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Joshi PR. Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges. Geriatrics (Basel) 2024; 9:34. [PMID: 38525751 PMCID: PMC10961796 DOI: 10.3390/geriatrics9020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
As the global population ages, pulmonary diseases among older people have emerged as a significant and growing public health concern. The increasing incidence of these conditions has led to higher rates of morbidity and mortality among older adults. This perspective study offers a thorough overview of the prevalent pulmonary diseases affecting the elderly demographic. It delves into the challenges encountered during the diagnosis and management of these conditions in older individuals, considering factors such as comorbidities, functional limitations, and medication complexities. Furthermore, innovative strategies and personalized interventions such as precision medicine, advanced therapies, telemedicine solutions, and patient-centered support systems aimed at enhancing the care provided to older individuals grappling with pulmonary disorders are thoroughly explored. By addressing the unique needs and complexities of this vulnerable population, healthcare systems can strive towards improving outcomes and enhancing the quality of life for elderly individuals affected by pulmonary diseases.
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Affiliation(s)
- Pushpa Raj Joshi
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
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2
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Teixeira PM, Lemos F, Yaphe J, Alves L, de Sousa JC. Respiratory medicine curriculum in Portuguese family medicine training: A Delphi study. Pulmonology 2024; 30:145-151. [PMID: 33298375 DOI: 10.1016/j.pulmoe.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Respiratory diseases (RD) constitute a significant part of the workload of family physicians. There is no consensus on what family doctors should know in this area but established methods for achieving consensus may help to overcome this. OBJECTIVES The purpose of the study was to obtain a national consensus on the required knowledge and skills in respiratory medicine for family medicine trainees after vocational training. METHODS A Delphi study was conducted via e-mail with a diverse panel of experts. We developed a Learning Curriculum Framework (LCF) with 399 items adapted from the Royal Australasian College of Physicians ..÷ Respiratory Medicine Advanced Training Curriculum. The LCF was submitted to the experts in two rounds for consensus. Consensus was considered for items that had an agreement of 80% in the classifications above 4 on a scale of importance that ranged from 1 (not important) to 5 (very important). RESULTS Consensus was obtained for 159 items (38.8%). These included structure and function of the respiratory tract (0.6%), presenting problems (21.4%), diagnosis (7.5%), interventions and prevention (11.3%), COPD-emphysema (12.6%), tumours (3.1%), infections (10.7%), tuberculosis (5.7%), HIV (1.3%), thromboembolic disease (2.5%), pleural-pulmonary disease (3.1%), pregnancy (0.6%) and sleep disorders (3.8%). Items on iatrogenic diseases and respiratory research did not reach consensus. CONCLUSIONS Consensus on the respiratory medicine curriculum may contribute to further development of the vocational training curriculum in Portugal. This approach may help teachers in other countries in Europe to develop curricula for respiratory medicine and other areas of general practice.
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Affiliation(s)
- P M Teixeira
- ICVS/3B...s ..÷ PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal; School of Medicine, University of Minho, Portugal.
| | - F Lemos
- ICVS/3B...s ..÷ PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal; Tiago de Almeida USF, Viana do Castelo, Portugal
| | - J Yaphe
- ICVS/3B...s ..÷ PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal; School of Medicine, University of Minho, Portugal
| | - L Alves
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Portugal; St. Andr.. de Canidelo Family Health Unit, ACES Grande Porto VII ..÷ Gaia, Vila Nova de Gaia, Portugal
| | - J C de Sousa
- ICVS/3B...s ..÷ PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal; School of Medicine, University of Minho, Portugal; Horizonte Family Health Unit, ULS Matosinhos, Porto, Portugal
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3
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Lovett R, Bonham M, Yoshino Benavente J, Hosseinian Z, Byrne GJ, Varela Diaz M, Bass M, Yao L, Adin-Cristian A, Batio S, Kim M, Sluis A, Moran M, Buchanan DR, Hunt J, Young SR, Gershon R, Nowinski C, Wolf M. Primary care detection of cognitive impairment leveraging health and consumer technologies in underserved US communities: protocol for a pragmatic randomised controlled trial of the MyCog paradigm. BMJ Open 2023; 13:e080101. [PMID: 37852774 PMCID: PMC10603543 DOI: 10.1136/bmjopen-2023-080101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Early identification of cognitive impairment (CI), including Alzheimer's disease and related dementias (ADRD), is a top public health priority. Yet, CI/ADRD is often undetected and underdiagnosed within primary care settings, and in health disparate populations. The MyCog paradigm is an iPad-based, self-administered, validated cognitive assessment based on the National Institutes of Health (NIH) Toolbox Cognition Battery and coupled with clinician decision-support tools that is specifically tailored for CI/ADRD detection within diverse, primary care settings. METHODS AND ANALYSIS We will conduct a two-arm, primary care practice-randomised (N=24 practices; 45 257 active patients at the proposed practices), pragmatic trial among geographically diverse Oak Street Health sites to test the effectiveness of the MyCog paradigm to improve early detection CI/ADRD among low socioeconomic, black and Hispanic older adults compared with usual care. Participating practices randomised to the intervention arm will impart the MyCog paradigm as a new standard of care over a 3-year implementation period; as the cognitive component for Annual Wellness Visits and for any patient/informant-reported or healthcare provider-suspected cognitive concern. Rates of detected (cognitive test suggesting impairment) and/or diagnosed (relevant International Classification of Diseases-9/10 [ICD-9/10] code) cognitive deficits, impairments or dementias including ADRD will be our primary outcome of study compared between arms. Secondary outcomes will include ADRD severity (ie, mild or later stage), rates of cognitive-related referrals and rates of family member or caregiver involvement in ADRD care planning. We will use generalised linear mixed models to account for clustered study design. Secondary models will adjust for subject, clinic or visit-specific characteristics. We will use mixed-methods approaches to examine fidelity and cost-effectiveness of the MyCog paradigm. ETHICS AND DISSEMINATION The Institutional Review Board at Advarra has approved the study protocol (Pro00064339). Results will be published in peer-reviewed journals and summaries will be provided to the funders of the study. TRIAL REGISTRATION NUMBER NCT05607732.
