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1.
PLoS One ; 19(6): e0302357, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38857297

RESUMO

BACKGROUND: Self-management support improves asthma outcomes and is widely recommended in guidelines, yet it is poorly implemented in routine practice. There may be additional challenges in the context of ethnic minority groups, where making sense of culture may be necessary. This study aimed to explore the perspectives of healthcare professionals on supporting UK Bangladeshi and Pakistani patients to self-manage their asthma. METHODS: One-to-one semi-structured interviews with professionals (primary and secondary care; medical and nursing) who routinely provide asthma care to Bangladeshi or Pakistani patients. Topics addressed included perceptions of professionals in supporting patients with asthma self-management and ideas for improving culturally competent care. Data were analysed thematically. RESULTS: Nine professionals, from a range of ethnic backgrounds, with considerable experience of treating patients from these communities were interviewed. Despite organisational restrictions (language and time/resources) and expressed gaps in cultural knowledge and training, all interviewees reported attempting to tailor support according to culture. They used their perception of the patient's culture (e.g., big families and family involvement), integrated with their perception of patients' ability to self-manage (e.g., degree of responsibility taken for asthma), to formulate theories about how to culturally adapt their approach to supported self-management, e.g., supporting barriers in understanding asthma. There was consensus that gaps in cultural knowledge of professionals needed to be addressed through training or information. Interventions recommended for patients included basic education, group meetings, and culturally relevant action plans. CONCLUSION: In the absence of formal training and constrained by organisational limitations, self-management support was adapted based on personal and professional perception of culture. These ideas were based on experience and formulated a chain of reasoning. Professionals recognised the limitations of this approach and potential to overgeneralise their perceptions of culture and adaptations of supported self-management. Interventions were desired and need to address professional training in cultural competence and the provision of culturally relevant materials.


Assuntos
Asma , Pessoal de Saúde , Autogestão , Humanos , Asma/terapia , Paquistão/etnologia , Bangladesh , Reino Unido , Pessoal de Saúde/psicologia , Feminino , Masculino , Adulto , Atitude do Pessoal de Saúde , População do Sul da Ásia
2.
Acta Derm Venereol ; 104: adv34961, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38828609

RESUMO

Atopic diseases such as atopic dermatitis, food allergy, allergic rhinoconjunctivitis, and/or asthma are common. In Denmark, however, there are multiple referral pathways for these diseases in the healthcare system and they are poorly understood. To describe how children with atopic diseases navigate their way through the Danish healthcare system, a questionnaire was distributed to children aged ≤ 17 years, who were being treated for atopic diseases between August 2020 and June 2021, either by a practising specialist or a hospital department, in the Capital Region of Denmark. A total of 279 children completed the questionnaire and most were referred to a specialist or to a hospital by their general practitioner. No "common track" to hospital existed for patients with ≥ 3 atopic diseases. These patients were more often referred to a hospital compared with children with 2 atopic diseases or fewer (odds ratio [OR] 3.79; 95% CI 2.07-7.24). The primary determinants for hospital treatment were food allergy (OR 4.69; 95% CI 2.07-10.61) and asthma (OR 2.58; 95% CI 1.18-5.63). In conclusion, children with multiple atopic diseases were more likely to be referred to hospital departments than to practising specialists, mainly due to food allergies.


Assuntos
Encaminhamento e Consulta , Humanos , Dinamarca/epidemiologia , Criança , Masculino , Feminino , Adolescente , Pré-Escolar , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/diagnóstico , Lactente , Asma/epidemiologia , Asma/diagnóstico , Asma/terapia , Inquéritos e Questionários , Dermatite Atópica/epidemiologia , Dermatite Atópica/diagnóstico , Dermatite Atópica/terapia , Departamentos Hospitalares
3.
Dtsch Med Wochenschr ; 149(13): 764-770, 2024 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-38863145

RESUMO

Symptom prevention and remission are the goals of asthma treatment. Precise phenotyping of the patients, including history, lung function, allergology and measurement of type 2 biomarkers, is the essential prerequisite for treatment success. Basic measures, treatment with DMAADs ("disease-modifying anti-asthmatic drugs": predominantly inhaled corticosteroids, biologics, and allergen immunotherapy) and treatment of comorbidities are the cornerstones of modern asthma management. The treatment of upper airway diseases such as allergic rhinitis (often associated with early-onset asthma) or chronic rhinosinusitis (often associated with adult-onset asthma, with 2 forms: either with nasal polyps, CRSwNP, or without nasal polyps, CRSsNP) is of major importance in this regard.


