Respiratory disease terminology: Discordance between pulmonologists and patients

Exploring the disease experience and supportive care for people with very severe chronic obstructive pulmonary disease in Malaysia: a multiperspective qualitative study

Background

In Malaysia, palliative services are almost non-existent for those with severe organ failure such as chronic obstructive pulmonary disease (COPD). Access to palliative care services and awareness among the public and healthcare professionals remain low. While recognised as important in high income settings, the literature on palliative care for non-malignant disease is relatively uncommon in low- and middle-income countries, and none considered the multicultural setting of Malaysia. We aimed to explore the views and experiences of patients, healthcare providers (HCPs) and policymakers about their experience of very severe COPD and palliative care.

Methods

We undertook in-depth qualitative interviews with patients with very severe COPD, HCPs working in respiratory, palliative care, and primary care medicine, and health policymakers in Kuala Lumpur, Malaysia. Interviews followed a topic guide, were audio-recorded, transcribed verbatim, and analysed using a thematic analysis approach.

Results

We conducted 22 in-depth interviews with patients (n = 11), and physicians working in respiratory (n = 4), palliative care (n = 4) and primary care (n = 3) medicine. Four main themes emerged. First, there was poor understanding regarding severe, potentially life-limiting COPD and the need for palliative care. Second, patients were suffering from the severe physical, emotional, and psychosocial impact of the disease. Third, there was a lack of accessible, compassionate, holistic, and coordinated care. Finally, cultural issues such as religious norms, spirituality, community, and power hierarchies influenced patient care and acceptance of their condition.

Conclusions

The Malaysian healthcare system is responding poorly to the needs of patients with very severe COPD. Raising awareness of these needs is the first step, but there needs to be a major change within the system if the care of this hidden neglected population is to be improved.

Call to action: Addressing asthma diagnosis and treatment gaps in India

In comparison to the worldwide burden of asthma, although India contributes to 13% of the total asthma prevalence, it has a threefold higher mortality rate and more than twofold higher DALYs, indicating a substantial gap in asthma diagnosis and treatment. Asthma causes significant suffering, affecting people's quality of life and draining the country's resources; therefore, we must devise ways and means to fill these gaps. The most successful and cost-efficient strategy to battle asthma is to form strong partnerships between patients, the general public, the government, the pharmaceutical industry and non-governmental organisations. This necessitates a comprehensive approach that involves raising awareness, developing universally applicable recommendations, increasing access to high-quality asthma care, and other measures. The purpose of this article was to review the existing scenario of asthma management in India and the factors that contribute to it and devise unique and all-encompassing strategies to fill these gaps.

Prevalence, time trends and treatment practices of asthma in India: the Global Asthma Network study

Objective

The objective of this subanalysis of data from centres across urban areas in India of the Global Asthma Network (GAN) was to study 1) the prevalence of symptoms of asthma in children and adults, 2) the change in prevalence of asthma and its trigger factors since the International Study of Asthma and Allergies in Childhood (ISAAC), and 3) current asthma treatment practice.

Methods

In this cross-sectional, multicentre, school-based and self-administered questionnaire, responses from children aged 6-7 years and 13-14 years, and their respective parents, were analysed.

Results

The GAN Phase I study included 20 084 children in the 6-7-year age group, 25 887 children in the 13-14-year age group and 81 296 parents. The prevalence of wheeze in the previous 12 months was 3.16%, 3.63% and 3.30% in the three groups, respectively. In comparison to the ISAAC studies, there was a significant reduction in the prevalence of current wheeze (p<0.001). Bivariate analysis revealed a significant reduction in the prevalence of trigger factors. Almost 82% of current wheezers and 70% of subjects with symptoms of severe asthma were not clinically diagnosed as having asthma. The daily use of inhaled corticosteroids (ICS) was less than 2.5% in subjects with current wheeze and those with symptoms of severe asthma but less than 1% used daily ICS when asthma remained undiagnosed.

Conclusion

The prevalence of current wheeze and its causal factors showed a significant reduction compared to previous ISAAC studies. Among subjects with current wheeze and symptoms of severe asthma, the problem of under-diagnosis and under-treatment was widespread.

Disrupted breath, songlines of breathlessness: an interdisciplinary response

Health research is often bounded by disciplinary expertise. While cross-disciplinary collaborations are often forged, the analysis of data which draws on more than one discipline at the same time is underexplored. Life of Breath, a 5-year project funded by the Wellcome Trust to understand the clinical, historical and cultural phenomenology of the breath and breathlessness, brings together an interdisciplinary team, including medical humanities scholars, respiratory clinicians, medical anthropologists, medical historians, cultural theorists, artists and philosophers. While individual members of the Life of Breath team come together to share ongoing work, collaborate and learn from each other's approach, we also had the ambition to explore the feasibility of integrating our approaches in a shared response to the same piece of textual data. In this article, we present our pluralistic, interdisciplinary analysis of an excerpt from a single cognitive interview transcript with a patient with chronic obstructive pulmonary disease. We discuss the variation in the responses and interpretations of the data, why research into breathlessness may particularly benefit from an interdisciplinary approach, and the wider implications of the findings for interdisciplinary research within health and medicine.

Assessing health-seeking behavior among Asthma and COPD patients in urban South India

CONTEXT

Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) and asthma and the diagnosis told to them by doctors before they reach tertiary care is not well documented.

AIMS

This study aimed at describing the health-seeking behavior of asthma and COPD patients before they present to a tertiary care hospital in Trivandrum in South India.

METHODS AND MATERIALS

The hospital-based cross-sectional study was done at one government and one private tertiary care hospital in Trivandrum, Kerala, including diagnosed COPD and asthma patients. Data were collected using a pretested semistructured questionnaire paired with the results of clinical evaluation and spirometry.

RESULTS

Among the studied population, about half (53%) of the patients in this study sought initial treatment from government facilities and most patients continued the same pattern of government care or private providers till the final level. Most of them (91%) were likely to have a history of first care from modern medicine system. High proportion of patients (89%) did not have a diagnosis known after the initial consultations, among patients with asthma only 3.4% were given a correct diagnosis and only one person was given a correct diagnosis of COPD out of 129 patients with COPD as the final diagnosis. Out of 739 patients, only 135 patients had done pulmonary functtion test as investigation.

CONCLUSIONS

High proportions of patients do not know the diagnosis of their disease when they reached tertiary care. Patients tended to follow the same sector of health care (private/government) where they sought initial care.