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IMPROVEMENT OF ORGANIZATIONAL ACTIVITIES OF ASTHMA SCHOOLS IN THE CONDITIONS OF PRIMARY MEDICAL CARE *Aitmagambet Askar Ersaiynuly, Aimbetova Gulshara Ergaziyevna
Kazakhstan Medical University "KSPH" Almaty, Kazakhstan
ABSTRACT
Asthma is a chronic disease that has a significant impact on the patient's quality of life and requires a comprehensive approach to treatment. The main goal of asthma treatment is symptom control and exacerbation prevention. In this context, asthma schools play a key role by educating patients and their families on proper self-care, disease control and exacerbation prevention. In this article, we review the most recent studies that discuss the impact of self-management education on treatment outcomes for patients with asthma in primary care.
Keywords: bronchial asthma, asthma school, respiratory infections, obstruction, bronchial mucosa, primary care.
Introduction.Patient education is an integral component of asthma treatment. The modern approach to asthma education has shifted from programs based on "information delivery," which proved ineffective, to methods that promote self-management and active patient learning. Although there are some recent examples of asthma education practices in primary health care, they are mostly associated with community-level pharmacists and are largely limited to adults. It is evident that further research is needed, particularly concerning children and adolescents [1,2].
A key aspect of optimizing asthma self-management education for patients is the need for more effective educational interventions for primary health care providers, as well as structural and organizational reform based on solid evidence. Treatment outcomes can be improved if there is greater coordination between different primary health care providers treating children and families with asthma. It may make sense to expand the concept of multidisciplinary care by incorporating partnerships with community groups and organizations to ensure the dissemination of asthma education messages in a wide range of settings.
However, in primary health care (PHC) settings, organizing asthma schools often faces several challenges:
• Insufficient funding.
• Lack of unified standards and methodological guidelines for organizing asthma schools.
• Shortage of specialized personnel.
• Low patient awareness of asthma school opportunities [3,4].
In this regard, it is important to improve the organizational activities of asthma schools in primary health care, aimed at improving the efficiency of their work and improving the quality of life of patients with asthma. Asthma is one of the most common chronic childhood diseases, affecting almost 10% of all children under the age of 18 in the United States. National guidelines established by the National Heart, Lung, and Blood Institute (NHLBI) recommend that all patients with persistent asthma take preventive anti-inflammatory medications daily. These medications reduce symptoms and prevent hospitalization when used as recommended. However, many children who should take preventive medications do not, and inadequate therapy is most common among underserved minorities. In addition, many children who are prescribed preventive medications do not follow the treatment regimen well and subsequently do not achieve optimal control. Thus, a significant part of the incidence of asthma can be prevented. Interventions are urgently needed to improve morbidity outcomes in this disadvantaged population group. Ease of implementation, generalizability, and sustainability are the key to developing such approaches [5].
The purpose of the study: to identify the main problems in the organization of asthma schools in primary health care and to develop recommendations for improving the organizational activities of asthma schools for the quality of life of patients with asthma.
Research methods: study of regulatory legal acts regulating the organization of asthma schools, analysis of medical literature on the research topic, comparison of the results of asthma schools before and after the introduction of recommendations for improving their organizational activities.
Research results: Bronchial asthma is an environmentally caused disease of industrial chemical compounds, as well as exhaust gases from motor vehicles. However, the main role in the development of bronchial asthma in children is played by atopy - food allergies, household dust, house dust mites, mold, epidermal (animal hair - cats, dogs, aquarium fish food), pollen allergies, flowering plants. However, it is known that there are cases of asthma with non-allergic inflammation of the respiratory tract. These non-allergic mechanisms are currently poorly understood. The combination of allergic and non-allergic mechanisms in the development of the disease leads to a discussion about whether asthma is a disease with a single underlying causal mechanism or a combination of different conditions with the result of variable airway obstruction [6,7,8].
In recent years, attention has been paid to various respiratory infections that cause obstructive syndrome, respiratory syncytial virus, rhinovirus, influenza virus, parainfluenza,
chlamydophilic, mycoplasma infections [9]. In all forms of bronchial asthma, mast cells and eosinophils are involved in the inflammatory process as key effector cells of the inflammatory response, which is associated with their ability to produce a wide range of preformed or newly formed mediators acting directly or indirectly through neurogenic mechanisms in the respiratory tract [10]. In bronchial asthma, eosinophils are often localized in the bronchi under the basement membrane and secrete cytokines, active oxygen radicals, eicosanides, growth factors, platelet activation factor, toxic granuloproteins that can cause bronchoconstriction, increase vascular permeability, which probably contributes to the formation of hyperreactivity [11]. In addition, eosinophils, interacting with nerve endings, lead to an increase in the secretion of acetylcholine by the parasympathetic nervous system. Neutrophils secrete various enzymes, reactive oxygen, cytokines, and chemokines. Mast cells in bronchial asthma in a degranulated state are a source of pharmacoid mediators, neutral proteases, in particular tryptases. Macrophages are actively involved in the process of airway remodeling due to the secretion of growth factors such as platelet growth factor, the main fibroblast growth factor [12].