Assuntos
Antiasmáticos , Asma , Humanos , Asma/terapia , Antiasmáticos/uso terapêutico , Corticosteroides/uso terapêutico
4.
Trials ; 25(1): 359, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38835102

RESUMO

BACKGROUND: Providing supported self-management for people with asthma can reduce the burden on patients, health services and wider society. Implementation, however, remains poor in routine clinical practice. IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a UK-wide cluster randomised implementation trial that aims to test the impact of a whole-systems implementation strategy, embedding supported asthma self-management in primary care compared with usual care. To maximise opportunities for sustainable implementation beyond the trial, it is necessary to understand how and why the IMP2ART trial achieved its clinical and implementation outcomes. METHODS: A mixed-methods process evaluation nested within the IMP2ART trial will be undertaken to understand how supported self-management was implemented (or not) by primary care practices, to aid interpretation of trial findings and to inform scaling up and sustainability. Data and analysis strategies have been informed by mid-range and programme-level theory. Quantitative data will be collected across all practices to describe practice context, IMP2ART delivery (including fidelity and adaption) and practice response. Case studies undertaken in three to six sites, supplemented by additional interviews with practice staff and stakeholders, will be undertaken to gain an in-depth understanding of the interaction of practice context, delivery, and response. Synthesis, informed by theory, will combine analyses of both qualitative and quantitative data. Finally, implications for the scale up of asthma self-management implementation strategies to other practices in the UK will be explored through workshops with stakeholders. DISCUSSION: This mixed-methods, theoretically informed, process evaluation seeks to provide insights into the delivery and response to a whole-systems approach to the implementation of supported self-management in asthma care in primary care. It is underway at a time of significant change in primary care in the UK. The methods have, therefore, been developed to be adaptable to this changing context and to capture the impact of these changes on the delivery and response to research and implementation processes.


Assuntos
Asma , Atenção Primária à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Autogestão , Humanos , Asma/terapia , Autogestão/métodos , Resultado do Tratamento , Reino Unido , Autocuidado/métodos , Avaliação de Processos em Cuidados de Saúde
5.
Adv Mind Body Med ; 28(2): 10-15, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38837777

RESUMO

Context: Asthma is a chronic disease and its chronicity demands therapy with minimal harm and a good impact on the quality of life of asthmatics. Objective: This study evaluates the efficacy of structured yoga intervention integrated with routine care on asthma patients in improving their pulmonary function and quality of life. Design: The study was a single-blind (outcome assessor) hospital-based randomized controlled trial. Participants: Adults between 18 to 60 years, diagnosed with mild to moderate asthma as per Global Initiative for Asthma guidelines, with no exacerbation in the past month before screening, were included in the study. Intervention: A thirty-minute structured yoga intervention was delivered daily by a qualified yoga instructor through a virtual platform. Outcome measures: Questionnaires were utilized to assess the quality of life, and Breath-o-meter equipment was used to measure peak expiratory flow rate (PEFR). It was tested at baseline and then at 15 days, 45 days, and 90 days, whereas the quality of life was evaluated once a month. Statistical analysis: Intention to treat analysis was performed to compare the mean outcome between the yoga and control groups using an independent sample t test and repeated measures analysis of variance. Results: The yoga group significantly improved their PEFR and asthma-related quality of life scores compared to the control group (P < .001). A significant difference (F = 539.72, degree of freedom = 1.1618; P < .001) was detected between PEFR values at several time intervals (baseline, day 15, day 45, day 90) in the intervention group on repeated measures analysis of variance. The difference in quality-of-life scores between yoga and control was also statistically significant (P < .001), with an improvement in the quality-of-life domain of external stimuli. Conclusion: When combined with normal asthma treatment, the findings of this study show that structured yoga intervention integrated with routine care is more beneficial than traditional breathing exercises in increasing PEFR and quality of life.


