The Need for Asthma Guidelines

Transcript

1. The Need for Asthma Guideline in Nigeria Dr A. Adedokun MD, FMCFM
2. Defini.on of Asthma •  Asthma is defined as chronic inflammatory disease of the airways which is associated with airway hyper-responsiveness(AHR) that leads to recurrent episodes of wheezing, breathlessness, chest .ghtness and coughing par.cularly at night or early in the morning. •  These episodes are o?en associated with variable but reversible airway obstruc.on. (Global INi.a.ve for Asthma-GINA).
3. Asthma burden •  About 334 million people of all ages worldwide suffer asthma and prevalence is rising. •  Rising prevalence follows urbanisa.on and industrialisa.on par.cularly in developing countries. •  Globally, 250 000 people die of asthma annually. •  Most asthma deaths are related to lack of proper treatment and are preventable. •  Treatment for asthma is not available to all people who suffer asthma.
4. Burden contd. •  Asthma is the commonest chronic disease in children and remains major cause of school absenteeism. •  Pooled prevalence in Nigeria is roughly 10.1%. •  It comes at great economic cost to the country affec.ng physical, psychological and social well-being of individuals with disability-adjusted life years- DALYs of about 15million per year.
5. Prevalence of Asthma - ISAAC Study.
6. Global Trend •  Big Picture Increasing prevalence of diagnosed asthma Decreasing prevalence of asthma symptoms High number of countries with downward trend High number of developing countries with upward trend •  Decreasing hospital admissions for asthma •  Decreasing number of MORTALITY from asthma
7. Reasons •  Increasing prevalence of diagnosed asthma Real Changing diagnos.c criteria May be related to increased awareness by •  GPs •  Public •  Decreasing prevalence of symptoms Increasing numbers of pts. on adequate treatment
8. Global prevalence of Asthma Braman S S Chest 2006;130:4S-12S
9. Asthma case fatality rates worldwide (deaths/100,000 cases) Braman S S Chest 2006;130:4S-12S
10. Ae.ology and Pathophysiology of Asthma •  The cause of Asthma is yet not fully known. •  Perhaps an interplay of Gene.c and environmental factors. •  Certain risk factors had been highlighted therefore: a. Factors that aid development of Asthma- Genes. b. Factors that trigger asthma symptoms. •  Non-modifiable risk factors(Genes, Gender) and Modifiable risk factors.
11. Modifiable Risk Factors •  Tobacco smoke- including- passive smoking •  Indoor pollu.on including burning of fossil fuel for energy. •  Out-door pollu.on including car exhaust emissions, factory emission fumes, burning of bush etc. •  Allergens-Most common type of asthma. An.gen an.body IgE reac.on leads to asthma symptoms.
12. Modifiable Risk Factors contd. •  Indoor and outdoor allergens had been implicated. •  House Dust Mite- HDM •  Animal dander •  Cockroaches •  Aspergillus mould •  Pollen •  Occupa.onal sensi.sers.
13. Risk Factors contd. •  Diet – Omega 3 fa`y acids- low in food - Breasaeeding <3months •  Biological factors – Infec.ons par.cularly- Viruses •  Physical exercise •  Psychological- stress, fear, anger, excitement induced •  Medica.on related- ASA, Beta blocker, PCM •  GERD •  OBESITY
14. Effect size of Modifiable Risk Factors of Asthma Feo Brito F , MarOnez A , Palacios R , Mur P , Gómez E , Galindo PA , Borja J , MarOnez J Journal of Allergy and Clinical Immunology 1999 103, 1-10DOI: (10.1016/S0091-6749(99)70517-8
15. Fig. 3 Journal of Allergy and Clinical Immunology 1999 103, 1-10DOI: (10.1016/S0091-6749(99)70517-8) Copyright © 1999 Mosby, Inc. Terms and Conditions Odds of having asthma in Children who have dampness or mould at home
16. Asthma Pathogenesis •  Airway inflamma.on- infl. Cells •  Produc.on of various chemical mediators- mediator soup. •  Airway structural changes resul.ng from infl. process •  Airway narrowing and remodeling •  Airway func.onal changes – AHR from the infl. Process and structural changes.
17. Asthma pathogenesis
18. Norma and Asthma.c Bronchiole
19. Why the need for Asthma Guideline? •  Body of knowledge concerning asthma ae.ology, pathogenesis and treatment had changed over the years. •  New therapeu.c op.ons had emerged as well as devices. •  Private prac..oners get to see more than half of the pa.ents. •  In some places other members of the health team had to provide much needed care.
20. Need contd. •  There is gross underdiagnoses and under- treatment. •  Most countries that ins.tuted guidelines and follow them had recorded tremendous decrease in asthma symptom and deaths – Kenya inclusive. •  Deaths in asthma are AVOIDABLE and PREVENTABLE. •  Hence the need to harmonise these bodies of knowledge and provide framework for appropriate direc.on for GP who see the bulk of these pa.ents.
21. Emphasis of this guideline. •  To highlight heterogeneous nature of asthma. •  Confirma.on of the diagnosis of asthma to minimise under and over-treatment of asthma. •  Appropriate treatment modali.es according to current prac.ces- Stepwise mgt of asthma. •  Strengthening of Self Management Prac.ces through appropriate instruc.ons and direc.ons on use of new devices in the mgt of asthma.
22. Guideline contd. •  Provision of adequate direc.ves for physicians and pa.ents in the management of asthma in a poor resource sehng. •  Take into considera.on cultural influences on pa.ents and physician’s expecta.on. •  Provision of easy assessment tools for follow up. •  Provide current informa.on on mgt of asthma in condi.ons like pregnancy, children and in anesthesia.
23. Target audience •  First the target of this guideline shall be GPs prac.cing in private facili.es. •  Residents and ALL other professionals who take care of asthma pa.ents might also find this guideline useful. •  Commi`ee members were drawn from a list of eminent physicians and scholars including respiratory medicine, ENT, anesthesia, nursing, pharmacy and family medicine. 1st sihng was 5th of March 2015
24. Thank you
25. References •  FitzGerald J. Mark Chair. Global Strategy for Asthma Management and Preven.on 2014/Global Ini.a.ve for Asthma(GINA) Report Available at www.ginasthma.org •  Oni A O, Erhabhor GE, Egbagbe EE. The prevalence, management and burden of asthma - a Nigerian study. Iran J Allergy Asthma Immunol. 2010 Mar;9(1):35-41. doi: 09.01/ijaai.3541. •  Melani AS, Bonavia M, Cilen. V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med 2011; 105: 930–938. •  Guideling for Asthma management in kenya Division of Leprosy Tuberculosis and Lung Diseases, Ministry of Public Health and Sanita.on publica.on 2011p1-35