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Başa Akdoğan B, Koca Kalkan I, Köycü Buhari G, Özdedeoğlu Ö, Ateş H, Aksu K, Öner Erkekol F. What is the Best Way to Diagnose Possible Asthma Patients with Negative Bronchodilator Reversibility Tests? J Asthma Allergy 2024; 17:113-122. [PMID: 38410137 PMCID: PMC10895991 DOI: 10.2147/jaa.s437756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
Objective The best method and strategy for the diagnosis of asthma remains unclear, especially in patients with negative bronchodilator reversibility test (BDRT). In our study, we aimed to investigate the diagnostic yield of peak expiratory flow (PEF) variability for this patient group. Methods A total of 50 patients with suspected asthma, all with negative BDR test, were included in the study. Demographic information and symptoms were recorded and PEF variability was monitored for 2 weeks. Metacolinbronchial provocation test (mBPT) was performed. Asthma was diagnosed when PEF variability ≥20% and/or positive mBPT was observed. Results 30 of 50 patients were diagnosed with asthma. After 1 month, 17 patients were evaluated for treatment outcomes. The sensitivity and specificity of PEF variability for different cut-off values (≥20%, >15% and >10%) were 61.5-83.3, 88.5-62.5 and 100-16.7, respectively. One of the most important findings of our study was the absence of variable airflow limitation or airway hyper reactivity in 39% patients with a previous diagnosis of asthma. Multiple logistic regression analysis revealed that a low baseline FEF25-75 value was an independent predictive factor for the diagnosis of asthma (p= 0.05). Conclusion The most efficient diagnostic test for asthma is still unclear due to many factors. Our study is one of the few studies on this subject. Although current diagnostic recommendations generally recommend a PEF variability of 10% for the diagnosis of asthma, this threshold may not be appropriate for the BDR-negative patient group. Our results suggest using a threshold value of <15% for PEF variability when excluding asthma and ≥20% when confirming the diagnosis of asthma in patients with clinically suspected but unproven reversibility. Furthermore, FEF25-75 is considered to be an important diagnostic parameter that should be included in diagnostic recommendations for asthma.
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Affiliation(s)
- Buket Başa Akdoğan
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Ilkay Koca Kalkan
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Gözde Köycü Buhari
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Özlem Özdedeoğlu
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Hale Ateş
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Kurtuluş Aksu
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Ferda Öner Erkekol
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
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2
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Sharma A, James A, Kapoor DN, Kaurav H, Sharma AK, Nagraik R. An insight into biosensing platforms used for the diagnosis of various lung diseases: A review. Biotechnol Bioeng 2024; 121:71-81. [PMID: 37661712 DOI: 10.1002/bit.28538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/08/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
Many of the infectious diseases are ubiquitous in nature and pose a threat to global and public health. The original cause for such type of serious maladies can be summarized as the scarcity of appropriate analysis and treatment methods. Pulmonary diseases are considered one of the life-threatening lung diseases that affect millions of people globally. It consists of several types, namely, asthma, lung cancer, tuberculosis, chronic obstructive pulmonary disease, and several respiratory-related infections. This is due to the limited access to well-equipped healthcare facilities for early disease diagnosis. This needs the availability of processes and technologies that can help to stop this harmful disease-diagnosing practice. Various approaches for diagnosing various lung diseases have been developed over time, namely, autopsy, chest X-rays, low-dose CT scans, and so forth. The need of the hour is to develop a rapid, simple, portable, and low-cost method for the diagnosis of pulmonary diseases. So nowadays, biosensors have been becoming one of the highest priority research areas as a potentially useful tool for the early diagnosis and detection of many pulmonary lung diseases. In this review article, various types of biosensors and their applications in the diagnosis of lung-related disorders are expansively explained.
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Affiliation(s)
- Avinash Sharma
- Faculty of Applied Sciences and Biotechnology, Shoolini University, Solan, Himachal Pradesh, India
| | - Abija James
- Faculty of Applied Sciences and Biotechnology, Shoolini University, Solan, Himachal Pradesh, India
| | - Deepak N Kapoor
- Faculty of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
| | - Hemlata Kaurav
- Faculty of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
| | - Abhishek Kumar Sharma
- Faculty of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, India
| | - Rupak Nagraik
- Faculty of Applied Sciences and Biotechnology, Shoolini University, Solan, Himachal Pradesh, India
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3
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Zhang X, Ellis A, Quint JK, Bottle A. Survey-identified experiences of prediagnosis and diagnosis process among patients with COPD, asthma, interstitial lung disease and bronchiectasis. BMJ Open Respir Res 2023; 10:e001588. [PMID: 37993278 PMCID: PMC10668245 DOI: 10.1136/bmjresp-2022-001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/31/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Diagnosis of asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and interstitial lung disease (ILD) can be convoluted, and limited data exist on understanding the experience of diagnosis from a patient perspective. AIM To investigate a patient's 'route to diagnosis', particularly focusing on the time prior to seeking healthcare, and perceived experiences of the diagnostic pathway. METHODS An online survey was distributed via the UK Taskforce for Lung Health and member mailing lists to patients as well as the website and social media accounts from 23 May 2022 to 5 July 2022. Analysis was descriptive; χ2 tests were performed to make comparisons across diseases. RESULTS There were 398 valid responses (COPD=156, asthma=119, ILD=67 and bronchiectasis=56). While only 9.2% of respondents who were eventually diagnosed with asthma had not heard of their disease, the corresponding percentages for COPD, ILD and bronchiectasis were 34.0%, 74.6% and 69.6%, respectively. 33.9% of people with bronchiectasis believed their delayed diagnosis was due to the health professionals' lack of expertise or knowledge-24.4% for asthma, 19.2% for COPD and 17.9% for ILD.People with COPD were more likely (37.2%) and patients with asthma less likely (10.9%) to report they did not know the signs of potential lung disease (p<0.001). People with COPD were more likely to report that they did not appreciate the severity or urgency of the situation (58.3%) than people with asthma (32.8%), ILD (43.3%) or bronchiectasis (28.6%, p<0.001). The proportion of patients reporting that they were being initially treated for another lung condition was higher in people with bronchiectasis (44.6%) and lower in people with asthma (8.4%, p<0.001). CONCLUSIONS Perceived reasons for diagnostic delay can help health professionals promote early diagnosis and management. Patients' limited knowledge of respiratory diseases also played a factor, indicating the necessity to promote patients' knowledge to encourage earlier help seeking.
