NPJ Primary Care Respiratory Medicine最新文献

{"title":"Over-the-counter short-acting β₂-agonist purchase and asthma-related health outcomes: a post hoc analysis of the SABINA III study.","authors":"David Price, Maarten J H I Beekman, Walter Javier Mattarucco, Rocio Martina Barriga-Acevedo, Hao-Chien Wang, Dina V Diaz, Adel Khattab, Manuel Pacheco Gallego, Ashraf Al Zaabi, Hisham Farouk, Darush Attar-Zadeh","doi":"10.1038/s41533-024-00397-4","DOIUrl":"10.1038/s41533-024-00397-4","url":null,"abstract":"<p><p>This post-hoc analysis of the SABINA III study evaluated the association of short-acting β₂-agonist (SABA) prescriptions and self-reported over-the-counter (OTC) SABA purchase in the previous 12 months with asthma-related outcomes using multivariable regression models in 4556 patients (mean age, 48.9 years). Of the 2810 patients prescribed ≥3 SABA canisters, 776 (27.6%) also purchased ≥1 SABA OTC. This subset of 776 patients reported the highest disease burden; 73.2% had ≥1 severe exacerbation and 55.7% had uncontrolled asthma. Asthma-related outcomes worsened with any SABA OTC purchase, regardless of SABA prescriptions; disease burden was the highest in patients with ≥3 SABA prescriptions and ≥1 SABA OTC purchase vs 1-2 SABA prescriptions only (86% lower odds of having at least partly controlled asthma and 124% increased incidence of severe asthma (both P < 0.001). These findings emphasize the need to implement policy changes to restrict SABA purchase without prescriptions and ensure access to affordable asthma care.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"34"},"PeriodicalIF":3.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living with COPD and its psychological effects on participating in community-based physical activity in Brazil: a qualitative study. Findings from the Breathe Well group.","authors":"S M Martins, R Adams, E M Rodrigues, R Stelmach, P Adab, C Chi, K K Cheng, B G Cooper, J Correia-de-Sousa, A P Dickens, A Enocson, A Farley, N Gale, K Jolly, R E Jordan, S Jowett, M Maglakelidze, T Maghlakelidze, A Sitch, K Stavrikj, A M Turner, S Williams, V B Nascimento","doi":"10.1038/s41533-024-00386-7","DOIUrl":"10.1038/s41533-024-00386-7","url":null,"abstract":"<p><p>Physical activity (PA) improves dyspnoea, psychological wellbeing and quality of life (QoL) for people with COPD reducing their risk of exacerbation. However, engagement in PA is low especially amongst those with anxiety and depression, and PA programmes are limited in countries with limited resources such as Brazil. We explored perceptions of 21 people with COPD about the impact of their disease on taking part in community-based PA programmes in Sao Paulo, Brazil through semi-structured telephone interviews from October 2020 to April 2021. Discussions were audio-recorded, transcribed, and analysed using the Framework method. Five themes were identified: Knowledge about COPD and its management; Self-perception of life with COPD; Knowledge and experiences of depression and anxiety; Opinions on PA and repercussions of COVID-19. PA was considered to be important in bringing physical and mental health benefits but there were barriers in accessibility of formal PR programmes and therefore local community PA programmes were considered to be important. People with mental health conditions tended to view PA more negatively. COVID-19 had reduced PA opportunities, access to COPD treatment and social interaction, and was associated with more exacerbations and emotional suffering. In general, this study showed an urgent need to improve knowledge about COPD and its risk factors and management among both patients, the public and primary healthcare professionals. We provide important content for the formulation of public policies for the implementation of specific activity programmes for people with COPD in community spaces using local resources and intersectoral partnerships.