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Waląg D, Soliński M, Kołtowski Ł, Górska K, Korczyński P, Kuźnar-Kamińska B, Grabicki M, Basza M, Łepek M. Deep learning algorithm for visual quality assessment of the spirograms. Physiol Meas 2023; 44:085004. [PMID: 37552997 DOI: 10.1088/1361-6579/acee41] [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: 12/27/2022] [Accepted: 08/08/2023] [Indexed: 08/10/2023]
Abstract
Objective. The quality of spirometry manoeuvres is crucial for correctly interpreting the values of spirometry parameters. A fundamental guideline for proper quality assessment is the American Thoracic Society and European Respiratory Society (ATS/ERS) Standards for spirometry, updated in 2019, which describe several start-of-test and end-of-test criteria which can be assessed automatically. However, the spirometry standards also require a visual evaluation of the spirometry curve to determine the spirograms' acceptability or usability. In this study, we present an automatic algorithm based on a convolutional neural network (CNN) for quality assessment of the spirometry curves as an alternative to manual verification performed by specialists.Approach. The algorithm for automatic assessment of spirometry measurements was created using a set of randomly selected 1998 spirograms which met all quantitative criteria defined by ATS/ERS Standards. Each spirogram was annotated as 'confirm' (remaining acceptable or usable status) or 'reject' (change the status to unacceptable) by four pulmonologists, separately for FEV1 and FVC parameters. The database was split into a training (80%) and test set (20%) for developing the CNN classification algorithm. The algorithm was optimised using a cross-validation method.Main results. The accuracy, sensitivity and specificity obtained for the algorithm were 92.6%, 93.1% and 90.0% for FEV1 and 94.1%, 95.6% and 88.3% for FVC, respectively.Significance.The algorithm provides an opportunity to significantly improve the quality of spirometry tests, especially during unsupervised spirometry. It can also serve as an additional tool in clinical trials to quickly assess the quality of a large group of tests.
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Affiliation(s)
- Damian Waląg
- Faculty of Physics, Warsaw University of Technology, Koszykowa St. 75, 00-662, Warsaw, Poland
| | - Mateusz Soliński
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Łukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, Stefana Banacha St. 1a, 02-097, Warsaw, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Stefana Banacha St. 1A, 02-097, Warsaw, Poland
| | - Piotr Korczyński
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Stefana Banacha St. 1A, 02-097, Warsaw, Poland
| | - Barbara Kuźnar-Kamińska
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Szamarzewskiego St. 82, 61-001, Poznan, Poland
| | - Marcin Grabicki
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Szamarzewskiego St. 82, 61-001, Poznan, Poland
| | - Mikołaj Basza
- Medical University of Silesia, Poniatowskiego St. 15, 40-055, Katowice, Poland
| | - Michał Łepek
- Faculty of Physics, Warsaw University of Technology, Koszykowa St. 75, 00-662, Warsaw, Poland
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Valentino AS, Eddy E, Woods Z, Wilken L. Pharmacist Provided Spirometry Services: A Scoping Review. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2021; 10:93-111. [PMID: 34485107 PMCID: PMC8409516 DOI: 10.2147/iprp.s248705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Despite international guidelines' recommendations, spirometry is underutilized in the diagnosis and management of asthma and COPD. Spirometry may be an opportunity for trained pharmacists to meet the needs of patients with suspected or diagnosed lung conditions. The aim of this scoping review is to describe the literature including pharmacist provided spirometry services, specifically to identify: 1) the models of pharmacist provided spirometry services, and additional services commonly offered alongside spirometry, 2) pharmacist training and capability to obtain quality results, and (3) pharmacist, physician, and patient perspectives. Methods In September 2020, a comprehensive literature search in PubMed and EMBASE was conducted to identify all relevant literature on the topic of pharmacist provided spirometry services using the search term: "pharmacist or pharmacy" and "spirometry or pulmonary function test or lung function test." Literature was screened using inclusion/exclusion criteria and selected articles were charted and analyzed using the themes above. Results A total of 27 records were included. The scoping review found that pharmacist provided spirometry has been conducted around the world in community pharmacies and clinic settings. Community pharmacists may increase access to spirometry screening; the lack of communication with primary care providers and remuneration are barriers that need to be overcome to optimize the utility of the service. Clinic-based services are interprofessional and collaborative, allowing a patient to receive the test, results, diagnosis, and medication changes in one visit. Following comprehensive training, pharmacists felt confident in their ability to perform spirometry and met quality standards at acceptable rates. Conclusion Spirometry is an opportunity for pharmacists to improve evidence-based practice for screening and diagnosing lung conditions along with providing comprehensive services to complement testing. Data around provider and patient perspectives is limited and should be further investigated to determine if providers and patients would value and collaborate with pharmacists providing spirometry services.
