An audit of morbidity associated with chronic asthma in general practice
A survey of 312 adult asthmatic subjects has been undertaken. Only 3·5% of the total adult list were known to have asthma and this may represent underdiagnosis. Spirometry was normal in under half the patients and below 50% predicted in one fifth. Forced expired volume in 1s had declined more rapidly than expected with increasing age, particularly amongst smokers.
Morbidity from asthma was extensive, patients reporting substantial breathlessness and restrictions of their life style; nearly half had lost time from work in the preceding twelve months. Morbidity was correlated with spirometry.
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Cited by (27)
A comparison of primary care physicians and pneumologists in the management of asthma in Spain: ASES study
2003, Respiratory MedicineThe purpose of the ASES study is to determine the clinical characteristics of Spanish asthmatic patients seen in primary care (PC) and in pneumology (P) departments, comparing the availability of diagnostic methods, morbidity, the type of treatment and follow-up between the two health care settings. ASES is a multicenter, descriptive, cross-sectional study. The physicians were selected by random sampling. The data were collected by the participating physicians using three questionnaires. Data were collected on 2349 asthmatic patients (1298 from hospitals and 1051 from PC). Smokers predominated in the PC setting (P=0.000). The spirometry was performed at least once a year in 87.2% of the patients seen in P and 39.8% in PC (P=0.000). Morbidity was high in both groups (P and PC), more than two nighttime awakenings per month (25.5% versus 29%) and emergency visits in previous year (26% versus 21%). A high percent of asthmatic patients was using both inhaled corticoids and long-acting β2-agonists (49.5% versus 32%). The 30% of PC patients could not be classified into any step of the treatment. In Spain, the morbidity of disease is high, despite the large use of drugs. Objective monitoring tests have very limited use in PC.
Lost income and work limitations in persons with chronic respiratory disorders
2002, Journal of Clinical EpidemiologyChronic respiratory diseases are prevalent, disabling, and rank fifth in terms of cost of illness among major disease groups; however, the degree of work loss and lost income is largely unknown. Lost wages in adults with chronic respiratory conditions were calculated from the Survey of Income and Program Participation (SIPP). The National Health Interview Survey (NHIS) was used to estimate work loss and limitations in specific chronic respiratory conditions, including allergic rhinitis, asthma, chronic bronchitis, and emphysema. The SIPP indicated that adults with chronic respiratory conditions average $3,143 annual earnings loss ($5,272 for those between the ages of 25 and 64 and $1,267 for those over age 65). The NHIS indicated that 19.9% of persons with chronic respiratory conditions report being unable to work. Comparisons across respiratory diseases are made.
Validation of checklists for assessing inhalation technique with pressurized inhalers and Turbuhaler®
1999, Archivos de BronconeumologiaComprobar la validez y fiabilidad intra e interobservador de dos listas de comprobación de la técnica de inhalación, para inhalador de cartucho presurizado y Turbuhaler®.
Estudio descriptivo transversal realizado en un centro de salud urbano en Gijón. Se estudiaron 34 pacientes que usaban inhalador de cartucho presurizado y 35 que usaban Turbuhaler®, seleccionados aleatoriamente entre los enfermos de asma del centro de salud, mayores de 14 años y menores de 65 años.
Se compararon los resultados obtenidos en cada lista por dos observadores con los obtenidos por monitores electrónicos (prueba patrón), realizando cada paciente 3 maniobras de inhalación.
Según la prueba patrón, realizaban correctamente la técnica de inhalador de cartucho presurizado entre el 35,2 y el 47% de los pacientes, mientras que para el Turbuhaler® esa cifra fue del 74,2%.
La sensibilidad de la lista de inhalador de cartucho presurizado oscilaba entre el 62,5 y 91,6% y la especificidad entre el 88,8 y 94,4%. Para la lista de Turbuhaler®, la sensibilidad iba de 50 a 76,9%, y la especificidad del 66,6 a 88,8%.
La concordancia intraobservador, medida mediante el índice kappa, fue de 0,62 a 0,74 para el inhalador de cartucho presurizado y de 0,77 a 0,81 para Turbuhaler®. La concordancia interobservador, usando igualmente el índice kappa, fue de 0,68 a 0,81 para inhalador de cartucho presurizado y de 0,53 a 0,60 para Turbuhaler®.
Las dos listas de comprobación propuestas son un instrumento válido y de buena fiabilidad intra e interobservador, permitiendo detectar fácilmente a aquellos pacientes que realizan incorrectamente la técnica de inhalación.
To determine the intra- and interobserver validity and reliability of two checklists for inhalation technique with a pressurized inhaler (PI) and the Turbuhaler.
Transversal descriptive study performed at an urban health clinic in Gijón (Spain). Thirtyfour patients, over 14 years of age but younger than 65, who used a PI and 35 who used a Turbuhaler were chosen randomly from among patients in our health clinic practice.
The results obtained with each list by two observers were compared with those obtained by electronic monitors (test pattern). Each patient performed 3 inhalation maneuvers.
Comparison with the test pattern showed that, between 35.2% and 47% of patients used the PI technique correctly, whereas 74.2% inhaled correctly using the Turbuhaler.
The sensitivity of the PI checklist ranger from 62.5 to 91.6 and specificity ranged from 88.8 to 94.4. The sensitivity of the Turbuhaler checklist ranged from 50 to 76.9 specificity ranged from 66.6 to 88.8.
