L’anno del Respiro 2009 e la costituzione del GARD … · Giovanni Viegi Member of GARD Planning...

Giovanni Viegi

Memberof GARD Planning Group

Direttore, Istituto di Biomedicina e Immunologia Molecolare

“Alberto Monroy”CNR, Palermo

Responsabile Scientifico,Unità.diRicerca di Epidemiologia

Ambientale Polmonare,

Istituto di Fisiologia Clinica CNR, Pisa

Professore, Corso di Laurea in Scienze Ambientali, Universitàdi Pisa

September2006-September 2007 PastPresident,

EuropeanRespiratorySociety (ERS)

Durata: 20’

L’anno del Respiro 2009 e la costituzione del

GARD-Italy: un’opportunitàper la lotta

contro le malattie respiratorie

Resp

iro èVita:

il 2

009 ann

o pe

r la S

alute

del Resp

iro

Fat

tori d

i rischio, ep

idem

iologia, cos

ti ed implicaz

ioni

sociali delle m

alat

tie re

spirat

orie nelle rea

ltàsa

nita

rie

Firen

ze, 21 ottob

re 2

009

http://www.who.in

t/gard/en/

Società

/ Istituzioni italiane partecipanti al G

ARD

1.Società

Italiana di M

edicina Respiratoria (SIMeR)

2.Istituto di N

eurobiologia e Medicina Molecolare CNR

3.Associazione Italiana Malattie Apparato Respiratorio (AIMAR)

4.Associazione Italiana Pneumologi O

spedalieri (AIPO)

5.Progetto LIBRA

6.Centro Nazionale per la Prevenzione ed il Controllo

delle Malattie

(CCM -Ministero della Sanità)

7. Società

Italiana per le Malattie Resp

iratorie Infantili (SIMRI)

8. S

ocietà

Italiana di A

llergologia e Im

munologia Clin

ica (SIAIC)

9. S

ocietà

Italiana di A

llergologia e Im

munologia Ped

iatrica (SIAIP)

10. E

v-K2 CNR

11. F

ederazione Mondiale del T

ermalismo e della Clim

atoterapia (FEMTEC)

Walter Canonica

Memberof WG “Diagnosis”

Leonardo Fab

bri

Memberof WG “Prevention”

Giovanni V

iegi

Planning Group Memberand ChairmanWG1

“Epidemiologyand surveillance”

Rappresentanti italiani nel GARD

Motivi principali d

ella scelta dell’Italia:

1.impegno del Governo italiano (Centro di Controllo delle M

alattie,

Ministero della Salute) nella partecipazione e nell’adesione al

GARD sino dall’inizio,

oltre che l’inserimento delle malattie

respiratorie tra le prioritàdi politica sanitaria;

2.volontà

delle Società

scientifiche pneumologicheAIPO, SIMeR,

FIMPST di indire l’Anno del Respiro (AdR) nel 2009. L’AdRèstato

considerato dal GARD AnnualGeneralMeeting come un m

odello

replicabile in altri Paesi.

Decisioni G

ARD AnnualGen

eralMeeting di Istan

bul

Italia sarà

Paese ospitante il prossimo GARD Annual

GeneralMeeting (12-13 giugno 2009).

11 giugno m

eeting del GARD Italia.

The Action Plan for the Global Strateg

y for the Prevention and Control o

f Nonco

mmunicab

le Diseases

Dr Fiona Adshead

Director

Chronic Diseases and Health Promotion

World Health Organization

Fourth General Meeting of the

Global Alliance against Chronic Respiratory Diseases (GARD)

Rome, Italy

12 –13 June 2009

Nonco

mmunicab

le Diseases

Magnitude

•Four major noncommunicable diseases (NCDs):

–Cardiovascular diseases

–Diabetes

–Cancers

–Chronic respiratory diseases

•Four shared m

odifiable risk factors:

–Tobacco use

–Unhealthy diet

–Physical inactivity

–Harm

ful use of alcohol

•60% of deaths globally (2005) of which 80% in developing countries

•40-50% are premature

•33% of preventable deaths among the world's two poorest quintiles

•Magnitude has a major socio-economic impact on developing countries

Objective 1:

Integrating NCD prevention in

to the developmen

t ag

enda, and in

to policies across all governmen

t dep

artm

ents

through the so

cial determinan

ts of health

Global NCD Action Plan 2008-2013

Global Conference on Health Promotion

(Nairobi, 25-29 October 2009)

