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Enviromental risk factors

Enviromental risk factors. Genetic susceptibility. Triggers. Triggers. AIM OF THE TREATMENT. Prevent of the symptoms Normal pulmonary function Normal dailly activity Prevent of the attacks Avoiding of the drugs side effects Needs the expectations of patients and families.

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Enviromental risk factors

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  1. Enviromental risk factors Genetic susceptibility Triggers Triggers

  2. AIM OF THE TREATMENT Prevent of the symptoms Normal pulmonary function Normal dailly activity Prevent of the attacks Avoiding of the drugs side effects Needs the expectations of patients and families

  3. Asthma Management + ± Avoidance Education Prevention Severity of the disease Drugs Long term treatment plan

  4. Difficulties in evaluation of asthma severity • Severity evaluation is diffucult during pharmacologic treatment • Asthma is a variable disease.It is difficult to assess the asthma severity in only one visit • Symptoms are not associated with asthma severity. • Response to treatment is variable. There is no similar response in same severity patients. Li JT. Attaining Optimal Asthma Control: A Practice Parameter JACI 2005; 116: S3-11

  5. The problem of perception in airway obstruction • Metacholine test in 82 asthmatic patients • %15 of the patients were unpercepted in %50 decrease of FEV1 • Weak perception in 1/7 of asthmatic patients Rubinfeld & Pain. Lancet. 1976.R

  6. I N S P I R E A I R E T A I R E Asthma Control Studies FACET OPTIMA Woolcock 2005

  7. % 50 of the patients were uncontrolled Controlled Uncontrolled 5-14 20-24 25 15-19 18% 44% 31% 7% Neffen et al, ATS 2006

  8. Asthma Diagnosis and Treatment Guidelines 1991 2006-2007 SEVERITY CONTROL Global Initiative for asthma. Global strategy for asthma management and prevention. NHLBI/WHO workshop report National Asthma Education and Prevention Program Expert panel report: Guidelines for the Diagnosis and Management of Asthma.

  9. GINA 2006: STEP TREATMENT ACCORDING CONTROL

  10. What is changed in Asthma Treatment? AIM:Achieve control and maintainance Treatment for achieving control American Academy of Asthma Allergy and Clinical Immunology Practice Standards 2005 French guidelines 2005 ERS/ATS Task Force on Asthma Severity and Control 2006 GINA 2006

  11. Management of the Asthma + ± Avoidance Prevention Education Control level of the disease Drugs Long term treatment plan

  12. Total Control • No symptom • No rescue medication • No nocturnal symptom and awakening • No limitation exercise ,loss of the school and work • Asthma is controlled according to physician and patient • FEV1 and PEF normal or in the personal best value Li JT. Attaining Optimal Asthma Control: A Practice Parameter JACI 2005; 116: S3-11

  13. Valided Asthma Control Tests • ACT http://www.asthmacontrol.com • ACQ http://www.qoltech.co.uk/Asthma1.htm • ATAQ http://www.ataqinstrument.com

  14. GINA 2006 :Levels of asthma controls

  15. Management approach based on control Maintain and fine lowestcontrolling step Controlled Consider stepping up togain control Partly controlled Uncontrolled Step up until controlled Exacerbation Treat as exacerbation Level of control Treatment action Reduce Increase Reduce Increase Treatment steps GINA Workshop Report 2006

  16. GINA 2006 : Asthma Treatment www.ginasthma.org

  17. National Childhood Asthma Control and Cost Study • Multicenter study (12 centers)April 2006 • 6-18 years of ages asthmatic children, n: 618, followed 1 year • study moderator; BE.Şekerel

  18. National Childhood Asthma Control Study

  19. National Childhood Asthma Control Study • Decreasing factors in asthma control during last 4 weeks • Moderate/severe asthma • Hospitality in last one year • No inhaled steroids • Female • The most important problem in therapy Unappropriate asthma step treatment

  20. USD coast Modarate / severe asthma Mild asthma

  21. Annual direct cost per one patient Bursa Mersin Adana Centers

  22. Direct medical cost of asthma in Ankara Celik GE et al. Direct medical cost of asthma in Ankara, Turkey. Respiration 2004 Nov-Dec;71(6):587-93.

  23. Cost difference according the asthma severity 630.8 ±53.5$ P<0.001 65 ±19.5$ 324.8 ±26.5$ 1317 ±157.6$

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