Patient education in asthma: a survey of physicians' knowledge of the principles and implementation of self management in practice

BACKGROUND

Therapeutic patient education, particularly when including written instructions in self-management, improves outcomes in asthma. The education of patients in self-management requires specific knowledge and skills, which are not generally taught in under- or postgraduate training programmes.

PURPOSE

To investigate physicians' knowledge of the principles and implementation of self-management in asthma care.

METHOD

A 14-item questionnaire was developed, piloted and subsequently sent to 1039 general physicians (general practitioners and internists) and pulmonologists registered as members of the Medical Society of Zurich.

RESULTS

368 (35%) of the physicians returned the questionnaire. 352 (96%) stated that they care for patients with asthma, 312 (87%) provided asthma education, 264 (75%) gave information about the mechanisms of illness, 272 (77%) provided instructions on how to use inhalers although only 212 (60%) checked inhaler technique. 170 (48%) instructed patients in home measurement of peak flow recordings (PEFR). 21% of general physicians and 52% of pulmonologists provided written action plans outlining what actions to take if PEFR or symptoms deteriorated. The majority of physicians were aware of positive benefits of patient education and over 80% stated that all asthmatic patients should be offered education. Only 32% felt that they should personally be educating the patients whilst two-thirds expressed a preference for the education to be provided by a specialist centre. 66% of the physicians expressed a desire to undertake further training in effective patient education.

CONCLUSION

Whilst most physicians in this study state to be aware of the benefits of patient education in asthma, only 24% actually provide their patients with asthma self-management plans. With a low response rate, our study is likely to be biased towards those physicians with a greater interest in asthma; hence actual use of self-management plans is likely be lower than in our sample.

Brominated flame retardants and other organobromines in Norwegian predatory bird eggs

A set of 62 unhatched eggs was collected from six different predatory bird species throughout Norway after incubation period was completed. They were analysed for PBDE, PBB, TBBP A and naturally occurring halogenated compounds. BDE 47, 99 and 153 were the dominating congeners, with species dependent PBDE patterns. BDE 153 was observed as the most abundant congener in eggs of peregrine falcon, golden eagle and merlin. The highest PBDE level (sum of nine congeners) was found in eggs of white-tailed sea eagle with up to 800ng/gww (median sumPBDE: 184ng/gww), followed by eggs of peregrine falcon and osprey (median sumPBDE: 155 and 105ng/gww, respectively). Golden eagle eggs showed the lowest concentration of all species (median sumPBDE: 3ng/gww). The levels in the peregrine falcon are similar to those found earlier in the Baltic region [Lindberg, P., Sellstrom, U., Haggberg, L., de Wit, C.A., 2004. Higher brominated diphenyl ethers and hexabromocyclododecane found in eggs of peregrine falcons (Falco peregrinus) breeding in Sweden. Environmental Science & Technology. 38 (1), 93-96]. The differences between species are not fully explainable, due to lack of data from the major food species. BB 101 and 153 were found in eggs of all investigated bird species. Especially in samples of white-tailed sea eagle, peregrine falcon and goshawk additional unknown penta- and hexabrominated biphenyls were detected. TBBP A was detected in all of eight eggs analysed sampled from four different bird of prey species. The naturally occurring halogenated compounds Q1, the dibromotrichloro monoterpene MHC-1, and 2,4,6-tribromoanisole (TBA) were detected in all of seven analysed samples except for one peregrine falcon egg.