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Affiliation(s)
- Alexa Sevin Valentino
- Pharmacy Practice and Science, The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Emily Eddy
- Pharmacy Practice, Ohio Northern University, Ada, OH, USA
| | - Zachary Woods
- Pharmacy Education and Innovation, The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Lori Wilken
- Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
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Jankowski P, Górska K, Mycroft K, Korczyński P, Soliński M, Kołtowski Ł, Krenke R. The use of a mobile spirometry with a feedback quality assessment in primary care setting - A nationwide cross-sectional feasibility study. Respir Med 2021; 184:106472. [PMID: 34049155 DOI: 10.1016/j.rmed.2021.106472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Mobile phone-linked portable spirometers are light-weight, easy to use and low cost, with new software to facilitate data collection. In this study we investigated the feasibility of the AioCare® mobile spirometry in primary care. METHODS In this nationwide, cross-sectional study, AioCare® spirometers (HealthUp, Poland) were distributed among primary healthcare centres across Poland. Operators (primary care professionals) received a 2-h training session, after which spirometry was performed in patients attending routine visits with respiratory symptoms or risk factors for obstructive airway diseases. Spirometry was considered technically correct when at least three manoeuvres met ERS/ATS acceptability and repeatability criteria. The most common spirometry errors were assessed and stepwise logistic regression was applied to identify factors associated with technically correct spirometry. Airway obstruction was defined as FEV1/FVC below the lower limit of normal. A restrictive pattern was defined as FVC below the lower limit of normal. RESULTS Between 1 September 2018 and 1 September 2019, 10,936 spirometry examinations were performed in 9855 patients by 673 operators. 5347 (49%) spirometry examinations met both acceptability and repeatability criteria. The most common error was plateau error (17.7%). Operator age >40 years (OR 1.49, 95% CI 1.35-1.64) and repetition of the examination at the same visit (OR 1.90, 95% CI 1.66-2.16) increased the likelihood of a technically correct examination. Airway obstruction was found in 17% of correctly performed spirometry examinations. CONCLUSIONS Our nationwide study suggests that use of the AioCare® mobile spirometer in primary care could be feasible. More intensive and continual training should be implemented to improve the quality of spirometry examinations.
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Affiliation(s)
- Piotr Jankowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
| | - Katarzyna Mycroft
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Korczyński
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Soliński
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland
| | - Łukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
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Schneider I, Rodwell L, Baum S, Borg BM, Del Colle EA, Ingram ER, Swanney M, Taylor D. Assessing spirometry competence through certification in community-based healthcare settings in Australia and New Zealand: A position paper of the Australian and New Zealand Society of Respiratory Science. Respirology 2020; 26:147-152. [PMID: 33319478 PMCID: PMC7898916 DOI: 10.1111/resp.13987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/02/2020] [Accepted: 11/23/2020] [Indexed: 12/03/2022]
Abstract
Spirometry has been established as an essential test for diagnosing and monitoring respiratory disease, particularly asthma and COPD, as well as in occupational health surveillance. In Australia and New Zealand, there is currently no pathway for spirometry operators in community‐based healthcare settings to demonstrate spirometry competence. The Australia and New Zealand Society of Respiratory Science (ANZSRS) has identified a need for developing a pathway for operators working in community‐based practices in Australia and New Zealand to demonstrate spirometry competence and certification. Spirometry certification provides evidence to patients, clients, employers and organizations that an individual has participated in an assessment process that qualifies them to perform spirometry to current international spirometry standards set out by the American Thoracic Society and the European Respiratory Society (ATS/ERS). This document describes a competence assessment pathway that incorporates a portfolio and practical assessment. The completion of this pathway and the award of certification confer an individual is competent to perform spirometry for 3 years, after which re‐certification is required. The adoption of this competency assessment and certification process by specialist organizations, and the commitment of operators performing spirometry to undergo this process, will enhance spirometry quality and practice in community‐based healthcare settings.