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Affiliation(s)
- Xiubin Zhang
- School of Public Health, Imperial College, London, UK
| | | | | | - Alex Bottle
- School of Public Health, Imperial College, London, UK
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4
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Proposed Strategies to Improve Adult Asthma Management in Egypt: Expert Review and Recommendations. Ann Glob Health 2022; 88:103. [DOI: 10.5334/aogh.3782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022] Open
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5
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Canny A, Donaghy E, Murray V, Campbell L, Stonham C, Bush A, McKinstry B, Milne H, Pinnock H, Daines L. Patient views on asthma diagnosis and how a clinical decision support system could help: A qualitative study. Health Expect 2022; 26:307-317. [PMID: 36370457 PMCID: PMC9854294 DOI: 10.1111/hex.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/22/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Making a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient-facing mode, could change how information is shared between patients and healthcare professionals and improve the diagnostic process. METHODS Participants diagnosed with asthma within the last 5 years were recruited from general practices across four UK regions. In-depth interviews were used to explore patient experiences relating to their asthma diagnosis and to understand how a CDSS could be used to improve the diagnostic process for patients. Interviews were audio recorded, transcribed verbatim and analysed using a thematic approach. RESULTS Seventeen participants (12 female) undertook interviews, including 14 individuals and 3 parents of children with asthma. Being diagnosed with asthma was generally considered an uncertain process. Participants felt a lack of consultation time and poor communication affected their understanding of asthma and what to expect. Had the nature of asthma and the steps required to make a diagnosis been explained more clearly, patients felt their understanding and engagement in asthma self-management could have been improved. Participants considered that a CDSS could provide resources to support the diagnostic process, prompt dialogue, aid understanding and support shared decision-making. CONCLUSION Undergoing an asthma diagnosis was uncertain for patients if their ideas and concerns were not addressed by clinicians and were influenced by a lack of consultation time and limitations in communication. An asthma diagnosis CDSS could provide structure and an interface to prompt dialogue, provide visuals about asthma to aid understanding and encourage patient involvement. PATIENT AND PUBLIC CONTRIBUTION Prespecified semistructured interview topic guides (young person and adult versions) were developed by the research team and piloted with members of the Asthma UK Centre for Applied Research Patient and Public Involvement (PPI) group. Findings were regularly discussed within the research group and with PPI colleagues to aid the interpretation of data.
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Affiliation(s)
- Anne Canny
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Eddie Donaghy
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Victoria Murray
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Leo Campbell
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Carol Stonham
- NHS Gloucestershire Clinical Commissioning GroupGloucesterUK,Primary Care Respiratory Society (PCRS)KnowleUK
| | - Andrew Bush
- Imperial Centre for Paediatrics and Child Health and National Heart and Lung InstituteImperial CollegeLondonUK,Department of Paediatric Respiratory MedicineRoyal Brompton HospitalLondonUK
| | - Brian McKinstry
- Centre for Population and Health Sciences, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Heather Milne
- South East GP UnitNHS Education for ScotlandEdinburghUK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Luke Daines
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
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6
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Mamyrbekova S, Iskakova G, Faizullina K, Kuziyeva G, Abilkaiyr N, Daniyarova A, Arynova G, Brimzhanova M, Abdushukurova G, Gazaliyeva M, Glushkova N, Semenova Y, Izmailovich M. The diagnostic accuracy of spirometry versus peak expiratory flow test for follow-up of adult asthma patients at primary care level. Allergy Asthma Proc 2022; 43:e58-e64. [PMID: 36065110 DOI: 10.2500/aap.2022.43.220049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The asthma burden is growing worldwide, and this is predisposed by environmental and occupational exposures as well as individual risk factors. This study was aimed at a comparison of diagnostic accuracy of spirometry and peak expiratory flow rate (PEFR) in asthma screening of adult patients with lung function abnormalities that present at the level of primary care. Methods: This study was conducted in Shymkent city, South Kazakhstan, the third most populous city of the country with developed industries and high rates of pulmonary diseases. Four hundred and ninety-five adult patients with lung function abnormalities were enrolled in the study and underwent two screening tests (spirometry and PEFR). The diagnosis of asthma was verified by a qualified pulmonologist after performance of screening tests and was based on symptoms, medical history, and laboratory and lung function tests. Results: The sensitivity of spirometry was 0.97 and that of PEFR was 0.95 (p = 0.721), whereas the specificity of spirometry was 0.37 and that of PEFR was 0.28 (p = 0.227). Both tests yielded the same results for the positive predictive value (0.98). The negative predictive value was significantly higher for spirometry versus PEFR (0.23 versus 0.08; p = 0.006). The positive and negative likelihood ratios of the two tests also differed significantly (p = 0.001 and p = 0.006, respectively), whereas the overall accuracy was comparable between the two tests (0.96 for spirometry and 0.94 for PEFR; p = 0.748). Conclusion: Ambulatory PEFR monitoring is non-inferior to the monitoring of the forced expiratory volume in 1 second and could be used for screening purposes on equal grounds with spirometry.
