Primary Care Respiratory Journal最新文献

{"title":"Editors' Choice","authors":"Z. Ballas","doi":"10.4104/pcrj.2013.00059","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00059","url":null,"abstract":"Asthma is a heterogeneous disease with high prevalence and a significant effect on quality of life. Severe asthma is notoriously hard to define, even more so for research. In this issue of the Journal, Mincheva et al (p 2256) propose a novel definition of asthma severity based on multiple signs, including daytime and nighttime symptoms, lung function, high degree of medication, and exacerbations. This algorithm was applied to a large-scale epidemiologic study, the West Sweden Asthma Study, and the following was concluded: Asthma severity phenotypes are exceptionally diverse and require individualized approaches to each asthmatic patient. Asthma severity is present in 13% to 36% of all asthmatic patients, depending on definition. Several factors are associated with asthma severity, most prominently smoking and obesity. In summary, every third asthmatic patient shows at least 1 sign of asthma severity, which is a clear indicator that there are still","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"3 1","pages":"i - i"},"PeriodicalIF":0.0,"publicationDate":"2013-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75184424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journalwatch@pcrj","authors":"","doi":"10.4104/pcrj.2013.00057","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00057","url":null,"abstract":"Here's the best of the rest: summary reviews of relevant papers from the top respiratory and general medical journals worldwide. Journalwatch@pcrj is produced by the PCRJ Editors-in-Chief — reviews were selected and written by Dr Paul Stephenson and edited by Professor Aziz Sheikh. Each summary contains the name of the first author, the title of the paper, the Vancouver reference and/or doi number, and a link to the abstract of the paper. In the majority of cases these are subscription journals, so to view the full text you will need to subscribe to the journal or pay to view on an individual article basis. These reviews were originally published by the Doctors.net.uk Journal Watch service, which covers other specialties as well as respiratory medicine. Doctors.net.uk is the largest network of GMC-registered doctors in the UK. To find out about membership, click on Doctors.net.uk. The opinions expressed herein may not necessarily reflect the views of the authors of the original articles.","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"21 1","pages":"253 - 257"},"PeriodicalIF":0.0,"publicationDate":"2013-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80015363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selected abstracts from the 3rd IPCRG International Scientific Meeting, Uppsala, May 2013","authors":"I. Tsiligianni, Siân Williams, C. Jong, T. Molen, R. Jordan, S. Majothi, N. Heneghan, A. Turner, D. Moore, D. O'Brien, S. Jowett, S. Singh, P. Adab, D. Fitzmaurice, S. Bayliss, R. Riley, J. Ayres, K. Jolly, D. M. S. Barne, K. Apte, S. Madas, J. Gogtay, S. Chhowala, N. Mahajan, S. Salvi, D. Price, M. Fletcher, T. Molen","doi":"10.4104/pcrj.2013.00056","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00056","url":null,"abstract":"Selected abstracts from the 3rd IPCRG International Scientific Meeting, Uppsala, May 2013 A1 PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org http://dx.doi.org/10.4104/pcrj.2013.00056 IPCRG13-1052 GENDER DIFFERENCES IN COPD: FINDINGS OF AN EARLY DETECTION PROGRAMME IN SINGAPORE T. L. Tan,* K. C. Ong, A. Earnest Medicine, Yong Loo Lin School Of Medicine, National University of Singapore, The Edinburgh Clinic, KC Ong Chest and Medical Clinic, Duke-NUS Graduate Medical School, NUS, Singapore, Singapore Aim: This study aimed to examine gender differences in the prevalence of COPD as detected during a public awareness programme with spirometry measurement in screening for COPD in a self-selected population. Method: A series of public education events were held in selected locations in Singapore from 2010 to 2011 on the causes, symptoms and risk of developing COPD. After completing the risk assessment questionnaire, participants were invited to undergo spirometry. Results: 928 unique subjects participated in the public education events. The mean age was 52 years, 63% were men. 81 (8.7%) had clinically significant airflow obstruction (FEV1/FVC<0.7). Of these, 33 subjects (41%) had mild COPD, (FEV1 > 80% pred), 36 (44%) had moderate COPD (FEV1<80% but >50%pred) and the remaining had severe COPD. There were no significant differences between the proportion of male and female subjects with COPD (8.9% and 8.4% respectively). The proportion of smokers/ex-smokers among men was significantly higher than among women (81% vs 