Assuntos
Asma , Qualidade de Vida , Yoga , Humanos , Asma/terapia , Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Adulto Jovem , Adolescente , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Testes de Função Respiratória , Resultado do Tratamento
6.
BMJ Open Respir Res ; 11(1)2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38862238

RESUMO

BACKGROUND: Herpes zoster (HZ) is a painful condition caused by reactivation of the varicella-zoster virus. The objectives of this study were to compare HZ incidence in adults with asthma versus adults without asthma and to compare healthcare resource use as well as direct costs in adults with HZ and asthma versus adults with asthma alone in the USA. METHODS: This retrospective longitudinal cohort study included adults aged ≥18 years across the USA. Patients were identified from Optum's deidentified Clinformatics Data Mart Database, an administrative claims database, between 1 October 2015 and 28 February 2020, including commercially insured and Medicare Advantage with part D beneficiaries. Cohorts of patients with and without asthma, and separate cohorts of patients with asthma and HZ and with asthma but not HZ, were identified using International Classification of Diseases 10th Revision, Clinical Modification codes. HZ incidence, healthcare resource use and costs were compared, adjusting for baseline characteristics, between the relevant cohorts using generalised linear models. RESULTS: HZ incidence was higher in patients with asthma (11.59 per 1000 person-years) than patients without asthma (7.16 per 1000 person-years). The adjusted incidence rate ratio (aIRR) for HZ in patients with asthma, compared with patients without asthma, was 1.34 (95% CI 1.32 to 1.37). Over 12 months of follow-up, patients with asthma and HZ had more inpatient stays (aIRR 1.11; 95% CI 1.02 to 1.21), emergency department visits (aIRR 1.26; 95% CI 1.18 to 1.34) and outpatient visits (aIRR 1.19; 95% CI 1.16 to 1.22), and direct healthcare costs that were US dollars ($) 3058 (95% CI $1671 to $4492) higher than patients with asthma without HZ. CONCLUSION: Patients with asthma had a higher incidence of HZ than those without asthma, and among patients with asthma HZ added to their healthcare resource use and costs.


Assuntos
Asma , Custos de Cuidados de Saúde , Herpes Zoster , Humanos , Herpes Zoster/economia , Herpes Zoster/epidemiologia , Asma/economia , Asma/epidemiologia , Asma/terapia , Masculino , Feminino , Estudos Retrospectivos , Incidência , Pessoa de Meia-Idade , Adulto , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Estados Unidos/epidemiologia , Estudos Longitudinais , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Adulto Jovem , Efeitos Psicossociais da Doença , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Adolescente
7.
PLoS One ; 19(6): e0304711, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38870226

RESUMO

BACKGROUND: Asthma is the leading source of unscheduled hospitalisation in Australian children, with a high burden placed upon children, their parents/families, and the healthcare system. In Australia, there are widening disparities in paediatric asthma care including inequitable access to comprehensive ongoing and planned asthma care for children. METHODS: The Asthma Care from Home Project is a comprehensive virtually enabled asthma model of care that aims to a. supports families, communities and healthcare providers, b. flexible and locally acceptable, and c. allow for adoption of innovations such as digital technologies so that asthma care can be provided "from home", reduce potentially preventable asthma hospitalisation, and ensure satisfaction at a patient, family, and healthcare provider level. The model of care includes standardisation of discharge care through provision of an asthma discharge resource pack containing individual asthma action plan, follow-up letters for the child's general practitioner (GP) and school/child care, and access to online asthma educational sessions and resource; post-discharge care coordination through text message reminders for families for regular GP review, email correspondence with their child's GP and school/childcare; and virtual home visits to discuss home environmental triggers, provide personalised asthma education and respond to parental concerns relating to their child's asthma. This study is comprised of three components: 1) a quasi-experimental pre/post impact evaluation assessing the impact of the model on healthcare utilisation and asthma control measures; 2) a mixed-methods implementation evaluation to understand how and why our intervention was effective or ineffective in producing systems change; 3) an economic evaluation to assess the cost-effectiveness of the proposed model of care from a family and health services perspective. DISCUSSION: This study aims to improve access to asthma care for children in rural and remote areas. Implementation evaluation and economic evaluation will provide insights into the sustainability and scalability of the asthma model of care.


