Health Education in Asthma & Allergies-2013

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Education for patients , their family members and the public regarding asthma and allerggies prevention and management.

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Health Education in Asthma & Mostafa Moin MD Professor of Allergy & Clinical Immunology Immunology , Asthma & Allergy Research Institute (IAARI ) I.R.IRAN Tehran University of Health Sciences 2013 ”بنام خداوند جان و خرد “ آموزش سلامت در آسم و آلرژی Allergies

آموزش سلامت Health Education:

آموزش سلامت Health Education The Latin origin of “doctor” ( doctere ) means “to teach”! Education of : Patients, Their families, Communities, is the responsibility of all Physicians. ”پزشک“ به عنوان یک آموزگار ! “Doctor” as a teacher!

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2- مركز تحقيقات ايمونولوژي، آسم و آلرژي(1379-000) 3- كميته كشوري آسم و آلرژي ( 1379– 000) 4- كرسي يونسكو در آموزش سلامت(1383- 000) آموزش سلامت – همکاری در پيشگيري و كنترل Health Education Collaboration in Prevention & Conrol (1996-20012) 1375- 1391 1- انجمن آسم و آلرژي ايران(1375- 000) 1- Iranian Society for Asthma & Allergy (Since 1996) 2- Immunology, Asthma & Allergy Research Institute (IAARI- since2000) 3- National Committee for Asthma & Allergy (since2000) 4- UNESCO Chair in Health Education (since2004)

آموزش سلامت- اهداف Health Education Goals :

↑ Knowledge about basic facts , causes & triggers ↑ Patient compliance by good communication ↑ The health of patients by guided Self-Management Plans ↑ Following a written action plan for exacerbations ↑ Proper drug , spacer & inhaler use ↑ Monitoring Sx‘s & Peakflowmeter values & Adjust drugs 5 آموزش سلامت- اهداف Health Education Goals

آموزش سلامت- گروه های هدف Health Education Targets:

6 آموزش سلامت- گروه های هدف Health Education Targets Families & group of patients Healthcare professionals Healthcare executives

آموزش سلامت- روش ها Health Education Methods:

آموزش سلامت- روش ها Health Education Methods Health talks , Slide show , Video … Pannel discussions Demonstration & practical education Seminars (World Asthma Day) Posters , Pamphlets , Guidelines , Booklets

آموزش سلامت- لوازم و امکانات Health Education Settings:

Health care facilities: Chidren Medical Center Hall Immunology , Asthma & Allergy Research Institute Different Universities & Health center facilities Tehran Different states 8 آموزش سلامت- لوازم و امکانات Health Education Settings

آموزش سلامت- اهداف Health Education Goals :

↑ Knowledge about basic facts , causes & triggers ↑ Patient compliance by good communication ↑ The health of patients by guided Self-Management Plans ↑ Following a written action plan for exacerbations ↑ Proper drug , spacer & inhaler use ↑ Monitoring Sx‘s & Peakflowmeter values & Adjust drugs 9 آموزش سلامت- اهداف Health Education Goals

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Genetics 30% Environment 5% Social 15% Life style 40% Health care 10% USA, Mc Ginnis 2003 Meeting in Helsinki ↑ Knowledge about basic facts , causes & triggers SDH Social Determinants of Health - SDH SDH & NCD

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1999 2020 DALY = Disability-adjusted life year 1. Acute lower respiratory infections 2. HIV/AIDS 3. Perinatal conditions 4. Diarrhoeal diseases 5. Unipolar major depression 6. Ischaemic heart disease 7. Cerebrovascular disease 8. Malaria 9. Road traffic injuries 10. CRD 11. Congenital abnormalities 12. Tuberculosis 13. Falls 14. Measles 15. Anaemias 1 . Ischaemic heart disease 2. Unipolar major depression 3. Road traffic injuries 4. Cerebrovascular disease 5. CRD 6. Lower respiratory infections 7. Tuberculosis 8. War 9. Diarrhoeal diseases 10. HIV 11. Perinatal conditions 12. Violence 13. Congenital abnormalities 14. Self-inflicted injuries 15. Trachea, bronchus and lung cancers WHO : Evidence, Information and Policy, 2000 Increasing burden of CRD (DALYs for the 15 leading causes) SDH & NCD

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Ischemic heart disease 1 Cerebrovascular disease 2 Lower respiratory infection 3 Diarrheal diseases 4 Conditions arising during the 5 perinatal period Chronic resoiratory 6 diseases Tubercolosis 7 Measles 8 Road traffic accidents 9 Trachea, bronchus and lung cancer 10 Malaria 11 Self induced injuries 12 Cirrosis of the liver 13 Stomach cancer 14 Diabetes mellitus 15 Violence 16 War 20 Liver cancer 21 HIV 30 1 2 4 11 16 3 7 27 6 5 29 10 12 8 19 14 15 13 9 1990 2020 Changes in ranking for Most Important Causes of Death from 1990 to 2020 C.J.L. Murray, A.D. Lopez The LANCET 1997