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Affiliation(s)
- Rebecca Lovett
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Morgan Bonham
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julia Yoshino Benavente
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zahra Hosseinian
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Greg J Byrne
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria Varela Diaz
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Bass
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lihua Yao
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrei Adin-Cristian
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephanie Batio
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Minjee Kim
- Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | | | - Justin Hunt
- Oak Street Health LLC, Chicago, Illinois, USA
| | - Stephanie R Young
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard Gershon
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy Nowinski
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Wolf
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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4
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Osundolire S, Goldberg RJ, Lapane KL. Anxiety and Depression Among US Nursing Home Residents with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1867-1882. [PMID: 37662488 PMCID: PMC10473093 DOI: 10.2147/copd.s417449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is highly prevalent among nursing home residents; however, few studies have focused on the psychological impact of this clinically significant condition on nursing home residents. Objective We examine the prevalence of, and factors associated with, anxiety and depression in nursing home residents with COPD. Methods Using the US 2018 Minimum Dataset (MDS), we conducted a cross-sectional study among 239,615 residents aged ≥50 years old in US Medicare/Medicaid certified nursing homes with COPD. Anxiety and depression were diagnosed based on clinical diagnoses, physical examination findings, and treatment orders. Multivariable adjusted Poisson models with a generalized estimating equations approach account for the clustering among residents within nursing homes. Results The average age of the study population was 79 years (SD: 10.6), 62.0% were women, and 43.7% had five or more comorbid conditions. In this population, 37.2% had anxiety, 57.6% had depression, and 27.5% had both mental health conditions. Women, current tobacco users, persons 50-64 years old, those who reported having moderate or severe pain, and nursing home residents with multimorbidity were more likely to have anxiety or depression than respective comparison groups. Conclusion Anxiety and depression are common among US nursing home residents with COPD. Women, medically complex patients, and those who report having moderate-to-severe pain appear to be more likely to have anxiety and depression. Clinical teams should be aware of these findings when managing nursing home residents with COPD and use various nonpharmacological and medical interventions for the effective management of anxiety and depression. Longitudinal studies evaluating how anxiety and depression affect the management of COPD and related outcomes, and how best to improve the quality of life of nursing home residents with COPD, are warranted.
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Affiliation(s)
- Seun Osundolire
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
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5
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Sigurgeirsdottir J, Halldorsdottir S, Arnardottir RH, Gudmundsson G, Bjornsson EH. Ethical Dilemmas in Physicians’ Consultations with COPD Patients. Int J Chron Obstruct Pulmon Dis 2022; 17:977-991. [PMID: 35528147 PMCID: PMC9075168 DOI: 10.2147/copd.s356107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Aim This phenomenological study was aimed at exploring principal physicians’ (participants’) experience of attending to COPD patients and motivating their self-management, in light of the GOLD clinical guidelines of COPD therapy. Methods Interviews were conducted with nine physicians, who had referred patients to PR, five general practitioners (GPs) and four lung specialists (LSs). The interviews were recorded, transcribed, and analyzed through a process of deconstruction and reconstruction. Results The participants experienced several ethical dilemmas in being principal physicians of COPD patients and motivating their self-management; primarily in the balancing act of adhering to the Hippocratic Oath of promoting health and saving lives, while respecting their patients’ choice regarding non-adherence eg, by still smoking. It was also a challenge to deal with COPD as a nicotine addiction disease, deal with patients’ denial regarding the harm of smoking and in motivating patient mastery of the disease. The participants used various strategies to motivate their patients’ self-management such as active patient education, enhancing the patients’ inner motivation, by means of an interdisciplinary approach, involving the patients’ significant other when appropriate, and by proposing PR. Conclusion The findings indicate that being a principal physician of COPD patients and motivating their self-management is a balancing act, involving several dilemmas. Patients’ nicotine addiction and physicians’ ethical obligations are likely to create ethical dilemmas as the physician is obligated to respect the patients’ will, even though it contradicts what is best for the patient. The participants suggest strategies to motivate COPD patients’ self-management.
