Prevention and control of childhood asthma and allergy

1.     Samoliński, B., Fronczak, A., Kuna, P., Akdis, C.A., Anto, J.M., Bialoszewski, A.Z., Burney, P.G., Bush, A., Czupryniak, A., Dahl, R. and Flood, B., 2012. Prevention and control of childhood asthma and allergy in the EU from the public health point of view: Polish Presidency of the European Union. Allergy, 67(6), pp.726-731.

·         Keywords :  asthma; allergy; rhinitis; specific immunotherapy; risk factor; public health

·         Target population : children and young people

Table 1 Applying three domains : Prevention and control of childhood asthma

Issue	Action
Health Improvement ·         Avoid environmental factors (maternal smoking, air pollution, housing conditions eg dustmite, sedentary lifestyle and stress)	·         Make healthy choices easier to reduce risk factor for the onset and progression throughout life of allergy and asthma. ·         Take into account socioeconomic inequalities
Health Protection ·         Screening and surveillance susceptibity factors (birth weight, prematurity, and obesity) ·         Early contact to environments rich in microbial exposures in farms and traditional rural settings may be protective ·         Avoid being second-hand smoke and urban traffic-related pollution ·         Allergen avoidance ·         Educate the patients and emphasize their empowerment in medical decision as they know best their disease.	·         Improve knowledge and education of all stakeholders
Health Service Quality ·         Prevention by antiviral treatment ·         Screening for early recognition of asthma and allergy (skin tests) ·         National programmes against asthma and the Polish national asthma programme (POLASTMA) facilitate the patients' to access to medical care to improve its quality. ·         Usage of allergen immunotherapy ·         Education and optimal pharmacologic  treatment even in underserved population ·         Primary care physicians should be fully involved in investigate the knowledge, attitudes and practices with regard to (ARIA,GINA) guidelines.	·         Develop patient-centred policies focused on patients' needs in cooperation with the relevant stakeholders, especially patients' organiations at all levels of care including primary health care to avoid progression into chronic respiratory diseases in adulthood and later in life. ·         Develop constant monitoring and surveillance of asthma and allergy using existing networks ·         Stimulate integrated research

Singapore National Asthma Program (SNAP) 
One component of the SNAP was directed at improving asthma control in the community by promoting preventive treatment with inhaled corticosteroids. This program describes on prescription patterns of preventor and reliever medication for asthma in the polyclinics. As the result, a simple audit and positive feedback program based on preventor-reliever (PR) ratios, accompanied by sustained local quality improvement cycles has been associated with significant shift in the drug treatment of asthma away from episodic quick relief medication towards long-term daily preventive treatment with inhaled steroids in polyclinics.

 Asthma : The Need for Good Control

What else can we do to further improve the care for our asthma patients?

 First, we should adhere to our local set of asthma management guidelines, which now focuses on achieving good control of asthma. To assess asthma control, a simple and robust tool, the Asthma Control Test (ACT), is recommended. Using a simple validated tool such as the ACT helps to objectively assess asthma control and to minimise asthma ‘disconnects’ – that is, patients overestimating their asthma control and doctors underestimating their patients’ symptoms.

 Second, every asthma patient should be armed with the skills of disease and self-management. A written asthma action plan should be taught so that patients can implement it for self-management of exacerbations between visits. Patients educated in self-management plans experience a one-third to two-third reduction in hospitalisation, emergency room visits, unscheduled clinic visits and missed workdays dueto asthma. The best disease manager for asthma is the patient himself or herself.

Finally, we can improve our care delivery of asthma by ‘connecting the dots’, improving the integration of care across the spectrum from primary care to emergency room visits to hospitalisations to specialist clinics. Asthma remains ever dynamic, and even patients with mild asthma can have a severe flare of their condition and end up in the emergency room or hospital. At the population disease management (macro) level, we ought to strive to provide care that is coordinated, seamless, timely and appropriate

Referensi :
1. Chong, P.N., Tan, N.C. and Lim, T.K., 2008. Impact of the Singapore National Asthma Program (SNAP) on preventor-reliever prescription ratio in polyclinics. ANNALS-ACADEMY OF MEDICINE SINGAPORE, 37(2), p.114.
2. Abisheganaden, J., 009. Asthma: The Need for Good Control. Annals of the Academy of Medicine, Singapore, 8(7), pp.567-562

Nurul Atiqah