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"33"},"PeriodicalIF":3.1,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11511987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term effects on physical activity level with web-based self-management support in people with COPD: a randomised controlled trial.","authors":"Tobias Stenlund, Åsa Karlsson, Per Liv, André Nyberg, Karin Wadell","doi":"10.1038/s41533-024-00394-7","DOIUrl":"10.1038/s41533-024-00394-7","url":null,"abstract":"<p><p>We aimed to evaluate short-term effects of a web-based self-management support on objectively measured physical activity (PA) compared to usual care in people with chronic obstructive pulmonary disease (COPD). We conducted a pragmatic randomised controlled trial including people with stable COPD within primary healthcare. Participants were randomised to intervention group, IG (access to the COPD Web, an interactive website to support self-management with focus on PA), or to control group, CG (usual care). Primary outcome at 3 months was change in accelerometry-measured daily steps analysed with ANCOVA, and secondary outcomes were self-reported PA, disease-related symptoms, and quality of life. Missing data in intention-to-treat (ITT) analyses were multiply imputed. One hundred and forty-six participants (n = 73/group), mean (SD) age 69.5 (6.7) years, FEV_1pred 60.7 (19.1)% were included. The ITT analysis showed no significant difference in steps between the groups: 1295 steps (95% CI: [-365, 2955], p = 0.12), while the complete case analysis (n = 98) revealed a significant difference of 1492 steps (95% CI: [374, 2609], p = 0.01) in favour of IG. A significant increase in self-reported PA was seen in IG in both the ITT and complete case analysis. In summary, access to the COPD Web was insufficient to increase short-term PA level compared to usual care. However, among participants with complete step data, a clinically relevant effect on daily steps exceeding the minimal important difference was observed, partly explained by higher baseline PA than among dropouts. This indicates that access to the COPD Web may increase PA levels for some people with COPD.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"32"},"PeriodicalIF":3.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends in the prevalence of GP registrars' long-term paediatric asthma control medications prescription.","authors":"Nina Reid, Katie Fisher, Anna Ralston, Amanda Tapley, Elizabeth Holliday, Ian Charlton, Katherine Chen, Jason Dizon, Dominica Moad, Alison Fielding, Andrew Davey, Mieke van Driel, Lisa Clarke, Parker Magin","doi":"10.1038/s41533-024-00395-6","DOIUrl":"10.1038/s41533-024-00395-6","url":null,"abstract":"<p><p>Asthma is one of the most common chronic illnesses affecting children. Long-term asthma control medications (LTACMs) are an important aspect of asthma management, with under-prescription associated with poor asthma control and increased asthma deaths. This study aimed to document temporal trends in the prescribing of LTACMs for paediatric patients for asthma-related presentations to Australian general practice registrars (trainees). Longitudinal analyses of data from 2010 to 2022 from the Registrars Clinical Encounters in Training study were undertaken. Proportions of paediatric presentations where LTACMs were prescribed were calculated, and temporal trends analysed and graphed. There was no change over time in registrar prescribing of LTACMs for paediatric asthma, although temporal changes were seen in the types of LTACMs prescribed. The lack of temporal increase in overall LTACMs prescription, despite evidence showing their importance in preventing asthma morbidity and mortality, has significant educational, clinical, and policy implications.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"30"},"PeriodicalIF":3.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation and validation of the COPD Patient Reported Experience Measure (PREM-C9) in Spanish and Catalan.","authors":"M Moharra, A Llupià, B Bayés, J Escarrabill, C Almazán","doi":"10.1038/s41533-024-00393-8","DOIUrl":"10.1038/s41533-024-00393-8","url":null,"abstract":"<p><p>Patient Reported Experience Measures (PREMS) are questionnaires developed to assess the patient experience¹ and incorporate a vision of patient centered care as a new element of value in the quality of healthcare. The PREM-C9 was developed and tested recently in the United Kingdom (UK) for patients with chronic obstructive pulmonary disease (CODP). The aim of the current study was to test the validity and reliability of the PREM-C9 in Spanish and Catalan. 