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Affiliation(s)
- Jonina Sigurgeirsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Pulmonary Department, Reykjalundur Rehabilitation Center, Mosfellsbaer, Iceland
- Correspondence: Jonina Sigurgeirsdottir, Pulmonary Department, Reykjalundur Rehabilitation Center, Furubyggd 28, Mosfellsbaer, 270, Iceland, Tel +354 6261740, Email
| | - Sigridur Halldorsdottir
- Faculty of Graduate Studies, School of Health Sciences, University of Akureyri, Akureyri, Iceland
| | - Ragnheidur Harpa Arnardottir
- Faculty of Graduate Studies, School of Health Sciences, University of Akureyri, Akureyri, Iceland
- Department of Rehabilitation, Akureyri Hospital, Akureyri, Iceland
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
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6
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Alfano P, Cuttitta G, Audino P, Fazio G, La Grutta S, Marcantonio S, Bucchieri S. Relationship between Multimorbidity and Quality of Life in a Primary Care Setting: The Mediating Role of Dyspnea. J Clin Med 2022; 11:jcm11030656. [PMID: 35160105 PMCID: PMC8837036 DOI: 10.3390/jcm11030656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner’s surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40–88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV1/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient’s global health.
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Affiliation(s)
- Pietro Alfano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
- Correspondence:
| | - Giuseppina Cuttitta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
| | - Palma Audino
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
| | - Giovanni Fazio
- Triolo Zanca Clinic, Piazza Fonderia 23, 90133 Palermo, Italy;
| | - Sabina La Grutta
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy;
| | - Salvatore Marcantonio
- Quality, Planning and Strategic Support Area, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy;
| | | | - Salvatore Bucchieri
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
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7
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Burrows AG, Ellis AK. Psychological Impacts of COVID-19 on people with Asthma, Allergic Rhinitis and Food Allergy. Ann Allergy Asthma Immunol 2021; 129:52-61. [PMID: 34971763 PMCID: PMC8714612 DOI: 10.1016/j.anai.2021.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Alyssa G Burrows
- Allergy Research Unit, Kingston Health Sciences Center - KGH Site, Kingston, ON, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Anne K Ellis
- Allergy Research Unit, Kingston Health Sciences Center - KGH Site, Kingston, ON, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
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Abstract
A gap exists between guidelines and real-world clinical practice for the management and treatment of chronic obstructive pulmonary disease (COPD). Although this has narrowed in the last decade, there is room for improvement in detection rates, treatment choices and disease monitoring. In practical terms, primary care practitioners need to become aware of the huge impact of COPD on patients, have non-judgemental views of smoking and of COPD as a chronic disease, use a holistic consultation approach and actively motivate patients to adhere to treatment.This article is based on discussions at a virtual meeting of leading Nordic experts in COPD (the authors) who were developing an educational programme for COPD primary care in the Nordic region. The article aims to describe the diagnosis and lifelong management cycle of COPD, with a strong focus on providing a hands-on, practical approach for medical professionals to optimise patient outcomes in COPD primary care.
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9
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Higbee DH, Nava GW, Kwong ASF, Dodd JW, Granell R. The impact of asthma on mental health and wellbeing during COVID-19 lockdown. Eur Respir J 2021; 58:13993003.04497-2020. [PMID: 33766952 PMCID: PMC7996219 DOI: 10.1183/13993003.04497-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/17/2021] [Indexed: 01/13/2023]
Abstract
It has been assumed that people with asthma would be at a high risk of developing severe illness from coronavirus disease 2019 (COVID-19), despite a lack of evidence [1]. Social isolation measures have aimed to mitigate this risk to vulnerable groups; however, such interventions can have negative mental health impacts [2]. People with asthma are more vulnerable to the negative mental health impact of lockdown. This is not explained by mental or physical comorbidities and highlights the need to provide support for anxiety and depression in younger people with asthma.https://bit.ly/3tEblYS
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Affiliation(s)
- Daniel H Higbee
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.,Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - George W Nava
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Alex S F Kwong
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - James W Dodd
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK .,Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK.,Joint senior authors
| | - Raquel Granell
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.,Joint senior authors
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10
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Tsiligianni I, Hoeines KJ, Jensen C, Kocks JWH, Ställberg B, Vicente C, Peché R. Towards Rational Prescription of Common Inhaler Medication in the Multimorbid COPD Patient. Int J Chron Obstruct Pulmon Dis 2021; 16:1315-1327. [PMID: 34012259 PMCID: PMC8127323 DOI: 10.2147/copd.s298345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
COPD is a chronic disease, typically accompanied by multiple comorbid conditions. The need to apply several, and sometimes conflicting, disease-specific treatment guidelines, complicates the management of individual patients. Moreover, national and international recommendations evolve rapidly but provide limited guidance on the integrated approach in the multimorbid patient. Particularly bothersome is the fact that the presence of comorbidities may deteriorate the course of COPD, and inversely COPD may affect the outcome of the comorbid diseases. In addition, some effects of commonly prescribed COPD inhaler medications, including beta2-agonists, long-acting antimuscarinics and especially inhaled corticosteroids, mimic or worsen COPD-related comorbidities. Therefore, the authors combined their perspectives to formulate advice that may help physicians to improve COPD patient care in daily practice when comorbidities are present. Diabetes, atrial fibrillation, osteoporosis/fractures, infections (pneumonia and tuberculosis) and asthma were identified as areas where practicing clinicians should give special attention to the risk-benefit ratio of the inhaled medication. Overall, the presence of multimorbidity in a COPD patient should act as a signal to carefully reconsider the treatment choices.
