Primary Care Respiratory Journal最新文献

{"title":"Effects of a written asthma action plan on caregivers' management of children with asthma: a cross-sectional questionnaire survey.","authors":"Ngiap Chuan Tan, Zhaojin Chen, Wern Fern Soo, Agnes Soh Heng Ngoh, Bee Choo Tai","doi":"10.4104/pcrj.2013.00040","DOIUrl":"10.4104/pcrj.2013.00040","url":null,"abstract":"<p><strong>Background: </strong>Caregivers of children with asthma provided with a written asthma action plan (WAAP) are reported to be more confident in their ability to provide care for their child during an asthma exacerbation. However, little is known about how a WAAP impacts on their care processes that contributed to this increased confidence.</p><p><strong>Aims: </strong>To determine the effects of a WAAP on caregivers' understanding of asthma symptoms, their use of asthma medications for their children, and acute care visits to consult their physicians.</p><p><strong>Methods: </strong>A questionnaire survey to caregivers of children with a WAAP (CW) and without a WAAP (CNW) who were followed up at nine public primary care clinics in Singapore. χ(2) test was used to determine the differences in outcomes between the CW and CNW groups, followed by logistic regression to adjust for potential covariates.</p><p><strong>Results: </strong>A total of 169 caregivers were surveyed (75 CNW, 94 CW). Caregivers in the CW group were more likely to understand bronchoconstriction (adjusted odds ratio (AOR) 4.51, p=0.025), to feel capable (AOR 2.77, p=0.004), safe (AOR 2.63, p=0.004), and had increased confidence (AOR 2.8, p=0.003) to change doses of inhaled medications during an asthma exacerbation. The CW group perceived inhaled asthma medication to be safe (AOR 3.42, p=0.015) and understood the use of controller medication (AOR 3.28, p=0.006). No difference was noted between caregivers in their likelihood to stop medications without consulting their physician, seek acute care consultation, and confidence in self-management of their children's asthma at home.</p><p><strong>Conclusions: </strong>The WAAP improved caregivers' understanding of the disease and use of inhaled asthma medications during asthma exacerbations but did not affect their decision regarding acute visits to their physician.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"188-94"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31476269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global strategies for reducing the burden from asthma.","authors":"Onno C P van Schayck","doi":"10.4104/pcrj.2013.00052","DOIUrl":"10.4104/pcrj.2013.00052","url":null,"abstract":"<p><p>Asthma is one of the most important chronic diseases in childhood. For several decades, a steady increase in prevalence has been observed worldwide. In the structural collaboration between the Centre for Population Health Services in Edinburgh and the Research Institute CAPHRI of Maastricht we investigated the possibilities for primary prevention of asthma in childhood. We found that a multifaceted approach might be effective in delaying or preventing asthma, whereas a mono-intervention does not seem to have such a protective effect. The most likely explanation is that the development of a multifactorial disease, such as asthma, is extremely difficult, if not impossible, to prevent by eliminating only one risk factor. Underdiagnosis of asthma is still a big problem in primary care. Most patients do not present bronchial symptoms to the general practitioner, even though they have decreased lung function, so they remain unknown and undiagnosed. However, patients who do present with respiratory problems and who have reduced lung function are not always recognised as such. We found that the perception of dyspnoea seems to determine, at least in part, the presentation to the general practitioner with symptoms. These observations show that both the prevention of the development of asthma in early childhood, as well as case finding of asthma in adulthood, do not seem to be very effective in primary care. More research is needed to clarify what steps can be taken to reduce the global burden from asthma.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"239-43"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31456936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spirometry in children.","authors":"Kana Ram Jat","doi":"10.4104/pcrj.2013.00042","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00042","url":null,"abstract":"<p><p>Respiratory disorders are responsible for considerable morbidity and mortality in children. Spirometry is a useful investigation for diagnosing and monitoring a variety of paediatric respiratory diseases, but it is underused by primary care physicians and paediatricians treating children with respiratory disease. We now have a better understanding of respiratory physiology in children, and