Causal links between Risk Factors of NCD Asthma & Allergies:

Causal links between Risk Factors of NCD Asthma & Allergies Smoking Cardiovascular Disease Unhealthy diet Overweight Alcohol abuse Pyschosocial stress Sedentary lifestyle Mental Ill-health Chronic Respiratory Disease Diabetes Cancer The prevalence of these behaviours is a powerful Indicator of the risk a population faces for developing Chronic diseases (CRD)

Impact of Health Promotio Strategies on NCD-Asthma & Allergies:

Impact of Health Promotio Strategies on NCD -Asthma & Allergies Smoking Cessation Supports Cardiovascular Disease Nutrition Counselling Increased Access to Healthy Food Alcohol Reduction Strategies Teaching Coping Skills Promoting Physical Activity Mental Ill-health Chronic Respiratory Disease Diabetes Cancer (CRD & Asthma)

Linneberg A. British Medical Journal, August 2005:

Linneberg A. British Medical Journal, August 2005 Changes in Atopy over 25 years : Allergic Epidemic has spread to Old Age >30 - 4O% of POPULATIONS! ↑ Knowledge about basic facts , causes & triggers

Global Chronic Respiratory Diseases Burden (WHO-2007) :

Global Chronic Respiratory Diseases Burden (WHO-2007) Allergic Rhinitis >500 m Asthma > 300 m , >400 m (2025) COPD >210 m Sleep Apnea Syndrome > 100 m Other CRD > 50 m Total > 1 billion (22%) Mortality > 4.6 million /Yr بارجهانی بیماری های غیر واگیر و مزمن

A Systemic Review of Recent Asthma Surveys in Iranian Children:

A Systemic Review of Recent Asthma Surveys in Iranian Children Moin M , Entezari A ,et al Ch Resp.Dis , 2009:6(2):109-14

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Purpose : To estimate the national Prevalence of asthma symptoms in Iranian children Methods : Internet search of 142 articles , dissertations and reports of research projects Between 1999 – 2004, by ISAAC protocol . Results : 19 studies , 61067 children below 18 years old Lowest prevalence 7.2% (Kerman ) Highest prevalence 35.4% (Tehran) Overall prevalence 13.14% (National level) Conclusion Prevalence higher than the previous international reports The asthma burden is increasing in Iran! Abstract

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Education : Why is Allergy Increasing? Air pollution  Allergen exposure  Indoor climate . Socioeconomic Factors …..and more 2-Environment 3 - Lifestyle Diet (e.g. antioxidants)  Vitamin D  Obesity and overweight  Physical inactivity  Alcohol Gene - Environment Interaction Complex Genetic Diseases 1-Genes SDH

1-Polygenic Inheritance:

1-Polygenic Inheritance Single gene diseases Gene Disease Complex genetic diseases Environmental Factor 2 Environmental Factor 1 Gene 2 Gene 1 DISEASE Gene 1 + Gene 2 + Gene 3…. + Environmental Factor 1 + Environmental Factor 2

3- آموزش عوامل خطر محیطی 2-Education : Enviorenmental Risk Factors:

Infections Allergens Irritants 3- آموزش عوامل خطر محیطی 2- Education : Enviorenmental Risk Factors Pollutants Stress

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دود سيگار = >3000 ماده سمي! ف Tobacco Smoking > 3000 Toxic Particles

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مرگ و میر و تلفات جهانی دود سیگار!

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آلودگی هوا در کلان شهرهای جهان سوم!! Airpollution in Megacities of Third – World !!

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Co No No2 Co2 So2 O3 & … !! ?? !! آلودگی هوای تهران- در پائیز و سایر فصل ها!! Tehran Airpollution in Falls & Other Seasons !! صدها و هزاران ذرات شمیایی وسمی!! هوای پاییز تهران - خیابان فاطمی از فراز ساختمان وزارت فخیمه کشور!!