Assuntos
Asma , População Rural , Asma/terapia , Humanos , Criança , New South Wales , Pré-Escolar , Feminino , Masculino , Telemedicina , Adolescente
8.
BMC Health Serv Res ; 24(1): 732, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38877510

RESUMO

BACKGROUND: To reduce the impact of chronic diseases (cardiovascular disease, diabetes mellitus type 2, and chronic lung disease (asthma or chronic obstructive pulmonary disease (COPD)), it is imperative that care is of high quality and suitable to patients' needs. Patients with intellectual disabilities (ID) differ from the average patient population in general practice because of their limitations in adaptive behaviour and intellectual functioning, and concomitant difficulties recognising and reacting to disease symptoms, proactively searching health information, and independently managing diseases effectively. Because of these differences, information on their care needs is essential for suitable chronic disease management (CDM). Inadequate recognition of the care needs of this vulnerable population may hamper the harmonisation of evidence-based and person-centred care, compounded by issues such as stigma, misconceptions, and diagnostic overshadowing. This study therefore aimed to explore the needs of patients with ID from perspectives of both patients and of healthcare providers (HCPs) in the context of CDM in general practice. METHODS: This qualitative study recruited patients with ID for face-to-face individual interviews and HCPs for focus groups. With the Chronic Care Model as the underlying framework, semi-structured interviews and focus-group guides were defined to explore patients' care needs and HCPs' perspectives. All interviews and focus groups were audio-recorded and transcribed verbatim. Using Atlas.ti software, data were analysed using reflexive thematic analysis. RESULTS: Between June and September 2022, 14 patients with ID and cardiovascular disease, diabetes mellitus type 2, and/or asthma/COPD were interviewed; and 32 general practitioners and practice nurses participated in seven focus groups. We identified six care needs underpinning suitable CDM: trusting relationship between patient and HCP; clear expectations about the CDM process; support in disease management; directive decision-making; support in healthy lifestyle; accessible medical information. CONCLUSIONS: This vulnerable patient population has complex care needs that must be acknowledged for suitable CDM. Although HCPs largely recognise these needs, organisational factors and lack of training or experience with patients with ID hamper HCPs' ability to fully adjust care provision to these needs. Access to, and knowledge of, easy-language information on chronic diseases and communication guidelines could aid HCPs to facilitate patients in managing their diseases more adequately.


Assuntos
Grupos Focais , Medicina Geral , Deficiência Intelectual , Pesquisa Qualitativa , Humanos , Doença Crônica/terapia , Masculino , Países Baixos , Feminino , Deficiência Intelectual/terapia , Deficiência Intelectual/psicologia , Pessoa de Meia-Idade , Adulto , Idoso , Necessidades e Demandas de Serviços de Saúde , Avaliação das Necessidades , Entrevistas como Assunto , Doença Pulmonar Obstrutiva Crônica/terapia , Diabetes Mellitus Tipo 2/terapia , Asma/terapia
10.
JAMA Netw Open ; 7(6): e2417319, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38884996

