Asthma used to be a severe chronic illness in Finland. It was mainly treated with bronchodilators, which alleviated the symptoms, but did not eliminate their cause.
“Asthma is an inflammatory disorder of the respiratory mucous membranes, which was understood in the early 1990s. When cortisone is used to control the inflammation, the symptoms decrease and may even disappear,” says Project Manager Erja Tommila from Filha, an expert association in tuberculosis and pulmonary diseases.
Today, most patients have their asthma under control and are able to enjoy life to the fullest.
From an asthma programme to an allergy programme
New information about asthma was one of the factors behind the national asthma programme from 1994 to 2004.
“The purpose was to keep the patients’ symptoms minimal and help them achieve their working capacity and ability to function in accordance with their age,” Erja Tommila explains.
The goal was to reduce the proportion of people with severe or relatively severe asthma from 20% to 10% during the programme and to reduce the number of hospital days and emergency clinic visits by 50%.
A national allergy programme was implemented in 2008–2018. Its goals included preventing deaths from asthma and the worsening of the disease. The most common reason for the worsening of asthma is rhinovirus infection, as well as pollen allergy for people suffering from allergies.
“The work to achieve these goals included establishing a network of asthma contact people at public healthcare centres and pharmacies and providing them with education on how to recognise asthma symptoms and refer patients to effective care as early as possible,” says Erja Tommila.
Optimal dosages through guided self-care
The asthma programme focused on instructing patients and creating a system of guided self-care for asthma. Within the system, the patients are guided to monitor their health, recognise symptoms and adjust their medication accordingly. The two national programmes produced excellent results.
“The number of people with asthma has not decreased, but the number of hospital days has decreased by more than 50%. Furthermore, the cost of asthma per patient has decreased by 50%,” says Erja Tommila.
At the beginning of the 1990s, 20% of asthma patients suffered from severe symptoms. Today, this proportion is 2.5%. Only a few adult patients with multiple diseases die from asthma each year.
Orion has focused on training and guidance for patients
Orion has participated in implementing asthma care in basic healthcare by providing patients and their attending physicians with a comprehensive selection of inhaled medicinal products.
“The national asthma programme established self-care as part of asthma care. We took this into account by focusing on guidance for patients using inhaled medications and on training for healthcare professionals,” says Paula Rytilä, Medical Director at Orion.
Pharmaceutical companies have joined forces to provide training for pharmacy employees on the use of inhaled medications, for example.
“Even people with mild asthma can experience phases when symptoms are worse. Patients must be instructed to use medications proactively, so they are able to recognise and prevent such episodes.”
The use of an inhaler must be taught properly
Significant progress has been made in using the instructions on and inside pharmaceutical packaging as part of guidance for patients.
“To use an inhaler properly, you must know the right technique. Our product packaging now has a QR code for access to instructional videos,” says Paula Rytilä.
There are several types of asthma. This, along with the changing nature of asthma, affects the medication. Orion has taken this into account in its product selection and offers medications for different types of asthma symptoms.
“Even if the active ingredient is different, the inhaler is always the same in all of our asthma medications, so the patient doesn’t need to learn how to use several devices. Having to use different devices might make treatment more difficult,” says Paula Rytilä.
Continued investment in good asthma care is needed
- The national asthma programme is known internationally as an example that other countries should follow.
- One of the reasons behind the good results is the extensive network of asthma contact people, which consisted of more than 200 doctors, 600–700 nurses and 900 pharmacists.
- While the number of asthma patients has increased, the cost of asthma to society has remained under control, thanks to good care.
- The good results produced by the national asthma programme may be at risk. The network of asthma contact people has deteriorated in part, and nurses no longer have time to focus only on asthma.
- According to the Current Care Guidelines, patients with regular asthma medication should be invited for a control visit once a year. Currently, only patients in specialised healthcare are invited for control visits.
Text: Virve Järvinen
5 June 2019