Portugal at the cross road of international chronic respiratory programmes
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Tonelli, E.M. Clini" "autores" => array:2 [ 0 => array:2 [ "Iniciales" => "R." "apellidos" => "Tonelli" ] 1 => array:2 [ "Iniciales" => "E.M." "apellidos" => "Clini" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915364891?idApp=UINPBA00004E" "url" => "/08732159/0000002100000005/v0_201604141143/X0873215915364891/v0_201604141143/en/main.assets" ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "Portugal at the cross road of international chronic respiratory programmes" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "230" "paginaFinal" => "232" ] ] "textoCompleto" => "<p class="elsevierStylePara">July 1–4, 2015 two meetings will be held with the Directorate General of Health in Lisbon, Portugal to discuss chronic respiratory programmes of the WHO Global Alliance against Chronic Respiratory Diseases (GARD)<a href="#bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">, </span><a href="#bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> and European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)<a href="#bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> (AIRWAYS ICPs: Integrated Care Pathways for airway diseases).<a href="#bib28" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> The goals of these meetings will be to make an update of these two international actions and to strengthen the WHO noncommunicable disease (NCD) action plan (2013–2020).</p><p class="elsevierStylePara">Chronic respiratory diseases (CRD) include asthma, rhinitis and COPD, occupational lung diseases, sleep apnoea syndrome and genetic syndromes such as cystic fibrosis.<a href="#bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">, </span><a href="#bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> Over 1 billion people in the world suffer from CRDs. They represent one of the priorities of the EU (3053rd and 3131st Conclusions of the EU Council, 2010 and 2011)<a href="#bib29" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">, </span><a href="#bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> and the United Nations (High Level meeting on Non-Communicable Diseases, 2011).<a href="#bib31" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> The 2011 Polish Presidence of the EU Council made the prevention, early diagnosis and treatment of asthma and allergic diseases a priority for the EU's public health policy in order to reduce health inequalities.<a href="#bib29" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> The early determinants of CRDs were reinforced during the Cyprus Presidency of the EU Council.<a href="#bib32" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> The 2014 Italian Presidence of the EU Council has prioritized CRDs. CRDs represent a model of chronic diseases due to their prevalence, burden (3 million annual deaths due to COPD), and comorbidities with other chronic diseases.<a href="#bib33" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a></p><p class="elsevierStylePara">European Innovation Partnerships (EIP) attempt to enhance EU competitiveness and tackle societal challenges by fostering innovation. Active and Healthy Ageing (AHA) is a major societal challenge common to all countries and to all populations.<a href="#bib34" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> Ageing, intertwined with socioeconomic inequalities, is an under-appreciated cause of poverty. AHA needs to be promoted very early in life to be successful. The EIP on AHA is deployed in 3 areas and 6 action plans.<a href="#bib35" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a></p><p class="elsevierStylePara">AIRWAYS ICPs (integrated care pathways for airway diseases) has been selected as the model of NCDs for Area 5 of the B3 Action Plan of the EIP on AHA (DG Sanco and DG CNECT).<a href="#bib28" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> It was launched by NHS England (Newcastle, February 2014) and has been endorsed by the EIP on AHA Reference Site Network. The goals of AIRWAYS ICPs include the launch of a collaboration to develop multisectoral CRD care pathways (ICPs) in European countries and regions, as part of the EIP on AHA (Area 5 of the Action Plan B3 of EIP on AHA, DG Sanco, DG CNECT) as well as a global scale up with WHO GARD (GARD demonstration research project).<a href="#bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">, </span><a href="#bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and the WHO NCD Action Plan (2013–2020). The goals of AIRWAYS ICPs are listed in <a href="#t0005" class="elsevierStyleCrossRefs">Table 1</a>.</p><p class="elsevierStylePara">Table 1. Goals of AIRWAYS ICPs.