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Omara HA, Mansour MG, Badr RM. Asthma education and its impact on pediatric asthma severity: a prospective cohort study. J Asthma 2023; 60:588-599. [PMID: 35616052 DOI: 10.1080/02770903.2022.2082306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma education has been shown to improve asthma control. Our goal was to evaluate the efficacy of asthma education on the frequency of utilization of health-care services, lung function results, degree of asthma severity, and quality of life (QOL) level in children with asthma. METHODS A single-arm prospective interventional trial was conducted in a tertiary facility. Thirty children with asthma and their parents were recruited for the research. Following an assessment of the participants' and caregivers' knowledge about asthma using an asthma knowledge questionnaire, degree of asthma control using asthma control test, inhaler technique using standardized inhaler technique checklists, and QOL using pediatric asthma QOL questionnaires, they participated in a three-month education program in the form of monthly live interactive sessions followed by weekly phone interviews. Measures taken before and after the intervention were compared. RESULTS The educational intervention improved asthma control dramatically including daytime asthma symptoms, night awakenings, and frequency of use of short-acting beta2- adrenergic receptor agonists. Furthermore, the number of emergency department visits and hospitalizations fell considerably after the intervention (p < 0.001 for all). Asthma education was also linked to better inhalation technique and lung function (p < 0.001). Furthermore, all quality-of-life measures increased (p < 0.001 for all). CONCLUSIONS Implementing an asthma education program that included both children with asthma and their parents improved asthma control levels, lung function measures, and overall quality of life. Furthermore, it increased asthma awareness, decreased the use of health-care resources, and reduced asthma severity, resulting in better asthma management.
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Affiliation(s)
- Heba A Omara
- Department of Pediatrics, Pulmonology Division, Faculty of Medicine, Ain Shams University Children's Hospital, Cairo, Egypt
| | - Mervat G Mansour
- Department of Pediatrics, Faculty of Medicine, Ain Shams University Children's Hospital, Cairo, Egypt
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2
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Borges RC, Alith MB, Nascimento OA, Jardim JR. Gender differences in the perception of asthma respiratory symptoms in five Latin American countries. J Asthma 2021; 59:1030-1040. [PMID: 33902380 DOI: 10.1080/02770903.2021.1922914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES To determine the differences between sexes in perceptions of asthma symptoms, asthma control, daily activities, and symptom exacerbation in Latin American countries. METHODS This cross-sectional study was performed using data from the Latin America Asthma Insight and Management (LA-AIM) study (n = 2167) carried out in Argentina, Brazil, Mexico, Venezuela, and Puerto Rico. Face-to-face interviews were conducted, and patients orally completed a 53-question survey assessing five main domains of asthma: symptoms, impact on daily activities, disease control, exacerbation, and treatment/medication. RESULTS Of the 2167 participants, 762 (35.2%) were males and 1405 (64.8%) were females. Male participants smoked more than females, but history of rhinitis and allergies was more common in females (p < 0.05). Women aged 18-40 years had a higher proportion of uncontrolled asthma compared to men of the same age (37.8% and 30.0%, respectively). A higher proportion of symptomatic females reported more frequent symptoms (daytime cough, shortness of breath, breathlessness/wheezing, sputum, tightness in the chest, etc.) than males (p < 0.05). Females also experienced more limitations in sports/recreational activities, normal physical exertion, social activities, sleep, and daily activities. Females consulted with health professionals more often than males (67.8% and 59.6%, respectively; p < 0.05). Asthma caused a feeling of lack of control over life in 42.6% of females and 31.4% of males. CONCLUSION In Latin America, females report more asthma symptoms, poorer asthma control, more impact on their daily activities, and more visits with health professionals than males.
