Workshop on the Epidemiological Survey of Chronic Obstructive Lung Diseases and Alpha‐1‐antitrypsin Deficiency in the Asian‐Pacific Region (2001)

First of all, I would like to express my sincere appreciation for your participation in this Workshop. At the very beginning of the meeting, I would like to introduce to you the mechanism that enabled us to hold the Workshop on the Epidemiological Survey of Chronic Obstructive Lung Diseases and Alpha-1-antitrypsin Deficiency in Asian-Pacific Region today. We applied for a special international promotional grant-in-aid offered by the Ministry of Education and Sports in Japan, in order that we might have a workshop that would facilitate our basic understanding of the epidemiology, pathogenesis, and clinical profiles (including management and the practical approach for promoting public awareness), particularly in the field of chronic obstructive lung diseases (COPD). We wanted to invite some distinguished investigators from the Asian-Pacific region and in order to further our primary aim of understanding and promoting, we wanted to initiate cooperative research projects in the field of COPD in this part of the world. We were fortunate to receive this grant and it has allowed us to realise our plans. Chronic obstructive lung diseases research in Asian-Pacific countries has come a long way to be where it is today, yet more effort is needed to improve our understanding of some aspects of the research in COPD. There are several issues that this Workshop will address. First, I would like to focus on the epidemiological aspect of COPD in this region. Because of our highly populated, wide distribution in ethnic backgrounds and very diverse economic and social structures, there might be considerable differences in natural disease profile, particularly in the case of COPD, which might be heavily influenced by the environmental situation in individual countries. Therefore, like any other research into particular diseases, we need to have an exact scientific basis by which we can further progress our strategy for the management of the disease. We probably lack, at the moment, an exact understanding of the prevalence and characteristics of the prevalence of COPD in our own region. The epidemiology, particularly seen in population-based studies, seems to be insufficient in our region. We would like to know the situation in other countries and we will have reports from our international participants. Through that discussion, we probably are much more interested in the genetic background of COPD including α1AT deficiency. It is well known that α1AT deficiency, a genetic disorder characterized by a high risk of developing emphysema at 30–40 years of age, is very rare among Asian countries while prevalent in the Caucasian population. Although the incidence of α1AT deficiency is indeed low in Japan, we have identified that the Siiyama-deficient variant is prevalent in Japanese patients with α1AT deficiency rather than the Z variant which is common in Caucasians. This suggests that there might be distinct genetic and clinical features of emphysema in Asian countries. Accordingly, its basic genetic background is one of the main topics to be addressed in this Workshop. Based on these understandings, we may be able to develop scientific knowledge about the character and risk factors for COPD that we can expect in our region. Tobacco smoke is the greatest risk factor for COPD. In some countries within our Asian-Pacific region there will be several other risk factors that might be relevant to the occurrence of this disease, for example, domestic fuel combustion and smoke. Through this discussion, we hope to achieve a unified concept in COPD in our region and some are already included in different guidelines. The question then to be addressed will be whether we need to have common guidelines in this region. We understand there are some ongoing discussions about establishing an Asian version of the COPD guidelines through the Asian Pacific Society of Respirology. Finally, one outcome that we might be able to achieve is deciding whether we do need any form of structure by which one can register special cases of COPD, such as patients with α1AT deficiency. With these main points for today's discussion, I would like to open this Workshop.