</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>1. Proposing a common framework of care pathways for chronic respiratory diseases which will facilitate comparability and trans-national initiatives</td></tr><tr align="left"><td>2. Proposing plans targeted to all populations according to culture, health systems and income</td></tr><tr align="left"><td>3. Developing a strategy based on WHO PEN and the essential list of drugs for low and middle income countries</td></tr><tr align="left"><td>4. Informing cost-effective policy development, in particular strengthening those on smoking and environment exposure</td></tr><tr align="left"><td>5. Aiding risk stratification in chronic disease patients with a common strategy</td></tr><tr align="left"><td>6. Building a sentinel network for allergic diseases and asthma</td></tr><tr align="left"><td>7. Having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and the long-term (healthy ageing)</td></tr><tr align="left"><td>8. Tackling chronic diseases across the life cycle</td></tr><tr align="left"><td>9. Defining active and healthy ageing</td></tr><tr align="left"><td>10. And ultimately reducing the healthcare burden (emergency visits, avoidable hospitalizations, disability and costs) while improving quality of life and promoting active and healthy ageing. In the longer term, the incidence of disease may be reduced by innovative prevention strategies</td></tr></table><p class="elsevierStylePara">Portugal has been promoting CRDs for over 10 years by the scientific Societies and, more recently, through the National Program on Respiratory Diseases, from the Directorate-General for Health.</p><p class="elsevierStylePara">The first meeting will review the different actions of AIRWAYS ICPs and launch some activities which are finalized. Among them, a repository for good practices, the new ARIA 2015 guidelines, the MACVIA-ARIA sentinel network and the scaling up strategy.</p><p class="elsevierStylePara">Allergic rhinitis is one of the most prevalent diseases in the world (25% of the EU population). Although symptoms of rhinitis appear to be trivial, the disease affects social activities, school and work performance and allergic rhinitis is associated with a detrimental effect on examination performance.<a href="#bib36" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a> It is often associated with or precedes asthma. Allergic rhinitis has been considered to alter AHA if not appropriately managed.<a href="#bib29" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">, </span><a href="#bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> ARIA, a guideline for allergic rhinitis and its comorbidity with asthma, was the first comorbidity guideline in chronic diseases. It was developed in the late 1999s in collaboration with WHO using the recommended methodology for guidelines (Shekelle).<a href="#bib37" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a> It was updated in 2008.<a href="#bib38" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a> It has been revised using the GRADE methodology (2010).<a href="#bib39" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">, </span><a href="#bib40" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">, </span><a href="#bib41" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">17</span></a> It is the most widely used guideline for rhinitis, and rhinitis and asthma comorbidity globally.<a href="#bib42" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">18</span></a> ARIA is implemented in 64 countries and the pocket guide of the guideline has been translated into 52 languages. However, there is a need to develop a new set of recommendations which will be integrated care pathways. The ARIA 2015 will be launched during the meeting in Lisbon.</p><p class="elsevierStylePara">The MACVIA-ARIA Sentinel Network (MASK) proposes to study the symptoms of patients suffering from allergic symptoms during the pollen season in order to make them sentinels for the onset and severity of the pollen season. Patients are geolocalised and will evaluate their symptoms by visual analogue scale (VAS) using a cell phone with a touch screen or internet. This information will be coded and sent to a central database and subsequently to all patients registered in the system. A Clinical Decision Support System (CDSS)<a href="#bib43" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">, </span><a href="#bib44" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">20</span></a> will immediately propose advice for (standardized) pharmacologic treatment. Patients with uncontrolled disease (SCUAD)<a href="#bib45" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">21</span></a> will be easily defined as those resistant to treatment despite optimal treatment. Moreover, conjunctival symptoms and asthma will be monitored by the system. It will be combined with CARAT (Control of Allergic Rhinitis and Asthma Test)<a href="#bib46" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleSup">, </span><a href="#bib47" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">23</span></a> in order to better phenotype the patients, and an e-learning tool.