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Le Mao R, Tromeur C, Lacut K, Couturaud F, Foucaud J, Leroyer C. [Patient expectations in asthma care]. Rev Mal Respir 2021; 38:514-523. [PMID: 34020836 DOI: 10.1016/j.rmr.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
Asthma, a common chronic disease characterized by variable levels of severity, requires patient-centered management to achieve the best health outcomes. Studies have highlighted the gap between consensus management recommendations and patient goals, which represent a potential source of therapeutic wandering and of poor compliance. Patient expectations are continually evolving and are dependent on knowledge, feelings and individual experience. From this perspective, listening carefully to patients and caregivers makes it easier to exchange views and define common goals. The active participation of patients at all levels of decision-making and transmission of information may improve asthma control and other quality of life parameters.
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Affiliation(s)
- R Le Mao
- EA 3878, CIC Inserm 1412, département de médecine interne, vasculaire et Pneumologie, université de Bretagne Occidentale, centre hospitalo-universitaire de Brest, Brest, France
| | - C Tromeur
- EA 3878, CIC Inserm 1412, département de médecine interne, vasculaire et Pneumologie, université de Bretagne Occidentale, centre hospitalo-universitaire de Brest, Brest, France
| | - K Lacut
- EA 3878, CIC Inserm 1412, département de médecine interne, vasculaire et Pneumologie, université de Bretagne Occidentale, centre hospitalo-universitaire de Brest, Brest, France
| | - F Couturaud
- EA 3878, CIC Inserm 1412, département de médecine interne, vasculaire et Pneumologie, université de Bretagne Occidentale, centre hospitalo-universitaire de Brest, Brest, France
| | - J Foucaud
- Laboratoire éducations et pratiques de santé (UR 3412), université Sorbonne Paris Nord, Paris, France
| | - C Leroyer
- EA 3878, CIC Inserm 1412, département de médecine interne, vasculaire et Pneumologie, université de Bretagne Occidentale, centre hospitalo-universitaire de Brest, Brest, France.
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Grosbois JM, Fry S, Tercé G, Wallaert B, Chenivesse C. [Physical activity and pulmonary rehabilitation in adults with asthma]. Rev Mal Respir 2021; 38:382-394. [PMID: 33744072 DOI: 10.1016/j.rmr.2021.02.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022]
Abstract
Physical activity is reduced in people with asthma compared to the general population, especially in situations where patients have uncontrolled asthma symptoms, persistent airflow obstruction and other long-term medical problems, in particular obesity and anxiety. Exertional dyspnea, which is of multifactorial origin, is the main cause of reduced physical activity reduction and draws patients into a vicious circle further impairing quality of life and asthma control. Both the resumption of a regular physical activity, integrated into daily life, adapted to patients' needs and wishes as well as physical and environmental possibilities for mild to moderate asthmatics, and pulmonary rehabilitation (PR) for severe and/or uncontrolled asthmatics, improve control of asthma, dyspnea, exercise tolerance, quality of life, anxiety, depression and reduce exacerbations. A motivational interview to promote a regular programme of physical activity in mild to moderate asthma (steps 1 to 3) should be offered by all health professionals in the patient care pathway, within the more general framework of therapeutic education. The medical prescription of physical activities, listed in the Public Health Code for patients with long-term diseases, and pulmonary rehabilitation should be performed more often by specialists or the attending physician. Pulmonary rehabilitation addresses the needs of severe asthma patients (steps 4 and 5), and of any asthmatic patient with poorly controlled disease and/or requiring hospitalized for acute exacerbations, regardless of the level of airflow obstruction, and/or with associated comorbidities, and before prescribing biological therapies.
