[Attitude changes needed to foster treatment adherence in patients with asthma]

Follow-up of patients with uncontrolled asthma: clinical features of asthma patients according to the level of control achieved (the COAS study)

Our aim was to study the asthma control achieved in patients with uncontrolled asthma who had received appropriate treatment according to the Global Initiative for Asthma (GINA) 2010 (valid at the time the study was designed), and to analyse the factors associated with a lack of asthma control.This was a multicentre study in routine clinical practice performed in patients with uncontrolled asthma according to GINA 2010. At visit 1, we recorded demographics, asthma characteristics and spirometry. We assessed asthma control using GINA 2010 criteria and the Asthma Control Test (ACT). Treatment was optimised according to GINA 2010. At visit 2, 3 months later, we reassessed spirometry, asthma control and factors associated with failure to achieve control.We recruited 1299 patients with uncontrolled asthma (mean age 46.5±17.3 years, 60.7% women, 25.8% obese). The mean percentage of predicted forced expiratory volume in 1 s was 76.4±12.8% and the mean post-bronchodilator increase was 14.9±6.8%. We observed poor agreement between ACT and GINA 2010 when evaluating asthma control (kappa = -0.151). At visit 2, asthma in 71.2% of patients was still not fully controlled. Patients whose asthma remained uncontrolled were older, had a higher body mass index, greater disease severity, longer disease evolution and worse lung function.After treatment optimisation, most patients did not achieve optimal control according to GINA 2010. Risk factors for failure to achieve asthma control were time of disease evolution, severity, age, weight and lung function impairment (excluded in the GINA 2014).

[Use of the reliable change index to evaluate the effectiveness of clinical interventions: Application of an asthma training program]

OBJECTIVE

To compare two methods for the evaluation of outcomes to assess effectiveness of a therapeutic intervention of a professional education program on asthma control.

DESIGN

A naturalistic, intervention study in which asthmatic patients were attended by clinicians (IG group) who Had taken part in a special education program and a control group (CG) that received medical assistance from clinicians still waiting to be trained.

LOCATION

Five urban Primary Care Health Centres of the same region.

PARTICIPANTS

From an initial sample of 100 patients, 76 formed the final sample for analysis. The study included 37 males and 39 females, aged between 18 and 65 years (M=41.2 years). The two study groups were found to be homogeneous except for the sex variable.

INTERVENTION

Training program for clinical treatment adherence.

MAIN MEASUREMENTS

Peak flow as spirometric index, and structured interview.

STATISTICAL ANALYSIS

The results were initially analysed using classical techniques based on robust ANOVA models, and then by calculating the Reliable Change Index (RCI).

RESULTS

ANOVA models, conducted separately for each sex, showed no significant differences, due to sample size. RCI methodology showed significant differences in the percentage of patients improved in both groups, as well as clinically relevant changes being observed individually.

CONCLUSIONS

The RCI method is presented as an attractive alternative as regards the classical methods of analysis that can help in the clinical decision.

[Knowledge, attitudes and perceptions of the Latin-American immigrant population of tuberculosis in the Community of Madrid]

OBJECTIVE

To identify the knowledge, attitudes and perceptions held by the Latin-American population on tuberculosis, after being discharged from hospital in the Community of Madrid.

DESIGN

Cross-sectional study.

SETTING

Community of Madrid.

PARTICIPANTS

Non-institutionalised Latin-American population over 15 years old, diagnosed with tuberculosis during the year 2003 (1st January-31st December).

MEASUREMENTS

A descriptive study and an analytical study were performed. The measure of association used was the odds ratio (OR) and 95% confidence intervals (95% CI), which were calculated by unconditional logistic regressions, using univariate and multivariate models. The dependent variables: to have correct knowledge of the disease and its treatments.

INDEPENDENT VARIABLES

sociodemographic indicators (sex, education level, age) and clinical variables (case definition, location of the disease).

RESULTS

A high percentage had correct knowledge of the disease (77.3%), its transmission (94.7%) and treatment (77.3%). An extra-pulmonary location was associated with a lower level of knowledge of the general characteristics of tuberculosis [OR (95% CI), 0.21 (0.05-0.85)] and its transmission [OR (95% CI) 0.05 (0-0.66)]. A high percentage of the population identified erroneous transmission routes, such as blood (42.3%); sexual fluids (50%), or utensils used for eating (81.3%).

CONCLUSIONS

After hospital discharge, a high percentage has correct knowledge about the disease, although there is a high prevalence of erroneous beliefs on its transmission. These beliefs must be taken into account in the information given to patients, since it could increase the stigmatisation and vulnerability of the patient.