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Affiliation(s)
- Rodrigo C Borges
- Hospital Universitário da Universidade de São Paulo (USP), São Paulo, Brazil
| | - Marcela B Alith
- Hospital Universitário da Universidade de São Paulo (USP), São Paulo, Brazil.,Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil
| | - Oliver A Nascimento
- Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil.,Respiratory Division of EPM/Unifesp, São Paulo, Brazil
| | - José R Jardim
- Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil.,Respiratory Division of EPM/Unifesp, São Paulo, Brazil
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Elsisi GH, Carapinha J, Amin W, Thabet E, Elafify S, Amin M, Hatem A. A budget impact analysis of budesonide/formoterol in patients with mild asthma in Egypt. J Med Econ 2019; 22:1047-1054. [PMID: 31298593 DOI: 10.1080/13696998.2019.1642899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: The aim of this study is to estimate the budget impact of budesonide/formoterol fixed dose combination (FDC) vs salbutamol, both used as needed, in mild asthma patients, from the perspective of the Health Insurance Organization (HIO). Methods: A static budget impact model was developed to assess the impact of budesonide/formoterol FDC entry on HIO budget over a 3-year period in Egyptian settings. Direct medical costs, including the costs of asthma medications, exacerbations, and management of side-effects, were obtained from HIO cost data. Population data were obtained from the World Bank and supplemented with local studies, and the rates of exacerbations, adverse effects, and number of sick leave days were elicited from the SYGMA 1 trial. Scenario analyses from a societal perspective and deterministic sensitivity analyses were conducted. Results: The total costs (drug and non-drug costs) for managing mild asthma patients from the HIO perspective were estimated to be EGP8.563 billion before budesonide/formoterol entry compared to EGP5.525 billion post-entry, leading to a total budget savings of EGP3.038 billion after 3 years. This total budget saving included an increase in drug costs (EGP104 million) and a decrease in non-drug costs (EGP3.143 billion). Drug costs were higher in the budesonide/formoterol group than in the salbutamol group, but this cost was offset by reductions in non-drug costs, resulting in a reduction in the total costs of healthcare resources. At the societal level, the total budget savings after including the indirect costs was expected to be EGP5.976 billion after 3 years of budesonide/formoterol entry. Conclusion: Budesonide/formoterol in mild asthma instead of salbutamol produces better patient outcomes and decreases total costs, with increases in drug cost offset by reductions in non-drug costs due to fewer exacerbations. Budesonide/formoterol is a budget saving option for guideline-directed treatment, from the economic perspective of the payer and the health perspective of the patient.
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Affiliation(s)
- Gihan Hamdy Elsisi
- HTA Office, LLC , Cairo , Egypt
- Pharmacy Practice & Clinical Pharmacy Department, Faculty of Pharmacy, Future University , New Cairo , Egypt
| | - João Carapinha
- Carapinha & Company , Boston , MA , USA
- Northeastern University School of Pharmacy , Boston , MA , USA
| | - Wagdy Amin
- Chest Diseases Sector, Ministry of Health , Cairo , Egypt
| | - Ehab Thabet
- Abbasya Chest Hospital, Faculty of Medicine, Ain Shams University , Cairo , Egypt
| | - Safaa Elafify
- Nasrcity Health Insurance Hospital, Health Insurance Organization , Cairo , Egypt
| | - Mohamad Amin
- Market Access and Governmental Affairs Director , Cairo , AstraZeneca , Egypt
| | - Ashraf Hatem
- Department of Chest Diseases, Faculty of Medicine, Cairo University , Cairo , Egypt
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Roche N, Campbell JD, Krishnan JA, Brusselle G, Chisholm A, Bjermer L, Thomas M, van Ganse E, van den Berge M, Christoff G, Quint J, Papadopoulos NG, Price D. Quality standards in respiratory real-life effectiveness research: the REal Life EVidence AssessmeNt Tool (RELEVANT): report from the Respiratory Effectiveness Group-European Academy of Allergy and Clinical Immunology Task Force. Clin Transl Allergy 2019; 9:20. [PMID: 30962875 PMCID: PMC6436229 DOI: 10.1186/s13601-019-0255-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/31/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A Task Force was commissioned jointly by the European Academy of Allergy and Clinical Immunology (EAACI) and the Respiratory Effectiveness Group (REG) to develop a quality assessment tool for real-life observational research to identify high-quality real-life asthma studies that could be considered within future guideline development. METHODS The resulting REal Life EVidence AssessmeNt Tool (RELEVANT) was achieved through an extensive analysis of existing initiatives in this area. The first version was piloted among 9 raters across 6 articles; the revised, interim, version underwent extensive testing by 22 reviewers from the EAACI membership and REG collaborator group, leading to further revisions and tool finalisation. RELEVANT was validated through an analysis of real-life effectiveness studies identified via systematic review of Medline and Embase databases and relating to topics for which real-life studies may offer valuable evidence complementary to that from randomised controlled trials. The topics were selected through a vote among Task Force members and related to the influence of adherence, smoking, inhaler device and particle size on asthma treatment effectiveness. RESULTS Although highlighting a general lack of high-quality real-life effectiveness observational research on these clinically important topics, the analysis provided insights into how identified observational studies might inform asthma guidelines developers and clinicians. Overall, RELEVANT appeared reliable and easy to use by expert reviewers. CONCLUSIONS Using such quality appraisal tools is mandatory to assess whether specific observational real-life effectiveness studies can be used to inform guideline development and/or decision-making in clinical practice.
