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G IN A

G IN A. lobal itiative for sthma. GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION (Revised 2006). GINA Program Objectives. Increase appreciation of asthma as a global public health problem Present key recommendations for diagnosis and management of asthma

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G IN A

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  1. GINA lobal itiative for sthma

  2. GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION (Revised 2006)

  3. GINA Program Objectives • Increase appreciation of asthma as a global public health problem • Present key recommendations for diagnosis and management of asthma • Provide strategies to adapt recommendations to varying health needs, services, and resources • Identify areas for future investigation of particular significance to the global community

  4. GINA Structure Executive CommitteeChair: Paul O’Byrne, MD Dissemination/Implementation Task Group Chair: Wan Tan, MD Science Committee Chair: Eric Bateman, MD

  5. GINA Executive Committee P. O’Byrne, Chair, Canada E. Bateman, S. Africa S. Pedersen, Denmark J. Bousquet, FranceR. Singh, India T. Clark, UK M. Soto-Quiroz, Costa Rica K. Ohta, Japan W. Tan, Canada P. Paggario,Italy

  6. GINA Science Committee E. Bateman, Chair,S. Africa P. Barnes, UK K. Ohta, Japan J. Bousquet, FranceS. Pedersen, Denmark J. Drazen, US E. Pizzichini, Brazil M. FitzGerald, CanadaS. Sullivan, US P. Gibson, Australia S. Wenzel, US P. O’Byrne, Canada H. Zar,S. Africa

  7. GINA Structure Executive CommitteeChair: Paul O’Byrne, MD Science Committee Chair: Eric Bateman, MD Dissemination/Implementation Task Group Chair: Wan Tan, MD GINA ASSEMBLY

  8. GINA Assembly • A network of individuals participating in the dissemination and implementation of asthma management programs at the local, national and regional level • GINA Assembly members are invited to meet with the GINA Executive Committee during the ATS and ERS meetings

  9. Bangladesh Saudi Arabia Slovenia Germany Ireland Yugoslavia Australia Croatia Canada Brazil Austria Taiwan ROC United States Portugal Thailand Malta Greece Moldova Mexico China Syria South Africa United Kingdom Hong Kong New Zealand Italy Chile Venezuela Argentina Israel Lebanon Pakistan Japan GINA Assembly Poland Korea Netherlands Switzerland Georgia Russia Macedonia France Czech Republic Denmark Turkey Slovakia Belgium Singapore Spain Colombia Ukraine Romania India Sweden Vietnam Kyrgyzstan Albania

  10. GINA Documents • Global Strategy for Asthma Management and Prevention (revised 2006) • Pocket Guide: Asthma Management and Prevention (revised 2006) • Pocket Guide: Asthma Management and Prevention in Children (revised 2006) • Guide for asthma patients and families All materials are available on GINA web site www.ginasthma.org

  11. Global Strategy for Asthma Management and Prevention • Evidence-based • Implementation oriented Diagnosis Management Prevention • Outcomes can be evaluated

  12. Global Strategy for Asthma Management and Prevention Evidence Category Sources of Evidence ARandomized clinical trials Rich body of data BRandomized clinical trials Limited body of data CNon-randomized trials Observational studies DPanel judgment consensus

  13. Global Strategy for Asthma Management and Prevention (2006) • Definition and Overview • Diagnosis and Classification • Asthma Medications • Asthma Management and Prevention Program • Implementation of Asthma Guidelines in Health Systems Revised 2006

  14. Definition of Asthma • A chronic inflammatory disorder of the airways • Many cells and cellular elements play a role • Chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing • Widespread, variable, and often reversible airflow limitation

  15. Asthma Inflammation: Cells and Mediators Source: Peter J. Barnes, MD

  16. Source: Peter J. Barnes, MD Mechanisms: Asthma Inflammation

  17. Asthma Inflammation: Cells and Mediators Source: Peter J. Barnes, MD

  18. Burden of Asthma • Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals • Prevalence increasing in many countries, especially in children • A major cause of school/work absence

  19. Asthma Prevalence and Mortality Source: Masoli M et al. Allergy 2004

  20. Countries should enter their own data on burden of asthma.

  21. Risk Factors for Asthma • Host factors: predispose individuals to, or protect them from, developing asthma • Environmental factors: influence susceptibility to development of asthma in predisposed individuals, precipitate asthma exacerbations, and/or cause symptoms to persist

  22. Factors that Exacerbate Asthma • Allergens • Respiratory infections • Exercise and hyperventilation • Weather changes • Sulfur dioxide • Food, additives, drugs

  23. Factors that Influence Asthma Development and Expression Host Factors • Genetic - Atopy - Airway hyperresponsiveness • Gender • Obesity • Environmental Factors • Indoor allergens • Outdoor allergens • Occupational sensitizers • Tobacco smoke • Air Pollution • Respiratory Infections • Diet

  24. Is it Asthma? • Recurrent episodes of wheezing • Troublesome cough at night • Cough or wheeze after exercise • Cough, wheeze or chest tightness after exposure to airborne allergens or pollutants • Colds “go to the chest” or take more than 10 days to clear

  25. Asthma Diagnosis • History and patterns of symptoms • Measurements of lung function - Spirometry - Peak expiratory flow • Measurement of airway responsiveness • Measurements of allergic status to identify risk factors • Extra measures may be required to diagnose asthma in children 5 years and younger and the elderly