Expert consultation

(17-18 Sep 2008, Geneva)

+Second expert consultation

(31 March –1 April 2009, Geneva)

Monograph

(September 2009)

Regional Ministerial M

eeting on Health Literacy

(Beijing, 29-30 April 2009)

+Regional Ministerial M

eeting on NCDs,

Poverty and Development

(Qatar, 10-11 May 2009)

+ECOCOS High Level Segment on Global Health

(Geneva, 6-8 July 2009)

Objective 2: To establish and strengthen national p

olicies

and plans for the prevention and control o

f NCDs


Package of Essential NCD

Interventions for Primary Care

(2009)

WHO Expert Consultation on

a Package of Essential NCD

Interventions for Primary

Care (December 2008)

National capacity assessm

ents

(2009)

Technical support to establish

and strengthen national

policies and plans to prevent

and control NCDs(2010-2013)

Objective 3:To promote in

terventions to reduce the m

ain

modifiable risk factors for NCDs: tobacco use, u

nhealthy

diets, p

hysical inactivity and harm

ful u

se of alcohol


Developing a set of recommendations on

marketing of foods and non-alcoholic

beverages to children

(2008-2009)

Technical support to build national

capacities in the area of tobacco control in

15 developing countries (ongoing)

Developing a draft global strategy on

harm

ful use of alcohol (2008-2009)

Technical support to establish

and strengthen national

policies and plans to prevent

and control NCDs(2010-2013)

Global Strategy on Infant and Young Child

Feeding

Objective 4:Promote research for the prevention and

control o

f NCDs


WHO

Adviso

ry

Committee

on Health

Research

WHO

Adviso

ry

Committee

on Health

Research

A Prioritized NCD Research Agenda

(2009)

WHO Meeting on A Prioritized Research Agenda

Geneva, 25-26 August 2008)

Ministerial Forum on Research for

Health, Bamako, 17-19 November 2008

•Draft agen

da circulated

•Peer review

s•Publication

•Consu

ltation to finalize

Objective 5:Promote partnerships for the prevention and

control o

f NCDs


Working

Group

Working

Group

Working

Group

Working

Group

Working

Group

Working

Group

Funding

Mechanism(s)

Funding

Mechanism(s)

Global/Reg

ional Forum Meetings

Global/Reg

ional Forum Meetings

Implemented in 2009

Implemented in 2009

Implemented in 2010

Implemented in 2010

International Adviso

ry Council

International Adviso

ry Council

WHO

Staff

Global N

CD network:

Objective 6:Monitoring NCDsand their determinants and

evaluate progress at national, regional and global levels


Progress report

World Health Assembly (May 2010)

Surveillance tool

developed

(First half of 2009)

Data collection in

193 Member States

(Second half of 2009)

Data analysis

(2010)

+ Global Burden of

Disease

WHO Global Status Report

on NCDs(December 2010)

Integrationof GARD in the NCD

Action Plan

Dr Jean Bousquet

GARD Chairman

Fourth General Meeting of the

Global Alliance against Chronic Respiratory Diseases (GARD)

Rome, Italy

12 –13 June 2009

GARD Book (September 2007)

GARD Book (September 2007)

Disease

Year of

estimate

Prevalen

ce

Asthma

2004

300 m

illion

COPD

2007

210 m

illion

Allergic

rhinitis

1996 -2006

400 m

illion

Sleep

apnea

1986 -2002

>100 m

illion

Others

2006

>50 m

illion

Global Alliance against Chronic Respiratory Diseases

www.who.int/respiratory/gard

•4 million peo

ple die eachyear

from

CRD

•And in

2030:

–COPD: 4th cause of death

(PlosMed 2006)

–Tobacco > 8 m

illion deaths

(PlosMed 2006)

–Biomassfuel combustion > 10 m

illion

deaths

(Ezzatti, Science 2005)

–> 50% of the world population willb

eallergic

Chronic

Chronicrespiratory

respiratorydiseases

diseases

Goal:

Goal: To reduce the global burden of chronic respiratory diseases

Vision:

Vision: A world where all people breathe freely

Objective:

Objective: To initiate a comprehensive approach to fight chronic

respiratory diseases

WHO Global Alliance against CRD

WHO Global Alliance against CRD

surveillancesurveillancesurveillance

advocacyadvocacyadvocacy

prevention and health promotionprevention and prevention and health promotionhealth promotion

controlcontrolcontrol

4 pillars

approach

4 pillars

approach

GARD Stepwise approach

GARD Stepwise approach

GARD priorities

IntegratedGARD action plan

IntegratedNCD/GARD

action plan

Step1

Step2

Step3

2005

2006

2007

2008

2009

2010

Pilot studiesin countries

GARD action plan in countries

GARD activities 31

GARD activities 31-- 1212-- 2008

2008

MOH involved

MOH informed

OtherGARD activities

National Allergy Programme 2008

National Allergy Programme 2008 -- 2018

2018

––cu

rren

t status an

d patient invo

lvem

ent

curren

t status an

d patient invo

lvem

ent

Asthma Programme 1994-2004

Focus: (1) inflammation, (2) early intervention, (3) guided self-management,

and (4) networking

Haahtela T, et al. Thorax 2006

Focus: (1) children, young people, (2) from treatment

to prevention, (3) tolerance, (4) diagnostic quality,

and (5) early intervention to control severe allergies

Ministry of Health; National Public Health Institute; NGOs: Alle

Ministry of Health; National Public Health Institute; NGOs: Allergy & Asthma Federation, Finnish

rgy & Asthma Federation, Finnish

Lung Health Association, Finnish Pulmonary Association HELI

Lung Health Association, Finnish Pulmonary Association HELI

Finn Med J 2008,Suppl 14:1-22; Allergy 2008;63:634-6 45; Allergy 2008;63:631-633, Editorial;

Allergy 2009;64:678-701

In association with the WHO GARD Programme= Global Alliance against Respiratory Diseases

GARD Action Plan

GARD Action Plan

Report GARD Secretariat

Forth General Meeting, Rome Italy,

12-13 June 2009

Dr. NikolaiKhaltaev

WHO

GARD collaborating parties

78 participants

14 observers

World COPD Day

–19

Nov

embe

r 20

08

On WHO in

ternet hom

epag

e

On WHO in

tran

et hom

epag

e

World Asthma Day is an annual event

organized by the Global Initiative for

Asthma

World Asthm

a Day

–5 May

200

9

Priorities for research

in chronic respiratory

diseases su

pporting the 2008-2013 WHO

Action Plan for the Prevention and Control

of Nonco

mmunicab

leDiseases

Dr Eric

Batem

an

on beh

alf o

f GARD Plann

ing Com

mittee

13th–14

thJu

ne 200

9, R

ome -Ita

ly

Priorities for research in chronic respiratory diseases

•Drafted by

J. Bousq

uet

(Montpellier, France)

J. Kiley(Bethesda, USA)

E.D. Batem

an(Cape Town, South Africa)

G. Viegi(Palerm

o, Italy)

A. A. Cruz(Salvador, Brazil)

•Reviewedby N. A

ït Khaled(Algiers, Algeria), C. B

aena-Cagnani

(Cordoba, Argentina), M. B

arreto

(Salvador, Brazil), N. B

ilo(Paris,

France), G.W

. Canonica(Genoa, Italy), K.H. C

arlsen

(Oslo,

Norway), N. C

havannes(Leiden, Nederlands), A. C

huchallin

(Moscow, Russia), J. D

razen(Boston, USA), L.M. F

abbri(M

odena,

Italy), M. G

erbase(Geneva, Switzerland), M. H

umbert(Clamart,

France), G. Joos(Ghent, Belgium), N. K

haltaev(Geneva,

Switzerland), M.R. M

asjedi(Teheran, Iran), S. M

akino(Tokyo,

Japan), K. R

abe(Leiden, Nederlands), T. T

o(Toronto, Canada), L.

Zhi(Beijing, China).

Res

earch Prio

rities in CRD’s-I

(v)To charac

terize

the phen

otypes

of

patients with

severe/unco

ntrolled

asthma an

d sea

rch

for sp

ecific risk

factors and co-

morbidities.

(vi) To in

vestigate

gen

omics.

(vii) After 5 yea

rs,

redefine se

vere

asthma phen

otypes

acco

rding to latest

research

.

(iii) To develop and

validate in pilot

studies, a protoco

l derived

from (1-i) to

estimate the

prevalence, mortality

and co-m

orbidities of

severe/unco

ntrolled

asthma.