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Affiliation(s)
- Nicolas Roche
- Pneumologie, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Jonathan D. Campbell
- Center for Pharmaceutical Outcomes Reasearch, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO USA
| | | | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skane University Hospital, 221, 85 Lund, Sweden
| | - Mike Thomas
- University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Eric van Ganse
- Claude-Bernard Lyon1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | | | - George Christoff
- Medical University - Sofia, Faculty of Public Health, 8 “Bialo more” str, 1527, Sofia, Bulgaria
| | - Jennifer Quint
- Imperial College London, South Kensington Campus, London, SW7 2AZ UK
| | | | - David Price
- Observational and Pragmatic Research Institute, 60 Paya Lebar Road, Paya Lebar Square, #05-33/34, Singapore, 409051 Singapore
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Kinsella N, Stattin P, Cahill D, Brown C, Bill-Axelson A, Bratt O, Carlsson S, Van Hemelrijck M. Factors Influencing Men's Choice of and Adherence to Active Surveillance for Low-risk Prostate Cancer: A Mixed-method Systematic Review. Eur Urol 2018; 74:261-280. [PMID: 29598981 PMCID: PMC6198662 DOI: 10.1016/j.eururo.2018.02.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/26/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Despite support for active surveillance (AS) as a first treatment choice for men with low-risk prostate cancer (PC), this strategy is largely underutilised. OBJECTIVE To systematically review barriers and facilitators to selecting and adhering to AS for low-risk PC. EVIDENCE ACQUISITION We searched PsychINFO, PubMed, Medline 2000-now, Embase, CINAHL, and Cochrane Central databases between 2002 and 2017 using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The Purpose, Respondents, Explanation, Findings and Significance (PREFS) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) quality criteria were applied. Forty-seven studies were identified. EVIDENCE SYNTHESIS Key themes emerged as factors influencing both choice and adherence to AS: (1) patient and tumour factors (age, comorbidities, knowledge, education, socioeconomic status, family history, grade, tumour volume, and fear of progression/side effects); (2) family and social support; (3) provider (speciality, communication, and attitudes); (4) healthcare organisation (geography and type of practice); and (5) health policy (guidelines, year, and awareness). CONCLUSIONS Many factors influence men's choice and adherence to AS on multiple levels. It is important to learn from the experience of other chronic health conditions as well as from institutions/countries that are making significant headway in appropriately recruiting men to AS protocols, through standardised patient information, clinician education, and nationally agreed guidelines, to ultimately decrease heterogeneity in AS practice. PATIENT SUMMARY We reviewed the scientific literature for factors affecting men's choice and adherence to active surveillance (AS) for low-risk prostate cancer. Our findings suggest that the use of AS could be increased by addressing a variety of factors such as information, psychosocial support, clinician education, and standardised guidelines.
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Affiliation(s)
- Netty Kinsella
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Urology, The Royal Marsden Hospital, London, UK.
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Declan Cahill
- Department of Urology, The Royal Marsden Hospital, London, UK
| | | | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden
| | - Sigrid Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Sweden; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Olivera CMX, Vianna EO, Bonizio RC, de Menezes MB, Ferraz E, Cetlin AA, Valdevite LM, Almeida GA, Araujo AS, Simoneti CS, de Freitas A, Lizzi EA, Borges MC, de Freitas O. Asthma self-management model: randomized controlled trial. HEALTH EDUCATION RESEARCH 2016; 31:639-652. [PMID: 27473571 DOI: 10.1093/her/cyw035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/25/2016] [Indexed: 06/06/2023]
Abstract
Information for patients provided by the pharmacist is reflected in adhesion to treatment, clinical results and patient quality of life. The objective of this study was to assess an asthma self-management model for rational medicine use. This was a randomized controlled trial with 60 asthmatic patients assigned to attend five modules presented by a pharmacist (intervention group) and 59 patients in the control group. Data collection was performed before and after this 4-month intervention and included an evaluation of asthma knowledge, lifestyle, inhaler techniques, adhesion to treatment, pulmonary function and quality of life. An economic viability analysis was also performed. The intervention group obtained an increase in asthma knowledge scores of 58.3-79.5% (P < 0.001). In this group, there was also an increase in the number of individuals who practiced physical exercise (36-43%), in the number of correct replies regarding the use of inhalers, in the percentage of adherent patients, and in quality of life scores for all domains. We concluded that this asthma self-management model was effective in improving the quality of life of asthma patients.
