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1.
COPD ; 18(1): 62-69, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33307857

RESUMO

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Telemedicina , Seguimentos , Hospitalização , Humanos , Alta do Paciente , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida
3.
Allergy ; 72(5): 802-812, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27732758

RESUMO

BACKGROUND: Continuous positive airway pressure (CPAP) in asthma patients with concomitant obstructive sleep apnea syndrome (OSAS) seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. METHODS: Prospective, multicenter study. We examined asthma outcomes after 6 months of CPAP in 99 adult asthma patients (mean age 57 years) with OSAS (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire (ACQ) and the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), respectively. Data were analyzed by intention-to-treat basis. RESULTS: The mean ± SD score of the ACQ decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the mAQLQ increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. CONCLUSIONS: Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome.


Assuntos
Asma/epidemiologia , Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Asma/diagnóstico , Asma/tratamento farmacológico , Pressão Positiva Contínua nas Vias Aéreas/métodos , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Qualidade de Vida , Testes de Função Respiratória , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Resultado do Tratamento
4.
An Sist Sanit Navar ; 39(2): 181-201, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-27599947

RESUMO

BACKGROUND: Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement. METHODS: The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II). RESULTS: In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups. CONCLUSIONS: The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma.


Assuntos
Asma/terapia , Fidelidade a Diretrizes , Assistência ao Paciente , Adulto , Criança , Pesquisas sobre Atenção à Saúde , Humanos , Espanha
5.
Artigo em Inglês | MEDLINE | ID: mdl-21313994

RESUMO

BACKGROUND: Data on the association between obesity and asthma control are conflicting. We performed an analysis to elucidate the association between body mass index (BMI) and asthma control in a large sample of asthmatics. MATERIALS AND METHODS: Data were obtained from a previous study in which the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT) were validated for a Spanish population. The study sample comprised 607 adult (> or = 18 years) asthmatic patients (61% female), of whom 235 (39%) had mild-persistent asthma, 246 (41%) had moderate-persistent asthma, and 126 (21%) had severe-persistent asthma. RESULTS: The analysis showed a significant but very low correlation between BMI and ACQ-forced expiratory volume in the first second of expiration (FEV1) (r=0.1, P=.007) and ACQ-peak expiratory flow (PEF) (r=0.1, P=.010), but not ACQ-without lung function (wLF) (r=0.06, P=.116) or ACT. No significant association was found between BMI and asthma control as defined by physicians or according to ACT or ACQ (ACQ-FEV1, ACQ-PEF and ACQ-wLF) scores. We found no significant associations between ACT, ACQs (ACQ-FEV1, ACQ-PEF and ACQ-wLF), and BMI when BMI was classified as low (BMI, <18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity (BMI, > or = 30 kg/m2), or morbid obesity (BMI, >34.9 kg/m2). However, the percentage of patients with poor control was slightly greater in patients with low BMI and obesity. CONCLUSIONS: Using specific and validated tools, and in the context of clinical practice, this study did not find a relevant association between BMI and asthma control.


Assuntos
Asma/fisiopatologia , Índice de Massa Corporal , Obesidade/fisiopatologia , Adolescente , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Testes de Função Respiratória
6.
J Asthma ; 44(10): 867-72, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18097865

RESUMO

OBJECTIVE: Validation of the Spanish version of the Asthma Control Test (ACT). METHODS: A total of 607 asthmatic patients were assessed. The psychometric properties of ACT were evaluated. The ACT capacity to predict the physician's assessment of asthma control was assessed using the area under the receiving operating characteristics (ROC) curve (AUC), sensitivity, specificity, and positive-negative predictive values. RESULTS: ACT's Cronbach alpha was 0.84. The intraclass correlation coefficient was 0.85. The AUC was 0.86, with a sensitivity of 71% and a specificity of 85% for a score of < or =19. CONCLUSIONS: The Spanish version of ACT is shown to be a reliable and valid tool for evaluating and discriminating asthma control.