RESUMO

Importance: Although children with asthma are often successfully treated by primary care clinicians, outpatient specialist care is recommended for those with poorly controlled disease. Little is known about differences in specialist use for asthma among children with Medicaid vs private insurance. Objective: To examine differences among children with asthma regarding receipt of asthma specialist care by insurance type. Design, Setting, and Participants: In this cross-sectional study using data from the Massachusetts All Payer Claims Database (APCD) between 2014 to 2020, children with asthma were identified and differences in receipt of outpatient specialist care by whether their insurance was public (Medicaid and the Children's Health Insurance Program) or private were examined. Eligible participants included children with asthma in 2015 to 2020 aged 2 to 17 years. Data analysis was conducted from January 2023 to April 2024. Exposure: Medicaid vs private insurance. Main Outcomes and Measures: The primary outcome was receipt of specialist care (any outpatient visit with a pulmonology, allergy and immunology, or otolaryngology physician). Multivariable logistic regression models estimated differences in receipt of specialist care by insurance type accounting for child and area characteristics including demographics, health status, persistent asthma, calendar year, and zip code characteristics. Additional analyses examined if the associations of specialist care with insurance type varied by asthma persistence and severity, and whether associations varied over time. Results: Among 198 101 unique children, there were 432 455 child-year observations (186 296 female [43.1%] and 246 159 male [56.9%]; 211 269 aged 5 to 11 years [48.9%]; 82 108 [19.0%] with persistent asthma) including 286 408 (66.2%) that were Medicaid insured and 146 047 (33.8%) that were privately insured. Although persistent asthma was more common among child-year observations with Medicaid vs private insurance (57 381 [20.0%] vs 24 727 [16.9%]), children with Medicaid were less likely to receive specialist care. Overall, 64 239 child-year observations (14.9%) received specialist care, with substantially lower rates for children with Medicaid vs private insurance (34 093 child-year observations [11.9%] vs 30 146 child-year observations [20.6%]). Regression-based estimates confirmed these disparities; children with Medicaid had 55% lower odds of receiving specialist care (adjusted odds ratio, 0.45; 95% CI, 0.43 to 0.47) and a regression-adjusted 9.7 percentage point (95% CI, -10.4 percentage points to -9.1 percentage points) lower rate of receipt of specialist care. Compared with children with private insurance, there was an additional 3.2 percentage point (95% CI, 2.0 percentage points to 4.4 percentage points) deficit for children with Medicaid with persistent asthma. Conclusions and Relevance: In this cross-sectional study, children with Medicaid were less likely to receive specialist care, with the largest gaps among those with persistent asthma. These findings suggest that closing this care gap may be one approach to addressing ongoing disparities in asthma outcomes.


Assuntos
Assistência Ambulatorial , Asma , Seguro Saúde , Medicaid , Humanos , Asma/terapia , Criança , Feminino , Masculino , Estados Unidos , Pré-Escolar , Estudos Transversais , Adolescente , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Assistência Ambulatorial/economia , Massachusetts , Especialização/estatística & dados numéricos
11.
Respir Med ; 230: 107691, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38844003

RESUMO

One of the most common respiratory chronic diseases is asthma, with 5-16 % of world prevalence. In chronic disease, prevention, diagnosis, management, and palliation are the strategies for a care model; the patient-self management is fundamental with the so-called therapeutic education (TE) to train the patient in the necessary skills. The challenge of TE grows when the patient is a child or a person with special needs, even more in public health care in low- and middle-income countries. This is a problematic human situation, that needs soft system thinking. In this research, the analytic hierarchy process was used to determine the perceived importance of the factors that affect children's asthma health care in a public health institution in Mexico. The soft systems methodology (SSM) was applied to learn about the disease self-management, in order to obtain activities models and an action plan. According to AHP, human resources and education were percived as the most important among the factors that affect children health care within the institution. The perceived importance of two main subfactors (human resources training and TE) was around 34 %, which emphasizes the need to generate strategies for the improvement of the education of patients and health care providers. In MSS, the rich vision, the CATWOE, the root definition, and an activities model were proposed, including the application of an instructional design methodology (ADDIE) for the development of learning objects of asthma for children. Desirable and feasible actions and recommendations include the update of the national clinical practice guides, the use of control measures such as the Asthma Control Test, and a daily asthma diary to register the daily status of the breathing capacity, the drug administration, and the potential trigger events. The proposed model can be used as part of a systemic patient-and-family centered approach for chronic care model (CCM), particularly in diseases unsuitable for prevention interventions.