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Affiliation(s)
- Carolina M X Olivera
- Department of Pharmaceutical Sciences, Pharmacy School, Ribeirão Preto 14040-903, Brazil
| | | | - Roni C Bonizio
- Department of Accounting, School of Economy, Administration and Accounting, Ribeirão Preto 14040-905, Brazil
| | | | - Erica Ferraz
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | - Andrea A Cetlin
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | | | | | - Ana S Araujo
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | | | - Amanda de Freitas
- Department of Social Medicine, Medical School, Ribeirão Preto 14049-900, Brazil and
| | - Elisangela A Lizzi
- Department of Mathematics, Federal University of Technology, Curitiba, 80230-901, Brazil
| | - Marcos C Borges
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | - Osvaldo de Freitas
- Department of Pharmaceutical Sciences, Pharmacy School, Ribeirão Preto 14040-903, Brazil
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Darbà J, Ramírez G, García-Rivero JL, Mayoralas-Alises S, Pascual JF, Roger A, Vargas D, Bijedic A. A budget impact analysis of Spiromax(®) compared with Turbuhaler(®) for the treatment of moderate to severe asthma: a potential improvement in the inhalation technique to strengthen medication adherence could represent savings for the Spanish Healthcare System and five Spanish regions. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:435-44. [PMID: 27660476 PMCID: PMC5019164 DOI: 10.2147/ceor.s111453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the economic impact of the introduction of DuoResp(®) Spiromax(®) by focusing on a potential improvement in the inhalation technique to strengthen medication adherence for the treatment of moderate to severe asthmatics in Spain and five Spanish regions including Andalusia, Catalonia, Galicia, Madrid, and Valencia. METHODS A 4-year budget impact model was developed for the period 2015-2018 from the Spanish Healthcare System perspective. Budesonide-formoterol fixed-dose combination delivered by Turbuhaler(®) was considered to be the most appropriate comparator for assessing the budget impact with the introduction of DuoResp(®) Spiromax(®). National and regional data on asthma prevalence were obtained from the literature. Input parameters on health care resources were obtained by consulting experts from different Spanish hospitals. Resources used included medical visits, emergency room visits, and hospitalizations. The average numbers of primary care and specialist visits per year were also gathered. Based on health care resource use per patient, the total treatment cost per patient was estimated. RESULTS The population with moderate to severe asthma treated with budesonide-formoterol fixed-dose combinations delivered by Turbuhaler(®) in 2015 was estimated to be 166,985 in Spain. Region-specific prevalence data resulted in 25,081, 12,392, 16,097, 17,829, and 15,148 patients in Andalusia, Catalonia, Galicia, Madrid, and Valencia, respectively. Based on the forecast uptake of DuoResp(®) Spiromax(®), the total budget savings in Spain were expected to be €1.509 million over the next 4 years. Region-specific rates imply that the total savings were expected to be €229,706 in Andalusia, €90,145 in Catalonia, €188,327 in Galicia, €122,669 in Madrid, and €165,796 in Valencia over 2015-2018. CONCLUSION The introduction of DuoResp(®) Spiromax(®), which represents a potential improvement in the inhalation technique to strengthen medication adherence for the treatment of moderate to severe asthma, could represent savings for the Spanish National Health Society and five Spanish regions.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona
| | | | | | | | | | - Albert Roger
- Hospital Universitario Germans Trias i Pujol, Barcelona
| | | | - Adi Bijedic
- Market Access and HEOR Department, TEVA Pharmaceutical, Madrid, Spain
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8
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Boulet LP. Asthma education: an essential component in asthma management. Eur Respir J 2016; 46:1262-4. [PMID: 26521279 DOI: 10.1183/13993003.01303-2015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
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Yılmaz FT, Çınar S, Yılmaz A, Kumsar AK. The Effect of a Training Program on Oral Health and Behavior Change in Asthma Patients. Balkan Med J 2016; 33:411-8. [PMID: 27606137 DOI: 10.5152/balkanmedj.2016.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 11/16/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Asthma is a chronic disease which is prevalent throughout the world. Physical problems such as deterioration in oral health, which may occur due to the triggering factors of asthma as well as the ineffective use of asthma medicine, seem to affect the daily lives of asthma patients. Therefore, it is important to protect oral health and promote positive behavior changes in asthma patients in order to achieve effective treatment and asthma control. AIMS The present study aimed to determine the effects of a training program provided for asthma patients on oral health, inhaler use skills, and behavior change. STUDY DESIGN Controlled experimental study. METHODS A total of 124 asthma patients were included in the study. Of the patients, 62 were assigned to the experimental group and the other 62 were assigned to the control group. Data were collected using the patient identification form, the oral assessment guide, the inhaler use skill form, and the evaluation form for behavior change over time. The experimental group received training provided by the researchers on the first meeting and one month later. Written and visual training material were used. Both groups were subject to a final evaluation which was conducted 4 months after their first meeting. RESULTS It was determined that the oral assessment guide scores (p<0.01) and inhaler use skills of the experimental group improved significantly after the training compared to the control group (p<0.01). In addition, it was observed that the number of patients in the experimental group who quit smoking (p<0.05), used their medicine (p<0.01) and brushed their teeth on a regular basis (p<0.01), and washed their mouth after inhaler use significantly increased in the experimental group after training compared to the control group (p<0.01). CONCLUSION The study demonstrated that the training provided for asthma patients improved oral health and promoted inhaler use skills and was partially effective in promoting positive asthma-related behavior change.
