Development of a South African integrated syndromic respiratory disease guideline for primary care

Abstract

Aims: The Practical Approach to Lung Health in South Africa (PALSA) initiative aimed to develop an integrated symptom-and sign-based (syndromic) respiratory disease guideline for nurse care practitioners working in primary care in a developing country.Methods: A multidisciplinary team developed the guideline after reviewing local barriers to respiratory health care provision, relevant health care policies, existing respiratory guidelines, and literature. Guideline drafts were evaluated by means of focus group discussions. Existing evidence-based guideline development methodologies were tailored for development of the guideline.Results: A locally-applicable guideline based on syndromic diagnostic algorithms was developed for the management of patients 15 years and older who presented to primary care facilities with cough or difficulty breathing.Conclusions: PALSA has developed a guideline that integrates and presents diagnostic and management recommendations for priority respiratory diseases in adults using a symptom-and sign-based algorithmic guideline for nurses in developing countries.

The social determinants of asthma: Fig. 1—

“…Simple interventions for management of asthma can control the disease, and reduce mortality, hospital admissions and costs [30][31][32][33][34], but they are not yet integrated to primary care policies or widely available. A crucial move towards feasibility and sustainability in LMICs would be the full integration of asthma management into primary healthcare routines, as reported in South Africa [35]. Moreover, most subjects with asthma have concomitant rhinitis [36], which has been strongly associated with lack of control of asthma [37] and is usually neglected by the health systems in LMICs.…”

Overview of the Management of Cough

“…8 Since then, and the publication of the second edition in 2006, 7 the impact of cough on global health has attained widespread recognition. Published cough guidelines, albeit of varying quality and foci (eg, adults, pediatrics, acute cough, chronic cough, cough in palliative care), have been developed by organizations not only from the United States 7 but also from Australia, 9 Belgium, 10 Brazil, 11 China, 12 Germany, 13 United Kingdom, 14 Ireland, 15 Netherlands, 16 Japan, 17 South Africa, 18 and Spain. 19 Prevalence data from Australia, Great Britain , Japan, and the United States provide the putative reason for the widespread interest in developing cough guidelines.…”

Summary of the 2008 BTS/SIGN British Guideline on the Management of Asthma

“…However, whatever the nature of guidelines -be they national, 1 global, 2 disease-specific, [1][2][3] integrated, [3][4][5][6] primary carebased, [3][4][5][6] intended for resource-rich 1,2,3,5 or for resource-poor [3][4][5][6] settings -dissemination and implementation is the crucial step. 1,2,4,7,8 In most countries, primary care clinicians treat the vast majority of patients with asthma and other chronic respiratory diseases.…”