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Affiliation(s)
- Saltanat Mamyrbekova
- From the Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Gulnara Iskakova
- Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan
| | - Kamila Faizullina
- Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan
| | - Gulmira Kuziyeva
- From the Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Nazerke Abilkaiyr
- From the Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Anara Daniyarova
- From the Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Gulbanu Arynova
- From the Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Marzhan Brimzhanova
- From the Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Gulzada Abdushukurova
- Department of Therapy, Faculty of Postgraduate Medical Education, Shymkent Medical Institute, Shymkent, Kazakhstan
| | | | - Natalya Glushkova
- From the Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Yuliya Semenova
- Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan; and
| | - Marina Izmailovich
- Department of Internal Diseases, Karaganda Medical University, Karaganda, Kazakhstan
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7
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Bartlow AW, Stromberg ZR, Gleasner CD, Hu B, Davenport KW, Jakhar S, Li PE, Vosburg M, Garimella M, Chain PSG, Erkkila TH, Fair JM, Mukundan H. Comparing variability in diagnosis of upper respiratory tract infections in patients using syndromic, next generation sequencing, and PCR-based methods. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000811. [PMID: 36962439 PMCID: PMC10022352 DOI: 10.1371/journal.pgph.0000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Abstract
Early and accurate diagnosis of respiratory pathogens and associated outbreaks can allow for the control of spread, epidemiological modeling, targeted treatment, and decision making-as is evident with the current COVID-19 pandemic. Many respiratory infections share common symptoms, making them difficult to diagnose using only syndromic presentation. Yet, with delays in getting reference laboratory tests and limited availability and poor sensitivity of point-of-care tests, syndromic diagnosis is the most-relied upon method in clinical practice today. Here, we examine the variability in diagnostic identification of respiratory infections during the annual infection cycle in northern New Mexico, by comparing syndromic diagnostics with polymerase chain reaction (PCR) and sequencing-based methods, with the goal of assessing gaps in our current ability to identify respiratory pathogens. Of 97 individuals that presented with symptoms of respiratory infection, only 23 were positive for at least one RNA virus, as confirmed by sequencing. Whereas influenza virus (n = 7) was expected during this infection cycle, we also observed coronavirus (n = 7), respiratory syncytial virus (n = 8), parainfluenza virus (n = 4), and human metapneumovirus (n = 1) in individuals with respiratory infection symptoms. Four patients were coinfected with two viruses. In 21 individuals that tested positive using PCR, RNA sequencing completely matched in only 12 (57%) of these individuals. Few individuals (37.1%) were diagnosed to have an upper respiratory tract infection or viral syndrome by syndromic diagnostics, and the type of virus could only be distinguished in one patient. Thus, current syndromic diagnostic approaches fail to accurately identify respiratory pathogens associated with infection and are not suited to capture emerging threats in an accurate fashion. We conclude there is a critical and urgent need for layered agnostic diagnostics to track known and unknown pathogens at the point of care to control future outbreaks.
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Affiliation(s)
- Andrew W. Bartlow
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Zachary R. Stromberg
- Physical Chemistry and Applied Spectroscopy, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Cheryl D. Gleasner
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Bin Hu
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Karen W. Davenport
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Shailja Jakhar
- Physical Chemistry and Applied Spectroscopy, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Po-E Li
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Molly Vosburg
- Medical Associates of Northern New Mexico, Los Alamos, New Mexico, United States of America
| | - Madhavi Garimella
- Medical Associates of Northern New Mexico, Los Alamos, New Mexico, United States of America
| | - Patrick S. G. Chain
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Tracy H. Erkkila
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Jeanne M. Fair
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Harshini Mukundan
- Physical Chemistry and Applied Spectroscopy, Chemistry Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
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8
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Islam MS, Huq S, Ahmed S, Roy S, Schwarze J, Sheikh A, Saha SK, Cunningham S, Nair H. Operational definitions of paediatric asthma used in epidemiological studies: A systematic review. J Glob Health 2021; 11:04032. [PMID: 34326990 PMCID: PMC8285759 DOI: 10.7189/jogh.11.04032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Researchers use different definitions to identify children with asthma in epidemiological surveys. We conducted a systematic review to describe the definitions used in epidemiologic studies for wheeze and asthma in the paediatric population, aimed to inform the development of a uniform definition of paediatric asthma for future epidemiological research. Methods We systematically searched terms to identify asthma and/or wheeze among children aged <13 years and published between 1995-2020 across seven databases (MEDLINE, EMBASE, PsycINFO, Global Health, AMED, LILACS and CINAHL). PRISMA guidelines were followed for this review. Results We extracted a total of 11 886 records, where 190 met our eligibility criteria and included in the analysis. Among the included studies, 62.1% (n = 118/190) used the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires, predominantly in developing countries (80%, n = 64/80). ‘Wheeze’ was reported in five categories, subdivided by 14 different definitions. “Current wheeze”, defined as caregivers report of wheezing sounds from the chest of the child in the past 12 months and “Wheeze ever”, defined as caregivers’ report of wheezing or whistling in the chest of the child at any previous time, were the most common wheeze category reported in 129 and 95 studies, respectively. Asthma was reported in nine categories using 53 definitions. The most common asthma category was “Asthma ever”, which was reported in 89 studies, based on caregiver statement that the child had asthma in the past. Conclusion Definitions of wheeze and asthma for children used in surveys are primarily based on parent-reported clinical features. Studies from developing countries more frequently used the ISAAC definitions to report childhood asthma and wheeze compared to the studies from developed counties. The use of a uniform asthma definition will aid the interpretation of research findings globally.
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Affiliation(s)
- Mohammad Shahidul Islam
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK.,Child Health Research Foundation, Dhaka, Bangladesh
| | - Samin Huq
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Salahuddin Ahmed
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK.,Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Sudipto Roy
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK.,KEM Hospital Research Centre, Pune, India
| | - Jürgen Schwarze
- Child Life and Health, University of Edinburgh, UK.,Centre for Inflammation Research, University of Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Steve Cunningham
- Child Life and Health, University of Edinburgh, UK.,Centre for Inflammation Research, University of Edinburgh, UK
| | - Harish Nair
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
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9
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Dubaybo BA. The Care of Asthma Patients in Communities with Limited Resources. Res Rep Trop Med 2021; 12:33-38. [PMID: 33727880 PMCID: PMC7954422 DOI: 10.2147/rrtm.s247716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
Asthma care has undergone significant changes over the past several years. Our understanding of the pathophysiology, risk factors, diagnosis, treatment, follow-up and prognosis has changed as more investigations shed new light on all of these aspects. This complexity has resulted in global guidelines aimed at improving the management of asthma patients. Among the multitude of guidelines, those published by the Global Initiative for Asthma (GINA) have achieved widespread and global acceptance. These guidelines cover the spectrum of factors that impact asthma care and include specific recommendations that treating physicians should follow to provide optimal patient care. In this review of asthma care in adult patients, we will outline some of the recommendations issued by GINA and discuss the challenges and limitations to the implementation of these guidelines in communities with limited resources. We will also propose recommendations to overcome these limitations in adult patients.
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Affiliation(s)
- Basim A Dubaybo
- Faculty Affairs and Professional Development, Wayne State University School of Medicine, Detroit, MI, USA
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10
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Lion-Cachet HC, Musonda JMM, Omole OB. Severe asthma in South Africa: A literature review and management approach for primary care. S Afr Fam Pract (2004) 2021; 63:e1-e10. [PMID: 33567835 PMCID: PMC8378165 DOI: 10.4102/safp.v63i1.5179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 11/01/2022] Open
Abstract
Severe asthma in South Africa (SA) is underappreciated, especially in the primary care setting. This study highlights the epidemiological context of severe asthma as a phenotypic variant. Primary care practitioners, as first-contact medical providers, need grounding in the management of severe asthma based on the precision of diagnosis and negotiated along the 10-point strategy. The underdiagnosis and undertreatment of asthma ought to inform educational programmes and research in this country.
