Guide Pratique : Prise en Charge des Maladies Respiratoires dans les Formations Sanitaires de Référence

Objectives

Provide a practical, standardised framework for doctors in Guinea’s reference health facilities to diagnose, treat, refer and follow up acute and chronic respiratory diseases, including tuberculosis, across consultations, emergency care, hospitalisation and continuing outpatient management.[1][2][3][4]The framework responds to respiratory diseases as a major cause of consultation and addresses severe presentations, persistent symptoms after initial treatment, chronic respiratory conditions and tuberculosis.[3][4]

• Recognise danger signs promptly, establish a working diagnosis, initiate treatment, hospitalise or urgently refer patients whose condition cannot safely be managed as an outpatient, and organise continuing care after acute episodes.[5][6][7]
• Manage common acute respiratory infections, pneumonia, pleural disease, pneumothorax, haemoptysis, severe infection, respiratory distress and cardiovascular emergencies presenting with dyspnoea through condition-specific clinical pathways.[8][9][10][11][12]
• Ensure comprehensive tuberculosis care through diagnosis, standardised chemotherapy, supervised treatment, patient education, bacteriological monitoring, registration and documented outcomes.[13][14][15]
• Strengthen long-term management of asthma, chronic obstructive pulmonary disease, bronchiectasis and pulmonary or pleural tuberculosis sequelae through registration, severity assessment, treatment plans, scheduled review and self-management support.[16][17][18]
• Develop respiratory-care information systems that capture diagnosis, treatment, follow-up, referral and clinical outcomes, while supporting planning for essential long-term medicines, particularly inhalers.[19][20][21]

The guide sets out clinical and operational objectives rather than quantified national targets, budgets or a time-bound implementation plan.[11][19][22]

Implementation

Deliver care through a tiered system linking basic health facilities, referral consultations, emergency departments, hospital medical services and specialised regional or national services.[3][4][18][23]Reference facilities provide diagnostic capacity, including microscopy, radiography, peak-flow measurement or spirometry, while hospital services provide beds and management for patients requiring admission.[3][4]The Ministry of Health and Public Hygiene, through the National Directorate for Prevention and Community Health and the National Tuberculosis Control Programme, provides the identified institutional framework.[1]

• Assess patients systematically through clinical history, examination of vital functions and respiratory signs, recording of diagnosis and management decisions, and explanation of the care plan to patients and accompanying persons.[4][5]Use symptom-led diagnostic pathways for cough, dyspnoea and chest pain, supported by radiography, sputum examination, blood tests, pleural-fluid investigations, spirometry and other tests where indicated.[8][10][24]
• Stabilise emergencies before transfer through oxygen, inhaled or nebulised medicines, intravenous access, pleural aspiration or drainage, resuscitation and tracheal intubation where necessary.[12][25][6]Refer life-threatening respiratory compromise, major haemoptysis, foreign-body inhalation, traumatic chest injury and complex pleural disease to the relevant hospital or specialist service.[11][26][12][27]
• Provide tuberculosis treatment as close as possible to the patient’s home through health centres or dispensaries, using treatment cards, regular medicine supply, directly observed treatment during the initial phase, contact screening and support for medical, socioeconomic and psychological problems.[14][28]Refer chronic cases with recurrent positive sputum after supervised retreatment to designated referral services for decisions on second-line chemotherapy.[14][13]
• Provide severity-based chronic respiratory care, including bronchodilator and anti-inflammatory treatment for asthma and chronic obstructive pulmonary disease, smoking-cessation support, influenza vaccination, rehabilitation where feasible, inhaler training and advice on recognising deterioration.[29][30][31][32]Train personnel in health centres, emergency departments and hospitals to use metered-dose inhalers, spacers and peak-flow meters and to identify severe or worsening disease.[32]
• Maintain continuity through patient-held tuberculosis treatment cards and chronic respiratory follow-up cards, individual medical records, consultation registers and disease-specific registers.[19][20][33]Referral-centre clinicians establish treatment and monitoring plans in coordination with staff at the health facility responsible for continuing care, supported by referral letters, hospital summaries and investigation results.[34][35][23]
• Monitor tuberculosis through scheduled sputum examinations, treatment records and outcome classification as cured, treatment completed, failure, deceased, lost to follow-up or transferred.[14][15]Monitor asthma and chronic obstructive pulmonary disease through symptoms, acute-care use, treatment adherence, inhaler technique, peak expiratory flow and spirometric measures where available, with review intervals determined by disease severity.[36][31][18][37][38]
• Equip respiratory services with examination, oxygen, suction, inhalation, emergency-medicine, pleural-procedure and spirometry equipment, alongside access to radiology, laboratory, cardiology and surgical services.[23][39][40]

Although the framework specifies clinical records and follow-up mechanisms, it does not define aggregate performance targets, reporting deadlines, formal audit arrangements, financing sources or budgets.[19][33][21]

