National and regional asthma programmes in Europe

Abstract

This review presents seven national asthma programmes to support the European Asthma Research and Innovation Partnership in developing strategies to reduce asthma mortality and morbidity across Europe. From published data it appears that in order to influence asthma care, national/regional asthma programmes are more effective than conventional treatment guidelines. An asthma programme should start with the universal commitments of stakeholders at all levels and the programme has to be endorsed by political and governmental bodies. When the national problems have been identified, the goals of the programme have to be clearly defined with measures to evaluate progress. An action plan has to be developed, including defined re-allocation of patients and existing resources, if necessary, between primary care and specialised healthcare units or hospital centres. Patients should be involved in guided self-management education and structured follow-up in relation to disease severity. The three evaluated programmes show that, thanks to rigorous efforts, it is possible to improve patients' quality of life and reduce hospitalisation, asthma mortality, sick leave and disability pensions. The direct and indirect costs, both for the individual patient and for society, can be significantly reduced. The results can form the basis for development of further programme activities in Europe.

FIGURE 1

Increase in number of asthmatic patients entitled to special reimbursement for their drug costs (need for regular maintenance treatment), increase in drug costs per patient, decrease in death rate and decrease in hospital days due to asthma. Numbers are relative changes after 1981. Reproduced from [8].

FIGURE 2

Realised annual expenditures of asthma care and theoretical annual costs where an increased prevalence of asthma is observed, but care practices remain at the 1987 level. Reproduced and modified from [55] with permission from the publisher.

FIGURE 3

Hospital admission rates in France during implementation of the National Asthma Programme. Data from the Agence Technique de l'Information sur l'Hospitalisation.

FIGURE 4

Flow chart of strategic planning, implementation and evaluation of the programme. GP: general practitioner; ICS: inhaled corticosteroid; NGO: non-governmental organisation. Reproduced and modified from [7] with permission from the publisher.