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Affiliation(s)
| | | | | | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
- Observational and Pragmatic Research Institute, Singapore
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | - Rudi Peché
- Department of Pneumology, ISPPC, CHU Charleroi, Charleroi, Belgium
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11
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Doe G, Chantrell S, Williams M, Steiner MC, Armstrong N, Hutchinson A, Evans RA. Breathless and awaiting diagnosis in UK lockdown for COVID-19…We're stuck. NPJ Prim Care Respir Med 2021; 31:21. [PMID: 33953200 PMCID: PMC8100135 DOI: 10.1038/s41533-021-00232-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/15/2021] [Indexed: 12/04/2022] Open
Abstract
During the COVID-19 pandemic, semi-structured interviews were undertaken with 20 adults awaiting a diagnosis for their chronic breathlessness. Three key themes were identified using thematic analysis: (1) de-prioritisation of diagnosis, (2) following UK 'lockdown' guidance for the general population but patients fearful they were more at risk, and (3) the impact of lockdown on coping strategies for managing breathlessness. The existing unpredictable pathway to diagnosis for those with chronic breathlessness has been further interrupted during the COVID-19 pandemic.
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Affiliation(s)
- Gillian Doe
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Stacey Chantrell
- NIHR Biomedical Research Centre-Respiratory theme, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Marie Williams
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Michael C Steiner
- Department of Respiratory Science, University of Leicester, Leicester, UK
- NIHR Biomedical Research Centre-Respiratory theme, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Ann Hutchinson
- Wolfson Palliative Care Research Centre, Hull and York Medical School, University of Hull, Hull, UK
| | - Rachael A Evans
- Department of Respiratory Science, University of Leicester, Leicester, UK.
- NIHR Biomedical Research Centre-Respiratory theme, University Hospitals of Leicester NHS Trust, Leicester, UK.
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12
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Perez-Benzo GM, Muellers K, Chen S, Liu B, Bagiella E, O'Conor R, Wolf MS, Wisnivesky JP, Federman AD. Identifying Behavioral Phenotypes in Chronic Illness: Self-Management of COPD and Comorbid Hypertension. PATIENT EDUCATION AND COUNSELING 2021; 104:627-633. [PMID: 32921518 PMCID: PMC7914263 DOI: 10.1016/j.pec.2020.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To identify and characterize the constellation, or clusters, of self-management behaviors in patients with chronic obstructive pulmonary disease (COPD) and comorbid hypertension. METHODS Cluster analysis (n = 204) was performed with standardized scores for medication adherence to COPD and hypertension medications, inhaler technique, and diet as well as self-reported information on physical activity, appointment keeping, smoking status, and yearly influenza vaccination for a total of eight variables. Classification and regression tree analysis (CART) was performed to further characterize the resulting clusters. RESULTS Patients were divided into three clusters based on eight self-management behaviors, which included 95 patients in cluster 1, 42 in cluster 2, and 67 in cluster 3. All behaviors except for inhaler technique differed significantly among the three clusters (P's<0.005). CART indicated physical activity was the first differentiating variable. CONCLUSIONS Patients with COPD and hypertensioncan be separated into those with adequate and inadequate adherence. The group with inadequate adherence can further be divided into those with poor adherence to medical behaviors compared to those with poor adherence to lifestyle behaviors. PRACTICE IMPLICATIONS Once validated in other populations, the identification of patient clusters using patient self-management behaviors could be used to inform interventions for patients with multimorbidity.