3- تغییر سبک زندگی- از روستایی به شهرنشینی مدرن 3-Changes in Lifestyle(Hygiene Hypothesis):

3- تغییر سبک زندگی- از روستایی به شهرنشینی مدرن 3-Changes in Lifestyle ( Hygiene Hypothesis ) Farm environment Family size Antibiotics Changed Intestinal flora Sterile foods endotoxin parasites Western lifestyle Allergy Reduced stimulation Of regulatory Th 2 Th 1 T_ cells SDH

آموزش تغییر سبک زندگی غیر بهداشتی Education for Change in Lifestyle:

Indoor Environmental Control No Tobacco Use (active/passive) Occupational Factors Control Air Pollution Control Physical Activity & Obesity Prevention Improper Dietary Habits Change Education , Education , Education ! SDH آموزش تغییر سبک زندگی غیر بهداشتی Education for Change in Lifestyle

آموزش دور کردن عوامل خطر محیطی Education forAvoidance from Env. Risk Factors!:

آموزش دور کردن عوامل خطر محیطی Education forAvoidance from Env. Risk Factors!

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آسم 41% از بيماران در حال درمان كنترل نبوده است ! Of those uncontrolled : 64% were on a controller and 25% were using only a short-acting beta 2 -agonist Data on file, GlaxoSmithKline (Asthma USA Study – Summer 2007). “Not well controlled asthma” was based on a score of ≤19 (ACT) on the Asthma Control Test™ in a Community-Based Survey 59% 41% 0 10 20 30 40 50 60 70 Controlled Uncontrolled % of Patients

فقدان آموزش در عدم همکاری بیماران ، کاهش کنترل آسم وکاهش کیفیت زندگی Lack of Education : Non-Compliance & Decreases in Quality of Life :

تشدید علائم محدودیت در فعالیت بد خوابی حمله های بیشتر آسم افزایش مصرف سالبوتامل حالت انزوا و گوشه گیری حمله های مرگبار 66% 48% 46% 40% 34% 21% 9% گزارش وضعیت بیماری (%) فقدان آموزش در عدم همکاری بیماران ، کاهش کنترل آسم وکاهش کیفیت زندگی Lack of Education : Non-Compliance & Decreases in Quality of Life 0 70 60 50 40 30 20 10

Health Education in Allergy &Asthma Goals: :

↑ Knowledge about basic facts , causes & triggers ↑ Patient compliance by good communication ↑ The health of patients by guided Self-Management Plans ↑ Following a written action plan for exacerbations ↑ Proper drug , spacer & inhaler use ↑ Monitoring Sx‘s & Peakflowmeter values & Adjust drugs 32 Health Education in Allergy &Asthma Goals: آموزش سلامت- اهداف

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Patients Physicians Healthcare system TOTAL CONTROL TOTAL CONTROL of ALLERGY & ASTHMA by Parents EDUCATION نقش آموزش در کنترل کامل آسم

EDUCATION! آموزش، آموزش، آموزش! EDUCATION!:

EDUCATION! آموزش، آموزش، آموزش! EDUCATION!

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آمو زش آموزش آموزش = = = Education Education Education

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World Asthma Day - WAD

شما ! می توانید آسم خود را کنترل کنید ! :

شما ! می توانید آسم خود را کنترل کنید ! ! YOU CAN CONTROL YOUR ASTHMA! ”پانزدهمين همایش روز جهانی آسم- 1391“ WORLD ASTHMA DAY 2012

” آموزش تغيير سبك زندگي غير بهداشتي و كنترل عوامل محيطي“ Lifestyle Change Education& Env. Control:

” آموزش تغيير سبك زندگي غير بهداشتي و كنترل عوامل محيطي“ Lifestyle Change Education & Env . Control 1. كنترل عوامل محيطي در منزل و فضاي بسته Indoor Environmental Control 2. عدم مصرف سيگار( فعال / غيرفعال) No Tobacco Use (active/passive) 3. كنترل عوامل شغلي Occupational Factors Control

”آموزش تغيير سبك زندگي غير بهداشتي و كنترل عوامل محيطي“ Unhealthy Lifestyle Change & Environmental Control:

”آموزش تغيير سبك زندگي غير بهداشتي و كنترل عوامل محيطي“ Unhealthy Lifestyle Change & Environmental Control 4. كنترل آلودگي هواي شهرها Air Pollution Control 5. انجام فعاليت بدني و پيشگيري از چاقي Physical Activity & Obesity Prevention 6. تغيير عادات غذايي نامناسب Improper Dietary Habits Change

”اولین برنامه ملی کنترل آسم“ “First Nationa Plan for Asthma Control”:

كميته کشوری آسم و آلرژی National Committee for Asthma & Allergy 2013-2016 وزارت بهداشت ، درمان و آموزش پزشكي Ministry of Heath & Medical Education 1392- 1395 ”اولین برنامه ملی کنترل آسم“ “First Nationa Plan for Asthma Control”

” آسم و آلرژي“:

” آسم و آلرژي“ كنفرانس آموزش بيماران و خانواده ه ا ( 50 كنفرانس1375- 1390 < ) دكتر مصطفي معين انجمن آسم و آلرژي ايران

