General Approach to Lowering Risk of Adult Respiratory Disease
Although interventions of various sorts are indicated for each of the disease categories discussed, these interventions are often costly and sometimes ineffective in lowering or preventing premature mortality. Thus, from an operational perspective, it is important to consider preventive and therapeutic strategies that will have greater societal effect than will the management of the manifestations of diseases as they arise in individuals. This approach applies to acute diseases (vaccination schemes to reduce the burden of influenza, in contrast to individual management of community-acquired pneumonia) and chronic diseases (smoking prevention and reduction programs, compared with availability of routine asthma medication). Primary prevention strategies should include efforts by multiple agencies of government and the community coming together to establish appropriate priorities for action. Four sources of exposure stand out: tobacco smoke, indoor smoke, outdoor air pollutants, and occupational exposure (see chapters 46, 42, 43, and 60, respectively). Of these, the most pressing and cost-effective is a cohesive policy to control tobacco smoking.
In conjunction with the International Union against Tuberculosis and Lung Disease (IUATLD) and selected universities and health institutions in various countries, WHO is developing the Practical Approach to Lung Health (PAL, previously known as the Adult Lung Health Initiative). The program is focused on improving primary care services, as well as appropriate referral to secondary health care facilities, for individuals with tuberculosis, acute respiratory infections (especially pneumonia), asthma, and COPD. Four countries (Chile, Morocco, Nepal, and South Africa) are serving as the pilot implementation sites (WHO 2003).
In Chile, where respiratory symptoms account for one-third of primary health care visits, a respiratory disease program was initiated in 2001 as part of ongoing efforts to strengthen primary health care. The pilot program was implemented in 15 centers. Standard formats are used to devise scores to determine follow-up for asthma and COPD. Sentinel centers are used to provide epidemiologic information. Influenza immunization coverage of the elderly and at-risk population has reached 85 percent (WHO 2003).
In Morocco, survey work done before establishing a PAL strategy showed that 31 percent of patients who consult primary health care centers present with respiratory symptoms. Of those patients, 85 percent have acute respiratory infections, 14 percent have chronic conditions, and 1 percent have tuberculosis. In Mexico, an IUATLD study implementing asthma control measures was shown to be cost-effective. Control of asthma improved, and the majority of patients experienced a decrease in the severity of asthma. The cost of asthma management decreased because of lower costs for emergency services and hospitalizations (WHO 2003).