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Affiliation(s)
| | - Kimberly Muellers
- Department of Psychology, Pace University, New York, NY, United States
| | - Shiqi Chen
- ISO, Verisk Analytics, Jersey City, NJ, United States
| | - Bian Liu
- Institute for Translational Epidemiology, Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Juan P Wisnivesky
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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13
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Chua YP, Xie Y, Lee PSS, Lee ES. Definitions and Prevalence of Multimorbidity in Large Database Studies: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041673. [PMID: 33572441 PMCID: PMC7916224 DOI: 10.3390/ijerph18041673] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022]
Abstract
Background: Multimorbidity presents a key challenge to healthcare systems globally. However, heterogeneity in the definition of multimorbidity and design of epidemiological studies results in difficulty in comparing multimorbidity studies. This scoping review aimed to describe multimorbidity prevalence in studies using large datasets and report the differences in multimorbidity definition and study design. Methods: We conducted a systematic search of MEDLINE, EMBASE, and CINAHL databases to identify large epidemiological studies on multimorbidity. We used the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) protocol for reporting the results. Results: Twenty articles were identified. We found two key definitions of multimorbidity: at least two (MM2+) or at least three (MM3+) chronic conditions. The prevalence of multimorbidity MM2+ ranged from 15.3% to 93.1%, and 11.8% to 89.7% in MM3+. The number of chronic conditions used by the articles ranged from 15 to 147, which were organized into 21 body system categories. There were seventeen cross-sectional studies and three retrospective cohort studies, and four diagnosis coding systems were used. Conclusions: We found a wide range in reported prevalence, definition, and conduct of multimorbidity studies. Obtaining consensus in these areas will facilitate better understanding of the magnitude and epidemiology of multimorbidity.
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Affiliation(s)
- Ying Pin Chua
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore;
| | - Ying Xie
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore; (Y.X.); (P.S.S.L.)
| | - Poay Sian Sabrina Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore; (Y.X.); (P.S.S.L.)
| | - Eng Sing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore;
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore; (Y.X.); (P.S.S.L.)
- Correspondence:
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14
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Faronbi JO, Ajadi AO, Gobbens RJ. Associations of chronic illnesses and socio-demographic factors with health-related quality of life of older adults in Nigeria: A cross-sectional study. Ghana Med J 2020; 54:164-172. [PMID: 33883761 PMCID: PMC8042799 DOI: 10.4314/gmj.v54i3.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The increase in life expectancy has brought about a higher prevalence of chronic illnesses among older people. OBJECTIVES To identify common chronic illnesses among older adults, to examine the influence of such conditions on their Health-Related Quality of Life (HRQoL), and to determine factors predicting their HRQoL. METHOD A population-based cross-sectional study was conducted involving 377 individuals aged 60 years and above who were selected using multi-stage sampling techniques in Olorunda Local Government, Osun State, Nigeria. Data were collected using an interviewer-administered questionnaire comprising socio-demographic characteristics, chronic illnesses, and the World Health Organization quality of life instrument (WHOQOL-BREF) containing physical health, psychological, social relationships, and environmental domains. RESULTS About half (51.5%) of the respondents reported at least one chronic illness which has lasted for 1-5 years (43.3%). The prevalence of hypertension was 36.1%, diabetes 13.9% and arthritis 13.4%. Respondents with chronic illness had significantly lower HRQoL overall and in the physical health, social relationships and the environmental domains (all p<0.05) compared to those without a chronic illness. Factors that predicted HRQoL include age, marital status, level of education, the presence of chronic illness and prognosis of the condition. CONCLUSION This study concluded that chronic illness is prevalent in Nigerian older people and significantly influence their HRQoL. Age, marital status, and level of education were associated with HRQoL in this group. FUNDING Postdoctoral fellowship from Consortium for Advanced Research Training in Afric.
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Affiliation(s)
- Joel O Faronbi
- Department of Nursing Science, College of Health Science, Obafemi Awolowo University, Ile-Ife, Nigeria
- Frail Elderly Research Support Group (FRESH), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Aishat O Ajadi
- Department of Nursing Science, College of Health Science, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
- Department of General Practices, University of Antwerp, Belgium
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15
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Yadav UN, Lloyd J, Hosseinzadeh H, Baral KP, Bhatta N, Harris MF. Levels and determinants of health literacy and patient activation among multi-morbid COPD people in rural Nepal: Findings from a cross-sectional study. PLoS One 2020; 15:e0233488. [PMID: 32469917 PMCID: PMC7259703 DOI: 10.1371/journal.pone.0233488] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 05/06/2020] [Indexed: 01/07/2023] Open
Abstract
Background Health literacy (HL) and patient activation (PA) are necessary foundations to engage patients in self-management intervention. Each concept plays a unique role in improving access to the effective self-management of chronic disease. In this cross-sectional study, we examined the levels and determinants of HL and PA among the multi-morbid COPD patients in Nepal. Methods We conducted interviews with a simple random sample of 238 multi-morbid COPD people from July 2018 to January 2019. The questionnaire included sociodemographic profiles, five domains of the Health Literacy Questionnaire (HLQ), 13-item Patient Activation Measure (PAM) and patient’s illness perception by Brief Illness Perception Questionnaire (BIPQ). Multivariable logistic regression was used to examine the associations. Results Most people with COPD had low health levels across each of the five domains of the HLQ. The proportion of people with low literacy level across each of the domains was: (i) feeling understood and supported by healthcare providers (79.0%), (ii) having sufficient information to manage my own health (76.5%), (iii) social support for health (77.3%), (iv) ability to find the good health information (75.2%), and (v) understand the health information well enough to know what to do (74.8%), respectively. The majority of patients also reported low levels of patient activation (level 1: 81.5%; level 2: 11.8%), with only 6.7% (level 3: 5%; level 4: 1.7%) reported higher patient activation level. We found significant associations between poor HL levels in the HLQ domains and having no education, being female or from Indigenous and Dalits communities, and having a monthly family income of less than USD176. Having no education and poor illness perception were significantly associated with poor activation level on PAM scale. Conclusion A high proportion of multi-morbid COPD peoples had low levels of HL and were less activated than what would be required to self-manage COPD. These were in turn associated with socioeconomic factors and poor illness perception. The findings from this study are being used to design a COPD self—management program tailored to the low health literate population.