30% respectively [p<0.001]). The smoking and age-group adjusted prevalence of COPD among males and females was 6.9% and 8.2% respectively. Conclusion: In spite of significantly lower self-declared smoking rates among women, COPD was more prevalent in women as compared to men who were screened during the COPD public awareness programme in our study population. We postulate that this may be due to a general under-reporting of the smoking rates among women, or that women are more susceptible to smoking-related lung damage. Disclosure of Interest: T. L. Tan Grant / Research Support from: Boehringer Ingelheim, K. C. Ong Grant / Research. Support from: Boehringer Ingelheim, A. Earnest Grant / Research Support from: Boehringer Ingelheim IPCRG13-1059 HOW PAIN AFFECTS PHYSICAL PERFORMANCE IN PEOPLE WITH COPD W. D. Reid,* B. HajGhanbari, J. Garland, J. D. Road Physical Therapy, Respiratory Division, University of British Columbia, Vancouver, Canada Aim: The purpose of this study was to determine the relationship between pain and the six-minute walk distance test (6MWT), physical activity (assessed by 3D accelerometry), and concentric knee extensor torque in people with COPD. Methods: Twenty-six people with moderate to severe COPD completed the McGill Pain Questionnaire (MPQ), the Brief Pain Inventory (BPI), the Short Form-36 (SF-36), and a form to list medications and co-morbidities. After spirometry, participants performed the 6MWT. Physical activity","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"1 1","pages":"A1 - A18"},"PeriodicalIF":0.0,"publicationDate":"2013-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88860987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to COPD guidelines in general practice: impact of an educational programme delivered on location in Danish general practices.","authors":"Charlotte Suppli Ulrik,&nbsp;Tina Brandt Sørensen,&nbsp;Torben Brunse Højmark,&nbsp;Kim Rose Olsen,&nbsp;Peter Vedsted","doi":"10.4104/pcrj.2012.00089","DOIUrl":"https://doi.org/10.4104/pcrj.2012.00089","url":null,"abstract":"<p><strong>Background: </strong>The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD).</p><p><strong>Aims: </strong>To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD guidelines.</p><p><strong>Methods: </strong>A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted of a 3-hr teaching lesson with a respiratory specialist and five visits by a representative from the sponsoring pharmaceutical company focusing on assessment and management of patients including written algorithms. A one-to-one propensity-matched control group of practices was selected. Register data were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity.</p><p><strong>Results: </strong>Data for 102 participating GP practices were analysed. Participating clinics had a significant increase in preventive consultations and influenza vaccinations (p<0.05). For the control group, a significant change was observed only for influenza vaccinations. No significant change was found when comparing participating and control clinics in the difference-in-difference estimator. However, a significant improvement was observed for the subgroup of 48 clinics with the lowest starting point of spirometry testing.</p><p><strong>Conclusions: </strong>Focused education of GPs and their staff delivered in the GPs' own practices may improve adherence to COPD guidelines, not least for clinics with a high potential for improvement.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 1","pages":"23-8"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2012.00089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30978006","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":"Is the family physician an accomplice in the development of the 'primary care gap'? The importance of high quality real-life primary care respiratory research.","authors":"Anthony D'Urzo","doi":"10.4104/pcrj.2013.00006","DOIUrl":"10.4104/pcrj.2013.00006","url":null,"abstract":"Is the family physician an accomplice in the development of the ‘primary care gap’? The importance of high quality real-life primary care respiratory research","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31194876","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":"Practical approach to exercise-induced bronchoconstriction in athletes.","authors":"Les Ansley,&nbsp;Glen Rae,&nbsp;James H Hull","doi":"10.4104/pcrj.2013.00004","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00004","url":null,"abstract":"<p><p>Exercise-induced bronchoconstriction (EIB) is highly prevalent in athletes of all abilities and can impact on their health and performance. The majority of athletes with exertional dyspnoea will be initially assessed and managed in primary care. This report provides a practical and pragmatic approach to the assessment and management of a young athlete presenting with suspected EIB in this setting.