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Affiliation(s)
- Irene Schneider
- Respiratory Investigation Unit, The Prince Charles Hospital, Brisbane, QLD, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Leanne Rodwell
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Sarah Baum
- Spirometry Training Company (Aust), Sessional Academic, Charles Sturt University, Sydney, NSW, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eleonora A Del Colle
- Respiratory Laboratory Services, Department of Respiratory Medicine, Box Hill Hospital, Melbourne, VIC, Australia.,Pulmetrics Pty Ltd, Melbourne, VIC, Australia
| | - Emily R Ingram
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Maureen Swanney
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Deborah Taylor
- Respiratory Laboratory, Hawke's Bay District Health Board, New Zealand, Hawke's Bay, New Zealand.,Spiro Me Training, Hawke's Bay, New Zealand
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Ayuk A, Ndukwu C, Uwaezuoke S, Ekop E. Spirometry practice and the impact of a phase 1 training workshop among health workers in southern Nigeria: a cross-sectional study. BMC Pulm Med 2020; 20:258. [PMID: 33023557 PMCID: PMC7538053 DOI: 10.1186/s12890-020-01291-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Global standards require that spirometry should be performed by trained and experienced personnel, who would be able to assess the correct performance of tests by patients and assure good quality of the result. The complete achievement of this requires a two-step assessment where competency in both knowledge and skills are tested. This study aims to assess the impact of a one-day hands-on spirometry training (Phase1), on the knowledge and application of spirometry among health workers. METHODS This was a descriptive cross-sectional study, which describes a one-day (seven hours) spirometry training and skills impartation done at two conference city locations in Enugu and Calabar in the southern part of Nigeria. All the verbally consenting attendees who completed the training assessment tests constituted the study population. The assessment of the spirometry knowledge base before and after the theory and practical sessions, on the various aspects of spirometry, according to international best practices, quality assurance and the interpretation of results, was done and the outcome was analyzed. Factors that could affect the outcome were also assessed. RESULTS There were 64 consenting participants of whom 54.7% (35/64) were females. Theparticipants demonstrated much improved post-intervention knowledge and could satisfactorily perform spirometry, calibration, interpretation of test results and quality control as evidenced by the post test scores after practical sessions were conducted. Pre-test mean scores improved by a mean difference of 12% (p < 001) and were affected by the year of academic graduation and availability of spirometers at the place of work, an effect that was no longer seen at post-test following the hands-on spirometry training. CONCLUSION The present study has shown that a one-day spirometry workshop significantly improved the knowledge of spirometry practice. There is need to set up more frequent locally-organized spirometry workshops since a one-day seven-hour effective knowledge and practical training would most likely have significant impact on participants' spirometry practice with its expected positive outcome on respiratory health in Nigeria.
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Affiliation(s)
- Adaeze Ayuk
- College of Medicine, University of Nigeria Ituku-Ozalla Enugu Campus, Enugu, Nigeria
- Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chizalu Ndukwu
- Department of Paediatrics, College of Medicine, Nnamdi Azikiwe University, Awka, Anambra Nigeria
| | - Samuel Uwaezuoke
- College of Medicine, University of Nigeria Ituku-Ozalla Enugu Campus, Enugu, Nigeria
- Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Eno Ekop
- College of Health Science, University of Abuja, Abjua, Nigeria
- Department of Paediatrics, Gwagwalada Teaching Hospital Abuja FCT, Abuja, Nigeria
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Cawley MJ, Warning WJ. Impact of a Pharmacist-driven Spirometry Clinic Service within a Community Family Health Center: A 5-year Retrospective Review. J Res Pharm Pract 2018; 7:88-94. [PMID: 30050962 PMCID: PMC6036877 DOI: 10.4103/jrpp.jrpp_17_101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This study was designed to describe the impact of a trained pharmacist in performing quality spirometry testing within a community family health center. Methods: This was a retrospective, cohort study of 150 physician-referred patients who attended their scheduled spirometry office appointment between November 2008 and December 2013. Information obtained included type of the disease (patients with obstructive or restrictive pulmonary disease), calculated lung age decline due to smoking history, quality of spirometry testing, and percentage of patients requiring pulmonary drug regimen alterations due to spirometry results. Pearson correlation and descriptive statistics were used to address study objectives. Findings: Spirometry testing performed by a pharmacist resulted in 87% of tests meeting guidelines for quality. Testing identified patients with reversible airway disease (39%), chronic obstructive pulmonary disease (21%), restrictive (11%), and mixed obstructive/restrictive (11%) lung defect. Patients with abnormal spirometry demonstrated a greater smoking pack-year history and calculated lung age than patients with normal spirometry (29.1 pack-years vs. 17 pack-years; P = 0.024 and 76.3 years vs. 54.6 years; P < 0.001, respectively). A weak correlation was found between a 29.1 smoking pack-year history and forced vital capacity (r = −0.3593, P = 0.018). The pharmacist assisted in modifying pulmonary drug regimens in 69% of patients based on evidence-based guidelines. Conclusion: A pharmacist-driven spirometry service was associated with quality testing results, identified respiratory disease abnormalities, and helped modifications of pulmonary drug regimens based on evidence-based guidelines. Future direction of this service may include collaborative practice agreements with physicians to expand services of pharmacists to include spirometry testing.