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Affiliation(s)
- Uday Narayan Yadav
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
- Forum for Health Research and Development, Dharan, Nepal
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
- * E-mail: ,
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
| | | | - Kedar Prasad Baral
- School of Public Health, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Narendra Bhatta
- Department of Pulmonary, Critical Care and Sleep Medicine, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
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16
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Marques de Mello L, Cruz ÁA. A proposed scheme to cope with comorbidities in asthma. Pulm Pharmacol Ther 2018; 52:41-51. [PMID: 30149069 DOI: 10.1016/j.pupt.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
Abstract
The prevalence of non-communicable chronic diseases has been on the rise and the co-occurrence of morbidities is becoming more common. Multimorbidities are found more frequently among women, those with a history of mental disorders, lower level of schooling, and unfavorable socioeconomic condition. Physical inactivity, smoking and obesity are also associated with multimorbidities. Its occurrence is directly related to the age, affecting the majority of the individuals with more than 50 years old. It is important to consider the possibility of comorbid conditions that aggravate, complicate or simulate the symptoms of the disease in the face of a patient with asthma and poor response to treatment. Among subjects with asthma, some conditions stand out as the most frequent: chronic rhinitis or rhinosinusitis, gastroesophageal reflux disease, obstructive sleep apnea syndrome, obesity, and cardiovascular disorders. Comorbidities reduce the chances of optimal asthma control. It is essential to assess and manage properly these complex situations, choosing wisely preventive strategies and treatment options to avoid adverse events and optimize outcomes. Medications for asthma have the potential to worsen cardiovascular conditions, while beta-adrenergic receptor blockers and angiotensin conversion enzyme inhibitors used for cardiovascular conditions, can worsen asthma. Handling properly these cases will save lives and resources. However, there are multiple gaps in knowledge requiring investigation in this field to inform integrated care pathways and policies. It is likely information may be obtained from real life studies and electronic medical databases. Communications between the providers and patients may be facilitated by electronic technology, opening a large window for guided self-management.
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Affiliation(s)
| | - Álvaro A Cruz
- ProAR - Federal University of Bahia School of Medicine, Brazil
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17
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Chanoine S, Sanchez M, Pin I, Temam S, Le Moual N, Fournier A, Pison C, Bousquet J, Bedouch P, Boutron-Ruault MC, Varraso R, Siroux V. Multimorbidity medications and poor asthma prognosis. Eur Respir J 2018; 51:13993003.02114-2017. [PMID: 29545275 DOI: 10.1183/13993003.02114-2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/01/2018] [Indexed: 11/05/2022]
Abstract
Multimedication related to multimorbidity is common in the elderly with asthma. We aimed at comprehensively characterising medications used by elderly women and assessing how multimedication impacts on asthma prognosis.We performed network-based analyses on drug administrative databases to visualise the prevalence of drug classes and their interconnections among 17 458 elderly women from the Asthma-E3N study, including 4328 women with asthma. Asthma groups sharing similar medication profiles were identified by a clustering method relying on all medications and were studied in association with adverse asthma events (uncontrolled asthma, attacks/exacerbations and poor asthma-related quality of life).The network-based analysis showed more multimedication in women with asthma than in those without asthma. The clustering method identified three multimedication profiles in asthma: "Few multimorbidity-related medications" (43.5%), "Predominantly allergic multimorbidity-related medications" (32.8%) and "Predominantly metabolic multimorbidity-related medications" (23.7%). Compared with women belonging to the "Few multimorbidity-related medications" profile, women belonging to the two other profiles had an increased risk of uncontrolled asthma and asthma attacks/exacerbations, and had lower asthma-related quality of life.The integrative data-driven approach on drug administrative databases identified specific multimorbidity-related medication profiles that were associated with poor asthma prognosis. These findings support the importance of multimorbidity in the unmet needs in asthma management.