The main three components of the modern definition of asthma are chronic inflammation, bronchial obstruction, and increased bronchial reactivity [13,14]. As a result of these pathophysiological changes, characteristic clinical manifestations of bronchial asthma appear -wheezing (sighing), shortness of breath, chest tightness, coughing, sputum production.
The prevalence of bronchial asthma in the world ranges from 4 to 10%. According to statistics, about 12% of the adult population and 17% of children in Kazakhstan suffer from asthma, and in recent years the situation has worsened further, the frequency of asthma and the severity of its course have increased. According to some reports, the number of people with asthma has doubled over the past 25 years.
In response to the need to improve compliance with preventive asthma treatment guidelines, we previously conducted a School Based Asthma Therapy (SBAT) study (20062009) to promote recommendation-based asthma treatment and reduce morbidity among poor and minority children with persistent symptoms. There were 530 children aged 3 to 10 years with persistent asthma who attended elementary school or preschool in the Rochester City School District (RCSD) in Rochester, New York. Children randomly assigned to the intervention group received daily preventive asthma medications prescribed as therapy under the direct supervision (DOT) of school medical staff, as well as ongoing symptom assessment and therapy adjustments based on recommendations, if necessary. Thus, we could ensure that preventive medications were followed on the days when the child attended school. It was found that children in the intervention group had significantly more days without symptoms than children
who received routine care. Children who received the intervention also experienced significantly fewer nights with asthma symptoms and fewer days with emergency medications [15].
Healthy parents practically do not threaten their children in any way, the risk of developing asthma in a child is only 20% (in official medicine this is considered a normal risk). But if at least one parent is sick in the family, the risk of childhood illness increases to 50%.
When both the mother and the father are sick, in 70 cases out of 100 the child gets sick. Already at the very beginning of the 21st century, mortality in the world increased 9-fold compared to the 90s! And about 80% of children's deaths due to bronchial asthma occur between the ages of 11 and 16! Regarding the age at which they begin to get sick: most often, the onset of the disease occurs in children under 10 years of age - 34%, from 10 to 20 years of age - 14%, from 20 to 40 years of age - 17%, from 40 to 50 years of age - 10%, from 50 to 60 years of age -6%, older - 2% [16].
Often, the first attacks of the disease begin in the first year of life. Bronchial asthma in children in early childhood is unusual, it is often mistaken for whooping cough, bronchopneumonia, bronchoadenitis (primary tuberculous bronchial lymphadenitis in children). In the Krasnodar Territory, more than 30 thousand people suffer from bronchial asthma, 7.5 thousand of them are children. The prevalence of the disease varies widely in different countries. The largest number of cases in Scotland is 18.4% of the total population suffering from bronchial asthma. The lowest rate in Macau is 0.7% of the total population. The prevalence of the disease in the United States is 5%. Studies in France, Mexico, Chile, Great Britain, and Italy on the effect of diet on the course of the disease have shown that people who consume plant products, juices rich in vitamins, fiber, and antioxidants have a slight tendency to a more favorable course of bronchial asthma, while eating animal products rich in fats, proteins, and refined, easily digestible carbohydrates are associated with a severe course of the disease and frequent exacerbations. For a long time, there was an idea of the existence of asthma of an infectious and allergic nature [17].
The factors causing attacks of suffocation and exacerbation of the disease are
allergens in exogenous bronchial asthma and NSAIDs in aspirin bronchial asthma, as well as cold, pungent odors, physical exertion and chemical agents [18, 19].
Most allergens are found in the air. These are plant pollen, microscopic fungi, household and library dust, the exfoliating epidermis of house dust mites, the hair of dogs, cats and other pets. The degree of reaction to the allergen does not depend on its concentration [18, 19].
Some studies have shown that exposure to mite allergens, house dust, cat and dog dander, and aspergillus causes sensitization to these allergens in children under 3 years of age. The
relationship between allergen exposure and sensitization depends on the type of allergen, dose, duration of exposure, age of the child, and possibly genetic predisposition [18, 19]. The structure of asthma schools in Kazakhstan
1. Organization of school work:
• Schools operate at polyclinics, dispensaries and hospitals.