Assuntos
Asma , Educação de Pacientes como Assunto , Autogestão , Humanos , Asma/terapia , Criança , Educação de Pacientes como Assunto/métodos , Autogestão/educação , Autogestão/métodos , México , Feminino , Masculino , Autocuidado
12.
Rev Med Liege ; 79(5-6): 405-410, 2024 Jun.
Artigo em Francês | MEDLINE | ID: mdl-38869131

RESUMO

Allergen immunotherapy is still the only curative treatment for respiratory allergies. It is based on repeated administration of allergenic extracts to sensitized patients. It can be administered either by subcutaneous or by sublingual route. The purpose of the treatment is to modulate the immune response to a specific allergen and to alter the course of the disease over a long-term period. Numerous studies and meta-analyses have demonstrated its efficacy in terms of symptoms and quality of life improvement as well as reduction of the allergic march. Indication of allergen immunotherapy includes moderate to severe allergic rhinitis and mild to moderate allergic asthma from GINA step 3. Early intervention in sensitized patients is nowadays promoted.


L'immunothérapie allergénique représente, encore aujourd'hui, le seul traitement curatif des allergies respiratoires. Elle consiste en l'administration répétée d'extraits allergéniques auxquels le patient est allergique. Elle peut se faire par voie sous-cutanée ou sublinguale. L'objectif est de moduler la réponse immunitaire afin de réduire les symptômes de l'allergie et de modifier le cours de la maladie allergique avec des effets perdurant sur le long terme. De nombreuses études et méta-analyses ont prouvé son efficacité en termes d'amélioration symptomatique, d'amélioration de la qualité de vie mais également de la réduction de l'évolution de la marche allergique. L'immunothérapie allergénique est indiquée dans le traitement de la rhinite allergique modérée à sévère et de l'asthme allergique dès le palier 3 du GINA («Global Initiative for Asthma¼). Une utilisation plus précoce est de plus en plus mise en avant pour bénéficier des effets préventifs de la modulation immunitaire.


Assuntos
Alérgenos , Dessensibilização Imunológica , Humanos , Dessensibilização Imunológica/métodos , Alérgenos/imunologia , Asma/terapia , Asma/imunologia , Rinite Alérgica/terapia , Rinite Alérgica/imunologia , Rinite Alérgica/prevenção & controle
13.
BMC Pulm Med ; 24(1): 214, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38698432

RESUMO

BACKGROUND: In western Yokohama, our hospital and primary care clinics manage adults with asthma via a coordinated care system. We investigated the changes in the fractional expired nitric oxide (FeNO), forced expiratory volume in 1 second (FEV1), and forced oscillation technique (FOT) parameters over 3 years in a cohort of patients in our collaborative system. METHODS: From 288 adults with well controlled asthma managed under the Yokohama Seibu Hospital coordinated care system between January 2009 and May 2018, we selected 99 subjects to undergo spirometry, FeNO and FOT testing over 3 years and analyzed the changes in these parameters. RESULTS: Of the 99 patients enrolled, 17 (17.2%) experienced at least one exacerbation (insufficiently controlled (IC)), whereas, 82 (82.8%) remained in well controlled during the 3-year study period. Of well-controlled patients, 54 patients (54.5%) met the criteria for clinical remission under treatment (CR); the remaining 28 patients did not meet the CR criteria (WC). There were no differences in FeNO, FEV1, or FOT parameters at baseline among the IC, WC, and CR groups. The levels of FEV1 decreased gradually, whereas the levels of FeNO decreased significantly over 3 years. The levels of percent predicted FEV1 (%FEV1) significantly increased. We also observed significant improvement in FOT parameters; reactance at 5 Hz (R5), resonant frequency (Fres), and integral of reactance up to the resonant frequency (AX). The CR group demonstrated significant relationships between the change in FeNO and the change in FEV1 and between the change in FEV1 and the change in FOT parameters. No significant correlations emerged in the IC or WC group. CONCLUSION: The decrease in FeNO and increase in %FEV1, we observed in all study participants suggest that the coordinated care system model benefits patients with asthma. Although it is difficult to predict at baseline which patients will experience an exacerbation, monitoring changes in FeNO and FEV1 is useful in managing patients with asthma. Furthermore, monitoring changes in R5, Fres, and AX via forced oscillation technique testing is useful for detecting airflow limitation.