علت شناسي آسم:

علت شناسي آسم عوامل ارثي ( ژنتيك) عوامل محيطي 1. مواد حساسيت زا ( آلرژن ) 2. مواد محرك( دود سیگار ) 3. عفونت ها ( سرماخوردگي ) 4. ورزش 5. هواي سرد 6. هيجانات

علت شناسي آسم:

علت شناسي آسم بيماريهاي همزمان 1- آلرژي بيني 2- اگزما 3- سينوزيت 4- رفلاكس ( برگشت غذا از معده)

آسيب شناسي آسم:

آسيب شناسي آسم تعامل عوامل ارثي و محيطي التهاب مجاري تنفسي تحريك پذيري مجاري تنفسي علائم آسم حمله آسم

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54 تشخيص آسم و نقش آلرژي ها - انجام معاينه باليني :

Health Education in Allergy &Asthma Goals: :

↑ Knowledge about basic facts , causes & triggers ↑ Patient compliance by good communication ↑ The health of patients by guided Self-Management Plans ↑ Following a written action plan for exacerbations ↑ Proper drug , spacer & inhaler use ↑ Monitoring Sx‘s & Peakflowmeter values & Adjust drugs 57 Health Education in Allergy &Asthma Goals: آموزش سلامت- اهداف

علائم و نشانه هاي حمله آسم:

علائم و نشانه هاي حمله آسم 1. تنگي نفس شديد 2. سرفه هاي شديد 3. افزايش تعداد تنفس 4. افزايش ضربان نبض 5. كبودي لب ها و ناخن ها 6. تعريق، هيجان يا خواب آلودگي

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59 Asthma Action Plan

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Lack of Education is the main Risk Factor inSevere Asthma Attack Moin et al. Int Arch Allergy Immunol 2008

Health Education in Allergy &Asthma Goals: :

↑ Knowledge about basic facts , causes & triggers ↑ Patient compliance by good communication ↑ The health of patients by guided Self-Management Plans ↑ Following a written action plan for exacerbations ↑ Proper drug , spacer & inhaler use ↑ Monitoring Sx‘s & Peakflowmeter values & Adjust drugs 62 Health Education in Allergy &Asthma Goals: آموزش سلامت- اهداف

درمان دارويي آسم:

درمان دارويي آسم روش مصرف : استنشاقي( خوراكي_ تزريقي) وسايل كمكي : ( آسان نفس، آسم يار، دم يار...) داروهاي پيشگيري كننده :( بكلومتازون – فلوتيكازون) داروهاي باز كننده نايژه : ( سالبوتامل _ سالمترول) داروهاي فرعي :( كرومولين، تئوفيلين،آتروونت....)

Health Education in Allergy &Asthma Goals: :

↑ Knowledge about basic facts , causes & triggers ↑ Patient compliance by good communication ↑ The health of patients by guided Self-Management Plans ↑ Following a written action plan for exacerbations ↑ Proper drug , spacer & inhaler use ↑ Monitoring Sx‘s & Peakflowmeter values & Adjust drugs 66 Health Education in Allergy &Asthma Goals:

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Peakflowmetry Educatin آموزش پیک فلومتری -

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Peakflowmetry Education پيك فلومتري - 3- آموزش

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آموزش انجام اسپيرومتري Spirometry Education

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Education : Expected Outcomes Promote knowledge & compliance of patients Reduction in asthma E.D.visits Reduction in asthma admissions Improvement of the QOL of the patients Reduction of Asthma Burden آموزش بیماران و نتایج مورد انتظار

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References: Pollard SM et al . J Allergy Clin Immunol 1989; 83: 875-887 Call RS et al. J pediatrics 1992;121:862-866 Strachan DP et al. BMJ 1996;312:195-199 Moin M et al. Acta Medica Iranica 2001;39(1):14-16 Moin M et al. Irn JMed Sci 2001;26(3-4) Martinez.FD.Paediatr Respir J 2002;3:193-197 Moin M et al. Asthma:Basic&Clinical Sciences,2003,A cademic Press,p22-31 Moin M et al. Aerobiologica 2004;20:111-118 Bousquet J et al . Clin Exp Allergy 2005:35:723-727 Asher V et al. Lancet 2006;368:733-743 Waltraud E et al. N Engl J Med 2006;355:2226-2235 Pearce N et al. Thorax 2007;62(9):758-766 Urs Frey.Curr Opin Allergy Immunol 2007;7(3): 223-230 Moin M et al. Int Arch Allergy Immunol 2008;145:244-248 Moin M et al. Chron Respir Dis.2009;6(2):109-14

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