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Appropriate use and withdrawal of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD)
Román-Rodríguez, M.; Tsiligianni, I.; Wiliams, S.; et al.
International Primary Care - Respiratory Group
(2020)
CC2
The document "Appropriate use and withdrawal of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD)" from the IPCRG provides guidance on when to start, adjust, or discontinue ICS in COPD treatment. It highlights the benefits and risks, emphasizing personalized
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treatment based on patient history, exacerbation frequency, and eosinophil count, while detailing how to optimize bronchodilator use to manage symptoms effectively.
more
Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced a
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sthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
more
he aetiology of asthma and allergic disease remains poorly understood, despite considerable research. The International Study of Asthma and Allergies in Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease, by establishing a standardized m
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ethodology and facilitating international collaboration. Its specific aims are: 1) to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres, and to make comparisons within and between countries; 2) to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and 3) to provide a framework for further aetiological research into genetic, lifestyle, environmental, and medical care factors affecting these diseases. The ISAAC design comprises three phases. Phase 1 uses core questionnaires designed to assess the prevalence and severity of asthma and allergic disease in defined populations. Phase 2 will investigate possible aetiological factors, particularly those suggested by the findings of Phase 1. Phase 3 will be a repetition of Phase 1 to assess trends in prevalence.
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As we approach World Asthma Day on the May 2, 2023, we reflect on the theme “ Asthma Care for All”. Prevalence of Asthma is increasing amongst children, adolescents and adults. Under-diagnosis, underutilization of inhaled corticosteroids, inaccessibility of treatment, and unaffordability of medi
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cines are amongst the challenges that low-middle income countries are faced with. This commentary seeks to highlight the challenges, the resources available and to suggest recommendations that can be implemented to improve asthma care for all and reduce burden of asthma in Africa.
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Asthma is the most common noncommunicable disease in children, and among the most common in adults. According to the most recent estimates from the Global Asthma Network Phase I study, around one in 10 children and adults have symptoms of asthma and one in 20 school-aged children have severe asthma
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symptoms, with marked variations in prevalence and in prevalence trends between countries and regions of the world. The Global Burden of Disease Study estimated that asthma caused the loss of 21.6 million healthy years of life (disability-adjusted life years) and 461 069 deaths in 2019. Approximately 90% of the asthma burden of disease is borne by people living low and middle income countries (LMICs). Some countries report very high (up to 90%) rates of uncontrolled asthma. While the prevalence of asthma is highest in countries with a high Socio-Demographic Index (SDI), death rates from asthma are highest in countries with low and lower middle incomes.
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The 2023 meeting of the WHO Clinical Consortium on Healthy Ageing (CCHA) was the group’s ninth gathering and took place in Geneva 5–7 December 2023. The meeting was structured around seven panels, with a series of technical presentations, plenary discussions and group work, and a final session o
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utlining the work programme for 2024.
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This guide provides a systematic, practical approach to support primary care and other healthcare professionals to improve the care of peopel over the age of 18 years with difficult to manage asthma.
This articel summarises the evidence base underpinning supported self-management for asthma. It provides clinicians with a practical approach to providing supported self-management for asthma and suggests an appropriate strategy for implementing supported self-management.
Over 90% of the morbidity and mortality related to chronic obstructive pulmonary disease (COPD) and asthma occurs in low-income and middle-income countries (LMICs) due to well documented factors including decreased access to screening, trained health professionals, and therapies for disease manageme
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nt. Inhaler therapy (eg, aerosolised medications by inhalation, nebulisation, or propellant) is the mainstay of treatment for COPD and asthma. Adherence to maintenance medications for COPD and asthma results in improved lung function and quality of life, as well as decreased hospitalisation and mortality. WHO have included short-acting beta-agonists, long-acting muscarinic antagonists, and inhaled corticosteroids on the essential medications list, with a target goal of achieving 80% availability of these medications in public and private facilities. However, despite these efforts, accessibility, and affordability of medications for COPD and asthma remains scarce.