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Affiliation(s)
- J-M Grosbois
- FormAction Santé, zone d'activité du bois, rue de Pietralunga, 59840 Pérenchies, France; CH Béthune, service de réadaptation respiratoire et de pneumologie, 62400 Béthune, France; Alvéole, groupe de travail de la SPLF, exercice et réadaptation respiratoire, 75006 Paris, France.
| | - S Fry
- CHU Lille, service de pneumologie et immuno-allergologie, université Lille, institut Pasteur de Lille, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), 59000 Lille, France; CRISALIS, F-CRIN INSERM network, Lille, France
| | - G Tercé
- CH Béthune, service de réadaptation respiratoire et de pneumologie, 62400 Béthune, France
| | - B Wallaert
- Alvéole, groupe de travail de la SPLF, exercice et réadaptation respiratoire, 75006 Paris, France; CHU Lille, service de pneumologie et immuno-allergologie, université Lille, institut Pasteur de Lille, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), 59000 Lille, France
| | - C Chenivesse
- CHU Lille, service de pneumologie et immuno-allergologie, université Lille, institut Pasteur de Lille, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), 59000 Lille, France; CRISALIS, F-CRIN INSERM network, Lille, France
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- Alvéole, groupe de travail de la SPLF, exercice et réadaptation respiratoire, 75006 Paris, France
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Bassam M, Behbehani N, Farouk H, Alsayed M, Montestruc F, Al-Jahdali H, Iqbal MN, Al Zaabi A. Adherence to medication among adult asthma patients in the Middle East and North Africa: results from the ESMAA study. Respir Med 2020; 176:106244. [PMID: 33253971 DOI: 10.1016/j.rmed.2020.106244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Low levels of adherence to asthma medication is reported in many countries worldwide. Improved knowledge of adherence in the Middle East and North Africa (MENA) is needed to address this major public healthcare burden. OBJECTIVE Assess the level of adherence in patients attending a routine consultation and the relationship between adherence, patient/disease characteristics, disease control, and quality of life. METHODS A large-scale cross-sectional epidemiological study was performed on adults suffering from asthma for at least 1 year and without an acute asthma episode within 4 weeks. Adherence was assessed using the MMAS-4 questionnaire©. Predictive factors of adherence were analyzed with logistic regressions. RESULTS Overall 7203 eligible patients were included in 577 sites. Mean age was 45.4 years (±14.7), 57.2% were female, mean BMI was 28.5 kg/m2 (±6.0), and 11% were active smokers. Good adherence was observed in 23.6% with a country effect (p < 0.001). Higher age, higher SF-8 Mental component score, and high level of control were associated with good adherence (p < 0.001). Patients treated with a fixed combination (ICS + LABA) have better adherence and patients treated with short-acting beta agonist alone have a lower adherence. Good adherence has been noted in 528 uncontrolled patients suggesting the existence of a subgroup difficult to treat and who have severe asthma. CONCLUSIONS Asthma adherence in the MENA is unsatisfactory with less than one quarter of asthma patients having good adherence. This finding highlights the need to improve access to treatment, ensure better control follow-up and improved education among healthcare providers and patients.
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Affiliation(s)
- Mahboub Bassam
- University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates.
| | - Naser Behbehani
- Department of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait.
