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Practical approach to lung health: lung health for everyone?

Agnes Hamzaoui, Salah Ottmani
European Respiratory Review 2012 21: 186-195; DOI: 10.1183/09059180.00002612
Agnes Hamzaoui
*Dept of Pneumology, Hôpital Abderrahmen Mami, Ariana, Tunisia. #World Health Organization, Stop TB Partnership, Geneva, Switzerland.
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  • For correspondence: agnes.hamzaoui@gmail.com
Salah Ottmani
*Dept of Pneumology, Hôpital Abderrahmen Mami, Ariana, Tunisia. #World Health Organization, Stop TB Partnership, Geneva, Switzerland.
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Tables

  • Table 1. Equipment required for practical approach to lung health strategy implementation#
    First-level health facilities
        Sputum containers
        Peak flow meters with mouthpieces
        Inhalation chamber with masks (for children)
        Pulse oximeter
        Oxygen sources (cylinder and/or concentrators and accessories)
        Nebuliser with mask (manual at least)
    District referral outpatient services or laboratories
        Binocular microscope
        Centrifuge and incubator (if cultures for TB are performed)
        Basic radiology equipment
        Spirometer
        Pulse oximeter
        Equipment for tracheal aspiration
        Oxygen sources
        Equipment for pleural drainage
        Needles and instruments for transthoracic pleural biopsy
        Blood gas analyser
    Second referral level
        Bronchoscope (if there is a chest specialist trained to use it)
    • TB: tuberculosis. #: according to the World Health Organization practical approach to lung health implementation guideline [8].

  • Table 2. Practical approach to lung health (PAL) reported results on clinical outcomes
    OutcomesClinical outcomesCountries
    Diagnosis of chronic respiratory diseases#Increase in diagnosis of CRDAlgeria, Chile, Jordan, Morocco, Kyrgyzstan, South Africa, Tunisia, Syria
    Quality of care of asthma and COPD patientsImprovement of patients' management
    Improvement of patients' quality of life
    South Africa, El Salvador Chile, Nepal
    TuberculosisImprovement in the quality of the diagnostic process of TB
    Improvement in TB case detection
    Algeria, Bolivia, Morocco, South Africa, Syria, Tunisia South Africa, Algeria
    Treatment
        AntibioticsDecrease in drug prescription, particularly antibiotics and adjuvant drugsAlgeria, Bolivia, El Salvador, Jordan, Kyrgyzstan, Morocco, Nepal, Syria, Tunisia
        CRD drugsPAL improves the quality of drug prescription for CRD patients
    Increase in inhaled steroid prescription
    Decrease in oral steroid prescription
    Algeria, Chile, Jordan, Kyrgyzstan, Morocco, South Africa, Syria, Tunisia
    • COPD: chronic obstructive pulmonary disease; CRD: chronic respiratory diseases; TB: tuberculosis. #: asthma and COPD.

  • Table 3. Practical approach to lung health (PAL) reported results on managerial and economic outcomes
    OutcomesClinical outcomesCountries
    Managerial
        ReferralIncrease in respiratory disease management in primary healthcare
    Decrease in referral to upper health level
    Bolivia, El Salvador, Guinea, Jordan, Kyrgyzstan, South Africa
        Strengthening health servicesStrengthening of health workers' self confidence
    Upgrading of health workers' skills
    South Africa
    Economic
        CostReduction in the average cost of drug prescription per respiratory patientAlgeria, Bolivia, Jordan, Kyrgyzstan, Morocco, Syria, Tunisia
        Patient out-of-pocket expenseDecrease in direct and indirect costsNepal
        Cost effectiveness of PALRelatively cost effectiveNepal, South Africa
  • Table 4. Impact of practical approach to lung health on drug prescription in seven countries
    AlgeriaMoroccoKyrgyzstanTunisiaJordanBoliviaSyria
    Number of drugs per patient-10.1***-15***-11.1***-18.8***-12.2***-17.0***-14.3***
    Patients with antibiotic prescription-10.0**-25***-22.0***-21.1***-15.9***-12.3**-33.3***
    Drug prescription cost per patient-13.6***-18***-32.4***-19.3***-8.7*-17.7***-26.2***
    • Data are presented as %. *: p<0.05; **: p<0.01; ***: p<0.001.

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Practical approach to lung health: lung health for everyone?
Agnes Hamzaoui, Salah Ottmani
European Respiratory Review Sep 2012, 21 (125) 186-195; DOI: 10.1183/09059180.00002612

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Practical approach to lung health: lung health for everyone?
Agnes Hamzaoui, Salah Ottmani
European Respiratory Review Sep 2012, 21 (125) 186-195; DOI: 10.1183/09059180.00002612
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  • Article
    • METHODS
    • EPIDEMIOLOGICAL JUSTIFICATION OF PAL: RESPIRATORY BURDEN ON PHC
    • PAL ELABORATION
    • GUIDELINES
    • TRAINING HEALTH WORKERS TO STRENGTHEN HEALTH SYSTEMS
    • EQUIPMENT
    • ARE THERE ANSWERS CONCERNING EFFICIENCY OF PAL IN VIEW OF ITS OUTCOMES?
    • DIFFICULTIES DURING PAL IMPLEMENTATION
    • IS PAL IMPLEMENTATION JUSTIFIED IN EUROPE?
    • CONCLUSION
    • Footnotes
    • REFERENCES
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