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Affiliation(s)
- Michael J Cawley
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
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Swanney MP, O'Dea CA, Ingram ER, Rodwell LT, Borg BM. Spirometry training courses: Content, delivery and assessment - a position statement from the Australian and New Zealand Society of Respiratory Science. Respirology 2017; 22:1430-1435. [PMID: 28681980 DOI: 10.1111/resp.13133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/02/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
Spirometry training courses are provided by health services and training organizations to enable widespread use of spirometry testing for patient care or for monitoring health. The primary outcome of spirometry training courses should be to enable participants to perform spirometry to international best practice, including testing of subjects, quality assurance and interpretation of results. Where valid results are not achieved or quality assurance programmes identify errors in devices, participants need to be able to adequately manage these issues in accordance with best practice. It is important that potential participants are confident in the integrity of the course they attend and that the course meets their expectations in terms of training. This position statement lists the content that the Australian and New Zealand Society of Respiratory Science (ANZSRS) has identified as required in a spirometry training course to adequately meet the primary outcomes mentioned above. The content requirements outlined in this position statement are based on the current international spirometry standards set out by the American Thoracic Society and European Respiratory Society. Furthermore, recommendations around course delivery for theoretical and practical elements of spirometry testing and post-course assessment are outlined in this statement.
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Affiliation(s)
- Maureen P Swanney
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Christopher A O'Dea
- Department of Respiratory Medicine, Princess Margaret Hospital, Perth, WA, Australia
| | - Emily R Ingram
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Leanne T Rodwell
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
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George J, Zairina E. The potential role of pharmacists in chronic disease screening. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 24:3-5. [DOI: 10.1111/ijpp.12246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Johnson George
- Centre for Medicine Use and Safety, Monash University, Parkville, Melbourne, Australia
| | - Elida Zairina
- Centre for Medicine Use and Safety, Monash University, Parkville, Melbourne, Australia
- Department of Pharmacy Practice, Faculty of Pharmacy, Airlangga University, Surabaya, Indonesia
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Cawley MJ, Warning WJ. Pharmacists performing quality spirometry testing: an evidence based review. Int J Clin Pharm 2015; 37:726-33. [PMID: 26148860 DOI: 10.1007/s11096-015-0160-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/29/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The scope of pharmacist services for patients with pulmonary disease has primarily focused on drug related outcomes; however pharmacists have the ability to broaden the scope of clinical services by performing diagnostic testing including quality spirometry testing. Studies have demonstrated that pharmacists can perform quality spirometry testing based upon international guidelines. AIM OF THE REVIEW The primary aim of this review was to assess the published evidence of pharmacists performing quality spirometry testing based upon American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. In order to accomplish this, the description of evidence and type of outcome from these services were reviewed. METHODS A literature search was conducted using five databases [PubMed (1946-January 2015), International Pharmaceutical Abstracts (1970 to January 2015), Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews] with search terms including pharmacy, spirometry, pulmonary function, asthma or COPD was conducted. Searches were limited to publications in English and reported in humans. In addition, Uniform Resource Locators and Google Scholar searches were implemented to include any additional supplemental information. RESULTS Eight studies (six prospective multi-center trials, two retrospective single center studies) were included. Pharmacists in all studies received specialized training in performing spirometry testing. Of the eight studies meeting inclusion and exclusion criteria, 8 (100%) demonstrated acceptable repeatability of spirometry testing based upon standards set by the ATS/ERS guidelines. Acceptable repeatability of seven studies ranged from 70 to 99% consistent with published data. CONCLUSION Available evidence suggests that quality spirometry testing can be performed by pharmacists. More prospective studies are needed to add to the current evidence of quality spirometry testing performed by pharmacists and to measure health outcomes of the pulmonary patient.
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Affiliation(s)
- Michael J Cawley
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, 600 South 43rd Street, Philadelphia, PA, 19104-4495, USA.