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Affiliation(s)
- Huibrecht C Lion-Cachet
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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11
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The use of a direct bronchial challenge test in primary care to diagnose asthma. NPJ Prim Care Respir Med 2020; 30:45. [PMID: 33067465 PMCID: PMC7567813 DOI: 10.1038/s41533-020-00202-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/14/2020] [Indexed: 11/09/2022] Open
Abstract
Many asthmatics in primary care have mild symptoms and lack airflow obstruction. If variable expiratory airflow limitation cannot be determined by spirometry or peak expiratory flow, despite a history of respiratory symptoms, a positive bronchial challenge test (BCT) can confirm the diagnosis of asthma. However, BCT is traditionally performed in secondary care. In this observational real-life study, we retrospectively analyze 5-year data of a primary care diagnostic center carrying out BCT by histamine provocation. In total, 998 primary care patients aged ≥16 years underwent BCT, without any adverse events reported. To explore diagnostic accuracy, we examine 584 patients with a high pretest probability of asthma. Fifty-seven percent of these patients have a positive BCT result and can be accurately diagnosed with asthma. Our real-life data show BCT is safe and feasible in a suitably equipped primary care diagnostic center. Furthermore, it could potentially reduce diagnostic referrals to secondary care.
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12
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Axelsson M, Ilmarinen P, Backman H, Ekerljung L, Hedman L, Langhammer A, Lindberg A, Lindqvist A, Nwaru BI, Pallasaho P, Sovijärvi A, Vähätalo I, Kankaanranta H, Hisinger-Mölkänen H, Piirilä P, Rönmark E. Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland - the Nordic EpiLung study. J Asthma 2020; 58:1196-1207. [PMID: 32475292 DOI: 10.1080/02770903.2020.1776727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. METHOD In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. RESULTS The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2% versus 6.3-6.7%) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7 and 2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. CONCLUSION The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.
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Affiliation(s)
- Malin Axelsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Linda Ekerljung
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Ari Lindqvist
- Clinical Research Unit of Pulmonary Diseases, Helsinki University Hospital, Helsinki University and Clinical Research Institute HUCH Ltd, Helsinki, Finland
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Anssi Sovijärvi
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | | | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
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13
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Zejda JE, Beridze V, Bakhtadze T, Beridze S, Abuladze L, Partenadze N, Lawson J. Prevalence of and factors associated with underdiagnosis of pediatric asthma in Batumi, Georgia. Allergol Immunopathol (Madr) 2020; 48:73-77. [PMID: 31477393 DOI: 10.1016/j.aller.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/12/2019] [Accepted: 05/22/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE A recent survey in Batumi, Georgia showed a low prevalence of asthma in children (1.8%). A potential explanation is underdiagnosis of asthma. To investigate this, we conducted a follow up to the survey with the objective of estimating the level of childhood asthma underdiagnosis and to describe factors related to it. METHODS Subjects included 437 survey participants who had a history of asthma-like symptoms and no diagnosis of asthma. All children underwent clinical examination (spirometry, skin prick tests, FeNO measurement) to identify new cases of asthma. The distribution of host and environmental factors was compared between the group with newly identified asthma and a group of 59 children with previously known asthma (diagnosed asthma). RESULTS Clinical investigation identified 107 cases of undiagnosed asthma. The corrected asthma prevalence estimate was 5.1% (95%CI: 4.4%-5.9%) suggesting that 65% of asthma cases were undiagnosed. Compared to children with diagnosed asthma, children with undiagnosed asthma were younger (8.2±1.6 vs. 9.3±2.1; p=0.0005), had less frequent history of allergic disorders (38.3% vs. 64.4%; p=0.001), and a lower prevalence of parental asthma (1.8% vs. 8.4%; p=0.04). The groups did not differ in terms of environmental characteristics except for more exposure to passive smoking in the undiagnosed asthma group (p=0.01). Multivariate analysis confirmed results of simple analyses. CONCLUSION In Batumi, 65% of children with asthma remain undiagnosed. Older age of a child, coexisting allergic disorders, and parental asthma seem to facilitate diagnosis. Implementation of current diagnostic guidelines should improve diagnostic accuracy of pediatric asthma in Batumi.
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Affiliation(s)
- J E Zejda
- Department of Epidemiology, School of Medicine, Medical University of Silesia, Katowice, Poland.
| | - V Beridze
- Faculty of Natural Sciences and Health Care, Shota Rustaveli State University, Batumi, Georgia
| | - T Bakhtadze
- Faculty of Natural Sciences and Health Care, Shota Rustaveli State University, Batumi, Georgia
| | - S Beridze
- Faculty of Natural Sciences and Health Care, Shota Rustaveli State University, Batumi, Georgia
| | - L Abuladze
- Maternity and Child Health Center, Batumi, Georgia
| | - N Partenadze
- Maternity and Child Health Center, Batumi, Georgia
| | - J Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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14
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Rupani H, Chauhan AJ. Measurement of FeNO in asthma: what the hospital doctor needs to know. Br J Hosp Med (Lond) 2019; 80:99-104. [PMID: 30746998 DOI: 10.12968/hmed.2019.80.2.99] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Asthma is the commonest chronic lung disease. Airway inflammation is a central component of asthma but clinical symptoms of asthma and standard spirometry are insensitive in reflecting the underlying inflammatory processes. Measurement of the fractional nitric oxide concentration in exhaled breath (FeNO) is a quantitative, non-invasive and safe method of measuring airway inflammation. Advances in technology and standardization have made FeNO measurements simple, enabling their use as a biomarker alongside traditional clinical tools in the assessment and management of asthma. Specifically, it can predict responsiveness to steroids and also newer biological therapy, predict future risk of exacerbation and help highlight treatment non-adherence, making it a useful asset to personalized medicine.
