Difficult asthma: people's perspectives on taking corticosteroid therapy.

AIMS AND OBJECTIVES: This study aimed to explore the experiences of patients with difficult asthma, who take corticosteroid therapy, and provide insight into why some patients comply with therapy, whilst others do not. BACKGROUND: Asthma is growing in prevalence and affects more than 100 million people worldwide. Corticosteroids are the mainstay treatment but, despite considerable risk to the individual in terms of morbidity and mortality, compliance is low. Previous research has been mainly quantitative and analysed variables associated with compliance, doing little to increase professional understanding of the patient's perspective on taking corticosteroid treatment. METHODS: A hermeneutic phenomenological approach was selected as most appropriate for this study. Unstructured interviews were undertaken with a purposive sample of 10 participants. Interviews were taped, transcribed and the data were analysed using a multi-step technique described by Holloway. FINDINGS: Fear of side effects was the strongest theme to emerge; illustrated by the negative images participants described such as weight gain, anxiety, irritability and depression. Participants related control and power over their condition to knowledge and information. They wanted more information, but believed that health professionals assumed they were already well informed. Costs and benefits of treatment were weighed up before decisions were made. Participants described feelings of 'not being themselves' and personality changes resulting in the loss of their role within relationships. Routine, time and opinions of significant others, also impacted on taking steroids. CONCLUSION: Decision-making was a complex process, involving evaluation of the personal costs and benefits of treatment; fear of side effects was the dominant concern. Compliance with treatment saves lives in this population. RELEVANCE TO CLINICAL PRACTICE: This study uncovers issues participants consider when making decisions regarding adherence and highlights the importance of the nurse's role in eliciting patients' concerns and the providing appropriate information to allay fears and misconceptions.

Inflammation in chronic obstructive pulmonary disease: implications for new treatment strategies.

Chronic obstructive pulmonary disease (COPD) is a treatable and preventable disease but current predictions are that it will continue to rise as an important cause of mortality and morbidity worldwide. COPD is a complex inflammatory disease with both airway and parenchymal lung injury. Currently there is growing recognition that the inflammatory response extends beyond the lung, with evidence of systemic inflammation, which may account for the multi-organ effects associated with COPD. Early diagnosis and timely therapeutic intervention are likely to make a significant contribution to tackling this disease. Smoking cessation remains the single most effective means of preventing lung function decline and reducing mortality. At present, no currently available drugs have been shown to slow the progression of the disease. Pharmacological treatment has focused largely on symptomatic relief and short-acting bronchodilators have been the mainstay therapy. Long-acting beta-2 agonists and anti-cholinergics have provided additional benefit and anti-inflammatory agents such as inhaled corticosteroids and theophylline seem to offer benefit in selected patients. Combinations of the different classes of treatment, particularly in the same inhaler device, seem to confer particular advantage with improvements in symptoms, exercise capacity, health status and reductions in exacerbations. More research is needed to unravel the important cellular and molecular processes involved in the pathophysiology of COPD and ultimately to develop new and more effective forms of therapy.