Global strategy for asthma management and prevention

Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

The chronic care model is a guide to higher-quality chronic illness management within primary care. The model predicts that improvement in its 6 interrelated components—self-management support, clinical information systems, delivery system redesign, decision support, health care organization, and community resources—can produce system reform in which informed, activated patients interact with prepared, proactive practice teams. Case studies are provided describing how components of the chronic care model have been implemented in the primary care practices of 4 health care organizations.

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Improving Primary Care for Patients With Chronic Illness

Asthma is a serious health problem throughout the world During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively However, recommendations for asthma care need to be adapted to local conditions, resources and services Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations A comprehensive workshop report entitled "A Global Strategy for Asthma Management and Prevention", first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines The 2006 report contains important new themes First, it asserts that "it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained," and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised

https://erj.ersjournals.com/content/erj/31/1/143.full.pdf

Global strategy for asthma management and prevention: GINA executive summary.

Objective: To compare the efficacy of self management of asthma with traditional treatment. Design: 12 month prospective randomised trial. Setting: Outpatient clinics in Finland. Subjects: 115 patients with mild to moderately severe asthma. Interventions: Patient education and adjustment of anti-inflammatory therapy guided by peak flow measurements. Main outcome measures: Unscheduled admissions to hospital and outpatient visits, days off work, courses of antibiotics and prednisolone, lung function, and quality of life. Results: The mean number of unscheduled visits to ambulatory care facilities (0.5 v 1.0), days off work (2.8 v 4.8), and courses of antibiotics (0.4 v 0.9) and prednisolone (0.4 v 1.0) per patient were lower and the quality of life score (16.6 v 8.4 at 12 months) higher in the self management group than in the traditionally treated group. In both groups admissions for asthma were rare. Conclusions: Self management reduces incidents caused by asthma and improves quality of life. Key messages Key messages This trial of 115 patients with mild to moderately severe disease randomised half to a traditional care and half to a self management programme consisting of education about asthma and daily peak flow readings Intervention thresholds of The self management group had fewer incidents (consultations, days off work, courses of prednisolone or antibiotics) than the traditionally treated group and better quality of life scores Adherence of patients to the self management instructions was better than expected

/pdf/randomised-comparison-of-guided-self-management-and-3m2hchkk2u.pdf

Randomised comparison of guided self management and traditional treatment of asthma over one year

In many countries the cost of caring for patients with asthma is high.1 Guidelines have recommended guided self management for the treatment of asthma. 2 3 We recently compared the efficacy of guided self management with traditional treatment for asthma4 and here report the cost effectiveness of the two treatments.

One hundred and fifteen patients with mild to moderately severe asthma were randomly allocated guided self management or traditional treatment. The 56 patients allocated guided self management were given personal education and they were taught to measure their peak expiratory flow rate every morning for a year. If the value fell below 85% of their predetermined optimal value on any morning they were instructed to double their dose of inhaled corticosteroid for 2 weeks. If the value fell below 70% of the optimal value on any morning they were to take oral prednisolone (40 mg/day) for 7 days and immediately contact their nurse or doctor. The 59 patients allocated traditional …

Randomised comparison of cost effectiveness of guided self management and traditional treatment of asthma in Finland

Comparison of high and low dose of the inhaled steroid, budesonide, as an initial treatment in newly detected asthma

A multicenter clinical trial on the efficacy and safety of a twice-a-day administration of erythromycin base was performed on 261 adolescent or adult patients with acute tonsillitis. The patients were randomized for each doctor separately into q.i.d. (4 x 250 mg) and b.i.d. (2 x 500 mg) groups. Throat swabs were cultured for group A beta-haemolytic streptococci before the treatment and, in positive cases (100 patients), 2-3 days after completing the treatment of at least 7 days. No significant difference in the efficacy between the two regimens was observed as judged by clinical evaluation or bacteriological examination. About 90% of patients were completely healed by both criteria in both treatment groups. Side-effects were reported in 40 and 44% respectively, in the treatment groups. However, only 9/244 (3.7%) had to stop the treatment because of side-effects. Six of these belonged to the b.i.d. group and 3 to the q.i.d. group. This difference is not statistically significant (p greater than or equal to 0.05). Our results suggest that twice-a-day regimen of erythromycin base is an effective and well-tolerated treatment of streptococcal tonsillitis.

Thore Svahn

Papers

Randomised comparison of guided self management and traditional treatment of asthma over one year

Randomised comparison of cost effectiveness of guided self management and traditional treatment of asthma in Finland

Comparison of high and low dose of the inhaled steroid, budesonide, as an initial treatment in newly detected asthma

Twice-a-day regimen of erythromycin base is effective in the treatment of acute streptococcal tonsillitis.