title: Asthma as a hidden disease in rural China: opportunities and challenges of standard case management.
abstract: OBJECTIVE
  To assess the implementation of standard case management of asthma in Huaiyuan County, Anhui Province, China, in 2008.
  
  
  METHODS
  The study project began with the local adaptation of international asthma guidelines, followed by a situation analysis, pre-intervention study, training and intervention. Inhaled beclomethasone (US$15 for a 200-puff [250 µg/puff] inhaler) was prescribed for patients with persistent asthma. Treatment outcome was assessed at 1 year after enrolment.
  
  
  RESULTS
  Asthma was never diagnosed in the participating facilities before the project was introduced. Of the 95 patients diagnosed with persistent asthma, 72 (75.8%) were prescribed inhaled beclomethasone, and 23 (24.2%) were not, because they either refused to use inhaled beclomethasone or did not return after the initial visit. At 1 year evaluation, of the 72 patients with persistent asthma treated with inhaled corticosteroids, 12 (16.7%) improved, 7 (9.7%) remained stable, none were worse, 1 (1.4%) had died, and 52 (72.2%) were lost to follow-up. Of the 52 patients lost to follow-up, 25 (48%) were found to be alive but had stopped using inhaled beclomethasone.
  
  
  CONCLUSIONS
  Asthma is more frequently disabling and costly than had been recognised earlier. Asthma patients can be provided the care that they require, but affordable access to inhaled corticosteroids remains a challenge.
authors.affiliation: Anhui Provincial Tuberculosis Institute, Anhui, China.
authors.forename: X H
authors.initials: XH
authors.lastname: Kan
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chiang
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
authors.affiliation: Anhui Provincial Tuberculosis Institute, Anhui, China.
authors.forename: H L
authors.initials: HL
authors.lastname: Rao
authors.affiliation: Huai Yuan Center for Disease Control, Anhui, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Chen
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Aït-Khaled
authors.affiliation: Anhui Provincial Tuberculosis Institute, Anhui, China.
authors.forename: G W
authors.initials: GW
authors.lastname: Chen
keywords: asthma; beclomethasone; outcome; treatment