newer computerised spirometry equipment is available with updated regional reference values for the paediatric age group. This review evaluates the current literature for indications, test procedures, quality assessment, and interpretation of spirometry results in children. Spirometry may be useful for asthma, cystic fibrosis, congenital or acquired airway malformations and many other respiratory diseases in children. The technique for performing spirometry in children is crucial and is discussed in detail. Most children, including preschool children, can perform acceptable spirometry. Steps for interpreting spirometry results include identification of common errors during the test by applying acceptability and repeatability criteria and then comparing test parameters with reference standards. Spirometry results depict only the pattern of ventilation, which may be normal, obstructive, restrictive, or mixed. The diagnosis should be based on both clinical features and spirometry results. There is a need to encourage primary care physicians and paediatricians treating respiratory diseases in children to use spirometry after adequate training.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"221-9"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31478667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The BREATHE study: Breathing REtraining for Asthma--Trial of Home Exercises. a protocol summary of a randomised controlled trial.","authors":"Anne Bruton, Sarah Kirby, Emily Arden-Close, Lynda Taylor, Frances Webley, Steve George, Lucy Yardley, David Price, Michael Moore, Paul Little, Stephen Holgate, Ratko Djukanovic, Amanda J Lee, James Raftery, Maria Chorozoglou, Jenny Versnel, Ian Pavord, Mark Stafford-Watson, Mike Thomas","doi":"10.4104/pcrj.2013.00047","DOIUrl":"10.4104/pcrj.2013.00047","url":null,"abstract":"","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"PS1-7"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31478669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Models for estimating projections for the prevalence and disease burden of chronic obstructive pulmonary disease (COPD): systematic review protocol.","authors":"Susannah McLean, Sarah H Wild, Colin R Simpson, Aziz Sheikh","doi":"10.4104/pcrj.2013.00048","DOIUrl":"10.4104/pcrj.2013.00048","url":null,"abstract":"","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"PS8-21"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31478670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations.","authors":"Lynn K Josephs,&nbsp;Robina K Coker,&nbsp;Mike Thomas","doi":"10.4104/pcrj.2013.00046","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00046","url":null,"abstract":"<p><p>Air travel poses medical challenges to passengers with respiratory disease, principally because of exposure to a hypobaric environment. In 2002 the British Thoracic Society published recommendations for adults and children with respiratory disease planning air travel, with a web update in 2004. New full recommendations and a summary were published in 2011, containing key recommendations for the assessment of high-risk patients and identification of those likely to require in-flight supplemental oxygen. This paper highlights the aspects of particular relevance to primary care practitioners with the following key points: (1) At cabin altitudes of 8000 feet (the usual upper limit of in-flight cabin pressure, equivalent to 0.75 atmospheres) the partial pressure of oxygen falls to the equivalent of breathing 15.1% oxygen at sea level. Arterial oxygen tension falls in all passengers; in patients with respiratory disease, altitude may worsen preexisting hypoxaemia. (2) Altitude exposure also influences the volume of any air in cavities, where pressure x volume remain constant (Boyle's law), so that a pneumothorax or closed lung bulla will expand and may cause respiratory distress. Similarly, barotrauma may affect the middle ear or sinuses if these cavities fail to equilibrate. (3) Patients with respiratory disease require clinical assessment and advice before air travel to: (a) optimise usual care; (b) consider contraindications to travel and possible need for in-flight oxygen; (c) consider the need for secondary care referral for further assessment; (d) discuss the risk of venous thromboembolism; and (e) discuss forward planning for the journey.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"234-8"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31478668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of patients preferring once-daily controller therapy for asthma and COPD: a retrospective cohort study.","authors":"David Price,&nbsp;Amanda J Lee,&nbsp;Erika J Sims,&nbsp;Linda Kemp,&nbsp;Elizabeth V Hillyer,&nbsp;Alison Chisholm,&nbsp;Julie von Ziegenweidt,&nbsp;Angela Williams","doi":"10.4104/pcrj.2013.00017","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00017","url":null,"abstract":"<p><strong>Background: </strong>Patient preference is an important factor when choosing an inhaler device for asthma or chronic obstructive pulmonary disease (COPD).