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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
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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.
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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!
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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.
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44-vuotias nainen, 3 vuotta pitkiä yskiä, nyt yskää 2 kuukautta
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PEF-seuranta
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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
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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
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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!
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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
Lisää lääkitystä 2 viikoksi!
Valtakunnallinen Allergiaohjelma 2008-2018
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Ohjattu omahoito on avain! – Apteekkariliitto 2010