Asthma in urban setting: A southern American perspective

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Summary

To manage Asthma in urban setting of developing countries is a challenge to the health system of developing countries. To reduce asthma morbidity (hospital admissions and emergency visits) is the main goal to be reached. It is necessary to adapt international guidelines considering the local constraints. The provision of free medication is mandatory. Education of parents and patients must be a priority of asthma programs.

Introduction

According to ISAAC studies Asthma prevalence is very high in Latin America, Brazil is situated amongst the higher rates, around 20% in school-aged children. Some indicators of Asthma morbidity such as hospital admissions and emergency visits are remarkably high. Partially the explanation of this phenomenon is explained by barriers to effective treatment such as the lack of free medication (mainly inhaled steroids), persistency of environmental risk factors and disparities in prescriptions.

Section snippets

Asthma morbidity

Asthma is a major cause of hospital admissions in both developed and developing countries. The hospitalization rate among asthmatic children is situated around 62.2–67.0%. The age of first admission usually is before the second birthday in the majority of cases. The median age of onset of symptoms is less than 12 months according some studies.

In a study developed in Porto Alegre, southern Brazil 3155 admissions (3 year period) were analyzed. In 63% of admissions fever was detected and 20% had

Asthma management

An international study developed to find out characteristics of Asthma management around the world was recently implemented in Latin America (Asthma insights and reality in Latin America, AIRLA). Even considering that this study was conducted mainly in adults, results from pediatric patients were relevant, 808 children were included. In this group of children 57% had significant respiratory symptoms in the previous four weeks before the interview. Night wakening due to asthma was detected in

Conclusion

In developing countries, asthma management represents a challenge to public health systems because of its prevalence, its severity and its economic impact. Health care planners must establish priorities for the allocation of limited resources. Nevertheless, standardized management programs should be implemented. International guidelines must be followed taking into account local adaptations. The routine training and supervision of health services personnel is crucial.

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