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Varkonyi-Sepp J, Freeman A, Ainsworth B, Kadalayil LP, Haitchi HM, Kurukulaaratchy RJ. Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome. J Pers Med 2022; 12:1435. [PMID: 36143220 PMCID: PMC9500722 DOI: 10.3390/jpm12091435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Three to ten percent of people living with asthma have difficult-to-treat asthma that remains poorly controlled despite maximum levels of guideline-based pharmacotherapy. This may result from a combination of multiple adverse health issues including aggravating comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence that may individually or collectively contribute to poor asthma control. Many of these are potentially "treatable traits" that can be pulmonary, extrapulmonary, behavioural or environmental factors. Whilst evidence-based guidelines lead clinicians in pharmacological treatment of pulmonary and many extrapulmonary traits, multiple comorbidities increase the burden of polypharmacy for the patient with asthma. Many of the treatable traits can be addressed with non-pharmacological approaches. In the current healthcare model, these are delivered by separate and often disjointed specialist services. This leaves the patients feeling lost in a fragmented healthcare system where clinical outcomes remain suboptimal even with the best current practice applied in each discipline. Our review aims to address this challenge calling for a paradigm change to conceptualise difficult-to-treat asthma as a multimorbid condition of a "Difficult Breathing Syndrome" that consequently needs a holistic personalised care attitude by combining pharmacotherapy with the non-pharmacological approaches. Therefore, we propose a roadmap for an evidence-based multi-disciplinary stepped care model to deliver this.
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Affiliation(s)
- Judit Varkonyi-Sepp
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical Health Psychology Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Anna Freeman
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Ben Ainsworth
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Department of Psychology, University of Bath, Bath BA2 7AY, UK
| | - Latha Perunthadambil Kadalayil
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Hans Michael Haitchi
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - Ramesh J. Kurukulaaratchy
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- The David Hide Asthma & Allergy Research Centre, St Mary’s Hospital, Isle of Wight, Newport PO30 5TG, UK
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Long-term systemic glucocorticoid therapy: Patients’ representations, prescribers’ perceptions, and treatment adherence. Joint Bone Spine 2014; 81:64-8. [DOI: 10.1016/j.jbspin.2013.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 11/22/2022]
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Estes TS. Moving towards effective chronic illness management: asthma as an exemplar. Chron Respir Dis 2011; 8:163-70. [PMID: 21799082 DOI: 10.1177/1479972311412251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The United States health care system is at a pivotal point in its ability to manage chronic illness. The demands and philosophical differences between the management of acute and chronic illnesses suggest the need for different strategies for effective and efficient management of chronic illness. The purpose of this article is to discuss the Chronic Care Model and the collaborative approach to managing chronic illnesses. Asthma, as an exemplar, will be used to illustrate the need for the development of new models of collaborative care for the treatment of chronic illnesses.
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Affiliation(s)
- Tracy S Estes
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, USA.
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Ring N, Jepson R, Hoskins G, Wilson C, Pinnock H, Sheikh A, Wyke S. Understanding what helps or hinders asthma action plan use: a systematic review and synthesis of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2011; 85:e131-e143. [PMID: 21396793 DOI: 10.1016/j.pec.2011.01.025] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 01/20/2011] [Accepted: 01/23/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To understand better what helps and/or hinders asthma action plan use from the professionals and patients/carers perspective. METHODS Systematic review and qualitative synthesis (using meta-ethnography). RESULTS Nineteen studies (20 papers) were included in an analysis of patients/carers' and professionals' views. Seven main influences on action plan implementation were identified including perceived un-helpfulness and irrelevance of the plans. Translation and synthesis of the original authors' interpretations suggested that action plan promotion and use was influenced by professional and patient/carers' asthma beliefs and attitudes and patient/carer experiences of managing asthma. Action plan use is hindered because professionals and patients/carers have different explanatory models of asthma, its management and their respective roles in the management process. Patients/carers, based on their experiential knowledge of their condition, perceive themselves as capable, effective in managing their asthma, but health professionals do not always share this view. CONCLUSION Professionally provided medically focused action plans that do not 'fit' with and incorporate the patients'/carers' views of asthma, and their management strategies, will continue to be under-utilised. PRACTICE IMPLICATIONS Professionals need to develop a more patient-centred, partnership-based, approach to the joint development and review of action plans, recognising the experiential asthma knowledge of patients/carers.
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Affiliation(s)
- Nicola Ring
- Alliance for Self-Care Research, School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK.
