will be seriously damaged, many patients can not even recover. The lung function is the same as before the exacerbation. More dangerous, the patient is at high risk of death if not treated promptly. Therefore, the detection and recognition of signs of exacerbation are extremely important. At the same time, prevention and treatment are of utmost importance to reduce the occurrence of exacerbations. In our study, 100% of patients were diagnosed with COPD in hospitals. even at district, provincial and other hospitals. This shows that only when the symptoms of a very serious or even very ill patient are admitted to the hospital for a diagnosis and detection of COPD; or maybe the patient came for another illness and found out that he had COPD; Thus, it can be seen that COPD has not really been concerned by people and communities, necessary to improve people's knowledge, attitudes and practices about COPD. 4.2. Several factors related to Chronic obstructive pulmonary disease in studied area 4.2.1. Survey results in the community: Our research results show a correlation between factors such as age, gender of subjects and COPD. With p <0.05, it is shown that the elderly and men tend to have higher disease than the young and the women. 4.2.2. Research results at the hospital: Research results on 260 patients with COPD inpatient treatment at 02 general hospitals of Que Vo district and general hospitals of Thuan Thanh district, Bac Ninh province with the design of cross-sectional descriptive research have shown the results: About the patients' knowledge about COPD: The research results show that the patients with good general knowledge about COPD are only 46.9%, of which Que Vo district is 52.6% higher than in Thuan Thanh district. However, this difference is not statistically significant (p> 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 self-prevention 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 19 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 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 20 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. Self-management 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. Self-management 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 improve and improve the health of people with COPD, such as guiding patients to self-manage 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; In addition, in the outpatient group at Thuan Thanh General Hospital this rate also decreased from 72.2% to 69.4% but it was