The FRESH AIR project in Vietnam is led by Dr Pham An of the University of Medicine & Pharmacy, Ho Chi Minh City.
Air pollution: background
More and more research is being carried out into the impact of air pollution on health. In May 2015, the World Health Assembly declared air pollution to be the world’s largest single environmental health risk. With approximately 44,000 premature deaths associated with outdoor air pollution every year, Vietnam ranked as the 10th most vulnerable country in the world in 2010. We await the Lancet Commission's report on pollution in May 2017 (which will also be presented at the IPCRG's conference in Sri Lanka in August 2017). Here are a few news and research articles describing the situation in Vietnam:
Dr An Le Pham - University of Medicine & Pharmacy, Ho Chi Minh City
Dr An founded the Family Medicine Training Center in UMP, and has overseen the development of several e-health initiatives. He has published widely on paediatrics and family medicine
Vietnam has a population of 92 million people, of which over 42% is under the age of 24.
The current smoking rate in adult males is 56.1%. COPD prevalence in Vietnam is the highest in the Asia Pacific region at 6.7%. It has very sparse health infrastructure in rural areas so there are long travel times and poor access.
Summary - for public
Summary - for clinicians and researchers
The FRESH AIR team carried out a visit to Vietnam on 17-21 October, 2016. FRESH AIR actions in WP5 are designed to improve diagnosis and treatment of lung disease in the country, and this visit was to inform the WP5 team of the current situation.
Estimates suggest that the prevalence of COPD in Vietnam is currently 5-10%. This estimate is likely to rise as more people are diagnosed with the condition and because there is a high number of male smokers in the country. In addition, some 5% of adults and 8% of children have been diagnosed with asthma.
Vietnam’s health system of specialist and acute hospital services, and approximately 12,000 GP-run community clinics, currently has to adjust to the problems of non-communicable diseases, such as caring for people with COPD who have ongoing needs.
In the country, the most commonly prescribed treatments for chronic lung disease are salbutamol inhalers (cost US$ 2-3) and inhaled steroids ($ 5-10). Ongoing maintenance treatments with inhaled steroids are out of the reach for most patients, as medicines are only partially covered by a person’s health insurance.
Pulmonary rehabilitation, based on international standards, could help improve care. Rehabilitation is already provided in the hospitals, but not for people with respiratory problems. However, pulmonary rehabilitation, performed in close collaboration with GP-run community clinics, could be a new and innovative way to tackle chronic lung conditions and symptoms such as breathlessness.
In order to understand the best ways to provide pulmonary rehabilitation programmes in Vietnam, the FRESH AIR team visited local hospitals and a medical college.
The pulmonary rehabilitation pilot project will start at the Rehabilitation and Occupational Disease Hospital in Ho Chi Minh City. The hospital offers facilities for pulmonary rehabilitation to take place, such as a large room with an open walkway, and all the necessary equipment.
Once established in this hospital, rehabilitation will be started at two further hospitals ‒ one in Ho Chi Minh City and one in Tien Giang. The FRESH AIR team visited both sites and saw the excellent facilities and met the teams who will be conducting pulmonary rehabilitation and the senior staff members. The FRESH AIR team organised one full day of training on pulmonary rehabilitation with the FRESH AIR train the trainer programme. The training was well attended, with 18 people from three hospitals, demonstrating that there is great interest in pulmonary rehabilitation. Most attendees were experienced rehabilitation clinicians. The FRESH AIR team concluded that staff from the hospital are already in a position to organise and run sessions with support from the FRESH AIR project.
The FRESH AIR training session is the first step to help Vietnam to establish international standard pulmonary rehabilitation.
The FRESH AIR team gave a presentation on the project and its aims at the Tien Giang Medical College, located in the Mekong Delta region of southern Vietnam. The College provides education to over 3,000 students and is very supportive of rehabilitation for chronic lung diseases, as it sees that such non-communicable diseases are a rising threat to health in their area.
Following the site visit, the FRESH AIR team agreed on the next steps to successfully introduce pulmonary rehabilitation in Vietnam. The protocol of FRESH AIR intervention is being updated. The first round of pulmonary rehabilitation will start in March 2017, after which the FRESH AIR team will make a second visit. The intention is to gradually roll out the service to other rehabilitation hospitals in Vietnam, and this will involve an education programme for the hospitals and the primary care referrers.
Link back to FRESH AIR 1st Newsletter - December 2016