Perceptions of air quality and concern for health in relation to long-term air pollution exposure, bushfires, and COVID-19 lockdown: A before-and-after study.

Background: Air pollution is a major health burden and the leading environmental risk factor for non-communicable diseases worldwide. People's perceptions and concerns about air pollution are important as they may predict protective behaviour or support for climate change mitigation policies. Methods: This repeat cross-sectional study uses survey data collected from participants in Sydney, Australia in September-November 2019 (n = 1,647) and October-December 2020 (n = 1,458), before and after the devastating 2019/2020 bushfires and first COVID-19 lockdown restrictions in Sydney in 2020. Participants' perceptions of air quality and concerns for health in relation to air quality were modeled against estimates of annual average NO2 and PM2.5 concentrations in their neighbourhood. Results: Participants in suburbs with higher estimated air pollution concentrations generally perceived poorer air quality and were more concerned for health in relation to air quality. A 5 µg/m3 increase in NO2 was associated with perceived poorer air quality (OR 1.32, 95%CI 1.18-1.47). A 1 µg/m3 increase in estimated PM2.5 was associated with perceived poorer air quality (OR 1.37, 95%CI 1.24-1.52) and greater concern for health (OR 1.18, 95%CI 1.05-1.32). Air quality was perceived as better in 2020 than in 2019 in both NO2 and PM2.5 models (p<0.001). Air quality concern increased in 2020 in both models. Discussion: This study provides the first Australian data on the association between estimated air quality exposure and air quality perceptions and concerns, contributing new evidence to inform public health approaches that increase awareness for air pollution and reduce the health burden.

Unmet needs of older people with asthma: cross-sectional survey.

INTRODUCTION: Asthma in older people is a major cause of disease burden in Australia and is projected to increase over the next two decades. Current guidelines for asthma care rely predominantly on studies from younger populations. METHODS: We undertook a cross-sectional survey of older people with asthma to identify their concerns and their perceived asthma symptom burden. One hundred and ninety-nine people over 55 years of age with asthma were recruited from community pharmacies, in the states of Victoria and NSW, Australia. RESULTS: One-hundred and twenty (62%) participants reported "perfectly" or "very well controlled" asthma over the past month, and 78% claimed adherence to asthma treatment. Despite this, 105 (55%) reported experiencing moderate to severe symptoms and 58 (30%) moderate to extreme restrictions on their lifestyle in the past month. Exacerbations were also common with over one-third of participants seeking emergency asthma care or requiring oral corticosteroids in the past 12 months. In spite of 80% of participants reporting confidence of how to manage their asthma properly, only 10% said they would call an ambulance or visit an Emergency Department if their asthma was "out of control." Further asthma self-management education was considered desirable by two-thirds. However, those over 65 years preferred less autonomy in decision-making compared to those under 65 years. CONCLUSION. Older people with asthma experience a high symptom burden. A simplified version of our questionnaire could assist GPs, specialists, and asthma educators to identify the individual needs of older patients and to tailor their delivery of asthma care accordingly.

Inhaler device technique can be improved in older adults through tailored education: findings from a randomised controlled trial.

AIM: To investigate the effects of inhaler device technique education on improving inhaler technique in older people with asthma. METHODS: In a randomised controlled trial, device technique education was provided to a sample of 123 adults aged >55 years who had a doctor diagnosis of asthma. The active education group received one-on-one technique coaching, including observation, verbal instruction and physical demonstration at baseline. The passive group received a device-specific instruction pamphlet only. Inhaler technique, including the critical steps for each device type, was assessed and scored according to Australian National Asthma Council (NAC) guidelines. Device technique was scored objectively at baseline and again at 3 and 12 months post education. RESULTS: The majority of participants demonstrated poor technique at baseline. Only 11 (21%) of the active intervention group and 7 (16%) of the passive group demonstrated 100% correct technique. By 3 months 26 (48%) of the active group achieved adequate technique. Improvement in technique was observed in the active group at 3 months (P<0.001) and remained significant at 12 months (P<0.001). No statistically significant improvement was observed in the passive group. CONCLUSION: The provision of active device technique education improves device technique in older adults. Passive education alone fails to achieve any improvement in device technique.

Development and validation of the Patient Asthma Concerns Tool (PACT) to identify the needs of older people with asthma.

BACKGROUND: Tools which assist practitioners to identify patient concerns and increase understanding of their needs can improve both the delivery of care and adherence to treatment. The aim of this study was to test the validity and reliability of a 14-item tool, to identify the unmet needs and concerns of older people with asthma. METHODS: The Patient Asthma Concerns Tool (PACT) was developed from a pool of 55 items derived from a comprehensive literature review. After pilot and field testing, the initial 55 item questionnaire was administered to a community sample (n = 193), psychometrically tested, and refined to a 14 item PACT tool which was evaluated by a group of clinicians. RESULTS: The PACT was shown to have good content and construct validity and was well received by clinicians. The PACT also correlated well with the Juniper ACQ and Brooks' adherence score on related variables and showed good reliability with good-excellent Kappa and ICC scores. Internal consistency of factors was high, and the overall Cronbach's α was 0.70. CONCLUSION: The PACT questionnaire was shown to be a valid and reliable tool clinically and psychometrically. We intend to test it in primary care settings and anticipate that its use will assist health professionals to identify the needs and concerns of older patients with asthma and direct tailored asthma management accordingly.