CHRONIC DISEASE & HEALTH MANAGEMENT Redesigning Health Systems for the !

st Cent"ry

#arti$"laritati ale management"l"i m"$o%is$ido&ei si astm"l"i in 'atologia 'ediatri$a

Crai" Mihai MD #hD #rof Gherghina Ioan MD #hD

IOMC (Alfred R"ses$") *"$"resti

*OLI CRONICE LA CO#IL+

Co'il"l $" ,oala $roni$a are $a 'arti$"laritati Este s"ferind intr.o 'erioada de ma/ima de&%oltare
Somati$a #sihoafe$ti%a

Intera$ti"ni $om'le/e $" familia s$oala so$ietatea

*OLI CRONICE LA CO#IL+

Im'a$t"l emotional al ,olii $roni$e la %arsta $o'ilariei este $om'le/0 la m"lti'le ni%ele Gre" de a$$e'tat
1alilie So$ietate Indi%id

Mod si stil de %iata al $o'il"l"i N2 e/'li$a ,oala

*OLI CRONICE LA CO#IL+

Management"l efi$ient al *C la $o'il 'res"'"ne o a$ti"ne $on$ertata a 1amiliei
Com'lianta0 aderenta tratament0 intermediere 'arentala0 stat"t so$io.e$onomi$0 $"lt"ra0 religie

Instit"tiilor medi$ale

Ni%el 'rimar0 se$"ndar si tertiar A$$es ra'id 3 e/a$er,are #lan"ri de s$reening0 're%entie0 monitori&are Cer$etare f"ndamentala 3 st"dii $lini$e 1inantare $onstanta

*OLILE CRONICE ALE CO#IL2L2I

Instit"t"l de O$rotire a Mamei si Co'il"l"i (Alfred R"ses$") din *"$"resti are o l"nga traditie in st"dii de #ediatrie So$iala si #atologie 'ediatri$a $roni$a L"$rari de 'ionierat in domenii %ariate 13C0 ,olilor de n"tritie si meta,olism 4hTir0 'atol I0 #h.$et5 ,olilor re"matologi$e si im"nologi$e la $o'il

MORTALITATE LA CO#IL 67ANI IN ROMANIA 4OMS5

*OLILE CRONICE ALE CO#IL2L2I

Cea mai fre$%enta ,oala $roni$a a $o'ilariei 8 ASTM2L *ROSIC 2na dintre $ele mai se%ere 8 M2CO9ISCIDO:A 41I*RO:A CHISTICA5

*OLILE CRONICE ALE CO#IL2L2I

Cea mai fre$%enta ,oala $roni$a a $o'ilariei 8 ASTM2L *ROSIC ;

; S2A <0= mil $o'ii 3 >0? mil e/a$er, @@= ACenters for Disease Control and #re%ention- National Center for Health Statisti$s0 National Health Inter%ieB S"r%ey RaB Data0 @@= 4Ameri$an L"ng Asso$iation . Asthma & Children 1a$t Sheet0 C"ne @@D5E

#re%alen$e of asthma and allergies in $hildren @@=

ASTM2L *ROSIC LA CO#IL IN ROMANIA #re%alenta in $restere la ni%el national ;

<FGH la $o'ii de <.= ani =F H la $o'ii de !>.!G ani

; CF Gheonea0 DF AF #les$a0 DF Dragomir0 DF Orasean"0 IF Cernates$"0 MF Nan"les$"0 MF Neamt"0 NF *is$a0 #F Chere$hes.#anta0 SF Gotia . #re%alen$e of asthma in $hildren in Romania "r,an areas I A,stra$t @D? ERS *erlin @@?

A1ECTI2NILE C2 JHEE:ING S2NT 1REC9ENTE LA 2#2 ;

Click to edit Master text styles Second level Third level Re$"rrent Jhee&ing in the ER of IMCC Fourth level 4No% . De$ @@?5 Fifth level

@ Jhee&ing disorders

G Non.J diseases

; M Crai"0 # A%ram0 A9 Co$hino0 I Stan . E%al"ation of $ontrola,le triggering fa$tors for e/a$er,ation in 'res$hool %iral Bhee&eF A,stra$t ! GG0 ERS Jien @@D

MANAGEMENT2L ASTM2L2I LA CO#IL GHID2RI

Ghid"l GINA a,ordea&a $o'ii in > gr"'e de %arsta
6 7 ani < I ! ani Adoles$enti 4la fel $a ad"lt"lK5

