Conduct disorder

Katerina Obo~ki
What is the Practall and who perform it? Asthma experts ( number of 44 from two
continents), Final work was published in Allergy, January 2008; Practall guidelines
respect that patient – based practice is much more complicated than simply
applying the available evidence to every patient equivalently; Practall uses common
sense thinking by attempting to determine therapy based on diagnosis, as opposed
to symptoms; Practall encourages the process of individualizing patient care by first
improving pediatric asthma diagnosis; This involves: Differential Diagnosis
Consideration, Phenotype-determining the type of asthma, Identification of
comorbidities ; re-analysis of therapy approach.
New Practall guidelines have to be with the pediatrician in mind! Asthma treatment
should be Global- trigger avoidance, education of children and their surrounding,
immunotherapy and monitoring are essential as pharmacotherapy. Inhaled steroids
and LTRA are important tools in childhood asthma treatment, LABA only in severe
persistent asthma. Phenotypes should be taken into account – steroids are more
effective in atopic background, LTRA in young children with post viral asthma. The
correct choice is individual – dependent on child and physician.
Astmata e vode~ko hroni~no zaboluvawe vo mnogu industrijalizirani zemji.
(1) Dokaznata osnova na specifi~nite aspekti na pedijatriskata astma, vkulu~uvaj]i
ja i terapevtskata strategija e ograni~ena i nema skore[ni internacionalni
vodi~i, koi se fokusirani posebno na decata pod pet godini.
Prevalencata na astmata dramati~no raste vo poslednite 20 godini (1). Vo
tek na edna godina, nasekade niz svetot, se referiraat 180 000 smrtni slu-
~ai od astma.(2).
Tro[ocite vo Evropa se slednive: 17,7 bilioni evra vo 2003 godina (9,8 bilioni
evra vo pomalata produktivnost i 7,9 bilioni evra kako direktno
medicinsko ~inewe)(3,4). Zgolemenata prevalenca na astmata vo poslednive
dekadi e povrzana so zgolemuvaweto na atopiskata senzitizacija (pokraj
drugite faktori) i alergiskite kondicii kako alergiski rinit (AR) i sinuzit,
sugeriraj]i deka sistemskite komponenti na inflamacijata se asocirani
so astmata (5,6). Dvaeset milioni Amerikanci imaat astma, vklu-
~uvaj]i i 9 milioni deca, sekoj den 40 000 propu[teni rabotni i [kolski
denovi, 30 000 egzacerbacii, 5000 urgentni poseti, 1000 hospitalizacii,
11 smrtni slu~ai (7).
Aktuelna situacija vo Evropa poka`uva deka vo poslednive godini, incidencata
se zgolemuva 200%, pove]e od 10% od decata vo WHO EU regionot se
zdobivaat so simptomi na astma, edno od naj~estite hroni~ni zaboluvawa po
svojata kompleksnost i heterogenost, majoren globalen zdravstven problem,
vku~uvaj]i go deteto, semejstvoto, zdravstveniot sistem i op[testvoto. Vo
Страна 206