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by Olof Selroos , MD, PhD, Emeritus Professor SEMECO AB, Selroos Medical Consulting AB

Presentation of publication National and regional asthma programmes in Europe: a systematic review. by Olof Selroos , MD, PhD, Emeritus Professor SEMECO AB, Selroos Medical Consulting AB Ängelholm , Sweden. Background. In Europe 10 million people <45 years of age have asthma

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by Olof Selroos , MD, PhD, Emeritus Professor SEMECO AB, Selroos Medical Consulting AB

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  1. Presentation of publication National and regional asthma programmes in Europe: a systematic review by OlofSelroos, MD, PhD, Emeritus Professor SEMECO AB, Selroos Medical Consulting AB Ängelholm, Sweden

  2. Background • In Europe 10 million people <45 yearsof age haveasthma • Prevalencewithin EU 8.2% in adults 9.4% in children The EuropeanLung White Book, ERS 2013 • Directcosts €11 billion, indirectcosts €14 billion Lung Health in Europe, Facts and figures, ERS 2013

  3. Disability Adjusted Life Years - DALYs DALY: measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death 5.2 billion DALYs/year are lost within EU Source: Institute for Health Metrics and Evaluation (IHME)

  4. Aim of the project • The European Asthma Research and Innovation Partnership (EARIP) aims to build on and harmonise existing asthma activities in order to generate interconnectivities in asthma management, to develop an approach to reduce asthma-related mortality and morbidity across Europe • A systematic review of existing asthma programmes should form a part of the basis for future activities

  5. National and regional asthma programmesin Europe Olof Selroos, Maciej Kupczyk, Piotr Kuna, Piotr Łacwik, Jean Bousquet,David Brennan, Susanna Palkonen, Javier Contreras, Mark FitzGerald,Gunilla Hedlin, Sebastian L. Johnston, Renaud Louis, Leanne Metcalf,Samantha Walker, Antonio Moreno-Galdó, Nikos G. Papadapolous,José Rosado-Pinto, Pippa Powell and Tari Haahtela EurRespir Rev 2015;24:474-483

  6. Methods • To identify publications on national and regional initiatives in Europe that aimed to improve quality of asthma care in large populations • Only papers published in English were considered

  7. Systematic Search • PubMed • CochraneDatabaseof Systematic Reviews • EMBASE • Web of Science • Science Citation Index • GARD and GAN documents • Asthma Health Outcome Project (AHOP) • Reference lists ofpublications

  8. Result of the search • 12 531 citations screened • 732 potentially relevant papers identified for further evaluation • 412 abstracts evaluated • 147 publications found relevant for inclusion • 53 publications (19 European – 10 from Finland) related to national asthma programmes

  9.  National and regional asthma programmes identified in Europe Country Study period Initiator Executor National Finland 1994–2004 Finnish Ministry of Social Affairs Finnish Lung Health organisation, and Health and Working group a nongovernmental organisation France 2002–2005 National Agency for Accreditation Eight medical specialist societies and Evaluation of Health on behalf of the French National Health Executive Ireland 2014–2017 Health Service Executives Asthma Society of Ireland Italy 2013 Global Alliance against Chronic 42 partners Respiratory Diseases The Netherlands 2014–2018 Lung Alliance Netherlands Poland 2009 Polish Society of Allergology –ongoing Portugal 2000–2011; Directorate General of Health Directorate General of Health 2012–2016 Portuguese Ministry of Health Turkey 2008 Turkish Ministry of Health Turkish Respiratory Society –ongoing Regional Poland 2000–2003 Dept of International Medicine Lodz Regional Health Insurance Asthma and Allergy, Bazlicki Fund (sponsor) University Hospital, Lodz

  10. Based on the Finnish programme we know that: • The asthmaburdencanbereducedbyrelativelysimplemeans via: earlydiagnosis, effectiveanti-inflammatorymedication, guidedself-management, and networking • Asthmadeathsareavoidable • Hospitalizationscanbereduced

  11. The Finnish Asthma Programme 1994-2004 Increase the number of asthmatics on regular maintenance medication Decrease in disability 76% Haahtela T, et al. Thorax 2006

  12. Asthma Barometer Study in Finland 2001-2010 Self-reported asthma severity and use of care during the last year 62% 45% 45% 34% 10% 4% Kauppi P, et al. Asia Pac Allergy 2015

  13. Total asthma costs in Finland 1987-2010.True costs in red.Annual theoretical costs in blue and min costsin grey Reissell E, et al. Asthma costs in Finland. A public health model to indicate cost effectiveness during 20 years. Finnish Medical Journal 2010. Haahtela T, et al. Reduction of asthma costs in Finland 1987-2010. A prevalence based cost of illness study Manuscript 2015.