(iv) To implement

studies in LMICsto

confirm

impact of

access to IC

S on

morbidity an

d

mortality in children

and adults.

(i)

To reach

conse

nsu

s on a universa

l definition of se

vere /

unco

ntrolled asthma

in adults and child

ren

with id

entification of

gap

s in the

knowledge.

(ii) To estimate (an

d

monitor yearly)the

number of co

untries

with access to

spirometry, essen

tial

med

icines

for CRDs

and adeq

uate care

(common to Topics 1, 3

, 4,

5).

1.

Severe /

unco

ntrolle

d asthma

and co-

morbidities

Longer term

Medium term

Short term

Topic

(vi) After 5 years,

review

risk ch

arts

and assess im

pact

of its ad

option on

tangible hea

lth

outcomes.

(iv) To develop risk

charts for COPD and

OSAS using the

methodology of WHO

CVD risk ch

arts, and

to tes

t its usefulness

as a tool to change

beh

aviourof health

profess

ionals, users

of health services

and the community.

(v) To develop and

validate in pilot

studies, sim

ple

protoco

ls (including

questionnaires and

spirometry) to assess

the CRD risks.

To develop m

odels to estimate:

(i) the regional an

d global

attributable fraction of risk

of

CRD related

to tobacco

smoke,

solid

fuel combustion, outdoor

air pollution and allergen

s; and

the potential im

pact of

interventions.

(ii) the impac

t of healthy diet

and physical activity on

prevention and control of

obesity an

d its m

ajor co

-morbidities, such

as CVDs,

type II diabetes an

d SDB.

(iii) the im

pact of early

detec

tion of occ

upational C

RDs

and subse

quen

t interven

tion

on the prevention of disab

ility

due to occupational CRDs

2.

Impact of

primary

and

seco

ndar

y preventio

n of

CRDs

Longer term

Medium term

Short term

Topic

Res

earch Prio

rities in CRD’s–2.

(vi) Birth cohort

studies an

d other

longitudinal studies to

assess gen

etic and

early en

vironmental

determinan

ts on CRD

causality (especially

asthma).

(vi) Develop and

evaluate efficac

y of

preventive

interventions

worldwide an

d

particu

larly in LMICs.

(vii) After 5 years,

review

the cu

rren

t kn

owledge an

d plan

for large scale

intervention studies.

(iv) Surveys using

spirometry an

d other

case finding

strategies to

determine CRD

prevalence (including

asthma) in children

and adolescen

ts and

to id

entify risk factors

in early life.

(v) To develop and

validate strategies for

the man

agem

ent of

acute res

piratory

diseases an

d asthma

in LMICsfor children

under 5

(i)

To reach

conse

nsu

s on the major CRDsby

age groups, risk

factors and identify

gap

s in knowledge.

(ii) Develop m

ethodology

for a su

rvey in LMICs

to study prevalence of

CRD and high risk

child

ren 5 years and

less.

(iii)To estim

ate (an

d

monitor yearly)the

number of co

untries

with access to

spirometry, essen

tial

med

icines

for CRDs

and adeq

uate care.

(common to Topics 1, 3

, 4,

5).

5.

Early

determinan

ts

of ch

ronic

resp

iratory

diseases

Indoor an

d

outdoor air

pollution,

infections,

allergen

s,

lack of

awaren

ess

and deman

d

to health

services

, lack of

access to

proper care.

Longer term

Medium term

Short term

Topic

Res

earch Prio

rities in CRD’s–5.

Presentazione ed obiettivi Anno del

Respiro

L’ADR si rivolge a tutti, ma èanche di tutti

AN

NO

DE

L

RE

SP

IRO

SE

NS

IBIL

IZZ

AZ

ION

E

CO

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UM

AT

OR

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CIT

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PU

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& P

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Presentazione ed obiettivi Anno del

Respiro

Obiettivi

1.INFORMARE PER PREVENIRE, accrescendo nella popolazione la

conoscenza dei fattori di rischio e rafforzando la consapevolezza

dell’importanza e dell’efficacia della prevenzione.

2.MIGLIORARE L’OFFERTA DI

SALUTE RESPIRATORIA,

promuovendo sul territorio una più

equa distribuzione dei servizi

pneumologici, anche attraverso una maggiore integrazione fra unità

ospedaliere e servizi territoriali, nonché

attraverso l’attivazione di

assistenza domiciliare e riabilitativa.

