 Education is "…more than the simple provision of information. Education is the integration of new information into a person's pre-existing beliefs and understandings."
--Chris Hogan RESPONSES BY SUBJECT
 Are there any special problems in diagnosing asthma in children? Do they vary by age?
What do you think are the special issues and challenges in treating children with asthma? Do they vary by age?
What questions do parents/carers and patients ask of you?
Which educational strategies work?
Which in your opinion are the top three problems children and parents/carers face in managing asthma in daily life?
RESPONSES BY COUNTRY
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Responses by countryChris Hogan (Australia):
Are there any special problems in diagnosing asthma in children? Do they vary by age?For children under the age of 2, you don't know what it is. Even if there's a response to treatment, you can't be sure that it's asthma. There's wheezing associated with respiratory infection. Children may present with a wheeze on only one or two occasions. Also in that age group you can have children presenting with a floppy larynx, with chondromalacia of their upper airway, with polyps, with a vascular ring; there are all sorts of differentials. The other issue of course that's true in Australia and in a whole range of other countries as well is that there's a resistance to the diagnosis of asthma, and there's steroid phobia. Another issue is that people with culturally and linguistically diverse backgrounds, those who come from traditional cultures, often don't have a concept of chronic illness. In a more traditional society, there's no such thing as a chronic illness. Because what happens if you've got a severe arthritis or respiratory illness or cardiac disease, in a traditional society these people are dead. So there isn't this philosophy or the support from the carers for a chronic disease. They're expecting either death or a cure. The idea of modification of lifestyle is very difficult. And we find this not only for asthma but more specifically for the epidemic of type 2 diabetes that we're experiencing not only in our own society but certainly in our traditional societies as well, both the indigenous Australians and also peoples from other countries, especially the Pacific islanders.What do you think are the special issues and challenges in treating children with asthma? Do they vary by age?I happened to chair the Victoria State Government Asthma Expert Advisory Board, and we did a study on the public health interventions in asthma. And across a range of criteria, the most common and severe issue we found was cigarette smoking. Australian smoking rates are probably amongst the lowest in the world, but they're still a major issue. The incidence of smoking in adults has dropped from about 45-55% 30 years ago to 10-15% now. But what's happened is that the incidence of smoking among people under the age of 25 is steadily climbing. So it's a matter of fighting that battle all over again. What's happened is that a lot of people now are well aware of the health messages and well aware of the reasons that they shouldn't smoke, but they just don't care.What questions do parents/carers and patients ask of you?Are you sure it's asthma? Will it seriously affect my child's health or development? Are the drugs safe? Will they grow out of it?Which educational strategies work?What I believe is that the effective strategy is to have multiple strategies. First of all there needs to be provision of basic information in a way that people can understand it. People then need to be educated, in other words they need to have assistance and support to integrate the new information. Education is more than the simple provision of information. Education is the integration of new information into a person's pre-existing beliefs and understandings. We need to operate off a system of narrative, and there needs to be a consistent message delivered by all health professionals.Which in your opinion are the top three problems children and parents/carers face in managing asthma in daily life?
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