Monitoring & Evaluation

The guide establishes a primarily clinical monitoring system based on standardised registers, individual records, treatment and follow-up cards, scheduled reviews, diagnostic testing and documented outcomes. It does not set aggregate programme targets, reporting deadlines, formal audit procedures, surveillance analyses or sanctions for incomplete reporting.[19][20][33]

• Record every consultation consecutively in a general register, including patient identity, suspected or confirmed diagnosis, the ambulatory-care or referral decision, and essential medicines prescribed.[19][20]
• Use consultation-register data to assess daily and monthly curative-care activity volumes.[19]
• Maintain tuberculosis treatment registers, individual treatment records and patient-held treatment cards, documenting diagnosis, regimen, treatment start date, medicine-delivery dates and planned bacteriological checks.[19][33]
• Conduct tuberculosis bacteriological monitoring through two sputum samples at the end of the initial phase, during continuation treatment and at treatment completion, with timing determined by the six-month Category I or eight-month Category II regimen.[14]
• Record tuberculosis outcomes in the individual record and register as cured, treatment completed, failure, deceased, lost to follow-up or transferred.[15]
• Monitor asthma diagnosis through peak expiratory flow before and after bronchodilator or corticosteroid testing, with an increase of at least 15% supporting diagnosis.[41]
• Confirm chronic obstructive pulmonary disease through spirometry, using a forced expiratory volume in one second to forced vital capacity ratio below 70%, and assess bronchodilator reversibility through improvement in forced expiratory volume in one second.[42][30]
• Register chronic respiratory disease patients at referral centres and maintain standardised medical files and patient-held follow-up cards, recording diagnosis, initial status, prescribed treatment, responsible follow-up facility and scheduled reviews.[20][33][21]
• Monitor asthma control through symptoms, including nocturnal symptoms, peak expiratory flow variability and inhaled salbutamol use; reduce treatment stepwise after three to six months of control and review inadequate control for exacerbation or poor adherence before intensifying therapy.[29][36]
• Schedule chronic respiratory disease reviews according to severity, from on-demand review for intermittent asthma and simple chronic bronchitis to monthly health-centre review and four referral-centre reviews yearly for severe persistent asthma or stable chronic obstructive pulmonary disease with severe dyspnoea and cyanosis.[18]
• Record annual review dates, urgent consultations and hospitalisations in chronic respiratory disease records, and use follow-up consultations to reassess functional status, smoking behaviour, treatment needs and health education.[36][17][31]
• Capture clinical history and respiratory-function information, including symptom frequency, night symptoms, hospitalisations, emergency visits, peak expiratory flow, spirometry, inhaler technique and treatment adherence.[37][43][38]
• Reassess acute asthma after one hour when initial response is incomplete, monitor severe asthma for at least six hours during hospital admission, and monitor oxygen therapy, response and progression during inpatient care.[6][34][44]
• Use condition-specific reassessment schedules, including severe pneumonia review after seven and 14 days, lung-abscess assessment at two, three and four weeks, and daily sputum observation for superinfection of tuberculosis sequelae or bronchiectasis.[45]
• Maintain continuity and accountability through referral letters, hospital summaries, confidential clinical summaries, discharge documentation and communication between referral-centre physicians and primary health-care staff.[34][35][23]

Costing & Financing

The guide identifies substantial service inputs for respiratory, tuberculosis, emergency and long-term care, but does not provide monetary budgets, unit costs, financing sources, resource-mobilisation plans, funding-gap estimates or economic assumptions.[39][40][46]

• Provide differentiated facility-level capacity, including health professionals, laboratory and radiology services, peak-flow measurement or spirometry, hospital beds and tuberculosis information support.[4]
• Equip respiratory-care rooms for oxygen delivery, inhalation therapy, secretion aspiration, pleural aspiration and drainage, biopsy, bronchoscopy and calibrated spirometry.[39]
• Provide hospital respiratory-care rooms with two to four beds near oxygen and vacuum aspiration systems, alongside access to radiology, ultrasound, laboratory, cardiology and general-surgery services.[40]
• Ensure emergency capacity for tracheal intubation, pleural procedures, intravenous treatment, blood transfusion, oxygen, ventilation and emergency medicines.[12][25][23]
• Supply essential medicines and clinical commodities for respiratory disease, tuberculosis, asthma and chronic obstructive pulmonary disease, although listed doses and treatment regimens are clinical requirements rather than financial valuations.[14][29][30][47][48]
• Provide patient education materials on asthma treatment and trigger avoidance, tuberculosis treatment and contact screening, smoking cessation, inhaler technique and self-management.[32][46]
• Use standardised asthma and chronic obstructive pulmonary disease records to support forecasting of long-term essential-medicine needs, particularly metered-dose inhalers.[20][33]
• Support tuberculosis delivery through regular medicine supplies, treatment or retreatment cards, directly observed treatment during the initial phase, planned clinical and bacteriological review, contact screening and support for socioeconomic or psychological problems.[14][28]