| | - William J Warning
- Family Medicine Residency Program, Crozer-Keystone Center for Family Health, Springfield, PA, USA
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Lei Burton D, LeMay KS, Saini B, Smith L, Bosnic-Anticevich S, Southwell P, Cooke J, Emmerton L, Stewart K, Krass I, Reddel H, Armour C. The reliability and utility of spirometry performed on people with asthma in community pharmacies. J Asthma 2015; 52:913-9. [PMID: 25563059 DOI: 10.3109/02770903.2015.1004684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the reliability and the utility of spirometry generated by community pharmacists participating in two large asthma intervention trials of 892 people. METHODS The Pharmacy Asthma Care Program (PACP) and the Pharmacy Asthma Management Service (PAMS) involved up to four visits to the pharmacy over 6 months for counseling and goal setting. Pharmacists performed spirometry according to ATS/ERS guidelines to inform management. The proportion of A-E, F quality tests, as per EasyOne QC grades, were recorded. Lung function results between visits and for participants referred/not referred to their general practitioner on the basis of spirometry were compared. RESULTS Complete data from 2593 spirometry sessions were recorded, 68.5% of spirometry sessions achieved three acceptable tests with between-test repeatability of 150 ml or less (A or B quality), 96% of spirometry sessions included at least one test that met ATS/ERS acceptability criteria. About 39.1% of participants had FEV1/FVC values below the lower limit of normal (LNN), indicating a respiratory obstruction. As a result of the service, there was a significant increase in FEV1 and FEV1/FVC and asthma control. Lung function values were significantly poorer for participants referred to their general practitioner, compared with those not referred, on the basis of spirometry. CONCLUSIONS Community pharmacists are able to reliably achieve spirometry results meeting ATS/ERS guidelines in people with asthma. Significant improvements in airway obstruction were demonstrated with the pharmacy services. Pharmacists interpreted lung function results to identify airway obstruction for referral, making this a useful technique for review of people with asthma in the community.
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Affiliation(s)
- Deborah Lei Burton
- a Department of Biomedical Science , Charles Sturt University , Orange , NSW , Australia
| | - Kate S LeMay
- b Woolcock Institute, the University of Sydney , Sydney , Australia
| | - Bandana Saini
- c Faculty of Pharmacy, The University of Sydney , Sydney , Australia
| | - Lorraine Smith
- c Faculty of Pharmacy, The University of Sydney , Sydney , Australia
| | - Sinthia Bosnic-Anticevich
- b Woolcock Institute, the University of Sydney , Sydney , Australia .,d Sydney Local Health District , Sydney , NSW , Australia
| | - Phillipa Southwell
- a Department of Biomedical Science , Charles Sturt University , Orange , NSW , Australia
| | - Julie Cooke
- e Faculty of Health, University of Canberra , Canberra , ACT , Australia
| | - Lynne Emmerton
- f School of Pharmacy, Faculty of Health Sciences, Curtin University , Perth , Australia , and
| | - Kay Stewart
- g Centre for Medicine Use and Safety, Monash University , Monash , VIC , Australia
| | - Ines Krass
- c Faculty of Pharmacy, The University of Sydney , Sydney , Australia
| | - Helen Reddel
- b Woolcock Institute, the University of Sydney , Sydney , Australia
| | - Carol Armour
- b Woolcock Institute, the University of Sydney , Sydney , Australia .,d Sydney Local Health District , Sydney , NSW , Australia
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Redlich CA, Tarlo SM, Hankinson JL, Townsend MC, Eschenbacher WL, Von Essen SG, Sigsgaard T, Weissman DN. Official American Thoracic Society technical standards: spirometry in the occupational setting. Am J Respir Crit Care Med 2014; 189:983-93. [PMID: 24735032 DOI: 10.1164/rccm.201402-0337st] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This document addresses aspects of the performance and interpretation of spirometry that are particularly important in the workplace, where inhalation exposures can affect lung function and cause or exacerbate lung diseases, such as asthma, chronic obstructive pulmonary disease, or fibrosis. METHODS Issues that previous American Thoracic Society spirometry statements did not adequately address with respect to the workplace were identified for systematic review. Medline 1950-2012 and Embase 1980-2012 were searched for evidence related to the following: training for spirometry technicians; testing posture; appropriate reference values to use for Asians in North America; and interpretative strategies for analyzing longitudinal change in lung function. The evidence was reviewed and technical recommendations were developed. RESULTS Spirometry performed in the work setting should be part of a comprehensive workplace respiratory health program. Effective technician training and feedback can improve the quality of spirometry testing. Posture-related changes in FEV1 and FVC, although small, may impact interpretation, so testing posture should be kept consistent and documented on repeat testing. Until North American Asian-specific equations are developed, applying a correction factor of 0.88 to white reference values is considered reasonable when testing Asian American individuals in North America. Current spirometry should be compared with previous tests. Excessive loss in FEV1 over time should be evaluated using either a percentage decline (15% plus loss expected due to aging) or one of the other approaches discussed, taking into consideration testing variability, worker exposures, symptoms, and other clinical information. CONCLUSIONS Important aspects of workplace spirometry are discussed and recommendations are provided for the performance and interpretation of workplace spirometry.
