The patient community proposes to treat chronic obstructive pulmonary disease at the expense of smokers

The All-Russian Patients’ Union (VSP) proposes that the Ministry of Health include chronic obstructive pulmonary disease (COPD) in the list of socially significant diseases along with HIV and hepatitis C. COPD is one of the three most deadly diseases in the Russian Federation, second only to stroke and coronary heart disease. Officially, there are more than 800 thousand patients with COPD in the country, but, experts assure, their real number can reach 12 million. Moreover, in 90% of patients the disease develops due to the fact that they smoked or are still smoking. Therefore, the VSP proposes to introduce an additional excise tax on tobacco and tobacco products and use a “certain percentage” of these revenues to finance activities to combat COPD. In this regard, a Kommersant source on the tobacco products market recalled that in 2024 the excise tax rate on tobacco products will already increase by 8%, and on vapes by 110%.

The All-Russian Patients’ Union asks the Minister of Health Mikhail Murashko to take measures to improve medical care for patients with chronic obstructive pulmonary disease. COPD, which causes restricted airflow in the airways and makes breathing difficult, is sometimes called emphysema or chronic bronchitis. According to Rosstat, in Russia in 2019, 828,096 patients with COPD were registered. However, as Sergei Avdeev, chief freelance pulmonologist of the Russian Ministry of Health, head of the department of pulmonology at the Sechenov Moscow State Medical University, told Kommersant, today in Russia COPD affects, according to various studies, approximately 7–8% of the adult population. This is at least 10–12 million people. According to him, 90% of patients develop the disease due to the fact that they smoked or are smoking. These are mainly men and women over 40 years of age who have a long history of smoking. In addition, there is an occupational risk factor: constant contact with dust, gas and smoke. Miners, welders, and workers exposed to inorganic dust suffer from this.

Representatives of the VSP indicate that in Russia COPD ranks first (47–55%) in the structure of the prevalence of respiratory diseases, significantly ahead of bronchial asthma (19%) and pneumonia (14%). Moreover, COPD ranks first in mortality among respiratory diseases (47%) and third among all diseases, second only to stroke and coronary heart disease. Up to half of patients require hospitalization on average once a year due to exacerbations. In addition, COPD is a highly disabling disease. Thus, the proportion of patients with disabilities suffering from moderate, severe and extremely severe COPD is about 70%. COPD is often associated with cardiovascular disease, skeletal muscle dysfunction, osteoporosis, lung cancer, and depression. Severe attacks lead to decompensation of concomitant diseases and double the likelihood of myocardial infarction.

Despite the fact that COPD is a serious and disabling disease, patients without disability status are not provided with medications at the expense of regional and federal benefit budgets. The VSP asks the Ministry of Health to include COPD in the list of socially significant diseases (currently this includes, for example, malignant neoplasms, mental disorders, tuberculosis, HIV, hepatitis C). According to Part 2 of Art. 43 of the Law “On the Fundamentals of Protecting the Health of Citizens”, this list is approved based on the high level of primary disability and mortality of the population, and the decrease in life expectancy of the sick. COPD occupies a leading position among the causes of mortality and disability in the world and in Russia, reduces life expectancy by 8–9 years, therefore, according to VSP, it meets all established criteria. Patients ask the medical department to create a registry of COPD patients. This, in their opinion, will make it possible to build a program of dispensary observation, which will further contribute to timely diagnosis, correct routing and drug provision of patients with pulmonary diseases.

The VSP proposes that the Ministry of Health petition for the introduction of an additional excise tax on tobacco and tobacco products and use a “certain percentage” of proceeds to finance measures to combat COPD, including free drug provision at the outpatient stage. In the “medium term,” as sufficient data emerges on the connection between the use of e-cigarettes and pulmonary diseases, it is necessary to consider the issue of an additional excise tax on vaping liquids, according to the VSP.

“We see that new highly effective medical technologies are emerging that reliably increase the life expectancy of patients, prolong their ability to work, and patients should have the right to preferential drug coverage,” Yuri Zhulev, co-chairman of the VSP, comments on the initiative. Sergey Avdeev confirms that pharmacological technologies have made great progress in the treatment of COPD. “However, in our country there is a difficulty with the availability of therapy,” says Mr. Avdeev. “The fact is that we do not yet have preferential programs that would allow us to provide patients with COPD with free therapy. For example, patients with bronchial asthma, a disease similar to COPD, have a benefit; the state finances their drug provision. For COPD patients, this benefit appears only if they receive disability status. Otherwise, the patient must buy the medicine at his own expense.” In a hospital where the patient does not stay for long, he receives treatment at the expense of the compulsory medical insurance fund, that is, free of charge, the pulmonologist continues. When the patient is discharged, he switches to outpatient treatment and receives recommendations from the attending physician to continue therapy, but he must purchase the necessary medications at his own expense. “A fairly large group of people suffering from COPD cannot afford to buy drugs with their own money. Accordingly, they do not receive the necessary therapy and the disease progresses. Without proper treatment, COPD can reduce life expectancy by about 15 years, so it is extremely important to provide patients with access to free medications,” says Sergey Avdeev.

A Kommersant source on the tobacco products market, commenting on the VSP initiative, noted that excise tax rates on tobacco products in Russia are already the highest in the EAEU. Tobacco excise taxes annually bring the federal budget more than 750 billion rubles, which can be used for healthcare, sports and any other social needs of the state, including to finance this proposal, Kommersant’s interlocutor says. In 2024, he adds, the excise tax rate on tobacco products will increase by 8%, and on vapes by 110%, which is higher than the predicted inflation rate, and will primarily hit consumers’ pockets, and may also lead to the opposite effect – consumer withdrawal into the illegal sector, which already today accounts for about 14% of the market in the cigarette segment alone.

The press service of the Ministry of Health assured Kommersant that VSP’s appeal will be considered in the prescribed manner.

Natalya Kostarnova, Anatoly Kostyrev