3.PROMUOVERE CAMPAGNE EDUCAZIONALI,per la diffusione e la

conoscenza di virtuosi stili

di vita, nonché

per la diffusione della

sensibilitàverso la tutela dell’ambiente e del rispetto della collettività.

La Campagna per la cura delle malattie

respiratorie ed i rapporti con le Istituzioni

Pubbliche

LA

BR

OC

HU

RE

DI

LA

NC

IO

AN

NO

DE

L

RE

SP

IRO

20

09



Pubbliche

La salute respiratoria, situazione attuale ed elementi

critici: i fattori di rischio.

INSUFFICIENTE INFORMAZIONE

A fronte della gravitàdei dati epidemiologici ed

ambientali, èla persistente insufficiente attenzione

dell’opinione pubblica al rischio di contrarre malattie

respiratorie e la scarsa inform

azione e

consapevolezza dei fattori predisponenti



Pubbliche

I RAPPORTI CON LE ISTITUZIONI COINVOLTE:

•-MINISTERO DELLA SALUTE

•-MINISTERO DELL’AMBIENTE

•-MINISTERO DELLA PUBBLICA ISTRUZIONE

•-ISTITUTO SUPERIORE DELLA SANITA’

•-CNR

Le attivitàpubbliche e la valorizzazione delle

Giornate Nazionali di Patologia

VALORIZZAZIONE E PROMOZIONE DELLE GIORNATE NAZIONALI DI

PATOLOGIA RESPIRATORIA GIÀ

ESISTENTI (ANNO 2009), che

saranno promosse e rese parte integrante dell’AdR:

GIORNATA NAZIONALE DELLE PATOLOGIE DEL SONNO –

14 M

ARZO

GIORNATA M

ONDIALE DELLA TUBERCOLOSI –24 M

ARZO

GIORNATA M

ONDIALE DELL’ASMA –

5 MAGGIO

SETTIMANA NAZIONALE DEL RESPIRO –25-30 M

AGGIO

GIORNATA M

ONDIALE CONTRO IL TABAGISMO –31 MAGGIO

MEETING GARD –

ROMA -11 GIUGNO

GIORNATA M

ONDIALE DELLA BPCO –

27 NOVEMBRE

Le attivitàpubbliche e la valorizzazione delle

Giornate Nazionali di Patologia

VALORIZZAZIONE E PROMOZIONE DELLE GIORNATE NAZIONALI DI

PATOLOGIA RESPIRATORIA GIÀ

ESISTENTI (ANNO 2009), che

saranno promosse e rese parte integrante dell’AdR:

In tutte le manifestazioni tenderanno ai seguenti obiettivi:

•L’organizzazione delle Giornate/Settimane si

avvantaggeranno della programmazione dell’AdRgià

predisposta.

•Obiettivo strategico della Giornate/Settimane sarà

di

fidelizzare a livello nazionale e regionale gli aderenti alla

realizzazione dell’evento, attraverso il materiale predisposto.

•Verràcostituita una rete-indirizzario di promotori della

Giornate/Settimane con le Associazioni sostenitrici dell’Anno

del Respiro.

Le attivitàscientifiche di AIPO e SIMeRper

l’Anno del Respiro

Tutte le attivitàpianificate nel corso del 2009

dalle SocietàScientifiche

indipendentemente dall’AdR,

prevederanno all’interno momenti di:

promozione, divulgazione, discussione e

comunicazione dell’AdR,

che appositamente codificati daranno diritto

all’USO DEL MARCHIO AdR.



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di

sen

sib

iliz

zazi

on

e d

ei

me

dic

i d

i m

ed

icin

a g

en

era

le e

sp

eci

ali

sti

me

dic

i, n

on

ché

de

lla

po

po

lazi

on

e.



PROGETTO CONTRO:

LA NUOVA FRONTIERA DEL CONTROLLO

DELLA TUBERCOLOSI

(In collaborazione con STOPTB)

OBIETTIVO:

L’obiettivo primario del progetto èl’aumento della

consapevolezza del problema della tubercolosi

attraverso una campagna di sensibilizzazione

dei medici di medicina generale e specialisti

medici, nonchédella popolazione.