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Affiliation(s)
- Feride Taşkın Yılmaz
- Department of Internal Diseases Nursing, Cumhuriyet University School of Suşehri Health High, Sivas, Turkey
| | - Sezgi Çınar
- Department of Internal Diseases Nursing, Celal Bayar University School of Nursing High, Manisa, Turkey
| | - Adnan Yılmaz
- Department of Pulmonology, Süreyyapaşa Chest Disease and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Azime Karakoç Kumsar
- Department of Internal Diseases Nursing, Bezmialem Vakıf University School of Health Sciences, İstanbul, Turkey
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Darbà J, Ramírez G, Sicras A, García-Bujalance L, Torvinen S, Sánchez-de la Rosa R. Identification of factors involved in medication compliance: incorrect inhaler technique of asthma treatment leads to poor compliance. Patient Prefer Adherence 2016; 10:135-45. [PMID: 26929605 PMCID: PMC4754100 DOI: 10.2147/ppa.s95303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To identify the impact of delivery device of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA) on asthma medication compliance, and investigate other factors associated with compliance. MATERIALS AND METHODS We conducted a retrospective and multicenter study based on a review of medical registries of asthmatic patients treated with ICS/LABA combinations (n=2,213) whose medical devices were either dry powder inhalers (DPIs, such as Accuhaler(®), Turbuhaler(®), and NEXThaler(®)) or pressurized metered-dose inhalers (pMDI). Medication compliance included persistence outcomes through 18 months and medication possession ratios. Data on potential confounders of treatment compliance such as asthma exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also explored. RESULTS The probability of asthma medication compliance in case of DPIs was lower compared to pMDIs, which suggests that inhaler devices influence inhalation therapies. There were additional confounding factors that were considered as explanatory variables of compliance. A worse measure of airflow obstruction (forced expiration volume in 1 second), comorbidities and general practitioner (GP) consultations more than once per month decreased the probability of compliance. Within comorbidities, alcoholism was positively associated with compliance. Patients of 29-39, 40-50, and 51-61 age groups or suffering from more than two exacerbations during the study period were more likely to comply with their medication regime. The effects of DPIs toward compliance varied with the different DPIs. For instance, Accuhaler(®) had a greater negative effect on compliance compared to Turbuhaler(®) and Nexthaler(®) in cases of patients who suffered exacerbations. We found that GP consultations reduced the probability of medication compliance for patients treated with formoterol/budesonide combination. For retired patients, visiting the GP increased the probability of medication compliance. CONCLUSION We concluded that inhaler devices influence patients' compliance for long-term asthma medication. The impact of Accuhaler(®), Turbuhaler(®), and NEXThaler(®) on medication compliance was negative. We also identified some confounders of medication compliance such as patient's age, severity of asthma, comorbidities, and health care costs.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | | | - Antoni Sicras
- Department of Planning, Badalona Serveis Assistencials S.A., Barcelona, Spain
| | | | - Saku Torvinen
- Market Access Department, Teva Pharmaceuticals Europe BV, Amsterdam, the Netherlands
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11
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Darbà J, Ramírez G, Sicras A, Francoli P, Torvinen S, Sánchez-de la Rosa R. The importance of inhaler devices: the choice of inhaler device may lead to suboptimal adherence in COPD patients. Int J Chron Obstruct Pulmon Dis 2015; 10:2335-45. [PMID: 26604733 PMCID: PMC4631413 DOI: 10.2147/copd.s90155] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to identify factors associated with poor adherence to COPD treatment in patients receiving a fixed-dose combination (FDC) of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA), focusing on the importance of inhaler devices. Methods We conducted a retrospective and multicenter study based on a review of medical registries between 2007 and 2012 of COPD patients (n=1,263) treated with ICS/LABA FDC, whose medical devices were either dry powder inhalers (DPIs) or pressurized metered-dose inhalers (pMDI). Medication adherence included persistence outcomes through 18 months and medication possession ratios. Data on exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also included as confounders of adherence. Results The analyses revealed that COPD patients whose medication was delivered through a DPI were less likely to have medication adherence compared to patients with pMDI, after adjusting for confounding factors, especially active ingredients. Younger groups of patients were less likely to be adherent compared to the oldest group. Smoker men were less likely to be adherent compared to women and non-smokers. Comorbidities decreased the probability of treatment adherence. Those patients that visited their doctor once a month were more likely to adhere to their medication regimen; however, suboptimal adherence was more likely to occur among those patients who visited more than three times per month their doctor. We also found that worsening of COPD is negatively associated with adherence. Conclusion According to this study, inhaler devices influence patients’ adherence to long-term COPD medication. We also found that DPIs delivering ICS/LABA FDC had a negative impact on adherence. Patients’ clinic and socioeconomic characteristics were associated with adherence.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Spain
| | | | - Antoni Sicras
- Dirección de Planificación, Badalona Serveis Assistencials, SA, Barcelona, Spain
| | | | - Saku Torvinen
- Market Access Department, TEVA Pharmaceutical Europe BV, Amsterdam, the Netherlands
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Plaza V, Peiró M, Torrejón M, Fletcher M, López-Viña A, Ignacio JM, Quintano JA, Bardagí S, Gich I. A repeated short educational intervention improves asthma control and quality of life. Eur Respir J 2015; 46:1298-307. [PMID: 26405291 DOI: 10.1183/13993003.00458-2015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/09/2015] [Indexed: 12/11/2022]
Abstract
We assessed the effectiveness of an asthma educational programme based on a repeated short intervention (AEP-RSI) to improve asthma control (symptom control and future risk) and quality of life. A total of 230 adults with mild-to-moderate persistent uncontrolled asthma participated in a 1-year cluster randomised controlled multicentre study. The AEP-RSI was given in four face-to-face sessions at 3-month intervals, and included administration of a written personalised action plan and training on inhaler technique. Centres were randomised to the AEP-RSI (intervention) group or usual clinical practice group. Specialised centres using a standard educational programme were the gold standard group. A significant improvement in the Asthma Control Test score was observed in all three groups (p<0.001), but improvements were higher in the intervention and gold standard groups than in the usual clinical practice group (p=0.042), which also showed fewer exacerbations (mean±sd; 1.20±2.02 and 0.56±1.5 versus 2.04±2.72, respectively) and greater increases in the Mini Asthma Quality of Life Questionnaire scores (0.95±1.04 and 0.89±0.84 versus 0.52±0.97, respectively). The AEP-RSI was effective in improving asthma symptom control, future risk and quality of life.