  14. Success factors in the Finnish programme ● Strong public health-care (also good registries) ● Historical reasons to regard asthma as an inflammatory airway disease. ● Generally recognized and accepted need for a change ● Large national consensus (health-care, medical scientific societies, non-governmental organisations and authorities) ● Support from Ministry of Health and Social Affairs and National Public Health Institute ● Simple organizational structure for leadership and implementation of the programme

  15. Generic Action Plan – to be adjusted for local and national needs Example: The Finnish Asthma Programme 1994-2004 Background ► NEW BODY OF KNOWLEDGE • Disability caused by asthma can be prevented ►EPIDEMIOLOGY Morbidity Prevalence ► ECONOMY Costs ►EVIDENCE • Implementation of best practices is highly cost-effective both on the patient and societal level

  16. Generic Action Plan 4-Step Action Plan Background ► CONCLUSIONS • Public health problem • Need for broad consensus • Need for action • Identification of key stakeholders • Focus on patients • Focus on severe asthma to stop exacerbations/attacks • Focus on effective use of available resources and registers ► NEW BODY OF KNOWLEDGE • Disability caused by asthma can be prevented ►EPIDEMIOLOGY Morbidity Prevalence ► ECONOMY Costs ►EVIDENCE • Implementation of best practices is highly cost-effective both on the patient and societal level

  17. Generic Action Plan Background 4-Step Action Plan ► CONCLUSIONS • Public health problem • Need for broad consensus • Need for action • Identification of key stakeholders • Focus on patients • Focus on severe asthma to stop exacerbations/attacks • Focus on effective use of available resources and registers ► NEW BODY OF KNOWLEDGE • Disability caused by asthma can be prevented ►EPIDEMIOLOGY Morbidity Prevalence ► ECONOMY Costs ►EVIDENCE • Implementation of best practices is highly cost-effective both on the patient and societal level ► STRATEGIC CHOICES • Practical action plan, not a consensus report • Strategies for: 1) those diseased, 2) general population • Quantitative and qualitative goals • Focus on primary health care and outpatients services • Promotion of asthma health • Asthma Control Tools for guided self-management to stop exacerbations/attacks • Search for critical mass for change through education and counselling

  18. Generic Action Plan Background 4-Step Action Plan ► CONCLUSIONS • Public health problem • Need for broad consensus • Need for action • Identification of key stakeholders • Focus on patients • Focus on severe asthma to stop exacerbations/attacks • Focus on effective use of available resources and registers ► GOALS, MEASURES • 1-3 key messages for the public • 3-5 numerical goals for Health Care to reduce the burden • Tools to be used locally • Measures to follow outcomes • Time lines ► NEW BODY OF KNOWLEDGE • Disability caused by asthma can be prevented ►EPIDEMIOLOGY Morbidity Prevalence ► ECONOMY Costs ►EVIDENCE • Implementation of best practices is highly cost-effective both on the patient and societal level ► STRATEGIC CHOICES • Practical action plan, not a consensus report • Strategies for: 1) those diseased, 2) general population • Quantitative and qualitative goals • Focus on primary health care and outpatients services • Promotion of asthma health • Asthma Control Tools for guided self-management to stop attacks • Search for critical mass for change through education and counselling

  19. Generic Action Plan Background 4-Step Action Plan ► NEW BODY OF KNOWLEDGE • Disability caused by asthma can be prevented ►EPIDEMIOLOGY Morbidity Prevalence ► ECONOMY Costs ►EVIDENCE • Implementation of best practices is highly cost-effective both on the patient and societal level ► CONCLUSIONS • Public health problem • Need for broad consensus • Need for action • Identification of key stakeholders • Focus on patients • Focus on severe asthma to stop exacerbations/attacks • Focus on effective use of available resources and registers ► STRATEGIC CHOICES • Practical action plan, not a consensus report • Strategies for: 1) those diseased, 2) general population • Quantitative and qualitative goals • Focus on primary health care and outpatients services • Promotion of asthma health • Asthma Control Tools for guided self-management to stop exacerbations/attacks • Search for critical mass for change through education and counselling ► GOALS, MEASURES • 1-3 key messages for the public • 3-5 numerical goals for Health Care to reduce the burden • Tools to be used locally • Measures to follow outcomes • Time lines ► ACTIVITIES • Leadership, steering group (local, national) • Capacity building, funding • New internet-based networking with specialists, GPs, nurses, pharmacists • In diagnostic work, improving early detection • In treatment, improving early and effective use of ICS • Education and publicity (with NGOs) • Legislation (essential medication, anti-smoking) • Feedback, follow-up Process evaluation Outcome evaluation

  20. Generic Template for a Local Asthma Plan For each Goal: what to do (Tasks), how to do it (Tools), and what to measure (Outcomes)? Quantitative (numerical) goals for health care professionals For general public, decision makers Goals(e.g. 1-5 goals for next 5 years) • .................................... • .................................... • e.g. Preventasthmaattacks ►Indicator: emergencyvisitsarereducedby 50% 4. ..................................... 5. ..................................... Main Messages ► e.g. Zero tolerance to asthma deaths ► ..................................... ► ..................................... ► ..................................... ► .....................................

  21. Conclusions Asthma is still seriously neglected This can be changed by • higher awareness of asthma • higher on national priorities • advocacy for change • national asthma strategies • standard case management • more data and monitoring “A community problem needs community solutions” Haahtela et al Thorax 2001;56:806-14

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