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 1","pages":"122-5"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31266840","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":"Usefulness of the COPD assessment test (CAT) in primary care.","authors":"Arnulf Langhammer,&nbsp;Rupert Jones","doi":"10.4104/pcrj.2013.00022","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00022","url":null,"abstract":"Optimum management of COPD can improve prognosis and reduce the impact of the disease on quality of life and health status. For this purpose, optimal assessments of multiple dimensions of the disease are necessary. Previous guideline recommendations were often based on limited evidence of therapeutic effectiveness and limited study of the feasibility of incorporating recommendations into primary care. Assessment of COPD severity was based solely on the degree of bronchial obstruction, despite a weak correlation between lung function parameters and perceived symptoms and limitations. However, current guidelines recommend assessment of patientfocused outcomes; these can be measured using various validated health status measures, from the simple one-question Medical Research Council (MRC) dyspnoea grade to the more complex St George’s Respiratory Questionnaire (SGRQ). The difficult question is how we should incorporate patientrelated outcome measures into routine primary care practice. One solution has been to use composite measures of disease severity including lung function and health status. The BODE index (Body mass index, Obstruction, Dyspnea, Exercise) uses the MRC as a measure of health status and has proved to be robust as a measure of disease severity and prognosis, but is not widely used in routine care. The latest GOLD guidelines suggest dividing patients into four categories based on current symptoms (assessed using the MRC or the COPD assessment test (CAT)), percent predicted FEV1, and the number of exacerbations. However, this system has met with significant objections since it was neither derived nor validated statistically, is complex to use, and may not be suitable for primary care. Valid and reliable tools for health status measurement in COPD patients are beneficial for comparative studies between populations as well as for measuring shortand long-term changes, perhaps especially for health authorities, researchers and pharmaceutical companies. Pivotal questions remain, however, such as whether these tools improve the communication between health professional and patient, contribute to improved patient outcomes, or if they are feasible to use in routine general practice. Newer scales could facilitate use in routine care. One of the aims during the development of the CAT was to improve communication between COPD patients and the clinician, thus enabling a common understanding of the severity and impact of the disease. This is not easy to determine, but in this issue of the PCRJ, Gruffydd-Jones et al. report a very interesting randomised controlled study on the utility of the CAT in primary care consultations. As many as 165 primary care physicians from six European countries conducted six consultations with standardised COPD patients (played by trained actors) covering a variety of COPD severities and co-morbidities. Physicians were randomised to see the patients in videoed consultations with or without the completed CAT. The physi","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 1","pages":"8-9"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31347839","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":"Increase in prevalence of physician-diagnosed asthma in Helsinki during the Finnish Asthma Programme: improved recognition of asthma in primary care? A cross-sectional cohort study.","authors":"Annette Kainu, Paula Pallasaho, Päivi Piirilä, Ari Lindqvist, Anssi Sovijärvi, Anne Pietinalho","doi":"10.4104/pcrj.2013.00002","DOIUrl":"10.4104/pcrj.2013.00002","url":null,"abstract":"<p><strong>Background: </strong>The continuing rise in asthma prevalence has been questioned, with recent reports suggesting a plateau.</p><p><strong>Aims: </strong>To assess a 10-year trend in the age-adjusted prevalence of physician-diagnosed asthma, respiratory and allergic symptoms, and use of asthma medication in the adult population of Helsinki during the Finnish Asthma Programme from 1994 to 2004.</p><p><strong>Methods: </strong>Two cross-sectional postal surveys were conducted among random Finnish National Population Registry samples 10 years apart using the same protocol. A total of 6,062 subjects (75.9%) and 2,449 subjects (61.9%) participated in 1996 and 2006, respectively.