</p><p class="elsevierStylePara">The EIP on AHA has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1–1) databases of good practices, (1–2) assessment of viability of the scaling up of good practices, (1–3) classification of good practices for local replication and (2) how to scale up: (2–1) facilitating partnerships for scaling up, (2–2) implementation of key success factors and lessons learnt. This strategy has already been applied to the CRD action plan of the EIP on AHA.</p><p class="elsevierStylePara">This meeting will have the support of the Région Languedoc Roussillon<a href="#bib48" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">24</span></a> and the Coimbra Region, and will be the third meeting of the Collaborative Network of EIP on AHA Reference Sites.</p><p class="elsevierStylePara">The second meeting will be the GARD annual meeting and will review advances of this WHO alliance.</p><p class="elsevierStylePara">Both meetings are supported by the Portuguese Respiratory Society and show the implication of this society in international actions on CRDs.</p><p class="elsevierStylePara">Corresponding author. carlos.crobalo@gmail.com</p>" "pdfFichero" => "320v21n05a90436490pdf001.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib25" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Global alliance against chronic respiratory diseases. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 4 | 12 |
| 2024 October | 37 | 33 | 70 |
| 2024 September | 55 | 28 | 83 |
| 2024 August | 57 | 33 | 90 |
| 2024 July | 60 | 39 | 99 |
| 2024 June | 57 | 26 | 83 |
| 2024 May | 45 | 32 | 77 |
| 2024 April | 56 | 32 | 88 |
| 2024 March | 41 | 26 | 67 |
| 2024 February | 47 | 22 | 69 |
| 2024 January | 49 | 27 | 76 |
| 2023 December | 30 | 32 | 62 |
| 2023 November | 33 | 32 | 65 |
| 2023 October | 29 | 38 | 67 |
| 2023 September | 33 | 38 | 71 |
| 2023 August | 31 | 21 | 52 |
| 2023 July | 34 | 27 | 61 |
| 2023 June | 39 | 15 | 54 |
| 2023 May | 60 | 24 | 84 |
| 2023 April | 43 | 24 | 67 |
| 2023 March | 93 | 18 | 111 |
| 2023 February | 57 | 24 | 81 |
| 2023 January | 31 | 17 | 48 |
| 2022 December | 62 | 18 | 80 |
| 2022 November | 97 | 42 | 139 |
| 2022 October | 51 | 35 | 86 |
| 2022 September | 33 | 43 | 76 |
| 2022 August | 38 | 50 | 88 |
| 2022 July | 46 | 50 | 96 |
| 2022 June | 35 | 34 | 69 |
| 2022 May | 45 | 43 | 88 |
| 2022 April | 34 | 36 | 70 |
| 2022 March | 33 | 50 | 83 |
| 2022 February | 34 | 35 | 69 |
| 2022 January | 33 | 35 | 68 |
| 2021 December | 34 | 38 | 72 |
| 2021 November | 31 | 32 | 63 |
| 2021 October | 36 | 43 | 79 |
| 2021 September | 36 | 29 | 65 |
| 2021 August | 28 | 25 | 53 |
| 2021 July | 35 | 20 | 55 |
| 2021 June | 34 | 25 | 59 |
| 2021 May | 35 | 37 | 72 |
| 2021 April | 97 | 53 | 150 |
| 2021 March | 70 | 29 | 99 |
| 2021 February | 48 | 15 | 63 |
| 2021 January | 23 | 16 | 39 |
| 2020 December | 28 | 13 | 41 |
| 2020 November | 34 | 18 | 52 |
| 2020 October | 32 | 21 | 53 |
| 2020 September | 50 | 21 | 71 |
| 2020 August | 55 | 21 | 76 |
| 2020 July | 71 | 20 | 91 |
| 2020 June | 58 | 17 | 75 |
| 2020 May | 54 | 15 | 69 |
| 2020 April | 57 | 5 | 62 |
| 2020 March | 62 | 14 | 76 |
| 2020 February | 53 | 17 | 70 |
| 2020 January | 63 | 10 | 73 |
| 2019 December | 46 | 19 | 65 |
| 2019 November | 59 | 18 | 77 |
| 2019 October | 47 | 19 | 66 |
| 2019 September | 46 | 20 | 66 |
| 2019 August | 108 | 13 | 121 |
| 2019 July | 141 | 13 | 154 |
| 2019 June | 144 | 15 | 159 |
| 2019 May | 114 | 19 | 133 |
| 2019 April | 136 | 17 | 153 |
| 2019 March | 164 | 14 | 178 |
| 2019 February | 145 | 9 | 154 |
| 2019 January | 152 | 14 | 166 |
| 2018 December | 89 | 9 | 98 |
| 2018 November | 32 | 2 | 34 |
| 2018 October | 52 | 5 | 57 |
| 2018 September | 25 | 11 | 36 |
| 2018 August | 34 | 21 | 55 |
| 2018 July | 28 | 20 | 48 |
| 2018 June | 44 | 15 | 59 |
| 2018 May | 58 | 15 | 73 |
| 2018 April | 109 | 23 | 132 |
| 2018 March | 62 | 18 | 80 |
| 2018 February | 71 | 7 | 78 |
| 2018 January | 15 | 17 | 32 |
| 2017 December | 90 | 17 | 107 |
| 2017 November | 19 | 19 | 38 |
| 2017 October | 26 | 11 | 37 |
| 2017 September | 23 | 14 | 37 |
| 2017 August | 23 | 18 | 41 |
| 2017 July | 15 | 12 | 27 |
| 2017 June | 15 | 12 | 27 |
| 2017 May | 19 | 22 | 41 |
| 2017 April | 13 | 8 | 21 |
| 2017 March | 11 | 14 | 25 |
| 2017 February | 6 | 12 | 18 |
| 2017 January | 10 | 8 | 18 |
| 2016 December | 6 | 8 | 14 |
| 2016 November | 9 | 5 | 14 |
| 2016 October | 9 | 13 | 22 |
| 2016 September | 5 | 2 | 7 |
| 2016 August | 13 | 6 | 19 |
| 2016 July | 14 | 15 | 29 |
| 2016 June | 0 | 14 | 14 |
| 2016 May | 0 | 11 | 11 |
| 2016 April | 10 | 1 | 11 |
| 2016 March | 16 | 24 | 40 |
| 2016 February | 14 | 30 | 44 |
| 2016 January | 20 | 25 | 45 |
| 2015 December | 78 | 47 | 125 |
| 2015 November | 69 | 57 | 126 |
| 2015 October | 81 | 60 | 141 |
| 2015 September | 173 | 116 | 289 |
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