</p><p><strong>Aims: </strong>To identify characteristics of patients with asthma or COPD who prefer a once-daily controller medication regimen.</p><p><strong>Methods: </strong>This retrospective observational study used electronic patient records and linked outcomes from patient-completed questionnaires in a primary care database. We compared the characteristics of patients indicating a preference for once-daily therapy with those who were unsure or indicating no preference.</p><p><strong>Results: </strong>Of 3,731 patients with asthma, 2,174 (58%) were women; the mean age was 46 years (range 2-94). Of 2,138 patients with COPD, 980 (46%) were women; the mean age was 70 years (range 35-98). Approximately half of the patients in each cohort indicated once-daily preference, one-quarter were unsure, and one-quarter did not prefer once-daily therapy. In patients with asthma or COPD, the preference for once-daily controller medication was significantly associated with poor adherence and higher concerns about medication. In asthma, good control and low self-perceived controller medication need were associated with once-daily preference. By contrast, in COPD, a high self-perceived need for controller medication was associated with once-daily preference. There was no significant relationship between once-daily preference and age, sex, disease severity, or exacerbation history.</p><p><strong>Conclusions: </strong>Understanding patient preferences may help prescribers to individualise therapy better for asthma and COPD.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"161-8"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31372724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Don't write off paediatric asthma action plans just yet.","authors":"Tracey Marshall,&nbsp;Peter van Asperen,&nbsp;Hiran Selvadurai,&nbsp;Paul Robinson","doi":"10.4104/pcrj.2013.00049","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00049","url":null,"abstract":"Children with asthma can experience poor control of their disease, resulting in decreased quality of life, recurrent asthma exacerbations, and hospital presentations. Health-related outcomes can be improved with comprehensive asthma management, and an important component of asthma selfmanagement is the Asthma Action Plan (AAP). Of particular significance in paediatrics is the fact that the primary caregivers have an important role in overseeing their child’s asthma management. Current international guidelines recommend that asthma management includes education about asthma medication and use of inhalation delivery devices, prevention of symptoms, management of acute episodes, self-management monitoring and control of asthma, with regular review and the provision of the AAP to help the patient and/or caregiver recognise and manage acute asthma episodes. Despite existing evidence on the benefit of having an AAP there are still many questions that remain about the individual patient’s confidence and understanding, and the effects of subsequent education, in their utilisation of their AAP. Some but not all of these questions are addressed in the study by Tan et al. published in this issue of the PRCJ. The authors conducted a questionnaire survey which aimed to explore the reasons for the reported increase in caregivers’ confidence to provide care to their child during an acute asthma episode associated with having a Written AAP (WAAP). They report that compared to caregivers who did not possess a WAAP, those with a WAAP demonstrated better understanding and recognition of the symptoms of an acute episode and had a better understanding of medications including being more confident with medication use and less concerned about possible side effects of asthma medications. However, no difference was noted between caregivers (with or without a WAAP) in their likelihood to stop medications without consulting their physician, seek acute care consultation, and their confidence in self-management of their children’s asthma at home. How does continuing to use the AAP as part of overall asthma management expand the opportunities for further improvements in asthma self-management? Fostering and then further developing an ongoing relationship with children, adolescents and caregivers to enhance their understanding of asthma management knowledge and confidence is vital to self-management. For example, a simple discussion on the role of the AAP and what this means for asthma management at home and/or school can assist with identifying barriers that may compromise adherence to asthma medications. A tailored approach with specialist care from medical and nursing staff