Asthma programs

However, does enhanced patient xmderstanding about medication use translate into improved patient outcomes A study of a physician-directed, pharmacist-managed asthma program evaluated the impact of attending a... 

Hindi-Alexander MC, Cropp GJA Evaluation of a family asthma program. J Allergy Clin Immunol 1984 74 505-510. 

Two studies provide evidence that the costs of asthma are increasing. A study of the trends of asthma costs in the US between 1985 and 1994 demonstrated increased total costs, with medication costs replacing hospital costs as the largest component of direct medical expenditures [22]. A study of trends of asthma costs in Sweden between 1980 and 1991 suggests a nearly 37% increase in total asthma costs, with a 41.1% increase in direct medical expenditures and a 34.2% increase in indirect costs [23]. In Finland, a national asthma program was launched in 1994 and evaluated in 2000. It was estimated that the total costs per patient had decreased by 10-20% even though the costs of medication had increased substantially [24]. 

In the USA, LTRAs have largely replaced theophylline as the incremental drug for the treatment of moderate and severe asthma, where LABA plus ICS alone do not provide adequate control. For patients with mild persistent asthma, LTRAs have been designated as a suitable substitute for low dose ICS by the National Asthma Education Panel Program (NAEPP) of the National Heart and Lung Institute (National Institutes of Health). However, inhaled ICS are more efficacious. 

Adapted from National Institutes of Health, National Heart Lung and Blood Institute. National Asthma Education and Prevention Program. 

Adapted from National Institutes of Health, National Heart Lung and Blood Institute. National Asthma and Education Prevention Program. Expert Panel Report. Guidelines for the Diagnosis and Management of Asthma. Update on Selected Topics 2002. http //www.nhlbi.nih.gov/guidelines/asthma/asthmafullrpt.pdf accessed August 2005 used with permission. 

NAEPP National Asthma Education and Prevention Program... 

National Asthma Education Program. Guidelines for the diagnosis and treatment of asthma II. Bethesda National Institutes of Health, 1997. 

The National Asthma Education and Prevention Program (NAEPP) defines asthma as a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. In susceptible individuals, inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. These episodes are usually associated with airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an increase in bronchial hyperresponsiveness (BHR) to a variety of stimuli. 

FIGURE 80-2. Home management of acute asthma exacerbation. Patients at risk of asthma-related death should receive immediate clinical attention after initial treatment. Additional therapy may be required. (MDI, metered-dose inhaler PEF, peak expiratory flow.) (Adapted from NHLBI, National Asthma Education and Prevention Program, Expert Panel Report 2. Guidelines for the Diagnosis and Management of Asthma. NIH Publication No. 97-4051. Bethesda, MD U.S. Department of Health and Human Services, 1997.)... 

National Asthma Education and Prevention Program. (2002) Executive summary of the NAREPP expert panel report. Guidelines for the diagnosis and management of asthma. Update on selected topics 2002. Bethesda, MD National Institutes of Health. NIH publication 02-5075. 

Sympathomimetics Accor6 ng to the National Asthma Education and Prevention Program s Expert Panel Report II, long-acting 2-agonists (eg, salmeterol) are used... 

Innovative programs are also available to help home residences reduce exposure to toxic substances. The Master Home Environmentalist program of the American Lung Association trains volunteers to visit homes and conduct a Home Environmental Assessment. Home residences are encouraged to make changes to reduce exposures to toxic substance. A major focus of this program is on reducing asthma in children. 

Site has information on childhood asthma and the Master Home Environmentalist Program. 

Murphy KR, Hopp RJ, Kittelson EB, Hansen G, Win-dle ML, Walburn JN. Life-threatening asthma and anaphylaxis in schools a treatment model for school-based programs. Ann Allergy Asthma Immnnol 2006 96(3) 398-405. 

Important commercial isocyanates include the diisocyanate monomers toluene diisocyanate (TDI), methylene diphenyl diisocyanate (MDI), hexamethylene diisocyanate (HDI), and MDI-, TDI-, and HDI-based isocyanates (e.g., prepolymers and polyisocyanates). World-wide production volume is estimated at over 12 billion lb. Isocyanates (diisocyanates, polyisocyanates, and prepolymers) all cause similar health effects, most commonly asthma [32]. Isocyanates are reported to be the leading attributable cause of work-related asthma [16]. Isocyanates are potent sensitizers that can trigger a severe and potentially fatal asthma attack in sensitized persons at very low isocyanate exposure levels [16]. Toluene diisocyanate is reasonably anticipated to be a human carcinogen by National Toxicology Program. 

The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med 2000 343(15) 1054-63. 

With these difficulties in mind, drug treatment programs do surprisingly well at keeping people on the road to recovery. The NIDA says the treatment of addiction is as successful in 2002 as the treatment of other chronic diseases such as diabetes, hypertension, and asthma. 

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