Bringing asthma care into the twenty-first century.

Despite access to diagnostic tests and effective therapies, asthma often remains misdiagnosed and/or poorly controlled or uncontrolled. In this review, we address the key issues of asthma diagnosis and management, recent evidence for levels of asthma control, the consequences of poor control and, in line with that, explore the potential reasons for poor asthma control and acute exacerbations. Based on recent evidence and current guidelines, we also aim to provide practical answers to the key questions of how to improve asthma management, with the best possible prevention of exacerbations, addressing the basics-adherence, inhaler misuse, obesity and smoking-and how to facilitate a new era of asthma care in the twenty-first century. We hope this review will be useful to busy primary care clinicians in their future interactions with their patients with both suspected and proven asthma.

Management of chronic obstructive pulmonary disease in general practice in Denmark.

INTRODUCTION: In recent years, increased awareness and focus on chronic obstructive pulmonary disease (COPD) has evolved. Alongside, a growing interest has emerged in quality of care including early diagnosis, smoking cessation, rehabilitation and relevant medication as tools for achieving a better prognosis. METHODS: The aim of this study was to analyse the quality of real-life management of COPD in a representative sample of Danish general practices. Our main focus was to measure the fulfilment of ten specific quality-of-care indicators at the annual control visit for management of COPD, as suggested by the Danish Society of General Practitioners (DSAM), by extracting relevant data from the electronic patient medical records (PMR) of the general practitioners' (GP) electronic patient filing systems. RESULTS: In total, 82 GP clinics participated in the study. Approximately half were solo clinics and the rest were various types of partnership clinics. The records of 1,556 COPD patients (51.3% males) with an average age of 69.7 years (range: 36-97 years) were included. We found the level of registration of the quality-of-care standards to be very low, as only 11.1% (95% confidence interval: 7.9-15.8%) of the PMR recorded an acceptable (80-99%) or excellent (100%) registration. Conclutions: Improvement of adherence to COPD guidelines among GPs is of paramount importance to improve management and reduce the overall burden of COPD. However, this study demonstrates that substantial room for improvement remains. FUNDING: This study was sponsored by Boehringer Ingelheim, Denmark, and the authors have all received payment for their contribution to the study. TRIAL REGISTRATION: The trial was approved by the Danish Health Authority and the Danish Data Protection Agency.

Patient perspectives on living with severe asthma in Denmark and Sweden.

Background: Severe asthma has an acknowledged impact on health-related quality of life (HRQOL) and is associated with substantial health care costs. This study aimed to investigate the patients' own experiences of the disease, perceptions of HRQOL, and awareness of disease management. Methods: This study included severe asthma patients in Sweden and Denmark. A quantitative Web-based survey and qualitative in-depth interviews (IDIs) were conducted. The survey included St. George's Respiratory Questionnaire (SGRQ), Asthma Control Test (ACT), Work Productivity and Activity Impairment (WPAI), and a study-specific questionnaire on quality of care and disease awareness. Telephone-based IDIs were conducted by medical interviewers following a semi-structured interview guide. Results: A total of 93 patients participated in the Web survey, and 33 participated in the IDIs. In the survey, the vast majority (77%; 72/93) had uncontrolled asthma (ACT<20). Mean total SGRQ score was 47.4 (59.7 symptom, 53.7 activity, 39.9 impact scores). Nearly 60% were treated in primary care. The IDIs revealed a long path to diagnosis, substantial and constant need for adaptations because of disease limitations, high burden on family members, social restrictions, and sick leaves and income losses. Patient awareness about guidelines, treatment goals, and available therapies was poor, and a low level of satisfaction by primary health care was seen. Conclusions: The vast majority of this severe asthma population had uncontrolled asthma and poor access to lung expert physicians. Impaired HRQOL despite patients' adaptations was indicated. These findings highlight the need for structured patient education and greater access to units with disease-specific knowledge.

[The quality of COPD care in general practice]. / Kvaliteten af diagnostik og behandling af kronisk obstruktiv lungesygdom i almen praksis--sekundaerpublikation.

We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were included in the first audit and 2394 in the second audit. We observed a significantly increased utilisation of spirometry from the first (52.7%) to the second audit (71.4%) (p < 0,001) and improvement in other parameters describing the quality of management. We conclude that participation in an educational programme can improve the quality of COPD care in general practice.

The quality of COPD care in general practice in Denmark: the KVASIMODO study.

AIM: We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence to COPD guidelines. METHODS: We performed two audit surveys of GPs' patients' notes, one year apart, before and after an educational programme for participating GPs and their staff. A total of 154 GPs participated in the study. 2549 patient records were included in the first survey and 2394 in the second. RESULTS: Based on analysis of all patient records, we observed a substantial improvement in the quality of care: recording of FEV1 improved from 52.7% of cases in the first survey to 71.4% in the second (p< 0.001). There was a significant improvement in the recording of body mass index and provision of smoking cessation advice, recommendation of physical activity, checking of inhalation technique, dietary instruction, and referral to pulmonary rehabilitation. We also found a decline in the use of inhaled corticosteroids in patients with mild COPD, from 60.2% in the first survey to 48.8% in the second. When analysing the results focussing on the performance of single GPs there was an improvement in quality, but this was less than the improvement for patients overall - suggesting that improvement in quality of care was not equally distributed throughout the GPs' practices. CONCLUSION: We conclude that it is possible to improve the quality of COPD care by educating GPs and their staff.