The Program for the Prevention of Childhood Asthma: a specialized care program for children with wheezing or asthma in Brazil

Abstract

Objective: To present the Programa Infantil de Prevenção de Asma (PIPA, Program for the Prevention of Childhood Asthma) and the characteristics of the patients followed in this program. Methods: Implemented in the city of Uruguaiana, Brazil, PIPA has as its target population children and adolescents (< 18 years of age) with asthma or suspected asthma. Patients either enroll in PIPA spontaneously or are referred by pediatricians or primary care physicians. In this retrospective study, we use a standardized protocol to assess PIPA patients. Results: By the end of the study period, 646 patients were being followed. Of those, 298 (46.1%) were ≤ 3 years of age. In this group of patients, recurrent wheezing was identified in 60.7%, and the first episode of wheezing occurred in the first six months of life in 86.0%. Severe wheezing was identified in 29.5% and 45.4% in the children ≤ 3 and > 3 years of age, respectively. Physician-diagnosed asthma was reported in 26.5% and 82.2%, respectively. In the sample as a whole, the prevalence of passive smoking was high (> 36%), occurring during pregnancy in > 15%; > 40% of the patients had been born by cesarean section; and 30% had a mother who had had < 8 years of schooling. Conclusions: A prevention program for children with asthma is an effective strategy for controlling the disease. Knowledge of local epidemiological and environmental characteristics is essential to reducing the prevalence of the severe forms of asthma, to improving the use of health resources, and to preventing pulmonary changes that could lead to COPD in adulthood.

<b> Hospitalizações por doenças crônicas em crianças menores de cinco anos no sistema público de saúde no Brasil e no Rio Grande do Sul/ Hospitalizations caused by chronic diseases among children under the age of five in the public health system in Brazil and in Rio Grande do Sul<b>

“…No Brasil, no município de Uruguaiana (RS), existe, desde 2012, o Programa Infantil de Prevenção de Asma (PIPA). Programas como este podem possibilitar um melhor acompanhamento da doença desde o início dos sintomas, diminuindo a procura pelos serviços de urgência e as hospitalizações, especialmente nos pacientes com asma não diagnosticada, subtratada ou mal controlada, evitando, assim, o aparecimento de alterações pulmonares que possam levar ao desenvolvimento de DPOC na fase adulta (11) .…”

Country activities of Global Alliance against Chronic Respiratory Diseases (GARD): focus presentations at the 11th GARD General Meeting, Brussels

“…There are several successful programs on morbidity and mortality control of these diseases, like Programa para controle da Asma e da Rinite Alérgica Calling to members of SLAAI for a joint meeting with GARD representatives and applying for GARD membership were established as next steps in near future (29)(30)(31)(32)(33) This guidebook includes: (I) guidelines for management of asthma and COPD in outpatients clinics of general secondary care hospitals; (II) audits for evaluation of practice based on GINA (www.ginasthma.org) and GOLD (www.goldcopd.org); (III) a book chapter on the essential facts that need to be known for primary care about asthma, COPD and allergic rhinitis, such as early diagnosis, patient education, smoking cessation, how to use inhalers and spacers, and safety of inhaled corticosteroids; (IV) how spacers could replace Nebulizer, peak flow, and how to interpret spirometry; and (V) algorithms protocols of WHO-PEN (translated to Arabic and adapted to Syria) for use in primary care centers.…”

“…Early in October 2017, a Skype Conference was made involving the delegates of the five countries and the GARD Secretary (Nils Billo). On October 26, the MoHs of CPLP (Angola, Brazil, Cape Verde, East Timor, Guinea-Bissau, Mozambique, Portugal, and São Tomé e Principe) approved the GARD Lusophone project based on GARD-Brasilia (Brazil) under the proposal of IHMT (47)(48)(49)(50)(51)(52)(53).…”

Global Alliance against Chronic Respiratory Diseases (GARD) Brazil success case: overcoming barriers

“…Two initiatives have pioneered city wide asthma control programmes and were recognized as GARD Demonstration Projects from 2007: (I) "Wheezy Child", in Belo Horizonte, building capacity of primary care teams to manage asthma in childhood and offering inhaled corticosteroids for free; and (II) ProAR, in Salvador da Bahia, providing free multidisciplinary approach and medication to patients with severe asthma. Both of these programmes have been successful, generated multiple publications (25)(26)(27) and became models for other initiatives elsewhere in Brazil, such as in Uruguaiana in the Southern Region, Itabira in the Centerwest and Feira de Santana, in the Northeast (28)(29)(30).…”