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A children's asthma education program: Roaring Adventures of Puff (RAP), improves quality of life. Can Respir J 2011; 17:67-73. [PMID: 20422062 DOI: 10.1155/2010/327650] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It is postulated that children with asthma who receive an interactive, comprehensive education program would improve their quality of life, asthma management and asthma control compared with children receiving usual care. OBJECTIVE To assess the feasibility and impact of 'Roaring Adventures of Puff' (RAP), a six-week childhood asthma education program administered by health professionals in schools. METHODS Thirty-four schools from three health regions in Alberta were randomly assigned to receive either the RAP asthma program (intervention group) or usual care (control group). Baseline measurements from parent and child were taken before the intervention, and at six and 12 months. RESULTS The intervention group had more smoke exposure at baseline. Participants lost to follow-up had more asthma symptoms. Improvements were significantly greater in the RAP intervention group from baseline to six months than in the control group in terms of parent's perceived understanding and ability to cope with and control asthma, and overall quality of life (P<0.05). On follow-up, doctor visits were reduced in the control group. CONCLUSION A multilevel, comprehensive, school-based asthma program is feasible, and modestly improved asthma management and quality of life outcomes. An interactive group education program offered to children with asthma at their school has merit as a practical, cost-effective, peer-supportive approach to improve health outcomes.
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Charles C, Ninot G, Sultan S. [Patients'illness perceptions and adherence to treatment with inhaled corticosteroids in asthma]. Rev Mal Respir 2011; 28:626-35. [PMID: 21645833 DOI: 10.1016/j.rmr.2010.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 11/13/2010] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Regular use of inhaled corticosteroids as preventive treatment of asthma is an integral part of management but remains inadequate among adults. Studying the perceptions of illness and treatment beliefs is one way to understand the patient's adherence to medication. METHOD A systematic review was performed of empirical studies in adults published between 1999 and 2009, and indexed in the Pubmed, PsycInfo and Scopus databases. We investigated the associations between (1) perceptions of asthma and treatment beliefs and (2) adherence to inhaled corticosteroids. Eighteen articles meet these criteria. RESULTS Perception of the chronicity of asthma and its consequences on daily life, as well as the concept that it is necessary to continue treatment in the absence of symptoms, are associated with better adherence. On the contrary, fear of side effects and the belief that treatment is ineffective in controlling symptoms, are associated with poor adherence. CONCLUSION Patients' perceptions of asthma and inhaled corticosteroids are predictors of adherence to treatment. The identification and discussion of these issues is an essential part of building a therapeutic relationship that facilitates adherence.
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Affiliation(s)
- C Charles
- Institut de Cancérologie Gustave-Roussy, 39 Rue Camille-Desmoulins, 94805 Villejuif, France.
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Préau M, Leport C, Salmon-Ceron D, Carrieri P, Portier H, Chene G, Spire B, Choutet P, Raffi F, Morin M. Health-related quality of life and patient–provider relationships in HIV-infected patients during the first three years after starting PI-containing antiretroviral treatment. AIDS Care 2010; 16:649-61. [PMID: 15223534 DOI: 10.1080/09540120410001716441] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this study was to investigate factors associated with better health-related quality of life (HRQL) during the first three years after starting PI-containing antiretroviral treatment. Clinical, social and behavioural data from the APROCO cohort enabled us to analyze simultaneously the association between HRQL and patients' relationships with their health care providers. A self-administered questionnaire collected information about HRQL (MOS-SF36) and relationships with medical staff (trust and satisfaction with information). Two aggregate scores, the physical (PCS) and mental (MCS) component summaries (adjusted for baseline HRQL), were used as dependent variables in the linear regressions to identify factors associated with HRQL. We had complete longitudinal data for 360 of the 611 patients followed through M36. Factors independently associated with a high MCS were (male) gender, no more than one change in treatment, (few) self-reported symptoms and trust in the physician. Factors independently associated with high PCS levels were employment, no children, (few) self-reported symptoms and satisfaction with the information and explanations provided by the medical staff. These results underline the need to improve patient-provider relationships to optimize long-term HRQL. Socio-behavioural interventions should focus on this goal.
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Affiliation(s)
- M Préau
- INSERM U379/ORS,Marseille and University Aix-Marseille, Aix en Provence, France.