MANAGEMENT2L ASTM2L2I LA CO#IL

GINA I ASTHMA MANAGEMENT & #RE9ENTION !F De&%oltarea 'arteneriat"l"i 'a$ient3'arinte3medi$ F Identifi$area si red"$erea e/'"nerii la fa$torii de ris$ 'entr" astm >F E%al"area0 Tratament"l si Monitori&area Astm GF Management"l e/a$er,arilor 7F Consideratii s'e$iale

GINA I ASTHMA MANAGEMENT & #RE9ENTION !F De&%oltarea 'arteneriat"l"i 'a$ient3'arinte3medi$ (Ed"$ation Bas signifi$antly asso$iated Bith less F e/a$er,ations Identifi$area 4' si red"$erea e/'"nerii la 8 @F@ >! 0 D7H CI . @F@@?7 fa$torii de ris$ 'entr" astm to @F@< >5) >F E%al"area0 Tratament"l si Monitori&area Astm GF Management"l e/a$er,arilor
A,stra$t ! GG0 ERS Jien @@D M Crai"0 # A%ram0 A9 Co$hino0 I Stan . E%al"ation of $ontrola,le triggering fa$tors for e/a$er,ation in 'res$hool %iral Bhee&eF

7F Consideratii s'e$iale

GINA I ASTHMA MANAGEMENT & #RE9ENTION !F De&%oltarea 'arteneriat"l"i 'a$ient3'arinte3medi$ F Identifi$area si red"$erea e/'"nerii la fa$torii de ris$ 'entr" astm >F E%al"area0 Tratament"l si Monitori&area Astm GF Management"l e/a$er,arilor 7F Consideratii s'e$iale

1ACTORII DE RISC #ENTR2 ASTM LA CO#IL

1ACTORII DE RISC #ENTR2 ASTM LA CO#IL

OR= 2.4, CI 95% (0.2911-19.7852)
10 " 8 ! children that do not develo& recurrent e&isodes of #hee(e 8 3 children that develo& recurrent e&isodes of #hee(e 2

5 4 3 2 1 0

children #ith s$okin% $others durin% &re%nancy

children #ith non's$okin% $othersdurin% &re%nancy

There Bas a high n"m,er of smoLing mothers Bhile 'regnant. >>HF A$$ording to JHO estimates in @@> only !@F>H Romanian Bomen smoLe Bhile 'regnantF
C Ta,an0 C CMn"les$"0 S *ast"res$"0M Merti$ari"0 * Androni$0 A Di$" . An e%al"ation of risL fa$tors for re$"rrent Bhee&ing after IC2 admission for ,ron$hiolitisF E"ro'ean Medi$al St"dents Congress0 *erlin @@D

GINA I ASTHMA MANAGEMENT & #RE9ENTION !F De&%oltarea 'arteneriat"l"i DE:9OLTAREA2NOR CENTRE REGIONALE DE 'a$ient3'arinte3medi$ DIAGNOSTIC0 C2 NI9EL DE ECHI#ARE CORES#2N:ATOR F Identifi$area si red"$erea e/'"nerii la 4CON1 CA*INET DE EN#LORARI 12NCTIONALE IOMC fa$torii de CERNATESC2 I5 ris$ 'entr" astm S#IROMETRIE CON9ENTIONALA
#NE2MOTACHOGRA1IE 4TODAL *REATHING GF Management"l e/a$er,arilor ANALOSIS5 IN1LAMOMETRIE NEIN9A:I9A 41eNO5

>F E%al"area0 Tratament"l si Monitori&area Astm TESTE DE E11ORT

7F Consideratii s'e$iale

GINA I ASTHMA MANAGEMENT & #RE9ENTION De&%oltarea 'arteneriat"l"i 'a$ient3'arinte3medi$ Identifi$area si red"$erea e/'"nerii la fa$torii de ris$ 'entr" astm E%al"area0 Tratament"l si Monitori&area Astm Management"l e/a$er,arilor Consideratii s'e$iale

AS#ECTE ED2CATIONALE JRITTEN ACTION #LAN

#LAN2L DE ACTI2NE SCRIS IOMC (AL1RED R2SESC2)

IOMC (AL1RED R2SESC2)

A$ti%itatea %i&and management"l astm"l"i la $o'il este str"$t"rat 'e mai m"lte ni%ele-