  26. Typical Spirometric (FEV1) Tracings Volume FEV1 Normal Subject Asthmatic (After Bronchodilator) Asthmatic (Before Bronchodilator) 1 2 3 4 5 Time (sec) Note: Each FEV1 curve represents the highest of three repeat measurements

  27. Measuring Variability of Peak Expiratory Flow

  28. Measuring Airway Responsiveness

  29. Clinical Control of Asthma • No (or minimal)* daytime symptoms • No limitations of activity • No nocturnal symptoms • No (or minimal) need for rescue medication • Normal lung function • No exacerbations _________ * Minimal = twice or less per week

  30. Levels of Asthma Control

  31. Revised 2006 Asthma Management and Prevention Program: Five Components 1.Develop Patient/Doctor Partnership 2. Identify and Reduce Exposure to Risk Factors 3. Assess, Treat and Monitor Asthma 4. Manage Asthma Exacerbations 5. Special Considerations

  32. Asthma Management and Prevention Program: Five Interrelated Components 1. Develop Patient/Doctor Partnership 2. Identify and Reduce Exposure to Risk Factors 3. Assess, Treat and Monitor Asthma 4. Manage Asthma Exacerbations 5. Special Considerations

  33. Asthma Management and Prevention Program Goals of Long-term Management • Achieve and maintain control of symptoms • Maintain normal activity levels, including exercise • Maintain pulmonary function as close to normal levels as possible • Prevent asthma exacerbations • Avoid adverse effects from asthma medications • Prevent asthma mortality

  34. . Asthma Management and Prevention Program • Asthma can be effectively controlled in most patients by intervening to suppress and reverse inflammation as well as treating bronchoconstriction and related symptoms • Early intervention to stop exposure to the risk factors that sensitized the airway may help improve the control of asthma and reduce medication needs.

  35. Asthma Management and Prevention Program • Although there is no cure for asthma, appropriate management that includes a partnership between the physician and the patient/family most often results in the achievement of control

  36. Asthma Management and Prevention ProgramComponent 1: Develop Patient/Doctor Partnership • Guidelines on asthma management should be available but adapted and adopted for local use by local asthma planning teams • Clear communication between health care professionals and asthma patients is key to enhancing compliance

  37. Asthma Management and Prevention ProgramComponent 1: Develop Patient/Doctor Partnership • Educate continually • Include the family • Provide information about asthma • Provide training on self-management skills • Emphasize a partnership among health care providers, the patient, and the patient’s family

  38. Asthma Management and Prevention ProgramComponent 1: Develop Patient/Doctor Partnership Key factors to facilitate communication: • Friendly demeanor • Interactive dialogue • Encouragement and praise • Provide appropriate information • Feedback and review

  39. Asthma Management and Prevention ProgramFactors Involved in Non-Adherence • Non-Medication Factors • Misunderstanding/lack of information • Fears about side-effects • Inappropriate expectations • Underestimation of severity • Attitudes toward ill health • Cultural factors • Poor communication Medication Usage • Difficulties associated with inhalers • Complicated regimens • Fears about, or actual side effects • Cost • Distance to pharmacies

  40. Asthma Management and Prevention Program Component 2: Identify and Reduce Exposure to Risk Factors • Measures to prevent the development of asthma, and asthma exacerbations by avoiding or reducing exposure to risk factors should be implemented wherever possible. • Asthma exacerbations may be caused by a variety of risk factors – allergens, viral infections, pollutants and drugs. • Reducing exposure to some categories of risk factors improves the control of asthma and reduces medications needs.

  41. Asthma Management and Prevention Program Component 2: Identify and Reduce Exposure to Risk Factors • Reduce exposure to indoor allergens • Avoid tobacco smoke • Avoid vehicle emission • Identify irritants in the workplace • Explore role of infections on asthma development, especially in children and young infants

  42. Asthma Management and Prevention Program Influenza Vaccination • Influenza vaccination should be provided to patients with asthma when vaccination of the general population is advised • However, routine influenza vaccination of children and adults with asthma does not appear to protect them from asthma exacerbations or improve asthma control

  43. Asthma Management and Prevention ProgramComponent 3: Assess, Treat and Monitor Asthma The goal of asthma treatment, to achieve and maintain clinical control, can be achieved in a majority of patients with a pharmacologic intervention strategy developed in partnership between the patient/family and the health care professional

  44. Asthma Management and Prevention ProgramComponent 3: Assess, Treat and Monitor Asthma • Depending on level of asthma control, the patient is assigned to one of five treatment steps • Treatment is adjusted in a continuous cycle driven by changes in asthma control status. The cycle involves: - Assessing Asthma Control - Treating to Achieve Control - Monitoring to Maintain Control

  45. Asthma Management and Prevention ProgramComponent 3: Assess, Treat and Monitor Asthma • A stepwise approach to pharmacological therapy is recommended • The aim is to accomplish the goals of therapy with the least possible medication • Although in many countries traditional methods of healing are used, their efficacy has not yet been established and their use can therefore not be recommended

  46. Asthma Management and Prevention ProgramComponent 3: Assess, Treat and Monitor Asthma • The choice of treatment should be guided by: • Level of asthma control • Current treatment • Pharmacological properties and availability of the various forms of asthma treatment • Economic considerations Cultural preferences and differing health care systems need to be considered

  47. Levels of Asthma Control

  48. Asthma Management and Prevention ProgramComponent 3: Assess, Treat and Monitor Asthma • The choice of treatment should be guided by: • Level of asthma control • Current treatment • Pharmacological properties and availability of the various forms of asthma treatment • Economic considerations Cultural preferences and differing health care systems need to be considered

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