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Affiliation(s)
- Hitasha Rupani
- Respiratory Consultant, Department of Respiratory Medicine, Queen Alexandra Hospital, Portsmouth PO6 3LY
| | - Anoop J Chauhan
- Director of Research and Innovation, Department of Respiratory Medicine, Queen Alexandra Hospital, Portsmouth
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15
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Fischer GB, Sarria EE, Camargos P, Mocelin HT, Soto-Quiroz M, Cruz AA, Bousquet J, Zar HJ. Childhood asthma in low and middle-income countries: Where are we now? Paediatr Respir Rev 2019; 31:52-57. [PMID: 30987798 DOI: 10.1016/j.prrv.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/04/2018] [Indexed: 01/08/2023]
Abstract
Pediatric asthma has been increasing in LMICs (Low Middle-Income Countries), leading to an important burden for both children and national health systems. Implementing measures to achieve control are influenced by the degree of organization health systems have, the availability and affordability of essential asthma medications, and the effective implementation of asthma programs and asthma guidelines. In this review authors give an updated view of the current situation of these components of asthma management in LMICs.
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Affiliation(s)
- Gilberto Bueno Fischer
- Department of Paediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Paediatric Pulmonology Section, Hospital da Crianças Santo Antônio (HCSA), Porto Alegre, Brazil.
| | - Edgar E Sarria
- Department of Biology and Pharmacy, School of Medicine, Universidade de Santa Cruz do Sul (UNISC), Brazil; Paediatric Pulmonology Section - HCSA, Brazil
| | - Paulo Camargos
- Department of Paediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Postgraduate Program on Health Sciences, Universidade Federal de São João del-Rei, Divinópolis, Brazil.
| | - Helena Teresinha Mocelin
- Department of Paediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Paediatric Pulmonology Section - HCSA, Porto Alegre, Brazil
| | - Manuel Soto-Quiroz
- Pediatric Pulmology, University of Costa Rica, Hospital CIMA, San Jose, Costa Rica
| | - Alvaro A Cruz
- ProAR - Federal University of Bahia, School of Medicine, Bahia, Brazil
| | - Jean Bousquet
- MACVIA, France; Contre les Maladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.
| | - Heather J Zar
- Dept Pediatrics & Child Health, Red Cross Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, South Africa.
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16
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Daines L, McLean S, Buelo A, Lewis S, Sheikh A, Pinnock H. Systematic review of clinical prediction models to support the diagnosis of asthma in primary care. NPJ Prim Care Respir Med 2019; 29:19. [PMID: 31073125 PMCID: PMC6509212 DOI: 10.1038/s41533-019-0132-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/15/2019] [Indexed: 12/23/2022] Open
Abstract
Diagnosing asthma is challenging. Misdiagnosis can lead to untreated symptoms, incorrect treatment and avoidable deaths. The best combination of clinical features and tests to achieve a diagnosis of asthma is unclear. As asthma is usually diagnosed in non-specialist settings, a clinical prediction model to aid the assessment of the probability of asthma in primary care may improve diagnostic accuracy. We aimed to identify and describe existing prediction models to support the diagnosis of asthma in children and adults in primary care. We searched Medline, Embase, CINAHL, TRIP and US National Guidelines Clearinghouse databases from 1 January 1990 to 23 November 17. We included prediction models designed for use in primary care or equivalent settings to aid the diagnostic decision-making of clinicians assessing patients with symptoms suggesting asthma. Two reviewers independently screened titles, abstracts and full texts for eligibility, extracted data and assessed risk of bias. From 13,798 records, 53 full-text articles were reviewed. We included seven modelling studies; all were at high risk of bias. Model performance varied, and the area under the receiving operating characteristic curve ranged from 0.61 to 0.82. Patient-reported wheeze, symptom variability and history of allergy or allergic rhinitis were associated with asthma. In conclusion, clinical prediction models may support the diagnosis of asthma in primary care, but existing models are at high risk of bias and thus unreliable for informing practice. Future studies should adhere to recognised standards, conduct model validation and include a broader range of clinical data to derive a prediction model of value for clinicians.
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Affiliation(s)
- Luke Daines
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
| | - Susannah McLean
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Audrey Buelo
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, UK
| | - Steff Lewis
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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17
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Abstract
Asthma is a serious global health issue and asthma guidelines recommend a stepwise approach to management with goals to achieve control and minimize future risk. Prior to escalation of pharmacotherapy, steps to confirm accurate diagnosis as well as address comorbidities and triggers are critical to effective asthma management. This article provides readers with a structured approach to evaluation and management of asthma of varying severity.
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Affiliation(s)
- Sandhya Khurana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mary Parkes Center for Asthma, Allergy and Pulmonary Care, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY 14642, USA.
| | - Nizar N Jarjour
- University of Wisconsin School of Medicine and Public Health, K4/914 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-9988, USA
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18
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Nardini S, Annesi-Maesano I, Simoni M, Ponte AD, Sanguinetti CM, De Benedetto F. Accuracy of diagnosis of COPD and factors associated with misdiagnosis in primary care setting. E-DIAL (Early DIAgnosis of obstructive lung disease) study group. Respir Med 2018; 143:61-66. [PMID: 30261994 DOI: 10.1016/j.rmed.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 08/03/2018] [Accepted: 08/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and results in both substantial and increasing socioeconomic burden. Guidelines on COPD encourage primary care physicians to detect the disease at an early stage. Our main aim was to evaluate the accuracy of the diagnosis of COPD at the primary health care. METHODS 6466 patients were randomly selected in 22 Italian primary care practices (46% males, mean age 56 ± 16 years) and were asked about respiratory symptoms and risk for any chronic respiratory disease including COPD. After a prior evaluation, 701 patients (51% males, mean age 59 ± 15 years) were sent by General Practitioners (GPs) to Pulmonary Units (PU) for confirming the diagnosis. The agreement in diagnosing COPD between GPs and pulmonary diseases specialists was assessed by using Cohen's kappa (k) statistic. RESULTS Lack of precision in COPD diagnosis resulted in 13% of over-diagnosis and 59% of under-diagnosis. GPs were quite good in correctly excluding the patients who did not have COPD (specificity = 87%), but less good in diagnosing the patients with COPD (sensitivity = 41%). The risk of under-diagnosis was higher in people with age >62 years and in current/ex-smokers, when compared to no COPD, whereas it was higher in subject <62 years old and in those with no previous spirometry when compared to correctly diagnosed COPD. CONCLUSION Our results confirm that COPD misdiagnosis is common in primary care and that under-diagnosis is a major problem. It is necessary to enhance COPD diagnosis and to reduce misdiagnosis in primary care settings.
