Finland, like many other western countries, has experienced profound structural changes during the post-war period: urbanisation, increasing education, smaller family size, improved hygiene for food and household water, and prophylaxis and effective care of many potentially dangerous infectious diseases. Many of these factors have been associated with the increased risk for asthma and allergies1 which has also been found in Finland.2

In 1993 the Ministry of Social Affairs and Health in Finland recognised asthma as an important public health issue by appointing a working group to design a national programme for the prevention and alleviation of problems caused by asthma and for reduction of the relevant costs. The group decided to create an action programme emphasising guideline implementation and follow up, which are often neglected in consensus reports on asthma treatment. The 10 year programme was launched in 1994.3 The goals of prevention and treatment were stated as follows: (1) recovery of as many patients as possible with early asthma; (2) asthmatic patients should feel well and their ability for work and functional capacity should correspond with their age; (3) decline in the percentage of patients with severe and moderate asthma from the current 40% to 20%; (4) decrease in the number of bed days of asthmatic patients by 50% by the year 2000 (that is, to 50 000 a year); and (5) reduction in the annual treatment costs per patient by 50% as a result of more effective prevention and treatment of symptoms.

The measures towards achieving the goals were as follows: (1) early diagnosis and active treatment; (2) guided self-management as the primary form of treatment; (3) decrease in respiratory irritants such as smoking and tobacco smoke; (4) implementation of rehabilitation on an outpatient basis combined with normal treatment, planned individually and timed appropriately; (5) increase …