PR

OG

ET

TO

CP

RO

LIF

E:

PR

OG

RA

MM

A P

ER

L’I

DE

NT

IFIC

AZ

ION

E D

IE

ND

-

PO

INT

FU

TU

RI

NE

I P

AZ

IEN

TI

CO

N B

PC

O

(in

co

lla

bo

razi

on

e c

on

GIM

BE

)

OB

IET

TIV

O:

Stu

dio

lo

ng

itu

din

ale

di

coo

rte

na

zio

na

le, a

l fi

ne

di

ide

nti

fica

re i

fa

tto

ri p

rog

no

stic

i e

gli

en

d-p

oin

t

clin

ica

me

nte

ril

ev

an

ti d

ell

a B

PC

O i

n u

n c

on

test

o

di

ass

iste

nza

sa

nit

ari

a r

ea

le.



PR

OG

ET

TO

AL

LE

RG

IT

PE

R M

EG

LIO

CO

NO

SC

ER

E I

L P

AZ

IEN

TE

AL

LE

RG

ICO

IN

IT

AL

IA.

OB

IET

TIV

O:

Pre

pa

razi

on

e d

i u

n q

ue

stio

na

rio

We

b-B

ase

dsu

lla

co

nd

izio

ne

de

l p

azi

en

te a

ffe

tto

da

rin

ite

ed

asm

a a

lle

rgic

a (

e n

on

-all

erg

ica

) in

It

ali

a.

In p

art

ico

lare

fin

ali

zza

to a

va

luta

re l

e c

on

osc

en

ze d

el

pa

zie

nte

su

lla

pa

tolo

gia

all

erg

ica

, le

su

e c

on

diz

ion

i cl

inic

he

, i f

att

ori

di

risc

hi

e t

ipo

e l

'ad

ere

nza

all

a t

era

pia

.

Lo

str

um

en

to p

otr

eb

be

ve

ico

lare

nu

me

rose

in

form

azi

on

i e

du

cazi

on

ali

su

all

erg

en

i, b

oll

ett

ini

po

llin

ici,

no

rme

di

pro

fila

ssi,

mo

da

lità

di

uti

lizz

o d

i te

rap

ia, C

ha

t p

er

risp

on

de

re a

q

ue

siti

.

ANNO DEL RESPIRO2009

“La Spirometria va a Scuola”

Proponente: SocietàItaliana per le Malattie Respiratorie Infantili

–SIMRI -

S. La Grutta–G. Rossi

The Forum of International Respiratory Societies

The Forum of International Respiratory Societies

(FIRS) has proposed:

(FIRS) has proposed:

2010 The Year of the Lung

2010 The Year of the Lung

•FIRS will convene a

unified effort to:

–R

ais

e a

wa

ren

ess

ab

ou

t lu

ng

he

alt

h a

mo

ng

th

e p

ub

lic

–In

itia

te a

ctio

nin

co

mm

un

itie

s

wo

rld

wid

e

–A

dv

oca

tefo

r re

sou

rce

s to

com

ba

t lu

ng

dis

ea

se a

nd

de

cre

ase

its

so

cie

tal

bu

rde

n

Web site www.yearofthelung.com

The Year of the

LUN G

Live. Learn. Breath.

Inp

uts

>W

eb

sit

e

>P

ress

re

lea

ses

>V

ira

l vid

eo

s

>F

act

sh

ee

ts

Ou

tpu

ts (

me

asu

rab

le)

Nu

mb

er

of:

>W

eb

sit

e h

its

>S

tori

es

in t

he

me

dia

>P

rog

ram

s e

xe

cute

d

>C

ou

ntr

ies

pa

rtic

ipa

tin

g

>M

ee

tin

gs

wit

h o

ffic

ials

Ou

tco

me

s

>In

cre

ase

d

aw

are

ne

ss

>P

oli

cy c

ha

ng

es

>R

ese

arc

h

Impact: Decreased Societal Burden

Live. Learn. Breathe.


The Decade of the Lung

The Decade of the Lung

•Objective: B

uild

ing upon the

Year of the Lung, F

IRS partners

may decide to exp

and the

campaign for greater public

awaren

ess an

d policy

advo

cacy.

•The campaign m

ight be stag

ed

as dem

onstrated below:

The Decade of the

L U N G


L’anno del Respiro 2009 e la costituzione del GARD … · Giovanni Viegi Member of GARD Planning...

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Transcript of L’anno del Respiro 2009 e la costituzione del GARD … · Giovanni Viegi Member of GARD Planning...