Practical considerations for managing asthma in adults

Randomized controlled trial of two forms of self-management group education in Japanese people with impaired glucose tolerance

The aim of this study was to determine the effectiveness of education on diabetes prevention in subjects with impaired glucose tolerance. A total of 100 subjects of impaired glucose tolerance with hemoglobin A1c (HbA1c) levels ≥5.5 to <6.1% were assigned randomly to either support or control groups. All subjects received education in 8 sessions over a 6-month period. The support group consisted of 10 members collaborating with a dietitian or a nurse who learned coping skills by employing a participant-centered approach. Participants in the support group were required to keep a diary that monitored weight, food intake and blood glucose levels, while the control group attended several lectures. Subjects assigned to the support group had a reduction in mean HbA1c levels from 5.77 ± 0.36% at baseline to 5.39 ± 0.24% at the endpoint (p<0.01). Weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels also decreased (p<0.01) in the support group, whereas subjects in the control group had no observable reduction in these indices. After intervention, participants of the support group had improvements in their 2-h post-meal blood glucose levels. Support group education can be effective for improving glycemic control in participants when carried out in collaboration with educators and other team members.

Monitoring pulmonary function in asthma and COPD: point-of-care testing

OBJECTIVE

To provide pharmacists and other healthcare providers with a better understanding of new monitoring technologies for asthma and chronic obstructive pulmonary disease (COPD) available to clinics and pharmacies.

DATA SOURCES

Forty scientific articles were identified through a MEDLINE search (1990-June 2003), additional references listed in articles, and abstracts from scientific meetings.

STUDY SELECTION AND DATA EXTRACTION

English-language literature of controlled human clinical studies was reviewed to evaluate the accuracy, reliability, validity, and response of the new monitoring technologies.

DATA SYNTHESIS

The In-Check DIAL is a pulmonary airflow meter that identifies the most appropriate inhaler for a patient and is useful in determining how efficiently patients use their inhalers. Electronic peak flow meters such as the AirWatch, VMX Wright Mini-Log, PiKo-1, and electronic asthma monitor store and download multiple pulmonary function test (PFT) readings to a personal computer, allowing easy identification of patients who are fabricating results. The AirWatch also has the ability to measure forced expiratory volume in 1 second. The Spirophone AG-SP, VM Plus, and Micro DiaryCard spirometer are portable spirometers that can be used at home without the need for supervision. Bronchial challenge tests have been recently standardized and may prove to be beneficial in modifying drug therapy in patients with asthma and COPD.

CONCLUSIONS

Despite recent advances in medical technology, monitoring of asthma and COPD has not changed significantly. PFTs continue to be the gold standard for evaluating airway obstruction and/or restriction. Clinical trials that will evaluate outcomes such as decreased number of hospitalizations, emergency department visits, unscheduled visits to physicians, and days absent from school or work are needed to determine the utility of new monitoring technologies.

Scope of the COPD problem in North America: early studies of prevalence and NHANES III data: basis for early identification and intervention

COPD is a common disease that is often not diagnosed in the primary-care setting. This review highlights the findings of studies ranging from the early 1960s to the third National Health and Nutrition Examination Survey (NHANES III) study, undertaken to try and accurately estimate the prevalence of COPD in the US population. Results of the NHANES III indicate that COPD remains frequently underdiagnosed, and that spirometry should be more widely used in the primary-care setting to identify asymptomatic disease. Early intervention, in particular smoking cessation, could alter the course and outcome of disease in patients with COPD.