Assuntos
Asma , Espirometria , Humanos , Masculino , Feminino , Asma/fisiopatologia , Asma/terapia , Asma/diagnóstico , Volume Expiratório Forçado , Pessoa de Meia-Idade , Adulto , Óxido Nítrico/análise , Óxido Nítrico/metabolismo , Idoso , Teste da Fração de Óxido Nítrico Exalado
14.
NPJ Prim Care Respir Med ; 34(1): 7, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38693173

RESUMO

Biologic treatments can alleviate severe asthma symptoms and reduce health service use. However, service capacity limits and low referral rates from primary care indicate unmet patient need. We report a mixed-methods evaluation of an enhanced severe asthma pathway implemented in Staffordshire and Stoke-on-Trent, UK which aimed to optimise primary care referrals through training/education, and increased capacity in specialist clinics. Quantitative analysis assessed patient wait times between pathway stages, prescribing changes, exacerbations, hospital admissions and asthma control. Interviews with 12 stakeholders evaluated perceptions of the enhanced pathway across settings. In 12 months, 564 patients from 28 general practices were reviewed for biologics eligibility, of whom 125 (22.2%) were referred for specialist assessment. Wait times were significantly lower under the enhanced pathway when compared against historic patients following the standard pathway, and reduced overall from a mean of 76.4 to 26.7 weeks between referral and biologics initiation (p < 0.001). Patients commencing biologics (n = 46) showed significantly reduced reliever inhaler prescribing rates (p = 0.037), 60% lower oral steroid use (p < 0.001), significantly reduced exacerbation rates (p < 0.001) and fewer hospital admissions (p < 0.001) compared with the 12 months pre-treatment. Mean asthma control scores reduced from 3.13 pre-initiation to 1.89 post-initiation (p < 0.001) - a clinically significant improvement. Interviewees viewed the enhanced pathway positively, although ongoing issues related to difficulties engaging primary care amid concerns around increased workloads and pathway capacity. The large number of referrals generated from a comparatively small number of general practices confirms substantial unmet need that an enhanced severe asthma pathway could help address if implemented routinely.


Assuntos
Asma , Produtos Biológicos , Procedimentos Clínicos , Encaminhamento e Consulta , Humanos , Asma/tratamento farmacológico , Asma/terapia , Produtos Biológicos/uso terapêutico , Masculino , Reino Unido , Feminino , Pessoa de Meia-Idade , Adulto , Antiasmáticos/uso terapêutico , Atenção Primária à Saúde/métodos , Hospitalização/estatística & dados numéricos
16.
Aust J Gen Pract ; 53(5): 327-331, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38697067

RESUMO

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic catalysed unprecedented changes to healthcare delivery in Australia, leading to a rapid transformation of asthma management, to which healthcare providers and patients have had to adapt. Understanding the impact of these changes is critical as we emerge from pandemic-affected workflows. METHOD: A qualitative study using semistructured interviews was conducted with 19 general practitioners across Sydney and regional New South Wales. Reflexive thematic analysis of interview data was undertaken. RESULTS: Four key themes were identified: disorganised asthma care before COVID­19; chaotic asthma care during the pandemic; adapting to non-guideline-driven telehealth asthma care; and widening health agenda misalignment. DISCUSSION: This study highlights the triumphs and gaps in asthma management during the pandemic and the vulnerability of existing asthma care systems to disruption. These lessons can be used to re-evaluate how we deliver asthma care and inform future models of care as we transition towards a 'post-COVID' landscape.