Assuntos
Asma/diagnóstico , Inquéritos e Questionários , Idoso , Asma/prevenção & controle , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Espanha
11.
Respir Med ; 94(8): 760-6, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10955751

RESUMO

We assessed whether peak expiratory flow monitoring added to a self-management education programme reduced morbidity and improved pulmonary function and adherence to treatment in 100 asthma patients (aged 17-65 years) with adequate treatment and regular 1-year follow-up. Patients randomized to the experimental group used peak expiratory flow readings as the basis for their therapeutic plan coupled with educational intervention, whereas patients in the control group received the same educational intervention and used symptoms only to guide self-management. Morbidity parameters, functional status and adherence to medical regimens improved in both groups, although the percentage of patients with satisfactory adherence was significantly better in the group with peak expiratory flow monitoring (83%) than in controls (52%) (P = 0.05). The multivariate analysis showed that severity of asthma (odds ratio 9.28, 95% confidence interval 1.87-45.96, P = 0.006 for moderate asthma) and type of self-management education programme (odds ratio: 6.19; 95% confidence interval: 2.04-18.81; P = 0.001 for the use of peak expiratory flow readings) were the only independent predictors of adherence to treatment. However, a statistically significant association between adherence and use of peak expiratory flow monitoring was only found in patients with moderate asthma (P = 0.0009). We conclude that peak expiratory flow monitorization in optimal conditions (adequate medical regimen, individualized self-management education and regular follow-up) showed a beneficial effect on adherence to prescribed regimens only in patients with moderate asthma.


Assuntos
Asma/terapia , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Adolescente , Adulto , Idoso , Asma/fisiopatologia , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Pico do Fluxo Expiratório/fisiologia , Estudos Prospectivos , Resultado do Tratamento , Capacidade Vital/fisiologia
12.
Aten Primaria ; 19(9): 477-81, 1997 May 31.
Artigo em Espanhol | MEDLINE | ID: mdl-9264683

RESUMO

OBJECTIVE: To determine whether differences exist in the monitoring, diagnosis and treatment of asthmatic patients between family doctors (FD) and pneumology specialists (PD). DESIGN: A descriptive crossover study, performed through an interview with the patients and a medical exploration. SETTING: Six health centres. PATIENTS: 195 asthmatic patients between 14 and 65, chosen by simple random sampling from among all those registered by computer in the SICAP. MEASUREMENTS AND MAIN RESULTS: Each patient answered a structured interview and had a spirometry test. Which doctor usually monitored their illness, social and demographic data, morbidity parameters, treatment prescribed and their compliance with it, were all determined. 66% of patients were under their FD. No differences were found in the clinical characteristics of patients treated by their FD against those treated by their PD. CONCLUSIONS: Most adult asthmatics are under the care of FDs; however, these appear to under-treat to a considerable degree, especially respecting the use of inhaled corticosteroids. It must be emphasised strongly that Asthma is an inflammatory disease; and FDs must become better informed of the directives of the international consensus on asthma.


Assuntos
Asma/tratamento farmacológico , Atenção Primária à Saúde , Pneumologia , Adolescente , Adulto , Asma/diagnóstico , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Pneumologia/estatística & dados numéricos , Distribuição Aleatória , Espanha , Espirometria
13.
Arch Bronconeumol ; 33(8): 389-94, 1997 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-9376939

RESUMO

To determine the clinical situation, prescribed treatment and compliance in patients with asthma, and to identify the parameters that most influence control of the disease. We studied 335 asthma patients assigned to health centers. All were interviewed and respiratory gases were measured. Disease symptoms were recorded, along with treatment prescribed and inhalation method used. Compliance and inhaler use were assessed on a scale. Treatment appropriateness was evaluated against criteria of international consensus. Multiple regression analysis was used to identify the variables that most influenced control of asthma. Variables considered were age, sex, smoking, treatment appropriateness, inhaler technique, compliance with prescribed treatment and time since diagnosis. Disease was mild in 96 patients (28.7%), moderate in 111 (33.1%) and severe in 128 (38.2%). Treatment was appropriate in 118 (35.2%). Seventy-two (21.5%) used more drugs or higher doses than recommended. Prescribed treatment was inappropriate in 145 (43.3%). The inhalation technique was appropriate in 87 (27.5%) and inappropriate in 229 (72.5%). Ninety-four patients (28.1%) complied well with treatment and 241 (71.9%) were poor compliers. The variables that were significantly related to control of asthma were appropriate treatment and compliance. There is a high rate of morbidity due to asthma in the population studied. The percentage of inappropriate treatment is high, and compliance is low, these factors being the ones that most influence control of the disease.


Assuntos
Asma/tratamento farmacológico , Adolescente , Adulto , Asma/fisiopatologia , Criança , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Cooperação do Paciente , Espanha
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