• Classes are conducted by internists, pulmonologists, nurses and other specialists.
• Classes include lectures, practical demonstrations, and case studies.
2. Program content:
• Fundamentals of bronchial asthma (disease mechanisms, triggers).
• Training on the proper use of inhalers and other therapies.
• Keeping diaries of symptoms and peak flowmetry.
• Prevention of exacerbations, the basics of a healthy lifestyle.
3. Target audience:
• Children and adult patients with asthma.
• Relatives of patients to increase their participation in treatment. Advantages of asthma schools
1. Educational support:
• Improving patients' understanding of their illness.
• Increased adherence to treatment and regular follow-up.
2. Reducing the frequency of exacerbations:
• Patients are less likely to require hospitalization.
• Improved disease control.
3. Economic efficiency:
• Reducing the cost of treating asthma complications.
4. Professional development of medical staff:
• Doctors and nurses working in schools are improving their professional skills. Disadvantages of the current organization of asthma schools in Kazakhstan
1. Lack of funding:
• Lack of a sustainable source of funding for school development.
• Limited resources for the purchase of educational materials and inhalation devices.
2. Low awareness of the population:
• Many patients are unaware of the existence of such schools.
3. Lack of uniform standards:
• There is no unified training program suitable for all regions of Kazakhstan.
4. Lack of qualified personnel:
• Not all specialists are trained in conducting educational classes.
Solution methods:
1. Development of uniform standards of work:
• Creation of a unified asthma school program based on international standards (for example, GINA).
• Implementation of a quality control system for schools.
2. Increased funding:
• Provision of government and grant sources to support schools.
• * Purchase of modern technical demonstration equipment (interactive panels, inhalers, peak flow meters).
3. Information campaigns:
• Raising public awareness of educational opportunities in asthma schools.
• Dissemination of information via the Internet, social media and local media.
4. Specialist training:
• Conducting training sessions for doctors and nurses on how to conduct classes.
• Organization of internships based on successful international asthma schools.
5. Expansion of the school network:
• Increase in the number of asthma schools, especially in rural and hard-to-reach regions.
• The introduction of distance learning for patients living in remote areas.
5. Integration with PHC:
• Active cooperation of schools with primary health care doctors to send patients for training.
Regulatory documents:
1. The Code of the Republic of Kazakhstan "On the Health of the People and the Healthcare System" is the fundamental document regulating the healthcare system, including primary health care and disease prevention.
2. Order of the Minister of Health of the Republic of Kazakhstan dated October 23, 2020 No. KR DSM-149/2020: "On approval of the rules for the organization of medical care for persons with chronic diseases, frequency and duration of follow-up, mandatory minimum and multiplicity of diagnostic tests." This order defines the procedure for providing medical care to patients with chronic diseases, including bronchial asthma. https://adilet.zan.kz/rus/docs/V2000021513
3. Order of the Minister of Health of the Republic of Kazakhstan dated April 28, 2015 No. 281: "On approval of the Rules for the provision of primary health care and the Rules for attachment to primary health care organizations." The document establishes the procedure for the
provision of primary health care, including preventive and educational measures for patients. https://adilet.zan.kz/rus/docs/V1500011268
4. Clinical protocols for the diagnosis and treatment of bronchial asthma: Approved by the Ministry of Health of the Republic of Kazakhstan, these protocols contain recommendations for the management of patients with asthma, including educational components.
5. International recommendations: Global Initiative for Asthma (GINA): A global strategy for the treatment and prevention of asthma, adapted for use in Kazakhstan.
Conclusion. The conducted research confirms the high relevance of the development of asthma schools in Kazakhstan. Despite the lack of large-scale programs, the experience of international asthma schools and the first initiatives in Kazakhstan demonstrate the enormous potential of this method in improving the quality of life of people with asthma.
Asthma schools in Kazakhstan are educational programs aimed at teaching patients with bronchial asthma and their families effective methods of self-control, proper use of medications and prevention of exacerbations of the disease. Currently, such schools are organized on the basis of primary health care (PHC) medical organizations and some specialized clinics.
Asthma is a common problem in Kazakhstan, however, the level of awareness about the disease and the skills of asthma management among patients remain low. An asthma school can become an effective tool for raising awareness, teaching self-control and adherence to treatment, which will lead to a reduction in the number of exacerbations and improve the quality of life of patients. It is necessary to overcome a number of obstacles to the development of asthma schools in Kazakhstan, including lack of funding, lack of uniform standards, lack of specialists trained to work in asthma schools, and low awareness among the population about the possibilities of asthma schools.