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Enright P, Schermer T. Don't pay for poor quality spirometry tests. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:15-6. [PMID: 23443224 PMCID: PMC6442761 DOI: 10.4104/pcrj.2013.00023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Paul Enright
- Professor of Medicine (retired), College of Public Health and Department of Medicine, The University of Arizona, Tucson, AZ, USA
- College of Public Health and Department of Medicine, The University of Arizona, Post office box 675, Mount Lemmon, Tucson, AZ, USA Tel: +520 576 1030 E-mail:
| | - Tjard Schermer
- Associate Professor and Director, COPD & Asthma Research & Development Unit, Department of Primary and Community Care, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
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Ayorinde AA, Porteous T, Sharma P. Screening for major diseases in community pharmacies: a systematic review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2013; 21:349-61. [PMID: 23683090 DOI: 10.1111/ijpp.12041] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 03/26/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this systematic review was to assess the published evidence about the feasibility and acceptability of community pharmacy-based screening for major diseases. METHOD Studies published between January 1990 and August 2012 involving community pharmacy-based screening interventions, published in the English language, were identified from electronic databases. Reference lists of included studies were also searched. KEY FINDINGS Fifty studies (one randomised controlled trial, two cluster randomised studies, five non-randomised comparative studies and 42 uncontrolled studies) were included. The quality of most of these was assessed as poor. Screening was mostly opportunistic and screening tools included questionnaires or risk assessment forms, medical equipment to make physiological measurements, or a combination of both. Few studies assessed the accuracy of pharmacy-based screening tools. More than half of the screening interventions included an element of patient education. The proportion of screened individuals, identified with disease risk factors or the disease itself, ranged from 4% to 89%. Only 10 studies reported any economic information. Where assessed, patient satisfaction with pharmacy-based screening was high, but individuals who screened positive often did not follow pharmacist advice to seek further medical help. CONCLUSION Available evidence suggests that screening for some diseases in community pharmacies is feasible. More studies are needed to compare effectiveness and cost-effectiveness of pharmacy-based screening with screening by other providers. Strategies to improve screening participants' adherence to pharmacist advice also need to be explored. This systematic review will help to inform future studies wishing to develop community pharmacy-based screening interventions.
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Cawley MJ, Moon J, Reinhold J, Willey VJ, Warning WJ. Spirometry: Tool for pharmacy practitioners to expand direct patient care services. J Am Pharm Assoc (2003) 2013; 53:307-15. [DOI: 10.1331/japha.2013.12134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fuller L, Conrad WF, Heaton PC, Panos R, Eschenbacher W, Frede SM. Pharmacist-managed chronic obstructive pulmonary disease screening in a community setting. J Am Pharm Assoc (2003) 2012; 52:e59-66. [DOI: 10.1331/japha.2012.11100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cawley MJ, Pacitti R, Warning W. Assessment of a pharmacist-driven point-of-care spirometry clinic within a primary care physicians office. Pharm Pract (Granada) 2011; 9:221-7. [PMID: 24198860 PMCID: PMC3818738 DOI: 10.4321/s1886-36552011000400007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 11/07/2011] [Indexed: 11/16/2022] Open
Abstract
Objective To assess value-added service of a pharmacist-driven point-of-care spirometry
clinic to quantify respiratory disease abnormalities within a primary care
physicians office Methods This retrospective, cohort study was an analysis of physician referred
patients who attended our spirometry clinic during 2008-2010 due to
pulmonary symptoms or disease. After spirometry testing, data was collected
retrospectively to include patient demographics, spirometry results, and
pulmonary pharmaceutical interventions. Abnormal spirometry was identified
as an obstructive and/or restrictive defect. Results Sixty-five patients with a primary diagnosis of cough, shortness of breath,
or diagnosis of asthma or chronic obstructive pulmonary disease were
referred to the spirometry clinic for evaluation. A total of 51 (32 patients
with normal spirometry, 19 abnormal spirometry) completed their scheduled
appointment. Calculated lung age was lower in normal spirometry (58.1; SD=20
yrs) than abnormal spirometry (78.2; SD=7.5 yrs, p<0.001). Smoking pack
years was also lower in normal spirometry (14.4; SD=10.7 yrs) than abnormal
spirometry (32.7; SD=19.5 yrs, p=0.004). Resting oxygen saturation of the
arterial blood (SaO2) was higher in normal spirometry than abnormal
spirometry (98.1% vs 96.5%, p=0.016). Mean change in the forced expiratory
volume in one second (FEV1) after administration of bronchodilator was
greater in patients with abnormal spirometry compared with normal spirometry
(10.9% vs 4.1%, p<0.001). Spirometry testing assisted in addition,
discontinuation or altering pulmonary drug regimens in 41/51 patients (80%)
and the need for further diagnostic testing or physician referral in 14/51
patients (27.4%). Conclusions Implementation of a pharmacist-driven spirometry clinic is a value-added
service that can be integrated with other clinical pharmacy services within
the ambulatory care setting. Further studies are needed to determine the
role of pharmacists in performing spirometry testing and measuring
performance outcomes of the pulmonary patient.