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It offers tips and suggestions that contribute to mental well-being and maintaining a positive outlook on life. Theyare intended as food for thought – try to incorporate one or more of these suggestions into your daily routine and allow yourself to be surprised!
The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project
Kirenga, B.J.; Chakaya, J.; Yimer, G. et al.
Journal of Allergy and Clinical Immunology: Global
(2024)
CC
Severe asthma is associated with high morbidity, mortality, and health care utilization, but its burden in Africa is unknown. This article wants to determine the burden (prevalence,
mortality, and activity and work impairment) of severe asthma in 3 countries in East Africa: Uganda, Kenya, and Ethio
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pia using the American Thoracic Society/European Respiratory Society case definition of severe asthma.
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PEPFAR Malawi’s Country Operational Plan (COP) 2021 reflects a culmination of strong interagency collaboration between the PEPFAR Malawi team, Government of Malawi (GoM), and civil society organizations (CSOs) to mitigate the devastating impacts of COVID-19 and sustain progress achieved over the l
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ast two decades towards HIV epidemic control.
At the conclusion of the March 2020 Johannesburg Regional Planning Meeting, the PEPFAR Malawi team presented a COP20 surge strategy to improve client-centered care, mitigate treatment disruption, scale prevention programs to key and vulnerable populations, and strengthen national health systems.
Following this meeting, the first three COVID-19 cases were reported in Malawi and immediately thereafter, adaptations to the COP20 strategy became imperative to deliver safe, client-centered care.
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This report on global leishmaniasis surveillance follows those published in 2016–2023.2–6 Six indicators of leishmaniasis are publicly available from the Global Health Observatory (GHO).7 In addition to the GHO, country profiles with up to 30 indicators are published, with detailed data received
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from 45 Member States.
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The Government of Malawi’s Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services i
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n all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016–September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.
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Healthy Settings, a key component of Malawi’s Health Sector Strategic Plan (HSSP) 2011–2016, is the World Health Organization’s (WHO) holistic community-led approach to achieving health improvement by addressing social determinants of health, an approach which is central to the current WHO fra
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mework on integrated people-centred health services. Healthy Settings projects by their construct have many different components which vary from one group and community to another depending on their priorities: from housing, hospital improvements and waste management to “softer” interventions like leadership skills training and health promotion. It can be challenging to find relevant indicators to monitor and assess the impact of such a complex holistic project, this paper explores if social capital data can provide useful impact assessment indicators at the start of such a project.
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This brief highlights the urgency of addressing gender inequalities across the Rio Conventions, provides examples of where progress has been made, and identifies clear entry points for addressing gender equality considerations across the Conventions. It makes recommendations for actions to accelerat
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e the synergistic implementation of the gender provisions and action plans of the Conventions.
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Monitoring Framework
UNICEF Malawi and its partners are prioritizing renewable energy solutions for children and communities across the country to access clean and affordable electricity, with a focus on hard-to-reach, rural communities unable to access the national electricity grid.
Antimicrobials are medicines, including antibiotics, antivirals, antifungals, and antiparasitics, that are used to prevent and treat infections in humans, animals, and plants. Antimicrobial Resistance (AMR) arises when bacteria, viruses, fungi, and parasites no longer respond to these medicines, ren
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dering them ineffective and making infections more difficult to treat. This resistance increases the risk of disease spread, severe illness, disability, and death. Although AMR is a natural phenomenon driven by genetic
changes in pathogens, it is significantly accelerated by human activities such as the misuse and overuse of antimicrobials in healthcare, agriculture, and animal husbandry.
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Caring for burns patients from the incident scene to definitive treatment can be a complex, resource-consuming process with the potential to overwhelm health system capacity.This document provides practical guidance for building capacity and capability for burns care from clinical, human resources a
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nd operational perspectives. It is therefore recommended that guidance in this document be applied to any contexts in which the local health system might struggle to cope and require surge support.
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