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Affiliation(s)
- Stefano Nardini
- Division of Respiratory Medicine, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Saint-Antoine Medical School, Paris, France.
| | - Marzia Simoni
- Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Saint-Antoine Medical School, Paris, France
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19
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Cho EY, Oh KJ, Rhee CK, Yoo KH, Kim BY, Bae HW, Lee BJ, Choi DC, Lee H, Park HY. Comparison of clinical characteristics and management of asthma by types of health care in South Korea. J Thorac Dis 2018; 10:3269-3276. [PMID: 30069323 DOI: 10.21037/jtd.2018.05.95] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Data on the clinical characteristics of asthma patients including utilization of medical facilities, disease management, and healthcare costs by types of health care are insufficient. Methods We evaluated data on 729,343 asthma patients from the Health Insurance Review and Assessment Service (HIRA) database of Korea between July 2013 and June 2014. Results Most asthma patients were treated via primary care (81.7%), followed by tertiary (17.8%) and secondary (0.5%) care. Patients requiring secondary or tertiary care exhibited more comorbidities and exacerbations than those treated via primary care, and utilized more medical facilities (associated with higher medical costs). The prescription rate of leukotriene receptor antagonists (LTRAs) was relatively high for those receiving all types of health care, ranging from 62% to 78%. However, the prescription rate of inhalants containing corticosteroids was significantly lower in patients treated via primary care than those receiving secondary or tertiary care (P<0.001). In addition, pulmonary function testing (PFT) was performed less often in patients treated via primary care than in those receiving secondary or tertiary care (P<0.001). Conclusions Most patients with asthma were treated via primary care; however, those receiving secondary or tertiary care exhibited substantial utilization of medical facilities with high costs. Diagnostic measures and the prescription of inhalants containing corticosteroids in primary care require urgent attention.
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Affiliation(s)
- Eun Yeong Cho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki Jong Oh
- Division of Pulmonology, Department of Internal Medicine, Chamjoeun Hospital, Gwangju, South Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Bo Yeon Kim
- Health Insurance Review & Assessment Service, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Won Bae
- Health Insurance Review & Assessment Service, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Chull Choi
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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20
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Daines L, McLean S, Buelo A, Lewis S, Sheikh A, Pinnock H. Clinical prediction models to support the diagnosis of asthma in primary care: a systematic review protocol. NPJ Prim Care Respir Med 2018; 28:15. [PMID: 29777106 PMCID: PMC5959853 DOI: 10.1038/s41533-018-0086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 02/01/2023] Open
Abstract
Substantial over-diagnosis and under-diagnosis of asthma in adults and children has recently been reported. As asthma is mostly diagnosed in non-specialist settings, a clinical prediction model (CPM) to aid the diagnosis of asthma in primary care may help improve diagnostic accuracy. We aim to systematically identify, describe, compare, and synthesise existing CPMs designed to support the diagnosis of asthma in children and adults presenting with symptoms suggestive of the disease, in primary care settings or equivalent populations. We will systematically search Medline, Embase and CINAHL from 1 January 1990 to present. Any CPM derived for use in a primary care population will be included. Equivalent populations in countries without a developed primary care service will also be included. The probability of asthma diagnosis will be the primary outcome. We will include CPMs designed for use in clinical practice to aid the diagnostic decision making of a healthcare professional during the assessment of an individual with symptoms suggestive of asthma. We will include derivation studies, and external model validation studies. Two reviewers will independently screen titles/abstracts and full texts for eligibility and extract data from included papers. The CHARMS checklist (or PROBAST if available) will be used to assess risk of bias within each study. Results will be summarised by narrative synthesis with meta-analyses completed if possible. This systematic review will provide comprehensive information about existing CPMs for the diagnosis of asthma in primary care and will inform the development of a future diagnostic model.
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Affiliation(s)
- L Daines
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland.
| | - S McLean
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - A Buelo
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, Scotland
| | - S Lewis
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - A Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - H Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
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21
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Barbosa ATF, Carneiro JA, Ramos GCF, Leite MT, Caldeira AP. Factors associated with Chronic Obstructive Pulmonary Disease among the elderly. CIENCIA & SAUDE COLETIVA 2018; 22:63-73. [PMID: 28076530 DOI: 10.1590/1413-81232017221.13042016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/21/2016] [Indexed: 11/22/2022] Open
Abstract
This study aimed to identify factors associated with Chronic Obstructive Pulmonary Disease (COPD) among non-institutionalized elderly people. It involved a cross-sectional study conducted on the basis of a household survey, followed by spirometry. People diagnosed with COPD were compared with those with normal spirometry, through bivariate analysis, followed by multivariate regression analysis. We identified 53 elderly people were identified with COPD. After multivariate analysis, the following factors associated with COPD were identified: past or current smoking (OR: 3.74; 95% CI: 1.65-8.46), presence of chronic sputum (OR: 4.92; 95% CI: 2.03-11.95), pulse oximetry at rest ≤ 90% (OR: 8.74; 95%CI: 1.27-60.07), self-reported asthma (OR: 3.41; 95% CI: 1.01-11.57). The results reveal associated factors that highlight the need to review the selection criteria for patients at risk of COPD among the elderly.