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Goeman DP, O'Hehir RE, Jenkins C, Scharf SL, Douglass JA. 'You have to learn to live with it': a qualitative and quantitative study of older people with asthma. CLINICAL RESPIRATORY JOURNAL 2010; 1:99-105. [PMID: 20298288 DOI: 10.1111/j.1752-699x.2007.00033.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Asthma mortality has declined overall because of a range of public health initiatives. In western countries, the majority of asthma deaths now occur in people over the age of 50. The reasons for the poorer response of older age groups to public health asthma initiatives are not known. OBJECTIVES We undertook a study to investigate the disease perspectives of older people with asthma and barriers which may exist and prevent optimal asthma care. METHODS Fifty-five participants (16 male and 39 female) aged over 50 from an inner city, suburban area and a rural region were recruited. Lung function was measured, and questionnaire data on asthma symptoms, knowledge and control, medication use and respiratory health were collected. Participants were also interviewed in-depth, and the quantitative and qualitative data were triangulated. RESULTS Participants with a duration of asthma for >30 years reported significantly fewer symptoms and better quality of life irrespective of asthma severity, indicating less appreciation of symptoms in those with a long asthma duration. Interviews revealed this was related to previous asthma management strategies when treatment options were limited. Participants with a recent diagnosis sought understanding of asthma and the reason for their illness. Initiatives to improve asthma care in older people need to reflect these findings. CONCLUSIONS Self-management strategies for older people need to be tailored according to the time of disease onset and the duration of disease.
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Affiliation(s)
- Dianne P Goeman
- Co-operative Research Centre for Asthma and Airways, Camperdown, Sydney, NSW, Australia, 2000.
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Bolman C, Arwert TG, Völlink T. Adherence to prophylactic asthma medication: habit strength and cognitions. Heart Lung 2010; 40:63-75. [PMID: 20561874 DOI: 10.1016/j.hrtlng.2010.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 01/20/2010] [Accepted: 02/09/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explain adherence to prophylactic asthma medication (PAM, inhaled corticosteroids) by the attitude, social influence, and self-efficacy (ASE) model added with the concept of habit strength and to study whether habit moderates or mediates relationships between ASE factors and adherence. METHODS A mail-out survey was conducted among 139 asthmatic adults. Multiple regression analysis was conducted, with self-reported adherence as the outcome and ASE factors and habit as the independent variables. Simple slope analyses and bootstrapping mediation analyses were also conducted. RESULTS Having more severe asthma, taking PAM habitually, and perceiving few negative consequences of taking PAM were associated with better adherence. Self-efficacy influenced adherence indirectly through habit. The relationship between social norms and adherence was moderated by habit: In the case of weak habits, a supportive norm in a patient's environment toward taking PAM was positively related to PAM adherence; in the case of strong habits, a supportive norm led to less adherence. CONCLUSION Interventions to increase adherence should enhance the formation of habits by stimulating patients to perform the behavior frequently in similar situations by increasing self-efficacy and providing environmental cues, such as reminder devices and pill organizers. In addition, the disadvantages of PAM use should be negated.
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Affiliation(s)
- Catherine Bolman
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands.
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Ross CJM, Williams BA, Low G, Vethanayagam D. Perceptions about self-management among people with severe asthma. J Asthma 2010; 47:330-6. [PMID: 20394519 DOI: 10.3109/02770901003611462] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The purpose of this study was to explore the perceptions about self-management among people who were being followed up in a severe asthma clinic by asthma specialists for confirmed, overall severe asthma. Such insight informs how best to tailor programs for this difficult to treat patient population. METHOD In-depth tape-recorded interviews of eight adults with severe asthma were transcribed and analyzed for salient themes using content analysis. RESULTS To self-manage their illness, over time participants sought asthma information from a variety of sources that they often viewed as inadequate due to lack of scope and or plain language. The most valued sources of asthma information were encountered after referral to an asthma specialist and were health professionals and a pulmonary rehabilitation program. CONCLUSION There is a need to examine the content of asthma information sources for their relevance to and influence on the behavior of patients with severe asthma.
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Walker HA, Chen E. The impact of family asthma management on biology: a longitudinal investigation of youth with asthma. J Behav Med 2010; 33:326-34. [PMID: 20373008 DOI: 10.1007/s10865-010-9258-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 03/05/2010] [Indexed: 10/19/2022]
Abstract
This study examined longitudinal associations of asthma management-related beliefs and behaviors with changes in asthma-relevant biological markers in a sample of 43 children with asthma. Children (M age = 12.4, 75% male) and parents were interviewed about asthma management beliefs and behaviors. Asthma outcomes included lung function (FEV(1)%), eosinophil counts, and daily cortisol measured at two time points, 18 months apart. Children with a less sophisticated disease belief (termed the "no symptoms, no asthma" belief) displayed eosinophil counts that increased over time, controlling for baseline levels. Poorer family asthma management was associated with increasing eosinophil counts over time. Poorer child asthma management was associated with cortisol output that declined over time. Further, families who reported poorer collaboration with their physician had children who displayed worsening lung function over time. These findings suggest that interventions aimed at teaching families better asthma management approaches and more accurate disease beliefs may have the potential to alter biological profiles in children with asthma.
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Affiliation(s)
- Hope A Walker
- Department of Psychology, University of Victoria, Victoria, Canada.
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