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Affiliation(s)
- Vicente Plaza
- Dept of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Meritxell Peiró
- Dept of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Montserrat Torrejón
- Dept of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Antolín López-Viña
- Pulmonology Dept, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | - Ignasi Gich
- Dept of Epidemiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain A full list of the PROMETHEUS Study Group investigators and participating centres can be found in the Acknowledgements section
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13
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Abstract
Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcutaneous or sublingual, stop treatment within the first year. Although research into interventions to improve AR adherence is lacking, lessons learned from adherence interventions in other chronic health conditions can be applied to AR. Two well-established, overriding models of care-the chronic care model and patient-centered care-can improve adherence. The patient-centered care model includes important lessons for allergy providers in their daily practice, including understanding and targeting modifiable barriers to adherence. Additionally, recent studies have begun to leverage health information and communication technologies to reach out to patients and promote adherence, extending patient-centered interventions initiated by providers during office visits.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA,
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Forno E, Gogna M, Cepeda A, Yañez A, Solé D, Cooper P, Avila L, Soto-Quiros M, Castro-Rodriguez JA, Celedón JC. Asthma in Latin America. Thorax 2015; 70:898-905. [PMID: 26103996 DOI: 10.1136/thoraxjnl-2015-207199] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/02/2015] [Indexed: 12/20/2022]
Abstract
Consistent with the diversity of Latin America, there is profound variability in asthma burden among and within countries in this region. Regional variation in asthma prevalence is likely multifactorial and due to genetics, perinatal exposures, diet, obesity, tobacco use, indoor and outdoor pollutants, psychosocial stress and microbial or parasitic infections. Similarly, non-uniform progress in asthma management leads to regional variability in disease morbidity. Future studies of distinct asthma phenotypes should follow-up well-characterised Latin American subgroups and examine risk factors that are unique or common in Latin America (eg, stress and violence, parasitic infections and use of biomass fuels for cooking). Because most Latin American countries share the same barriers to asthma management, concerted and multifaceted public health and research efforts are needed, including approaches to curtail tobacco use, campaigns to improve asthma treatment, broadening access to care and clinical trials of non-pharmacological interventions (eg, replacing biomass fuels with gas or electric stoves).
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Affiliation(s)
- Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mudita Gogna
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alfonso Cepeda
- Fundación Hospital Universitario Metropolitano, Laboratorio de Alergia e Inmunología, Universidad Metropolitana, Barranquilla, Barranquilla, Colombia
| | - Anahi Yañez
- Division of Allergy and Immunology, Servicio de Alergia e Inmunología Clínica, Hospital Aeronáutico Central, Buenos Aires, Argentina
| | - Dirceu Solé
- Escola Paulista de Medicina, São Paulo, Brazil
| | - Philip Cooper
- Laboratorio de Investigaciones FEPIS, Quinindé, Esmeraldas, Ecuador Institute of Infection and Immunity, St George's University of London, London, UK
| | | | | | - Jose A Castro-Rodriguez
- Departments of Pediatrics and Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Rondinel TZ, Corrêa IF, Hoscheidt LM, Bueno MH, Da Silva LMC, Reppold CT, Dal Lago P. Incentive spirometry combined with expiratory positive airway pressure improves asthma control and quality of life in asthma: a randomised controlled trial. J Asthma 2014; 52:220-6. [PMID: 25144550 DOI: 10.3109/02770903.2014.956890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The use of the incentive spirometer (IS) and expiratory positive airway pressure (EPAP) provides several benefits in patients with respiratory disorders. However, the effects of the use of these devices coupled (IS + EPAP) are still unknown in asthmatic patients. The aim of this study was to evaluate the effect of IS associated with EPAP on exercise tolerance (six-minute walk test - 6MWT), lung function (by spirometry), asthma control (Asthma Control Questionnaire - ACQ) and quality of life (Asthma Quality of Life Questionnaire - AQLQ) in patients with severe asthma. METHODS Patients were randomised into two groups: IS + EPAP (n = 8) and control (n = 6). The IS + EPAP group performed breathing exercises at home, twice daily for 20 min, over a period of 5 weeks. RESULTS There was no significant difference in spirometric variables and in the distance walked in the 6MWT in both groups. However, the IS + EPAP group showed an improvement in asthma control (p = 0.002) and quality of life (p = 0.02). CONCLUSIONS These findings demonstrate that the IS + EPAP protocol, when performed at home, provides an improvement in asthma control and quality of life for patients with severe asthma when evaluated by ACQ and AQLQ, respectively.
