Enabling Adults With Severe Asthma to Exercise: A Qualitative Examination of the Challenges for Patients and Health Care Professionals.

BACKGROUND: Adults living with severe asthma have lower physical activity levels, particularly high-intensity physical activity, compared with their healthy peers. Physical inactivity is associated with increased morbidity and mortality. OBJECTIVE: To understand patient and health care professional attitudes toward exercise and physical activity to inform future strategies for the improvement of healthy lifestyle behaviors, including exercise. METHODS: Participants recruited from a specialist difficult asthma service were interviewed individually, and health care professionals (HCPs) from primary care, secondary care, and a tertiary center were invited to attend focus groups. Interviews and focus groups were transcribed verbatim. We performed thematic analysis on interviews and focus groups separately, followed by an adapted framework analysis to analyze datasets together. RESULTS: Twenty-nine people with severe asthma participated in a semi-structured interview. A total of 51 HCPs took part in eight focus groups across the East Midlands, United Kingdom. Final analysis resulted in three major themes: barriers to exercise and exercise counseling - in which patients and HCPs identified disease and non-disease factors affecting those living with severe asthma; attitudes toward HCP support for exercise - highlighting education needs for HCPs and preference for supervised exercise programs; and areas for system improvement in supporting patients and HCPs - challenges exist across health sectors that limit patient support are described. CONCLUSIONS: Patients identified the important role of HCPs in supporting and advising on lifestyle change. Despite a preference for supervised exercise programs, both patient and HCP barriers existed. To meet patients' varied support needs, improved integration of services is required and HCP skills need extending.

Patient Perceptions of Living with Severe Asthma: Challenges to Effective Management.

BACKGROUND: The management of severe asthma poses many challenges related to treatment, adherence, and psychosocial morbidity. There is little direct data from the patient perspective to understand and negotiate the complexities of managing severe asthma. OBJECTIVE: To explore the patient perceptions of living with severe asthma and the experience of managing severe asthma, in order to better understand the support that might promote more effective self-management for severe asthma. METHODS: Participants were recruited from a specialist Difficult Asthma Service. Semistructured interviews were conducted by researchers independent of the patient's care. Interviews were transcribed verbatim and inductive thematic analysis was performed. RESULTS: Twenty-nine participants (13 male: mean [standard deviation] age, 49.5 [13.6] years: mean Asthma Control Questionnaire 2.2 [1.2]) participated in an interview. Analysis resulted in 4 major themes describing the experience and challenges to managing severe asthma: understanding of severe asthma, emotional impact of living with severe asthma (subtheme: fear of hospitalization), public perceptions of asthma, and concerns about medications. CONCLUSIONS: Health care professionals need to consider and discuss with patients their perceptions of severe asthma and the relevant treatments; particular attention should focus around education of disease control and actively exploring thoughts around hospitalization. Our data highlight the potential for psychological and social support to enhance self-management by directly addressing the wide-ranging individual challenges patients face. There is also a need for greater public awareness and education about severe asthma to minimize patient distress particularly in the work environment.

Protocol for a feasibility study to inform the development of a multicentre randomised controlled trial of asthma-tailored pulmonary rehabilitation versus usual care for individuals with severe asthma.

INTRODUCTION: Pulmonary rehabilitation with core components of exercise training and multiprofessional education is an integral part of the management of patients with chronic lung disease. International guidelines for individuals with asthma recommend exercise as exercise improves symptoms, indices of cardiopulmonary efficiency, health status and psychosocial outcome. However, there is little published evidence evaluating safety and acceptability of exercise training for individuals with severe asthma and there are concerns regarding exercise-induced asthma. We propose a feasibility study for a multicentre randomised controlled trial (RCT) of asthma-tailored pulmonary rehabilitation (asthma-tailored PR) versus usual care in individuals with severe asthma. METHODS AND ANALYSIS: The study will be conducted in three stages. Adults with severe asthma will be included if they have persistent symptoms despite being at step 4 or 5 of the British Thoracic Society guidelines. Stage 1: semistructured interviews will be used in a sample of 20-30 individuals with severe asthma to understand the experience and attitudes of this population towards exercise. Stage 2: eight focus groups of at least six healthcare professionals involved in the care of patients with severe asthma will be conducted to understand their attitudes towards exercise for this population. Stage 3: a small-scale RCT of the proposed multicentre RCT of asthma-tailored PR versus usual care for individuals with severe asthma will be conducted. The primary outcome measures will be recruitment, retention and adverse event rates. Semistructured interviews with participants of stage 3 will be used to identify further barriers or facilitators to participation in PR and the trial. Thematic analysis will be used for the interpretation of all interviews. ETHICS AND DISSEMINATION: The study results will inform the design of a larger multicentre RCT. The National Research Ethics Service Committee East Midland approved the study protocol. TRIAL REGISTRATION NUMBER: ISRCTN96143888.

Report on the 8th European Congress on Menopause.

The 8th European Congress on Menopause (EMAS), held 16-19 May 2009 in London, UK, was organized by the European Menopause and Andropause Society and hosted by the British Menopause Society (BMS). The Congress invited speakers from a range of European countries as well as some from the USA, Ecuador, Chile, Australia and South Africa, and attracted 1470 participants from over 70 countries as far afield as the Americas and East Asia.

Good phonetic errors in poor spellers are associated with right-handedness and possible weak utilisation of visuospatial abilities.

Poor spellers in normal schools, who were not poor readers, were studied for handedness, visuospatial and other cognitive abilities in order to explore contrasts between poor spellers with and without good phonology. It was predicted by the right shift (RS) theory of handedness and cerebral dominance that those with good phonology would have strong bias to dextrality and relative weakness of the right hemisphere, while those without good phonology would have reduced bias to dextrality and relative weakness of the left hemisphere. Poor spellers with good phonetic equivalent spelling errors (GFEs) included fewer left-handers (2.4%) than poor spellers without GFEs (24.4%). Differences for hand skill were as predicted. Tests of visuospatial processing found no differences between the groups in levels of ability, but there was a marked difference in pattern of correlations between visuospatial test scores and homophonic word discrimination. Whereas good spellers (GS) and poor spellers without GFEs showed positive correlations between word discrimination and visuospatial ability, there were no significant correlations for poor spellers with GFEs. The differences for handedness and possibly for the utilisation of visuospatial skills suggest that surface dyslexics differ from phonological dyslexics in cerebral specialisation and perhaps in the quality of inter-hemispheric relations.