It is necessary to develop uniform standards and guidelines for the organization of asthma schools in Kazakhstan, taking into account international experience and local peculiarities. It is important to train medical professionals in working methods in asthma schools, as well as to increase their competence in the field of asthma management. Information campaigns should be conducted to raise public awareness about the possibilities of asthma schools, their importance, and how to participate in the program. It is important to ensure adequate funding for the development of asthma schools in Kazakhstan in order to create high-quality programs and ensure their accessibility to all patients in need.
The development of asthma schools in Kazakhstan is an investment in the health and quality of life of people with asthma. The joint efforts of medical professionals, patients,
government agencies and public organizations can lead to a significant improvement in the asthma management situation in Kazakhstan.
Asthma School is an effective tool for improving asthma management. Teaching patients about self-control, medication use, and planning actions in case of an exacerbation can reduce the frequency of exacerbations, improve quality of life, and reduce treatment costs. The introduction of asthma schools in Kazakhstan is an important step towards improving the quality of medical care for patients with asthma.
МСАК ЖАГДАЙЫНДА ДЕМ1КПЕ МЕКТЕПТЕР1НЩ ¥ЙЫМДЬЩ
ЦЫЗМЕТ1Н ЖЕТ1ЛД1РУ *АйтмаFамбет Аскар Ерсайынулы, Аимбетова Гульшара Ергазыевна
«^ДСЖМ» ^азакстандык медицина университетi Алматы, ^азакстан
ТYЙIНДЕМЕ
Демiкпе - наукастьщ eмiр CYPУ сапасына айтарлыктай эсер ететш жэне емдеуге кешендi тэсiлдi кажет ететiн созылмалы ауру. Демшпеш емдеудщ негiзгi максаты -симптомдарды бакылау жэне eршудi болдырмау. Осы тургыда демiкпе мектептерi пациенттер мен олардыц отбасыларын д^рыс eзiн-eзi ^туге, ауруды бакылауга жэне eршушщ алдын алуга Yйрету аркылы мацызды рел аткарады. Бул макалада бiз алгашкы медициналык кeмек кeрсету мекемелерiнде демкпеа бар наукастар Yшiн eзiн-eзi баскару бшмшщ нэтижелерге эсерiн талкылайтын ец соцгы зерттеулердi карастырамыз.
ТYйiндi свздер: бронх дем1кпес1, дем1кпе мектебг, респираторлыц инфекциялар, обструкция, бронхтыц шырышты цабаты, медициналыц-санитарлыц алгашцы квмек.
СОВЕРШЕНСТВОВАНИЕ ОРГАНИЗАЦИОННОЙ ДЕЯТЕЛЬНОСТИ АСТМА
ШКОЛЫ В УСЛОВИЯХ ПМСП *АйтмаFамбет Аскар Ерсайынулы, Аимбетова Гульшара Ергазыевна Казахстанский медицинский университет «ВШОЗ», Алматы, Казахстан
АННОТАЦИЯ
Астма - хроническое заболевание, оказывающее значительное влияние на качество жизни пациента и требует комплексного подхода к лечению. Основной задачей лечения астмы является контроль над симптомами и предотвращение обострений. В данном
контексте астма-школы играют ключевую роль, обучая пациентов и их семьи правильному самоуходу, контролю над заболеванием и предотвращению обострений. В данной статье представлены результаты последних исследований, в которых рассматриваются вопросы влияние обучения самостоятельному контролю на результаты лечения пациентов с астмой в условиях первичной медико-санитарной помощи.
Ключевые слова: бронхиальная астма, астма-школа, респираторные инфекции, обструкция, слизистая оболочка бронхов, первично медико-санитарная помощь.
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Конфликт интересов. Автор заявляет об отсутствии потенциального конфликта интересов, требующего раскрытия в данной статье.
Вклад авторов. Автор внес вклад в разработку концепции, выполнение и обработку результатов, и написание статьи. Заявляем, что данный материал ранее не публиковался и не находится на рассмотрении в других издательствах.
Финансирование. Отсутствует.
Сведения об авторах:
1. Автор-корреспондент Айтмагамбет Асцар Ерсайыщлы - Магистр второго года обучения, кафедра общественного здравоохранения и социальных наук, Казахстанский медицинский университет «ВШОЗ»; Алматы, Казахстан. E-mail: [email protected]. ORCID— https://orcid.org/0009-0004-4147-4648
2. Аимбетова Гульшара Ергазыевна - Ассоциированный профессор кафедры "Общественное здравоохранение", КазНМУ им. С.Д.Асфендиярова; Алматы, Казахстан E-mail: [email protected]. ORCID— https://orcid.org/0000-0002-9466-6297
Статья поступила: 14.11.2024 Статья принята: 29.12.2024