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Affiliation(s)
- Sébastien Chanoine
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France.,Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Margaux Sanchez
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France
| | - Isabelle Pin
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France.,Clinique de Pédiatrie, Pôle Couple Enfant, CHU Grenoble Alpes, Grenoble, France
| | - Sofia Temam
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Nicole Le Moual
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France
| | - Agnès Fournier
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,Institut Gustave Roussy, Villejuif, France
| | - Christophe Pison
- Université Grenoble Alpes, Grenoble, France.,Service Hospitalier Universitaire Pneumologie-Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Grenoble, France.,INSERM, Laboratoire de Bioénergétique Fondamentale et Appliquée, U1055, Grenoble, France
| | - Jean Bousquet
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France.,Clinique de Pneumologie, CHU de Montpellier, Montpellier, France.,MACVIA-France, Contre les Maladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Pierrick Bedouch
- Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France.,CNRS, TIMC-IMAG UMR5525/ThEMAS, Université Grenoble Alpes, Grenoble, France
| | - Marie-Christine Boutron-Ruault
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,Institut Gustave Roussy, Villejuif, France
| | - Raphaëlle Varraso
- INSERM U1168, VIMA, Aging and Chronic Diseases: Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS-S 1168, Montigny le Bretonneux, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
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18
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Morrison D, Mair FS, Yardley L, Kirby S, Thomas M. Living with asthma and chronic obstructive airways disease: Using technology to support self-management - An overview. Chron Respir Dis 2017; 14:407-419. [PMID: 27512084 PMCID: PMC5729728 DOI: 10.1177/1479972316660977] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) are common, and cause high levels of morbidity and mortality. Supporting self-management is advocated for both asthma and increasingly so for COPD, and there is growing interest in the potential role of a range of new technologies, such as smartphone apps, the web or telehealth to facilitate and promote self-management in these conditions. Treatment goals for both asthma and COPD include aiming to control symptoms, maintain activities, achieve the best possible quality of life and minimize risks of exacerbation. To do this, health professionals should be (a) helping patients to recognize deteriorating symptoms and act appropriately; (b) promoting adherence to maintenance therapy; (c) promoting a regular review where triggers can be established, and strategies for managing such triggers discussed; and (d) promoting healthy lifestyles and positive self-management of symptoms. In particular, low uptake of asthma action plans is a modifiable contributor to morbidity and possibly also to mortality in those with asthma and should be addressed as a priority. Using technology to support self-management is an evolving strategy that shows promise. This review provides an overview of self-management support and discusses how newer technologies may help patients and health professionals to meet key treatment goals.
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Affiliation(s)
- Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Highfield, Southampton, UK
| | - Sarah Kirby
- Department of Psychology, University of Southampton, Highfield, Southampton, UK
| | - Mike Thomas
- Primary Care Research, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, UK
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19
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Houben-Wilke S, Augustin IM, Wouters BB, Stevens RA, Janssen DJ, Spruit MA, Vanfleteren LE, Franssen FM, Wouters EF. The patient with a complex chronic respiratory disease: a specialist of his own life? Expert Rev Respir Med 2017; 11:919-924. [PMID: 29025350 DOI: 10.1080/17476348.2017.1392242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The independent and central role of the patient with a complex chronic respiratory disease in targeted, personalized disease management strategies is becoming increasingly important. Patients are the ones living with the disease and are finally responsible for their lives underlining their role as essential members of the interdisciplinary treatment team. Areas covered: The present paper narratively reviews existing research and discusses the special, as well as specialized, role of the patient with a complex chronic respiratory disease in the healthcare system and highlights fundamental elements of the (future) relationship between patient and healthcare professionals. Expert commentary: Since the chronic respiratory disease at hand is part of the patient's entire life, we need holistic, personalized approaches optimizing patients' quality of life by not only treating the disease but considering the patients' whole environment and where healthcare professionals and patients are co-creating value care.