</p><p><strong>Results: </strong>The prevalence of physician-diagnosed asthma increased from 6.5% in 1996 to 10.0% in 2006 (p<0.001). This was evident in both genders aged <60 years, but particularly in women aged <40 years, paralleling an increased use of asthma medication. Concurrently, the prevalence of allergic rhinoconjunctivitis increased from 37.2% to 44.4% (p<0.001). The prevalence of physician-diagnosed chronic obstructive pulmonary disease remained unchanged (3.7%), while current smoking abated. Subjects with a smoking history had more respiratory symptoms (p<0.001). Among subjects without physician-diagnosed asthma, those reporting allergic rhinoconjunctivitis had a higher prevalence of lower respiratory tract symptoms.</p><p><strong>Conclusions: </strong>The prevalence of allergic rhinoconjunctivitis and physician-diagnosed asthma has increased in Helsinki during 10 years in adults, especially in women aged <40 years. Concomitantly, the use of asthma medication increased and subjects with physiciandiagnosed asthma were less symptomatic. The increase in the prevalence of physician-diagnosed asthma may partly be due to improved diagnostic recognition of asthma in primary care during the Finnish Asthma Programme, but the concurrent rise in allergic rhinoconjunctivitis may reflect a true rise in prevalence.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":" ","pages":"64-71"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40220670","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":"A scoring algorithm for predicting the presence of adult asthma: a prospective derivation study.","authors":"Katsuyuki Tomita,&nbsp;Hiroyuki Sano,&nbsp;Yasutaka Chiba,&nbsp;Ryuji Sato,&nbsp;Akiko Sano,&nbsp;Osamu Nishiyama,&nbsp;Takashi Iwanaga,&nbsp;Yuji Higashimoto,&nbsp;Ryuta Haraguchi,&nbsp;Yuji Tohda","doi":"10.4104/pcrj.2013.00005","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00005","url":null,"abstract":"<p><strong>Background: </strong>To predict the presence of asthma in adult patients with respiratory symptoms, we developed a scoring algorithm using clinical parameters.</p><p><strong>Methods: </strong>We prospectively analysed 566 adult outpatients who visited Kinki University Hospital for the first time with complaints of nonspecific respiratory symptoms. Asthma was comprehensively diagnosed by specialists using symptoms, signs, and objective tools including bronchodilator reversibility and/or the assessment of bronchial hyperresponsiveness (BHR). Multiple logistic regression analysis was performed to categorise patients and determine the accuracy of diagnosing asthma.</p><p><strong>Results: </strong>A scoring algorithm using the symptom-sign score was developed, based on diurnal variation of symptoms (1 point), recurrent episodes (2 points), medical history of allergic diseases (1 point), and wheeze sound (2 points). A score of >3 had 35% sensitivity and 97% specificity for discriminating between patients with and without asthma and assigned a high probability of having asthma (accuracy 90%). A score of 1 or 2 points assigned intermediate probability (accuracy 68%). After providing additional data of forced expiratory volume in 1 second/forced vital capacity (FEV(1)/FVC) ratio <0.7, the post-test probability of having asthma was increased to 93%. A score of 0 points assigned low probability (accuracy 31%). After providing additional data of positive reversibility, the post-test probability of having asthma was increased to 88%.</p><p><strong>Conclusions: </strong>This pragmatic diagnostic algorithm is useful for predicting the presence of adult asthma and for determining the appropriate time for consultation with a pulmonologist.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 1","pages":"51-8"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31185896","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":"Is education at the crossroads?","authors":"Ron Tomlins","doi":"10.4104/pcrj.2013.00020","DOIUrl":"https://doi.org/10.4104/pcrj.2013.00020","url":null,"abstract":"between specialists and primary care physicians, to assist harmonisation, and to design and deploy relevant educational tools (see www.eaaci.net). However, the impact of allergies has only recently been recognised at the political level in Europe, mostly in relation to respiratory allergies. This is an important step, but it lags behind the observed epidemiological trends with increases in systemic disease entities such as food allergy. In all, there is little doubt that recognition and prioritisation of allergy education in primary care is probably the only way to improve patient outcomes and to prevent devastating consequences in public health.","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":"22 1","pages":"6-8"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2013.00020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31252597","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}