Intra-observer agreement (Kappa index) was 0.62 to 0.74 for the PI checklist and between 0.77 and 0.81 for the Turbuhaler list. Interobserved agreement (Kappa index) was 0.68 to 0.81 for the PI list and 0.53 to 0.60 for the Turbuhaler list.
The two checklists are valid instruments and offer good intra and interobserved reliability, permitting easy identification of patients who perform the inhalation technique incorrectly.
Factors related to asthma morbidity
1997, Archivos de BronconeumologiaEl objetivo de este estudio ha sido averiguar la situación clínica, el tratamiento prescrito y el cumplimiento del mismo en los pacientes con asma, así como conocer cuáles son los parámetros que más influyen en el control de la enfermedad.
Se estudiaron 335 pacientes asmáticos adscritos a centros de salud. Se realizaron a todos una espirometría y una entrevista, recogiéndose parámetros de morbilidad, tratamiento prescrito y método de inhalación utilizado. Se valoró mediante escalas el cumplimiento del tratamiento y el uso de los inhaladores. La adecuación del tratamiento se estimó según los criterios del consenso internacional del asma.
Mediante análisis multivariante se estudió qué variables influyen en el control del asma, incluyéndose edad, sexo, hábito tabáquico, corrección del tratamiento, técnica de inhalación, cumplimiento del tratamiento y tiempo de evolución de la enfermedad.
Noventa y seis pacientes (28,7%) tenían morbilidad baja, 111 (33,1%) media y 128 (38,2%) alta. El tratamiento era correcto en 118 (35,2%), en 72 (21,5%) se utilizaban más fármacos o más dosis de los recomendados y en 145 (43,3%) el tratamiento era incorrecto. La técnica de inhalación era adecuada en 87 personas (27,5%) e inadecuada en 229 (72,5%). Cumplían bien el tratamiento 94 pacientes (28,1%), y mal 241 (71,.9%).
Las variables que mostraron influencia significativa sobre el asma fueron el tratamiento correcto y el cumplimiento.
Existe una elevada morbilidad por asma en la población estudiada. Se observa un alto porcentaje de tratamiento incorrecto y bajo cumplimiento, siendo estas las situaciones que más influyen en el control de la enfermedad.
To determine the clinical situation, prescribed treatment and compliance in patients with asthma, and to identify the parameters that most influence control of the disease.
We studied 335 asthma patients assigned to health centers. All were interviewed and respiratory gases were measured. Disease symptoms were recorded, along with treatment prescribed and inhalation method used. Compliance and inhaler use were assessed on a scale. Treatment appropriateness was evaluated against criteria of international consensus.
Multiple regression analysis was used to identify the variables that most influenced control of asthma. Variables considered were age, sex, smoking, treatment appropriateness, inhaler technique, compliance with prescribed treatment and time since diagnosis.
Disease was mild in 96 patients (28.7%), moderate in 111 (33.1%) and severe in 128 (38.2%). Treatment was appropriate in 118 (35.2%). Seventy-two (21.5%) used more drugs or higher doses than recommended. Prescribed treatment was inappropriate in 145 (43.3%). The inhalation technique was appropriate in 87 (27.5%) and inappropriate in 229 (72.5%). Ninety-four patients (28.1%) complied well with treatment and 241 (71.9%) were poor compliers.
The variables that were significantly realted to control of asthma were appropriate treatment and compliance.
There is a high rate of morbidity due to asthma in the population studied. The percentage of inappropriate treatment is high, and compliance is low, these factors being the ones that most influence control of the disease.
The experience of asthma
1992, Social Science and MedicineA group of seven asthmatics were identified from family practice, following administration of a questionnaire, as expressing feelings of stigma or pessimism concerning their condition. They were interviewed in depth, using interpretive research methods, concerning their experience of asthma. Interpretive research uses qualitative methods to explore the emotions, feelings and meaning of the event of interest. All the interviews were transcribed verbatim by the principal researcher and analyzed by the technique of immersion and crystallization. The picture of asthma that emerged for the participants in this study gave rise to the concept of a dynamic model to illustrate their asthma experience. The model showed asthma as a continuum from diagnosis to final acceptance. The transistion phase included a need to integrate knowledge, experience and self-awareness before progressing to acceptance and control. A mentoring relationship greatly facilitated resolution of the transition phase. Progress along the continuum was accompanied by diminishing fear. Another important theme to emerge was the fact that tiredness and physical limitations were common feelings, irrespective of the severity of the asthma in medical terms. The implications of this research for health workers is that they have much to contribute in assisting astmatics to gain control over their condition, particularly in respect to understanding what knowledge concerning their condition is relevant to asthmatics and in understanding the potential benefit to asthmatics of a mentoring relationship.
Can the morbidity of asthma be reduced by high doseinhaled therapy? A prospective study
1990, Respiratory MedicineA community based, prospective study of the value of high dose inhaled therapy for the reduction of themorbidity of asthma has been undertaken. One hundred and sixty adults with airflow obstruction were treated for up to 9 months with increasing doses of salbutamol. Two thirds of the patients also received increasing doses of beclomethasone dipropionate in a ‘partially double-blind’ manner.
The FEV1 rose by at least 10 per cent of that predicted in one third of the total patients and the overall meandomiciliary peak expiratory flow rates rose by approximately 501/min−1. All chronic symptoms were abolished in half of the patients and acute attacks of asthma in the majority. Asthma was controlled in a greater proportion of patients more effectively and rapidly by a combination of inhaled steroids and beta agonist than by salbutamol alone, particularly when inhaled steroids were started in relatively high dosage.