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Affiliation(s)
- Tatiana Zacarias Rondinel
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA , Porto Alegre, RS , Brasil
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16
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Oliveira PDD, Menezes AMB, Bertoldi AD, Wehrmeister FC. Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil. J Bras Pneumol 2014; 39:287-95. [PMID: 23857689 PMCID: PMC4075837 DOI: 10.1590/s1806-37132013000300005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: To evaluate the characteristics of users of inhalers and the prevalence of inhaler use among adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema. METHODS: A population-based study conducted in the city of Pelotas, Brazil, involving 3,670 subjects ≥ 10 years of age, evaluated with a questionnaire. RESULTS: Approximately 10% of the sample reported at least one of the respiratory diseases studied. Among those individuals, 59% reported respiratory symptoms in the last year, and, of those, only half reported using inhalers. The use of inhalers differed significantly by socioeconomic status (39% and 61% for the lowest and the highest, respectively, p = 0.01). The frequency of inhaler use did not differ by gender or age. Among the individuals reporting emphysema and inhaler use, the use of the bronchodilator-corticosteroid combination was more common than was that of a bronchodilator alone. Only among the individuals reporting physician-diagnosed asthma and current symptoms was the proportion of inhaler users higher than 50%. CONCLUSIONS: In our sample, inhalers were underutilized, and the type of medication used by the individuals who reported emphysema does not seem to be in accordance with the consensus recommendations.
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Chiu KC, Boonsawat W, Cho SH, Cho YJ, Hsu JY, Liam CK, Muttalif AR, Nguyen HD, Nguyen VN, Wang C, Kwon N. Patients' beliefs and behaviors related to treatment adherence in patients with asthma requiring maintenance treatment in Asia. J Asthma 2014; 51:652-9. [PMID: 24580369 PMCID: PMC4133971 DOI: 10.3109/02770903.2014.898772] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives To identify patients’ beliefs or behaviors related to treatment adherence and to assess association between asthma control and adherence in Asian patients with asthma. Methods We conducted a cross-sectional observational study of adult patients with asthma from specialist clinics in six Asian countries. Patients who were deemed by their treating physicians to require a maintenance treatment with an inhaler for at least 1 year were recruited. Patients completed a 12-item questionnaire related to health beliefs and behaviors, the 8-item Morisky Medication Adherence Scale (MMAS-8), the Asthma Control Test (ACT™), and the Standardized Asthma Quality of Life Questionnaire (AQLQ-S). Results Of the 1054 patients recruited, 99% were current users of inhaled corticosteroids. The mean ACT score was 20.0 ± 4.5 and 64% had well-controlled asthma. The mean MMAS-8 score was 5.5 ± 2.0 and 53% were adherent. Adherence was significantly associated with patients’ understanding of the disease and inhaler techniques, and with patients’ acceptance of inhaler medicines in terms of benefits, safety, convenience, and cost (p < 0.01 for all). In multivariate analysis, three questions related to patients’ acceptance of inhaler medicines remained significantly associated with poor adherence, after adjusting for potential confounders: “I am not sure inhaler type medicines work well” (p = 0.001), “Taking medicines more than once a day is inconvenient” (p = 0.002), and “Sometimes I skip my inhaler to use it over a longer period” (p < 0.001). Conclusions Our study showed that patients’ acceptance of the benefits, convenience and cost of inhaler medications have a significant impact on treatment adherence in the participating Asian countries.