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Affiliation(s)
| | | | - Birgit Bref Wouters
- b Department of Health, Ethics and Society, Faculty of Health , Medicine and Life Science, CAPHRI School for Public Health and Primary Care , Maastricht , The Netherlands
| | - Rosita Ah Stevens
- a Department of Research and Education , CIRO , Horn , The Netherlands
| | - Daisy Ja Janssen
- a Department of Research and Education , CIRO , Horn , The Netherlands.,c Centre of Expertise for Palliative Care , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Martijn A Spruit
- a Department of Research and Education , CIRO , Horn , The Netherlands.,d Department of Respiratory Medicine , Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism , Maastricht , The Netherlands
| | - Lowie Egw Vanfleteren
- a Department of Research and Education , CIRO , Horn , The Netherlands.,e Department of Respiratory Diseases , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Frits Me Franssen
- a Department of Research and Education , CIRO , Horn , The Netherlands.,e Department of Respiratory Diseases , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Emiel Fm Wouters
- a Department of Research and Education , CIRO , Horn , The Netherlands.,e Department of Respiratory Diseases , Maastricht University Medical Center , Maastricht , The Netherlands
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20
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Weatherburn CJ, Guthrie B, Mercer SW, Morales DR. Comorbidities in adults with asthma: Population-based cross-sectional analysis of 1.4 million adults in Scotland. Clin Exp Allergy 2017; 47:1246-1252. [PMID: 28665552 DOI: 10.1111/cea.12971] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/26/2017] [Accepted: 06/22/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Comorbidity in people with asthma can significantly increase asthma morbidity and lower adherence to asthma guidelines. OBJECTIVE The objective of this study was to comprehensively measure the prevalence of physical and mental health comorbidities in adults with asthma using a large nationally representative population. METHODS Cross-sectional analysis of routine primary care electronic medical records for 1 424 378 adults in the UK, examining the prevalence of 39 comorbidities in people with and without asthma, before and after adjustment for age, sex, social deprivation and smoking status using logistic regression. RESULTS Of 39 comorbidities measured, 36 (92%) were significantly more common in adults with asthma; 62.6% of adults with asthma had ≥1 comorbidity vs 46.2% of those without, and 16.3% had ≥4 comorbidities vs 8.7% of those without. Comorbidities with the largest absolute increase in prevalence in adults with asthma were as follows: chronic obstructive pulmonary disease (COPD) (13.4% vs 3.1%), depression (17.3% vs 9.1%), painful conditions (15.4% vs 8.4%) and dyspepsia (10.9% vs 5.2%). Comorbidities with the largest relative difference in adults with asthma compared to those without were as follows: COPD (adjusted odds ratio [aOR] 5.65, 95% CI 5.52-5.79), bronchiectasis (aOR 4.65, 95% CI 4.26-5.08), eczema/psoriasis (aOR 3.30, 95% CI 3.14-3.48), dyspepsia (aOR 2.20, 95% CI 2.15-2.25) and chronic sinusitis (aOR 2.12, 95% CI 1.99-2.26). Depression and anxiety were more common in adults with asthma (aOR 1.60, 95% CI 1.57-1.63, and aOR 1.53, 95% CI 1.48-1.57, respectively). CONCLUSIONS AND CLINICAL RELEVANCE Physical and mental health comorbidities are the norm in adults with asthma. Appropriate recognition and management should form part of routine asthma care.
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Affiliation(s)
- C J Weatherburn
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - B Guthrie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - S W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D R Morales
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK.,Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, UK
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21
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Moser S, Luxenberger W, Freidl W. The Influence of Social Support and Coping on Quality of Life Among Elderly With Age-Related Hearing Loss. Am J Audiol 2017; 26:170-179. [PMID: 28445580 DOI: 10.1044/2017_aja-16-0083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/10/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The consequences of hearing loss hinder the everyday life of older adults and are associated with reduced well-being. The research aim was to explore the influence of hearing problems, various coping strategies, and perceived social support on quality of life. METHOD Sixty-five older adults with age-related hearing loss (≥55 years) in Austria participated and completed a paper-pencil survey with standardized questionnaires: Hearing Handicap Inventory for the Elderly (Ventry and Weinstein, 1982), Assessment for Coping and Stress (Laireiter, 1997), short form of the Social Support Questionnaire (Fydrich, Sommer, Tydecks, & Brähler, 2009), and World Health Organization Quality of Life Scale-Brief Version (World Health Organization, 1996). RESULTS Quality of life was predicted by perceived social support and the number of comorbid diseases (i.e., the physical, psychological, environmental, and social quality of life was better the greater the extent of perceived social support and poorer the more diseases from which the participants suffered). CONCLUSIONS Perceived social support may be a relevant factor to focus on in auditory rehabilitation programs, in particular, for participants who communicate little support in hearing-related situations and are, hence, at a relative disadvantage. The involvement of significant others in counseling could facilitate the everyday life for older adults with age-related hearing loss and their significant others.
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Affiliation(s)
- Sarah Moser
- Department of Social Medicine and Epidemiology, Medical University of Graz, Austria
| | - Wolfgang Luxenberger
- Department of Social Medicine and Epidemiology, Medical University of Graz, Austria
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Austria
| | - Wolfgang Freidl
- Department of Social Medicine and Epidemiology, Medical University of Graz, Austria
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Pinnock H, Sohanpal R. Chronic Obstructive Pulmonary Disease: Reduced Nihilism, But There is Still a Ways to Go. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2016; 3:605-609. [PMID: 28848886 PMCID: PMC5556755 DOI: 10.15326/jcopdf.3.3.2016.0151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, United Kingdom
| | - Ratna Sohanpal
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, United Kingdom
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