A$ti%itate de $er$etare 4$entr" st"dii $lini$e5 A$ti%itate metodologi$a 4ela,orare de 'roto$oale interne0 $oo'erare la ni%el national I SR## #rof M Nan"les$"5 A$ti%itate dida$ti$a 4 $lini$i 2M15 #rograme ed"$ationale 4'liante0 tera'ie 'rin Po$0 'rograme T95

1C . M2CO9ISCIDO:A
ACTI9ITATEA DE #IONIERAT
Ca,inet de Geneti$a Clini$a 4dr EF Tomes$"5 Iontofore&a #ilo$ar'ini$a

CENTR2 REGIONAL DE 1C
In e%identa G> 'a$ienti G ad"lti 4$el mai %arstni$ @ F@ F!D=? K5

#ROGRAM NATIONAL !73G

MONITORI:AREA #ACIENTILOR DIAGNOSTICATI

DIAGNOSTICAREA 3 CON1IRMAREA 2NOR NOI #ACIENTI

1C . M2CO9ISCIDO:A
ENISTA GHID DE MANAGEMENT IN M2CO9ISCIDO:A I L #o'0 : #o'a0 C Calt A*ORDARE COM#LENA COM#ONENTA META*OLICA *OALA #2LMONARA CRONICA

1C . M2CO9ISCIDO:A
COM#ONENTA META*OLICA TERA#IA CRONICA DE S2*STIT2TIE $"'rindes",stit"tie 'an$reati$a $" en&ime 'an$reati$e A#ERTE $" mi$rosfere enterosol",ile0 do&ate in "nitati li'a&a. QREON adP"%ante $"m ar fi R %itaminele li'osol",ile AA0 D0 E0 QE0 medi$atie antia$ida $roni$aranetidina0 ome'ra&olF

1C . M2CO9ISCIDO:A
COM#ONENTA RES#IRATORIE

TERA#IA INHALATORIE CRONICA $" #"lmo&yme Aalfa dorna&aE sing"ra s",stanta do%edita a s$adea %as$o&itatea m"$"s"l"i din 1C0 si $are in$etineste de$lin"l f"n$tiei '"lmonareF Anti,ioti$e in ne,"li&are . $"re s$"rte de < sa'tamini.> l"ni la 'a$ientii $" $oloni&are ,ronsi$a $" #se"domnas Aer"ginosaF

COM#ONENTA RES#IRATORIE
TERAPIE ZILNICA PENTRU TOATA VIATA LA $ei aflati in stadi"l de infe$tie '"lmonara $roni$a $" #se"domonas Aer"ginosa MOLEC2LELE C2 ACITI9ITATE ANTI#SE2DOMONA:ICA $are se ne,"li&eara in mod $"rent s"nt Aminogli$o&idele R gentam$ina0 amiLa$ina0 netilmi$ina0 si to,rami$ina. 'entr" $are e/ista si %arianta dedi$ata ne,"li&arii 8TO*I Colistin"l A'olimi/ina *E. sing"ra mole$"la 'entr" $are #se"domonas Aer"ginosa

1C . M2CO9ISCIDO:A
IN #ERS#ECTI9A ACTI9ITATE DE CERCETARE 4ST2DII M2LTICENTRICE5 AMELIORAREA S#ERANTEI DE 9IATA GENEREA:A NOI TI#2RI DE #ATOLOGIE 4HT#0 IRC5
TRANS#LANT #2LMONAR TRANS#LANT CORD.#2LMON

CONCL2:II !
Cresterea 'erformantelor medi$ale in Romania d"$e la $resterea n"mar"l"i de $o'ii $" ,oli $roni$e aso$iate 'atologiei 'erinatale0 a $elei aso$iata ,olilor geneti$e0 a $elor degenerati%e A$esti 'a$ienti tre,"ies$ integrati in sisteme str"$t"rate de tratament si monitori&are

CONCL2:II
Ar tre,"i fa$"t "n design al $ir$"itelor din (Real.life) al 'a$ientilor $" *C0 'entr" a '"tea sa ii integram 'e a$estia in sisteme $om'le/e Sistemele $om'le/e INSTIT2TIONALE tre,"ies$ $oordonate si finantate la ni%el National Regional Lo$al

CONCL2:II >
#a$ientii de %arsta 'ediatri$a a%and ,oala $roni$a ar tre,"i sa fie in 'rim.'lan"l a$ti%itatilor t"t"ror for"rilor de s'e$ialitate0 ei re're&entand o in%estitie COST.E1ICIENTA si $" mare IM#ACT 4emotional0 mass.media5

9A M2LT2MESC K