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Affiliation(s)
- Ana Teresa Fernandes Barbosa
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Jair Almeida Carneiro
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Gizele Carmen Fagundes Ramos
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Maísa Tavares Leite
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Antônio Prates Caldeira
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros. Av. Rui Braga, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
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22
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Stafyla E, Kotsiou OS, Deskata K, Gourgoulianis KI. Missed diagnosis and overtreatment of COPD among smoking primary care population in Central Greece: old problems persist. Int J Chron Obstruct Pulmon Dis 2018; 13:487-498. [PMID: 29440886 PMCID: PMC5804734 DOI: 10.2147/copd.s147628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The diagnosis of COPD is not always consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy in daily clinical practice, especially in primary care. This study aimed to estimate the overall COPD prevalence and severity, to identify differences between newly and previously diagnosed patients, and to evaluate the potential COPD overtreatment in a smoking population attending a primary care spirometry surveillance program. Methods A study was conducted in 10 primary health care centers of Central Greece during a 7-month period. Eligible participants were aged ≥40 years and were either current smokers or exsmokers. Results A total of 186 subjects were included (68% males, mean age 62.3±12.6 years, mean life-time tobacco exposure 50 pack-years). COPD prevalence was 17.8%, identified to be higher in elderly males. Forty-two percent of the COPD group were newly diagnosed patients, who were of younger age, current smokers, presented with less dyspnea and better health status, and mainly appeared with mild-to-moderate disease. Interestingly, 61.4% of non-COPD and 85.7% of newly diagnosed COPD individuals had been using inhaled medication under primary care provider's prescription without ever undergoing spirometry or further evaluation by a pulmonologist; thus, the phenomena of COPD overdiagnosis and missed diagnosis came into the spotlight. Moreover, only 26.3% of known COPD patients were properly medicated according to GOLD guidelines, while half of them were inappropriately treated with triple inhaled therapy. Conclusion We reported a significant prevalence of COPD in smoking population attending this spirometry program. A remarkable proportion of COPD patients were undiagnosed and made case finding worthwhile. Underutilization of spirometry in the diagnosis and management of COPD as well as general practitioners' nonadherence to the GOLD treatment guidelines was confirmed by our data. These findings highlight the need for a major overhaul and culture change in primary care settings of Central Greece.
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Affiliation(s)
- Eirini Stafyla
- Department of Respiratory Medicine, School of Medicine, University of Thessaly, Biopolis, Larissa, Thessaly, Greece
| | - Ourania S Kotsiou
- Department of Respiratory Medicine, School of Medicine, University of Thessaly, Biopolis, Larissa, Thessaly, Greece
| | - Konstantina Deskata
- Department of Respiratory Medicine, School of Medicine, University of Thessaly, Biopolis, Larissa, Thessaly, Greece
| | - Konstantinos I Gourgoulianis
- Department of Respiratory Medicine, School of Medicine, University of Thessaly, Biopolis, Larissa, Thessaly, Greece
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23
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White J, Paton JY, Niven R, Pinnock H. Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. Thorax 2018. [DOI: 10.1136/thoraxjnl-2017-211189] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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24
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Cruz AA, Camargos PA, Urrutia-Pereira M, Stelmach R. Global Alliance against Chronic Respiratory Diseases (GARD) Brazil success case: overcoming barriers. J Thorac Dis 2018; 10:534-538. [PMID: 29600090 DOI: 10.21037/jtd.2018.01.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Alvaro A Cruz
- ProAR, Federal University of Bahia, Bahia, Brazil.,Global Alliance against Chronic Respiratory Diseases (GARD)/WHO
| | - Paulo A Camargos
- Global Alliance against Chronic Respiratory Diseases (GARD)/WHO.,Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marilyn Urrutia-Pereira
- Global Alliance against Chronic Respiratory Diseases (GARD)/WHO.,Department of Medicine, Universidade Federal do Pampa, Bagé, RS, Brazil
| | - Rafael Stelmach
- Global Alliance against Chronic Respiratory Diseases (GARD)/WHO.,Hospital da Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
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25
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França EB, Passos VMDA, Malta DC, Duncan BB, Ribeiro ALP, Guimarães MDC, Abreu DMX, Vasconcelos AMN, Carneiro M, Teixeira R, Camargos P, Melo APS, Queiroz BL, Schmidt MI, Ishitani L, Ladeira RM, Morais-Neto OL, Bustamante-Teixeira MT, Guerra MR, Bensenor I, Lotufo P, Mooney M, Naghavi M. Cause-specific mortality for 249 causes in Brazil and states during 1990-2015: a systematic analysis for the global burden of disease study 2015. Popul Health Metr 2017; 15:39. [PMID: 29166948 PMCID: PMC5700707 DOI: 10.1186/s12963-017-0156-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background Reliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015. Methods We describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states. Results There was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country’s Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI. Conclusions A widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly. Electronic supplementary material The online version of this article (10.1186/s12963-017-0156-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabeth B França
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação em Saúde Pública, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil.
| | | | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Materno Infantil, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Bruce B Duncan
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, R. Ramiro Barcelos 2600/414, Porto Alegre, 90035-003, Brazil
| | - Antonio Luiz P Ribeiro
- Universidade Federal de Minas Gerais, School of Medicine, Av. Alfredo Balena, 190., Belo Horizonte, 30130-100, Brazil
| | - Mark D C Guimarães
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação em Saúde Pública, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Daisy M X Abreu
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Nescon, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Ana Maria N Vasconcelos
- Universidade de Brasília, Programa de Pós-graduação em Desenvolvimento, Sociedade e Cooperação Internacional, Asa Norte, Brasília, 70910-900, Brazil
| | - Mariângela Carneiro
- Universidade de Federal de Minas Gerais, Instituto de Ciências Biológicas, Departamento de Parasitologia. Avenida Antônio Carlos, 6670, Belo Horizonte, MG, 31270-901, Brazil
| | - Renato Teixeira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação em Saúde Pública, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Paulo Camargos
- Universidade Federal de São João Del Rei, Faculdade de Medicina. Praça Frei Orlando, 170, Centro, São João del-Rei, 36307-352, Brazil
| | - Ana Paula S Melo
- Universidade Federal de São João Del Rei, Faculdade de Medicina. Praça Frei Orlando, 170, Centro, São João del-Rei, 36307-352, Brazil
| | - Bernardo L Queiroz
- Universidade Federal de Minas Gerais, Faculdade de Ciências Econômicas, Departamento de Demografia, Av. Antônio Carlos, 6670, Belo Horizonte, 31270-901, Brazil
| | - Maria Inês Schmidt
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, R. Ramiro Barcelos 2600/414, Porto Alegre, 90035-003, Brazil
| | - Lenice Ishitani
- Universidade Federal de Minas Gerais, Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde-GPEAS, Av. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Roberto Marini Ladeira
