To reduce asthma hospitalizations by

50% until 2015!

The example of Finland can be reproduced in the developing world

Professor Tari HaahtelaSkin and Allergy Hospital

Helsinki University Hospital

Rio de Janeiro , Curitiba 16.17..11.2010

2009Helsinki 26.11.2010

ProARProAR

2002 2003 2004 2005 2006

Souza-Machado C, et al. ERJ 2010

Rapid reduction in asthma hospitalizations in Salvador da Bahia,Brazil (2.7 million inhabitants)

Rapid reduction in asthma hospitalizations in Salvador da Bahia,Brazil (2.7 million inhabitants)

Franco R, et al. Allergy 2009

Family costs of severe asthma consumed about one-third of the family income of the underprivileged population in a middle-income country, Brazil.

GINA = Global Initiative for Asthma)

Asthma Control ChallengeCut hospitalizations 50% by 2015!

GINA challenges governments, health departments, an d health care workers worldwide to cut asthma-related

hospitalizations in half over the next 5 years.

How?By improving asthma control!

Cumulative asthma risk in Ontario,

Canada

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

0 20 40 60 80

(%)

Age (Years)

Diabetes

All Cancer

0

21.8

26.5

30.3

33.9

Asthma

To T. AJRCCM 2010; 181:337–343.

44-vuotias nainen, 3 vuotta pitkiä yskiä, nyt yskää 2 kuukautta

PEF-seuranta

Adult asthma Control Card/Stamp + Net/Mobile-version

1. Doctor – Nurse (Pharmacist)

How are you doing? OK

1. Reliever max 2 dose/wk

2. Symptoms max 2 day/wk

3. Symptoms max 1 night/wk

4. No activity restrictions

5. PEF-var. max 50 l/min/wk

How do you treat?

1. Reliever need minimal

2. Controller dose adequate

3. Adherent to treatment

4. Correct inhalation

5. Exacerbation plan exists

► Good morning PEF______

2. Patient - guided self-management

Notice symptom increase YES

1. Needing more reliever?

2. Feeling cold, flu?

3. Coughing Wheezing

4. Exercise tolerance

5. Morning-PEF

► PEF-decreases from____to____

Stop exacerbation

1. Increase controller 2-4 fold (2-4 wk),or start a course of controller (4 wk)

2. Increase reliever 2-4 fold (2-4 wk)or start to use it regularily

3. Prednisolon tabl. 20mg/day (1-2 wk)

4. Go to emergency, if no help

5. Later, check controller treatment

Doctor/Nurse uses the check-list to assure asthma c ontrol, and guide the patient to self-management. Zero tolerance to asthma attacks

Lahdensuo A, et al. Guided self-management in asthma BMJ 1996,1998; GINA 2009, modified

1. Doctor – Nurse (Pharmacist)

How are you doing? OK1. Normal breathing during

respiratory infections

2. No emergency visits

because of dyspnoe

or intractable cough

3. No coughing during night

or playing

How do you treat?1. Reliever need minimal

2. Controller dose adequate

3. Parents are able to deliver

medication

4. The child is able to inhale

with spacer

5. Exacerbation plan exists

2. Patient – guided self-management

Notice symptom increase Yes1. Notice flu and cough immediately

2. Need for reliever increases

the first day!

3. Cough increases

while playing or crying

Stop exacerbation

1. Increase controller 2-4 fold (1-2 wk),or start a course of controller (1-2 wk)

2. Use reliever frequently enough -

even 6 times per day

3. Severe dyspnoe may rapidly

exhaust a small child – go to

emergency if reliever does not help

4. Later, check maintenance treatment.

Change controller, if response is

inadequare

Doctor/Nurse uses the check-list to assure asthma control, and guide the patient to

self-management. Zero tolerance to asthma attacks.

Small children asthma Control Card/Stamp + Net/Mobile-version

Rhinitis Control Card/Stamp + Net/Mobile-version

1. Doctor – Nurse (Pharmacist)

How are you doing? OK

1. Reliever max 2 dose/wk

2. Symptoms max 2 day/wk

3. Symptoms max 2 night/wk

4. No activity restrictions

5. No sleeping problem

How do you treat?

1. Controller dose adequate

2. Treatment of co-morbidites

is adequate

3. Adherent to treatment

4. Correct nasal inhalation

5. Need for SIT evaluated

6. Exacerbation plan exists

2. Patient - guided self-management

Notice symptom increase YES

1. Needing more vasoconstrictor

2. Feeling cold, flu

3. Sneezing Discharge

4. Nasal obstruction

5. Mouth breathing during the night

Stop exacerbation

1. Regular antihistamine

2. Start NCS for 2 weeks, or

3. Double NCS for 2 weeks

4. Use vasoconstrictor 1-2 weeks

5. Rinse the nose with saline

6. See your doctor, if no help

Doctor/Nurse uses the check-list to assure rhinitis control, and guide the patient to self-management. Uncontrolled rhinitis worsens asthma!

Estä pahenemisvaihe

Inhal.kortis.200 µg/dos1-2 x 1-2

Inhaloitava kortisoni 200 µg/annos

2 x 2-4β2-agonisti

1-2 x 2-4aina ennen

Inhal. kortisonia

Inhal. kort.200 µg/dos1-2 x 1-2

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Valtakunnallinen Allergiaohjelma 2008-2018

Ohjattu omahoito on avain! – Apteekkariliitto 2010