239 patients with COPD completed the PREM-C9 (male 68.9%; female 30.2%). Internal consistency was high for both the Spanish [Cronbach's alpha=0.802] and Catalan [Cronbach's alpha=0.875] versions. Confirmatory Factor Analysis (CFA) proved the item distribution and dimensional structure of the questionnaire except for item2 of the scale \"My everyday life with COPD\". Goodness-of-fit indices were very close to acceptable values for the CFI/TLI of 0.90. Two of the three hypotheses tested to assess known groups' validity were confirmed, with statistically significant differences found between response categories on the satisfaction (p < 0.001) and breathlessness (p = 0.023) scales. No statistically significant differences were observed between the different categories for the education variable. The finding that educational level was not associated with PREM-C9 scores was supported by the results of the multiple regression analysis, which also showed that overall lower levels of overall satisfaction with health services and a greater degree of breathlessness were associated with poorer scores on the PREM-C9. This study has provided evidence for good reliability and structural and construct validity of the Catalan and Spanish versions of the PREM-C9.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"31"},"PeriodicalIF":3.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beliefs surrounding the use of inhaled asthma medication in The Gambia: a qualitative study of asthma patients and healthcare workers.","authors":"S Jayasooriya, M Inoue, H Allen, M Bojang, A Ceesay, S Touray, R Cooper, K Mortimer, J Balen","doi":"10.1038/s41533-024-00390-x","DOIUrl":"10.1038/s41533-024-00390-x","url":null,"abstract":"<p><p>Asthma-related mortality is high in low- and middle-income countries. Little is known about public perceptions of inhaled medicines. We conducted semi-structured interviews with asthma patients and healthcare workers at three secondary care facilities in The Gambia, between August and November 2022. Thematic analysis was used to interpret these data. A total of 20 patients and 15 healthcare workers were interviewed. Both groups noted limited access to inhalers was an issue resulting in continued use of oral medications. Some patients recognised the benefits of inhalers, yet beliefs that inhalers were dangerous were common. Reliance on oral short-acting beta agonists meant patients saw asthma as a recurrent acute condition resulting in an emphasis on hospital management with little awareness of inhaled preventative medicines. Increasing access to inhaled medicines has the potential to reduce costly avoidable admissions, but socio-cultural factors, in addition to medication supply, need addressing.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"29"},"PeriodicalIF":3.1,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The unreliability of crackles: insights from a breath sound study using physicians and artificial intelligence.","authors":"Chun-Hsiang Huang, Chi-Hsin Chen, Jing-Tong Tzeng, An-Yan Chang, Cheng-Yi Fan, Chih-Wei Sung, Chi-Chun Lee, Edward Pei-Chuan Huang","doi":"10.1038/s41533-024-00392-9","DOIUrl":"10.1038/s41533-024-00392-9","url":null,"abstract":"<p><strong>Background and introduction: </strong>In comparison to other physical assessment methods, the inconsistency in respiratory evaluations continues to pose a major issue and challenge.</p><p><strong>Objectives: </strong>This study aims to evaluate the difference in the identification ability of different breath sound.</p><p><strong>Methods/description: </strong>In this prospective study, breath sounds from the Formosa Archive of Breath Sound were labeled by five physicians. Six artificial intelligence (AI) breath sound interpretation models were developed based on all labeled data and the labels from the five physicians, respectively. After labeling by AIs and physicians, labels with discrepancy were considered doubtful and relabeled by two additional physicians. The final labels were determined by a majority vote among the physicians. The capability of breath sound identification for humans and AI was evaluated using sensitivity, specificity and the area under the receiver-operating characteristic curve (AUROC).</p><p><strong>Results/outcome: </strong>A total of 11,532 breath sound files were labeled, with 579 doubtful labels identified. After relabeling and exclusion, there were 305 labels with gold standard. For wheezing, both human physicians and the AI model demonstrated good sensitivities (89.5% vs. 86.0%) and good specificities (96.4% vs. 95.2%). For crackles, both human physicians and the AI model showed good sensitivities (93.9% vs. 80.3%) but poor specificities (56.6% vs. 65.9%). Lower AUROC values were noted in crackles identification for both physicians and the AI model compared to wheezing.