ABSTRACT

We describe a program designed for the primary care of respiratory diseases, based on the Practical Approach to Lung Diseases (PAL) from the World Health Organization. It is based on a syndromic approach to the most common respiratory diseases, both acute and chronic: asthma, COPD, acute upper respiratory infections, pneumonia, tuberculosis, smoking and sleep apnea, avoiding programs based on only one disease. It is centered on primary care, reinforcing its key role in the health system, both for caring of the sick, but also for health promotion and prevention. According to the experience from other countries the program can reduce or solve some common problems in the primary care of respiratory diseases: abuse of antibiotics for viral diseases, excessive referral to second or third level care, lack of use of inhaled corticosteroids in asthma, spirometric diagnosis of COPD, poor detection of tuberculosis, and in addition reinforces capacitation and resolutive capacity of primary care.

KEYWORDS

AIRE program, chronic diseases, respiratory diseases, policy.

REFERENCES

1. Perez-Padilla R. Hidden respiratory disease-associated deaths. Int J Tuberc Lung Dis 2008;12:458-464.

2. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997;349:1498-1504.

3. Lopez AD, Mathers CD. Measuring the global burden of disease and epidemiological transitions: 2002-2030. Ann Trop Med Parasitol 2006;100:481-499.

4. Health Organization. Preventing chronic diseases: A vital investment. Genève: World Health Organization; 2005.

5. Global Alliance against Chronic Respiratory Diseases (GARD). A comprehensive approach for the global surveillance, prevention and control of chronic respiratory diseases and for decreasing their burden. Genève, Switzerland: World Health Organization; 2006.

6. Organización Mundial de la Salud. La atención primaria de salud. Ginebra: Organización Mundial de la Salud; 2008.

7. International Conference on Primary Health Care. Declaration of Alma-Ata. WHO Chron 1978;32:428-430

8. English RG, Bateman ED, Zwarenstein MF, et al. Development of a South African integrated syndromic respiratory disease guideline for primary care. Prim Care Respir J 2008;17:156-163.

9. Camacho M, Nogales M, Manjon R, Del Granado M, Pio A, Ottmani S. Results of PAL feasibility test in primary health care facilities in four regions of Bolivia. Int J Tuberc Lung Dis 2007;11:1246-1252.

10. Murray JF, Pio A, Ottmani S. PAL: a new and practical approach to lung health. Int J Tuberc Lung Dis 2006;10:1188-1191.

11. Bateman E, Feldman C, Mash R, Fairall L, English R, Jithoo A. Systems for the management of respiratory disease in primary care--an international series: South Africa. Prim Care Respir J 2009;18:69-75.