Assuntos
Asma , COVID-19 , Medicina Geral , Pesquisa Qualitativa , Humanos , Asma/terapia , COVID-19/terapia , Medicina Geral/métodos , Telemedicina/métodos , SARS-CoV-2 , New South Wales , Entrevistas como Assunto/métodos , Feminino , Masculino , Austrália , Pandemias , Atenção à Saúde/métodos
17.
Adv Respir Med ; 92(3): 175-189, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38804437

RESUMO

Bronchial asthma is a chronic pathology and a global public health problem. However, asthma can be controlled and treated for the most part by patients, so the Portuguese General Directorate of Health recommends shared medical appointments in primary health care (PHC). The present study aims to identify the role of PHC nurses in the control and treatment of asthma in adults. Using the MeSH platform, the following descriptors were validated: asthma, nurses, adults. An individual search was carried out in the following databases: CINAHL (ESBSCO host), MEDLINE (Pubmed host), Web of Science, and Scopus. Out of a total of 280 publications, 79 of which were duplicates and 185 publications which did not meet the inclusion criteria, 16 publications remained readable. Of the eligible articles, there were 13 specialist reports, one mixed study, one quasi-experimental study, and one randomized trial. Education was the intervention most identified in the scientific evidence analyzed, and patient assessment, application of an asthma control questionnaire, verification and training of inhalation technique, empowerment for self-management of the disease, support, promotion of seasonal influenza vaccination, and use of written action plans were also identified. The results reveal that, although the scientific evidence on the intervention of these professionals is poorly developed, nurses play a crucial role in the control and treatment of asthma. The scientific evidence analyzed allowed the identification of interventions that can help the organization of a nursing health appointment, providing nurses with a crucial role in the control and treatment of asthma in adults in the context of PHC.


Assuntos
Asma , Papel do Profissional de Enfermagem , Humanos , Asma/enfermagem , Asma/terapia , Adulto , Atenção Primária à Saúde
18.
Nutrients ; 16(10)2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38794757

RESUMO

(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.


Assuntos
Asma , Exercício Físico , Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Asma/terapia , Asma/prevenção & controle , Abandono do Hábito de Fumar/métodos , Estilo de Vida Saudável , Estilo de Vida , Masculino , Feminino , Dieta
19.
West J Emerg Med ; 25(3): 407-414, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38801048

RESUMO

Background/Objective: Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma. Methods: We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2-17 years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers. Results: A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12 years (interquartile range 7-15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2-5 years, OR 2.0, 95% confidence interval [CI] 1.4-2.9), male gender (OR 1.4, 95% CI 1.1-1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2-2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1-0.4). Conclusion: Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.


Assuntos
Asma , Serviço Hospitalar de Emergência , Transferência de Pacientes , Humanos , Asma/terapia , Criança , Masculino , Feminino , Estudos Retrospectivos , Transferência de Pacientes/estatística & dados numéricos , Adolescente , Serviço Hospitalar de Emergência/estatística & dados numéricos , California , Pré-Escolar , Tempo de Internação/estatística & dados numéricos
20.
Chron Respir Dis ; 21: 14799731241251827, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38717428

RESUMO

Asthma and obstructive sleep apnea (OSA) are common respiratory disorders. They share characteristics such as airway obstruction, poor sleep quality, and low quality of life. They are often present as comorbidities, along with obesity, gastroesophageal reflux disease (GERD), and allergic rhinitis (AR), which impacts the disease's control. In recent years, there has been discussion about the association between these conditions and their pathophysiological and clinical consequences, resulting in worse health outcomes, increased healthcare resource consumption, prolonged hospital stays, and increased morbidity and mortality. Some studies demonstrate that treatment with continuous positive airway pressure (CPAP) can have a beneficial effect on both pathologies. This review summarizes the existing evidence of the association between asthma and OSA at their pathophysiological, epidemiological, clinical, and therapeutic levels. It intends to raise awareness among healthcare professionals about these conditions and the need for further research.


Assuntos
Asma , Pressão Positiva Contínua nas Vias Aéreas , Refluxo Gastroesofágico , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/epidemiologia , Asma/terapia , Asma/epidemiologia , Asma/complicações , Pressão Positiva Contínua nas Vias Aéreas/métodos , Refluxo Gastroesofágico/terapia , Refluxo Gastroesofágico/epidemiologia , Rinite Alérgica/terapia , Rinite Alérgica/complicações , Rinite Alérgica/epidemiologia , Comorbidade , Obesidade/complicações , Obesidade/terapia , Obesidade/epidemiologia , Qualidade de Vida , Assistência Integral à Saúde/métodos
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