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Affiliation(s)
- Michael J Cawley
- Department of Pharmacy Practice and Pharmacy Administration. Philadelphia College of Pharmacy, University of the Sciences . Philadelphia, PA ( United States )
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Armour CL, Lemay K, Saini B, Reddel HK, Bosnic-Anticevich SZ, Smith LD, Burton D, Song YJC, Alles MC, Stewart K, Emmerton L, Krass I. Using the community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control. J Asthma 2011; 48:914-22. [PMID: 21942306 DOI: 10.3109/02770903.2011.615431] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although asthma can be well controlled by appropriate medication delivered in an appropriate way at an appropriate time, there is evidence that management is often suboptimal. This results in poor asthma control, poor quality of life, and significant morbidity. METHODS The objective of this study was to describe a population recruited in community pharmacy identified by trained community pharmacists as being at risk for poor asthma outcomes and to identify factors associated with poor asthma control. It used a cross-sectional design in 96 pharmacies in metropolitan and regional New South Wales, Victoria, Queensland, and Australian Capital Territory in Australia. Community pharmacists with specialized asthma training enrolled 570 patients aged ≥18 years with doctor-diagnosed asthma who were considered at risk of poor asthma outcomes and then conducted a comprehensive asthma assessment. In this assessment, asthma control was classified using a symptom and activity tool based on self-reported frequency of symptoms during the previous month and categorized as poor, fair, or good. Asthma history was discussed, and lung function and inhaler technique were also assessed by the pharmacist. Medication use/adherence was recorded from both pharmacy records and the Brief Medication Questionnaire (BMQ). RESULTS The symptom and activity tool identified that 437 (77%) recruited patients had poor asthma control. Of the 570 patients, 117 (21%) smoked, 108 (19%) had an action plan, 372 (69%) used combination of inhaled corticosteroid (ICS)/long-acting β(2)-agonist (LABA) medications, and only 17-28% (depending on device) used their inhaler device correctly. In terms of adherence, 90% had their ICS or ICS/LABA dispensed <6 times in the previous 6 months, which is inconsistent with regular use; this low adherence was confirmed from the BMQ scores. A logistic regression model showed that patients who smoked had incorrect inhaler technique or low adherence (assessed by either dispensing history or BMQ) and were more likely to have poor control. CONCLUSION Community pharmacists were able to identify patients with asthma at risk of suboptimal control, and factors that contributed to this were elicited. This poorly controlled group that was identified may not be visible or accessible to other health-care professionals. There is an opportunity within pharmacies to target poorly controlled asthma and provide timely and tailored interventions.
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Affiliation(s)
- Carol L Armour
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
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Schermer TR, Akkermans RP, Crockett AJ, van Montfort M, Grootens-Stekelenburg J, Stout JW, Pieters W. Effect of e-learning and repeated performance feedback on spirometry test quality in family practice: a cluster trial. Ann Fam Med 2011; 9:330-6. [PMID: 21747104 PMCID: PMC3133580 DOI: 10.1370/afm.1258] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Spirometry has become an indispensable tool in primary care to exclude, diagnose, and monitor chronic respiratory conditions, but the quality of spirometry tests in family practices is a reason for concern. Aim of this study was to investigate whether a combination of e-learning and bimonthly performance feedback would improve spirometry test quality in family practices in the course of 1 year. METHODS Our study was a cluster trial with 19 family practices allocated to intervention or control conditions through minimization. Intervention consisted of e-learning and bimonthly feedback reports to practice nurses. Control practices received only the joint baseline workshop. Spirometry quality was assessed by independent lung function technicians. Two outcomes were defined, with the difference between rates of tests with 2 acceptable and repeatable blows being the primary outcome and the difference between rates of tests with 2 acceptable blows being the secondary outcome. We used multilevel logistic regression analysis to calculate odds ratios (ORs) for an adequate test in intervention group practices. RESULTS We analyzed 1,135 tests. Rate of adequate tests was 33% in intervention and 30% in control group practices (OR = 1.3; P=.605). Adequacy of tests did not differ between groups but tended to increase with time: OR = 2.2 (P = .057) after 3 and OR = 2.0 (P = .086) in intervention group practices after 4 feedback reports. When ignoring test repeatability, these differences between the groups were slightly more pronounced: OR = 2.4 (P = .033) after 3 and OR=2.2 (P = .051) after 4 feedback reports. CONCLUSIONS In the course of 1 year, we observed a small and late effect of e-learning and repeated feedback on the quality of spirometry as performed by family practice nurses. This intervention does not seem to compensate the lack of rigorous training and experience in performing spirometry tests in most practices.