</p><p><strong>Conclusion: </strong>Even with the assistance of artificial intelligence tools, accurately identifying crackles compared to wheezing remains challenging. Consequently, crackles are unreliable for medical decision-making, and further examination is warranted.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"28"},"PeriodicalIF":3.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referral to pulmonary rehabilitation and palliative care services in people with idiopathic pulmonary fibrosis in England, 2010-2019.","authors":"Ann D Morgan, Hakeem Khan, Peter M George, Jennifer K Quint","doi":"10.1038/s41533-024-00387-6","DOIUrl":"10.1038/s41533-024-00387-6","url":null,"abstract":"<p><p>The benefits of pulmonary rehabilitation (PR) and palliative care (PC) as non-pharmacological therapies for people with idiopathic pulmonary fibrosis (IPF) are increasingly being recognised but in the UK the proportion of people with this life-limiting condition who are referred to such services is thought to be low. This retrospective cohort study aimed to describe trends in referrals to PR and PC services among people with IPF over a 10-year period and to identify factors associated with non-referral. Our study cohort was drawn from the UK's pseudonymised Clinical Practice Research Datalink (CPRD) Aurum primary care database and comprised 17,071 individuals diagnosed with IPF between 2010 and 2019. While 12.0% of IPF patients were offered a referral to PR, less than 2% completed a PR programme. Around a fifth (19.4%) received a referral to generic PC support services; however, this is well below reported PC referral rates for lung cancer patients. Moreover, the majority of PC referrals occurred late; among those who died, 31% were referred within a month and 70% within 6 months of death. Referrals to PR and PC had however increased (by around 2-fold and 4-fold, respectively) over the course of the study period. Factors associated with non-referral to PR included female sex, older age and co-diagnosis of dementia; barriers to PC referral included being female or of Asian or Black ethnicity. We also found evidence of regional differences in referrals. These findings confirm that PR and PC service provision for people with IPF across England is suboptimal.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"27"},"PeriodicalIF":3.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breathlessness without borders: a call to action for global breathlessness research.","authors":"Joseph David Clark, Kate Binnie, Maddie Bond, Michael Crooks, David C Currow, Jordan Curry, Helen Elsey, Monsur Habib, Ann Hutchinson, Ireneous Soyiri, Miriam J Johnson, Shreya Nair, Seema Rao, Noemia Siqueira-Filha, Anna Spathis, Siân Williams","doi":"10.1038/s41533-024-00384-9","DOIUrl":"10.1038/s41533-024-00384-9","url":null,"abstract":"","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"26"},"PeriodicalIF":3.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long COVID demographic and secondary care referral characteristics in primary care: analysis of anonymised primary care data from a multiethnic, deprived urban area in the UK.","authors":"Martin Chapman, Stevo Durbaba, Florence Tydeman, Matt Friend, Laura Duly, Julie Moore, Vasa Curcin, Yanzhong Wang, Caroline J Jolley, Georgios Kaltsakas, Trudie Chalder, Nicholas Hart, Mark Ashworth","doi":"10.1038/s41533-024-00385-8","DOIUrl":"10.1038/s41533-024-00385-8","url":null,"abstract":"<p><p>Once the nature and number of patients with Long COVID was more fully understood, UK secondary care developed services to investigate, treat and support these patients. We aimed to identify evidence for demographic health inequalities based on general practitioner (GP) Long COVID referrals to available secondary care services. Despite Long COVID demographics broadly reflecting the multiethnic and socially disadvantaged profile of the study population, we found that secondary care referral was mainly focussed on older age patients and those born in the UK with co-morbid anxiety; although co-morbid diabetes was associated with reduced referrals.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"34 1","pages":"25"},"PeriodicalIF":3.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}