| | - Hisham Farouk
- AstraZeneca, Ibn Sina Building, Dubai Healthcare City, PO Box 505070, Dubai, United Arab Emirates
| | - Mohamed Alsayed
- AstraZeneca, Ibn Sina Building, Dubai Healthcare City, PO Box 505070, Dubai, United Arab Emirates
| | | | - Hamdan Al-Jahdali
- King Saud University for Health Sciences/McGill University/Sleep Disorders Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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Hannane A, Misane L, Devouassoux G, Colin C, Letrilliart L. Asthma patients' perception on their care pathway: a qualitative study. NPJ Prim Care Respir Med 2019; 29:9. [PMID: 30940806 PMCID: PMC6445145 DOI: 10.1038/s41533-019-0121-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/04/2019] [Indexed: 01/29/2023] Open
Abstract
Because of insufficient asthma control in many patients, the collaboration between stakeholders is regarded as a promising strategy to improve asthma outcomes. This study explored the perceptions of French adult asthma patients on their care pathway. We conducted a qualitative study based on the interviews of 30 asthma patients aged 18–40 years, recruited in French primary care. We performed a thematic analysis of the data collected, using the NVivo software. According to the patients, the stakeholders involved in asthma management included those visible to healthcare professionals (patient, general practitioner, specialist(s), pharmacist, physiotherapist, family and friends) and those concealed by the patients (complementary and alternative practitioners); other stakeholders, such as nurses and occupational physicians, were not involved. Asthma management at diagnosis and follow-up phases proved to be unstructured, and were associated with poor patient education. This was supported by patients’ ambivalence (in relation to illness and treatments), poor communication between patients and healthcare professionals (lack of listening and use of inappropriate vocabulary by physicians, underreporting of alternative medicine use by patients) and weak cooperation between professionals (limited to interaction between the general practitioner and the specialist, either pulmonologist or allergist). Asthma management would probably benefit from a more coordinated care pathway at each phase of the disease that is consistent with the expectations and goals of the patients. It should be based on improved organization (involvement of other healthcare professionals and the patient as partners) and processes (regular follow-up, specific tools such as peak flow meter or action plan).
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Affiliation(s)
- Anissa Hannane
- Univ. Lyon, Université Claude Bernard Lyon 1, Collège universitaire de médecine générale, F-69008, Lyon, France
| | - Lilia Misane
- Univ. Lyon, Université Claude Bernard Lyon 1, Collège universitaire de médecine générale, F-69008, Lyon, France
| | - Gilles Devouassoux
- Univ. Lyon, Université Claude-Bernard Lyon 1, Lyon, F-69008, France.,Hôpital de la Croix-Rousse, Service de pneumologie, Hospices Civils de Lyon, Lyon, France
| | - Cyrille Colin
- Unité d'Evaluation Médico-Economique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, 69003, Lyon, France.,Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
| | - Laurent Letrilliart
- Univ. Lyon, Université Claude Bernard Lyon 1, Collège universitaire de médecine générale, F-69008, Lyon, France. .,Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.
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Deccache A, Didier A, Mayran P, Jeziorski A, Raherison C. [Asthma: Adapting the therapeutic follow-up according to the medical and psychosocial profiles]. Rev Mal Respir 2018; 35:313-323. [PMID: 29602481 DOI: 10.1016/j.rmr.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/17/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION This work is based on the data of REALISE™, a survey conducted among 8000 European patients to identify the profiles of adult asthma patients and how these are linked with treatment adherence behaviors. METHODS A cluster analysis was performed by combining data in three ways: control of asthma, attitude towards the disease, compliance with treatment. A multidisciplinary group analyzed the results for the 1024 French survey respondents. RESULTS Four patient profiles were identified: "rather confident" (28% of patients), rather young patients with a low level of concern about their asthma. "Rather committed" (23%) patients considering themselves to be mostly healthy, reporting better therapeutic declared. "Rather questing" (26%), patients poorly controlled, seeking to manage their asthma themselves. "Rather concerned" profile (23%), a bit older, with poor clinical control, considering their asthma to be severe. CONCLUSIONS Cluster analysis provides a multidimensional approach to understand the therapeutic behavior of the different patient profiles better and so adjust communication by and education of healthcare professionals.
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Affiliation(s)
- A Deccache
- Université catholique de Louvain, 1200 Bruxelles, Belgique.
| | - A Didier
- Pôle des voies respiratoires, CHU de Toulouse, 31059 Toulouse, France
| | - P Mayran
- Éditions PM Santé, Garches, 92380 France
| | - A Jeziorski
- Laboratoires Mundipharma, 75015 Paris, France
| | - C Raherison
- U1219, service des maladies respiratoires, université de Bordeaux, CHU de Bordeaux, 33076 Bordeaux, France
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