has been shown to lead to better asthma control, lung function and adherence to asthma management. However, changing health-related activities and behaviours can be an ongoing challenge for caregivers and clinicians. One of the challenges for clinicians is the potential confusion over which type of AAP t","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"144-5"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31456940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alarmingly high prevalence of smoking and symptoms of bronchitis in young women in Sweden: a population-based questionnaire study.","authors":"Göran Wennergren, Linda Ekerljung, Bernt Alm, Anders Bjerg, Jan Lötvall, Bo Lundbäck","doi":"10.4104/pcrj.2013.00043","DOIUrl":"10.4104/pcrj.2013.00043","url":null,"abstract":"<p><strong>Background: </strong>After 10 years of a decrease in smoking among young people in Sweden, we now have indications of increased smoking.</p><p><strong>Aims: </strong>To provide up-to-date information on the prevalence of smoking and smoke-associated respiratory symptoms in young adults in Sweden, with a special focus on possible gender differences.</p><p><strong>Methods: </strong>In the West Sweden Asthma Study, a detailed postal questionnaire focusing on asthma, respiratory symptoms, and possible risk factors was mailed to 30,000 randomly selected subjects aged 16-75 years. The analyses are based on responses from 2,702 subjects aged 16-25 years.</p><p><strong>Results: </strong>More young women than men were smokers (23.5% vs. 15.9%; p<0.001). Women started smoking earlier and smoked more. Symptoms such as longstanding cough, sputum production, and wheeze were significantly more common in smokers. In the multiple logistic regression analysis, smoking significantly increased the risk of recurrent wheeze (odds ratio (OR) 2.0 (95% CI 1.4 to 3.0)) and sputum production, (OR 2.4 (95% CI 1.9 to 3.1)).</p><p><strong>Conclusions: </strong>The alarmingly high prevalence of smoking among young women was parallel to a similarly high prevalence of bronchitis symptoms. This is worrisome, both in itself and because maternal smoking is a risk factor for illness in the child. Adverse respiratory effects of smoking occur within only a few years of smoking initiation.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"214-20"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31418625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asthma control, quality of life, and the role of patient enablement: a cross-sectional observational study.","authors":"Jaime Correia de Sousa, Alexandra Pina, Ana Margarida Cruz, Ana Quelhas, Filipa Almada-Lobo, Joana Cabrita, Pedro Oliveira, John Yaphe","doi":"10.4104/pcrj.2013.00037","DOIUrl":"10.4104/pcrj.2013.00037","url":null,"abstract":"<p><strong>Background: </strong>Self-assessment of asthma and a stronger doctor-patient relationship can improve asthma outcomes. Evidence for the influence of patient enablement on quality of life and the control of asthma is lacking.</p><p><strong>Aims: </strong>To assess asthma severity, medication use, asthma control, and patient enablement in patients with asthma treated in primary care and to study the relationship between these variables and quality of life.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in an urban clinic in northern Portugal. Data were collected from both clinical records and questionnaires from a random sample of asthma patients. The modified Patient Enablement Instrument, the Asthma Quality of Life Questionnaire, and the Asthma Control Questionnaire were used. Peak expiratory flow and forced expiratory volume in one second (FEV1) were measured. Receiver operating characteristic curve analysis was performed to establish cut-off values for the quality of life measurements. The associations between enablement, asthma control, and quality of life were tested using logistic regression models.</p><p><strong>Results: </strong>The study sample included 180 patients. There was a strong correlation between asthma control and quality of life (r=0.81, p<0.001). A weak association between patient enablement and asthma control and quality of life was found in the logistic regression models. Poor control of asthma was associated with female gender, concomitant co-morbidities, reduced FEV1, and increased severity of asthma.</p><p><strong>Conclusions: </strong>The weak correlation between enablement and asthma control requires further study to determine if improved enablement can improve asthma outcomes independent of gender, severity, and concomitant co-morbidities. This study confirms the strong correlation between asthma control and quality of life.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 2","pages":"181-7"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31372827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}