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Affiliation(s)
- K-C Chiu
- Division of Chest, Department of Internal Medicine, Lotung Poh-Ai Hospital , Luodong , Taiwan
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18
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Rodrigues CDB, Pereira RP, Dalcin PDTR. Effects of an outpatient education program in patients with uncontrolled asthma. J Bras Pneumol 2013; 39:272-9. [PMID: 23857690 PMCID: PMC4075850 DOI: 10.1590/s1806-37132013000300003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/14/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the effects of an outpatient education program in patients with uncontrolled asthma. METHODS This was an uncontrolled study evaluating an educational intervention and involving patients with uncontrolled asthma ≥ 14 years of age. The participants completed a questionnaire designed to assess the level of asthma control, the inhalation technique, and quality of life. All of the patients underwent pulmonary function testing, after which they participated in an education program consisting of one 45-min face-to-face session, followed by phone interviews at two, four, and eight weeks. The participants were reevaluated after three months. RESULTS Sixty-three patients completed the study. There was a significant improvement in the level of asthma control (p < 0.001). Of the 63 patients, 28 (44.4%) and 6 (9.5%) were classified as having partially controlled asthma and controlled asthma, respectively. The mean FEV1 was 63.0 ± 20.0% and 68.5 ± 21.2% of the predicted value prior to and after the educational intervention, respectively (p = 0.002), and all of the quality of life scores improved (p < 0.05 for all). The same was true for the proportion of patients prior to and after the educational intervention using the proper inhalation technique when using metered dose inhalers (15.4% vs. 46.2%; p = 0.02) and dry powder inhalers (21.3% vs. 76.6%; p < 0.001). The logistic regression analysis revealed that an incorrect inhalation technique identified during the first evaluation was independently associated with a favorable response to the educational intervention. CONCLUSIONS This study suggests that an outpatient education program for asthma patients improves the level of asthma control, lung function parameters, and quality of life. An incorrect inhalation technique identified during the first evaluation was predictive of a favorable response to the educational intervention.
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Affiliation(s)
- Carmen Denise Borba Rodrigues
- Department of Pulmonology, Porto Alegre Hospital de Clínicas, Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil
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Athanazio R. Airway disease: similarities and differences between asthma, COPD and bronchiectasis. Clinics (Sao Paulo) 2012; 67:1335-43. [PMID: 23184213 PMCID: PMC3488995 DOI: 10.6061/clinics/2012(11)19] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 09/27/2012] [Indexed: 11/18/2022] Open
Abstract
Airway diseases are highly prevalent worldwide; however, the prevalence of these diseases is underestimated. Although these diseases present several common characteristics, they have different clinical outcomes. The differentiation between asthma, chronic obstructive pulmonary disease and bronchiectasis in the early stage of disease is extremely important for the adoption of appropriate therapeutic measures. However, because of the high prevalence of these diseases and the common pathophysiological pathways, some patients with different diseases may present with similar symptoms. The objective of this review is to highlight the similarities and differences between these diseases in terms of the risk factors, pathophysiology, symptoms, diagnosis and treatment.
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Affiliation(s)
- Rodrigo Athanazio
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, São Paulo, SP, Brazil.
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Mathew J, Aronow WS, Chandy D. Therapeutic options for severe asthma. Arch Med Sci 2012; 8:589-97. [PMID: 23056066 PMCID: PMC3460493 DOI: 10.5114/aoms.2012.30280] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 03/22/2012] [Accepted: 03/22/2012] [Indexed: 11/17/2022] Open
Abstract
As the overall prevalence of asthma has escalated in the past decades, so has the population of patients with severe asthma. This condition is often difficult to manage due to the relative limitation of effective therapeutic options for the physician and the social and economic burden of the disease on the patient. Management should include an evaluation and elimination of modifiable risk factors such as smoking, allergen exposure, obesity and non-adherence, as well as therapy for co-morbidities like gastro-esophageal reflux disease and obstructive sleep apnea. Current treatment options include conventional agents such as inhalational corticosteroids, long acting β(2) agonists, leukotriene antagonists, and oral corticosteroids. Less conventional treatment options include immunotherapy with methotrexate, cyclosporine and tacrolimus, biological drugs like monoclonal antibodies, tumor necrosis factor-α blockers and oligonucleotides, phosphodiesterase inhibitors, antimicrobials and bronchial thermoplasty.
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Affiliation(s)
- Jilcy Mathew
- Divisions of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York Medical College, Valhalla, USA
| | - Wilbert S. Aronow
- Divisions of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York Medical College, Valhalla, USA
- Cardiology Division, Department of Medicine, New York Medical College, Valhalla, USA
| | - Dipak Chandy
- Divisions of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York Medical College, Valhalla, USA
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Abstract
Asthma management requires adequate adherence to many recommendations, including therapy, monitoring of asthma control, avoidance of environmental triggers, and attending follow-up appointments. Poor adherence is common in patients with asthma and is often associated with increased health care use, morbidity, and mortality. Many determinants of poor adherence have been identified and should be addressed, but there is no clear profile of the nonadherent patient. Interventions to improve adherence therefore demand tailoring to the individual by including patient-specific education, addressing patient fears and misconceptions, monitoring adherence, and developing a shared decision process.
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