Wheezy Child Program

Abstract

BackgroundUntil 1994, assistance provided by the Municipal Public Health System to children with asthma in Belo Horizonte, Brazil, was ineffective because it focused only on treating exacerbations. This scenario motivated the implementation of the Wheezy Child Program.ObjectivesThe main objectives were to reduce emergency room visits and hospitalizations.MethodsThe strategies adopted were as follows: continued medical education for pediatricians, reorganization of public assistance into different levels of complexity regarding asthma care, and free dispensation of inhaled beclomethasone, albuterol, and valved spacers. A partnership between the Pediatric Pulmonology staff of the Federal University of Minas Gerais and the Belo Horizonte Municipal Health Authority made these strategies come to fruition, especially through the training of health workers and the devising of protocol after GINA guidelines.ResultsOf 2149 patients with a history of hospitalization after program admission, only 453 were re-admitted in the 6 to 12 months after, a reduction of 79%. There was a 300% increase in the use of aerosol and a reduction to 50% in the use of oxygen-driven nebulizers (P < 0.001) in the management of exacerbations. For patients enrolled in the program with moderate and severe persistent asthma, the median adherence rate was 50%.ConclusionsThe Wheezy Child Program has significantly reduced hospitalizations and emergency room visits, has improved quality of life, and has shown that programs of this kind are feasible in low- to middle-income countries. More than 30,000 children have been assisted by the program, and now it seeks to optimize asthma control and increase adherence rates.

Lung function in severe pediatric asthma: a longitudinal study in children and adolescents in Brazil

“…In addition, after initial efforts to educate the patients and their relatives, exposure to secondhand smoke in the home was reportedly eliminated and the comorbidities were addressed. All of our patients were treated within the public health care system, via the CEMAD and Wheezing Baby Program, which is the first of its kind in Brazil [ 13 ]. Since 1994, it has been offering specialized treatment with medications provided free of charge.…”

“…This was a prospective cohort study in which 384 spirometry tests of 65 patients with severe asthma, obtained over a period of 3 years, were referred by pediatric pulmonologists affiliated with the Wheezing Baby Program [ 13 ], which operates under the auspices of the Centro Multidisciplinar de Asma de Difícil Controle (CEMAD, Multidisciplinary Center for Difficult-to-Control Asthma), a university center in the city of Belo Horizonte, in southeastern Brazil. The methods of evaluation and therapeutic management of this cohort have previously been described [ 14 ].…”

“…All medications were provided free of charge to the patients by the pharmacies of secondary referral centers [ 13 ]. Over the course of the study, we monitored blood pressure, growth curves, body mass index, and the basal serum level of cortisol (measured annually), as well as monitoring clinical variables to identify any adverse effects of the medication prescribed.…”

Improving the global diagnosis and management of asthma in children

“…Shining examples of these are the Finland Asthma Project, 10 the 12-year to 15-year study in Costa Rica 66 and the Belo Horizonte Project in Brazil. 67 Lessons from these and other regional innovative incentives still need to be shared across the globe and we will incorporate these into our educational plan. In addition, the availability and cost of medications and spacers in LMICs remain a huge barrier that could be overcome with directed resources, much in the way vaccination rates have improved in this setting.…”

“… 38 In contrast, the Wheezy Child Programme in Belo Horizonte, Brazil, showed that expensive medications are not necessary to achieve a good outcome, with the simple use of regular ICS and intermittent short-acting β 2 -agonists (SABAs) highly effective in reducing hospital admissions and emergency room visits in young children with asthma from 1994 onwards. 67 Overdiagnosis in very young and underdiagnosis in older children are continuing themes. There is no consistent intercountry agreement about step-down treatment.…”