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Affiliation(s)
- Tjard R Schermer
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Schermer TRJ, Crockett AJ, Poels PJP, van Dijke JJ, Akkermans RP, Vlek HF, Pieters WR. Quality of routine spirometry tests in Dutch general practices. Br J Gen Pract 2009; 59:e376-82. [PMID: 19889258 PMCID: PMC2784552 DOI: 10.3399/bjgp09x473088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 12/29/2008] [Accepted: 03/18/2009] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care. AIM To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics. DESIGN OF STUDY Analysis of routine spirometry test records. SETTING Fifteen general practices which had a working agreement with a local hospital pulmonary function laboratory for spirometry assessment regarding test quality and interpretation. METHOD Spirometry tests were judged by a pulmonary function technician and a chest physician. Proportions of test adequacy were analysed using markers for manoeuvre acceptability and test reproducibility derived from the 1994 American Thoracic Society spirometry guideline. Associations between quality markers and age, sex, and severity of obstruction were examined using logistic regression. RESULTS Practices performed a mean of four (standard deviation = 2) spirometry tests per week; 1271 tests from 1091 adult patients were analysed; 96.4% (95% confidence interval [CI] = 95.6 to 97.2) of all tests consisted of ≥3 blows. With 60.6% of tests, forced expiratory time was the marker with the lowest acceptability rate. An overall 38.8% (95% CI = 36.0 to 41.6) of the tests met the acceptability as well as reproducibility criteria. Age, sex, and severity of obstruction were associated with test quality markers. CONCLUSION The quality of routine spirometry tests was better than in previous reports from primary care research settings, but there is still substantial room for improvement. Sufficient duration of forced expiratory time is the quality marker with the highest rate of inadequacy. Primary care professionals should be aware of patient characteristics that may diminish the quality of their spirometry tests. Further research is needed to establish to what extent spirometry tests that are inadequate, according to stringent international expert criteria, result in incorrect clinical interpretations in general practice.
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Affiliation(s)
- Tjard R J Schermer
- Department of Primary and Community Care, Asthma and COPD Research Unit, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study. Respir Med 2009; 103:839-45. [PMID: 19200706 DOI: 10.1016/j.rmed.2008.12.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 12/18/2008] [Accepted: 12/27/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND COPD case finding is currently recommended at primary and tertiary care levels only. AIM To evaluate the feasibility of a community pharmacy program for COPD case finding in high-risk customers by means of spirometry. METHODS Pilot cross-sectional descriptive study in 13 urban community pharmacies in Barcelona, Spain, from April to May 2007. Customers >40 years old with respiratory symptoms and/or a history of smoking were invited to participate in the study during pharmacists' routine work shifts. High-risk customers were identified by means of a 5-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease, and were invited to perform spirometry accordingly. Those with an FEV(1)/FVC ratio less than 0.70 were referred to the hospital for a repeat spirometry. RESULTS Of the 161 pharmacy customers studied, 100 (62%) scored 3 or more items in the COPD screening questionnaire, and after spirometry, 21 (24%) had an FEV(1)/FVC ratio<0.7. When these subjects with airflow limitation were offered referral to a hospital respiratory function laboratory for further assessments, 11 (52%) attended the appointment. Over 70% of spirometries were rated as being of acceptable quality. No significant differences were observed in lung function parameters between the pharmacy and hospital measurements. CONCLUSIONS COPD case finding by spirometry in high-risk customers of urban community pharmacies is feasible. Similarly to primary care practitioners, pharmacists have access to high-risk, middle-aged subjects who have never been tested for COPD. Pharmacists can help with early detection of COPD if they are correctly trained.
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Barnard A, Pond CD, Usherwood TP. Asthma and older people in general practice. Med J Aust 2006; 183:S41-3. [PMID: 15992323 DOI: 10.5694/j.1326-5377.2005.tb06918.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 04/22/2005] [Indexed: 11/17/2022]
Abstract
WHAT WE NEED TO KNOW: Why is there undiagnosed and untreated asthma in older people in the community and in general practice? What patient, general practitioner and organisational factors contribute to this? Are current best practice guidelines appropriate for older people with asthma? WHAT WE NEED TO DO: Undertake broad community and general practice screening to identify characteristics of older people with undiagnosed asthma. Analyse GPs' perspectives and decision-making processes for older people with dyspnoea. Undertake targeted research in general practice, trialling decision-making frameworks for older patients with dyspnoea. Undertake appropriate and relevant community and GP awareness campaigns about the prevalence of asthma in older people. Analyse current best practice management of asthma, including self-management and the Asthma 3+ Visit Plan, in older people.
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Affiliation(s)
- Amanda Barnard
- Medical School, Frank Fenner Building 42, Australian National University, Canberra, ACT 0200, Australia.
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