[Guidelines for occupational asthma]

Prevalence of Work-Related Asthma in Primary Health Care: Study Rationale and Design

Background :

Occupational Asthma (OA) is the most frequent origin of occupational respiratory diseases in industrialized countries and accounts for between 5% and 25% of asthmatic patients. The correct and early diagnosis of OA is of great preventive and socio-economic importance. However, few studies exist on OA’s prevalence in Catalonia and in Spain and those affected are mainly treated by the public health services and not by the occupational health services, which are private.

Objective :

To determine the prevalence of OA in patients diagnosed with asthma in the Primary Healthcare system and to evaluate the socio-economic impact of OA in the Primary Healthcare system.

Methods/Design :

We will carry out an observational, transversal and multi-center study in the Primary Healthcare Service in the Barcelona region (Catalonia, Spain), with 385 asthmatic workers aged between 16 and 64 who are currently working or have been working in the past. We will confirm the asthma diagnosis in each patient, and those meeting the inclusion criteria will be asked to answer a questionnaire that aims to link asthma to the patient’s past employment history. The resulting diagnosis will be of either occupational asthma, work-aggravated asthma or common asthma. We will also collect socio-demographic information about the patients, about their smoking status, their exposure outside of the workplace, their work situation at the onset of the symptoms, their employment history, their symptoms of asthma, their present and past medical asthma treatment, and, in order to estimate the economic impact in the Primary Healthcare system, where they have been attended to and treated. Prevalence will link OA or work-aggravated asthma to the total of patients participating in the study with a asthma diagnosis.

Discussion :

The results will show the prevalence of OA and work-aggravated asthma, and shall provide valuable information to set out and apply the necessary personal and technical measures, either in the public or in the occupational health services. No studies evaluating the costs generated by the OA in the Primary Healthcare system have been carried out.

Public facility workers' immunological characteristics involved with development of respiratory allergic diseases in Korea

We evaluated the immuno-pulmonary status of employees working at public facilities to determine whether they are at greater risk of developing respiratory allergies. Fifty-two employees from child daycare centers, elderly nursing homes, subway stations, and hypermarkets, and 17 office workers were recruited. All were subjected to a skin prick test (SPT) for 25 aeroallergens and the methacholine bronchial challenge test. Various immunological parameters, including plasma IgE and IgG4 levels, hematology parameters, and in vitro cytokine production from peripheral T cells, were assessed. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also determined. Of the facility employees, 54% responded to the SPT, and house dust mite induced positive skin reactions most frequently. Compared to the SPT-negative facility employees and the office workers, the SPT-positive facility employees had upregulated plasma IgE levels and eosinophil frequency in their peripheral blood. Their peripheral T cells also showed elevated IL-4 production relative to IFNgamma production. Four public facility employees who reacted to the methacholine challenge test had elevated eosinophil frequencies, increased plasma IgE levels, and lowered FEV1/FVC values. This study suggests that workers at public facilities could show greater risk towards the development of respiratory allergic diseases.

[Written information on the use of aerosols in COPD patients. Can we improve their use?]

OBJECTIVES

To determine whether the use of written information alone improved inhalation technique with pressurized canister inhalers in patients with chronic obstructive pulmonary disease (COPD). To compare the effectiveness of written information versus verbal explanation provided by nursing personnel on the use of inhalers.

DESIGN

Interventional study.

SETTING

Urban health center.

PARTICIPANTS

120 patients with COPD treated with pressurized canister inhalers.

INTERVENTIONS

The participants were divided randomly into three groups of 40 patients each. In one group no intervention was used, in the second group verbal explanations were provided, and in the third group written information was provided.

MAIN MEASURES

We recorded percentage compliance with 5 criteria for the correct use of inhalers at the start of the study and 3 months after the intervention in all groups.

RESULTS

Initially, performance of the inhalation technique by patients with COPD was poor (mean compliance 40%). Performance improved significantly in both intervention groups, with no significant difference between them. Final mean compliance was 74% in the written information group and 82% in the verbal information group.

CONCLUSIONS

The use of written information about the use of inhalers for patients with COPD significantly improved utilization to a degree similar to that obtained with verbal explanations.

[Evaluation of theory-practice knowledge on inhalation systems in primary care physicians, post-graduates in training and undergraduates]

OBJECTIVE

To find the theoretical and practical knowledge concerning inhalation systems of primary care doctors, postgraduates in training--family & community medicine (FCM) residents--and undergraduates who had passed their course in pneumology.

DESIGN

Crossover, descriptive study.

SETTING

FCM teaching unit of the Puerta del Mar Hospital (Cadiz), the Cadiz Faculty of Medicine and seven primary care centres on the Bay of Cadiz.

PARTICIPANTS

31 practising primary care doctors, 25 third-year FCM residents and 31 medical students were evaluated.

MEASUREMENTS AND MAIN RESULTS

A thirteen-point questionnaire was used to evaluate the subjects theoretical knowledge of inhalation systems. The percentage of correct replies was used to establish reply levels. Their techniques of handling different systems of inhalation (pressurised cartridge, pressurised cartridge with spacing chamber, Turbuhaler and Accuhaler) were assessed according to the guidelines of the SEPAR (Spanish Society of Pneumology and Thoracic Surgery). 26% of the practising doctors and residents answered over 75% of the questionnaire correctly, with no significant differences between the two groups (p > 0.66). No undergraduate reached 75% of correct answers. After exclusion of asthmatic participants, three of the practising doctors (9.7%) and one of the residents (4.8%) performed the technique correctly with the four systems: there were no differences between the two groups (p > 0.87). No undergraduate performed them satisfactorily.

CONCLUSIONS

Specific training for primary care doctors in handling inhalation therapy is recommended.