- Fundação Hospitalar do Estado de Minas Gerais, Alameda Alvaro Celso 100/231, Belo Horizonte, 30150-260, Brazil
| | - Otaliba L Morais-Neto
- Universidade Federal de Goiás, Departamento de Saúde Coletiva. Instituto de Patologia Tropical e Saúde Pública. Rua 235, S/N, Setor Universitário, Goiânia, Goiás, 74605050, Brazil
| | - Maria Tereza Bustamante-Teixeira
- Universidade Federal de Juiz de Fora, Programa de Pós-graduação em Saúde Coletiva, Campus Universitario da UFJF, Rua José Lourenço Kelmer, S/n, Martelos, Juiz de Fora, 36036-330, Brazil
| | - Maximiliano R Guerra
- Universidade Federal de Juiz de Fora, Programa de Pós-graduação em Saúde Coletiva, Campus Universitario da UFJF, Rua José Lourenço Kelmer, S/n, Martelos, Juiz de Fora, 36036-330, Brazil
| | - Isabela Bensenor
- Universidade de São Paulo. Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Av. Lineu Prestes, 2565 / 3° andar, São Paulo, 05508-000, Brazil
| | - Paulo Lotufo
- Universidade de São Paulo. Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Av. Lineu Prestes, 2565 / 3° andar, São Paulo, 05508-000, Brazil
| | - Meghan Mooney
- Institute for Health Metrics and Evaluation, 2301 5th Avenue, Suite 600, Box 358210, Seattle, WA, 98121, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, 2301 5th Avenue, Suite 600, Box 358210, Seattle, WA, 98121, USA
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School intervention in asthma for adolescents: it is time to act. Paediatr Respir Rev 2017; 23:50-52. [PMID: 27592297 DOI: 10.1016/j.prrv.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/01/2016] [Indexed: 11/20/2022]
Abstract
Asthma is a public health problem that is responsible for significant symptomatology and in extreme cases, premature deaths among adolescents. Lack of knowledge of the disease contributes to both its morbidity and mortality. In this manuscript, we discuss school interventions in asthma, in particular their impacts on improving knowledge of the disease and their ability to both make the school environment safer and reduce morbidity indicators. These interventions have been successful when implemented in higher income countries. Thus, to address the lack of interventions in low and middle income countries, we present an example of an alternative asthma intervention in the school curriculum developed in South America. The model has been proven to be both feasible and relatively inexpensive. It is easily structured by utilizing the staff of the school itself and is capable of being adapted to other countries.
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Gillis RME, van Litsenburg W, van Balkom RH, Muris JW, Smeenk FW. The contribution of an asthma diagnostic consultation service in obtaining an accurate asthma diagnosis for primary care patients: results of a real-life study. NPJ Prim Care Respir Med 2017; 27:35. [PMID: 28526889 PMCID: PMC5438345 DOI: 10.1038/s41533-017-0027-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/01/2017] [Accepted: 03/17/2017] [Indexed: 11/09/2022] Open
Abstract
Previous studies showed that general practitioners have problems in diagnosing asthma accurately, resulting in both under and overdiagnosis. To support general practitioners in their diagnostic process, an asthma diagnostic consultation service was set up. We evaluated the performance of this asthma diagnostic consultation service by analysing the (dis)concordance between the general practitioners working hypotheses and the asthma diagnostic consultation service diagnoses and possible consequences this had on the patients' pharmacotherapy. In total 659 patients were included in this study. At this service the patients' medical history was taken and a physical examination and a histamine challenge test were carried out. We compared the general practitioners working hypotheses with the asthma diagnostic consultation service diagnoses and the change in medication that was incurred. In 52% (n = 340) an asthma diagnosis was excluded. The diagnosis was confirmed in 42% (n = 275). Furthermore, chronic rhinitis was diagnosed in 40% (n = 261) of the patients whereas this was noted in 25% (n = 163) by their general practitioner. The adjusted diagnosis resulted in a change of medication for more than half of all patients. In 10% (n = 63) medication was started because of a new asthma diagnosis. The 'one-stop-shop' principle was met with 53% of patients and 91% (n = 599) were referred back to their general practitioner, mostly within 6 months. Only 6% (n = 41) remained under control of the asthma diagnostic consultation service because of severe unstable asthma. In conclusion, the asthma diagnostic consultation service helped general practitioners significantly in setting accurate diagnoses for their patients with an asthma hypothesis. This may contribute to diminish the problem of over and underdiagnosis and may result in more appropriate treatment regimens. ASTHMA SERVICE HELPS GENERAL PRACTITIONERS MAKE ACCURATE DIAGNOSES: A consultation service can help general practitioners more accurately diagnose asthma and select the appropriate treatments for their patients. Researchers in The Netherlands, led by Frank Smeenk from Catharina Hospital in Eindhoven, describe an asthma diagnostic consultation service they created to support GPs in their diagnostic process for patients suspected of having asthma. Over a four-year period, the service received a total of 659 referrals and only confirmed the diagnosis of asthma in 275 cases. Another 20 patients had asthma overlapping with chronic obstructive pulmonary syndrome. The service also picked up other diseases, such as rhinitis, that general practitioners had missed. Overall, because of the consultation service and its revised diagnoses, more than half of all patients adjusted their medications. Most patients required only a single consultation and could then be referred back to their physicians.
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Affiliation(s)
- R M E Gillis
- Department of Pulmonology, Catharina Hospital Eindhoven, Eindhoven, Netherlands.
| | - W van Litsenburg
- Department of Pulmonology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - R H van Balkom
- Department of Pulmonology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - J W Muris
- Department of Family Medicine, Research institute CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
| | - F W Smeenk
- Department of Pulmonology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
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Chambers D, Booth A, Baxter SK, Johnson M, Dickinson KC, Goyder EC. Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BackgroundCurrent NHS policy favours the expansion of diagnostic testing services in community and primary care settings.ObjectivesOur objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.Review methodsWe performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.ResultsWe identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.ConclusionsIn the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.LimitationsWe have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.Future workThere is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan K Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katherine C Dickinson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth C Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Garrastazu R, García-Rivero JL, Ruiz-Nuñez M, Helguera JM, Arenal S, Bonnardeux C, León C, Miravitlles M, Santibañez M. [Reliability of a chronic obstructive pulmonary disease diagnosis register in Primary Care]. Semergen 2016; 43:364-374. [PMID: 27692678 DOI: 10.1016/j.semerg.2016.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/24/2016] [Accepted: 06/02/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/OBJECTIVE One of main limitations in studies of COPD in health databases could be the low quality of the information. Our first aim was evaluate reliability of the registry of COPD diagnosis register in Primary Care. A description and comparison is also presented of the characteristics of the patients according to the diagnostic confirmation. MATERIAL AND METHODS A cross-sectional study using healthcare databases of Cantabria. A pre-selected sample of 1,457 patients was obtained in which COPD diagnosis was specifically registered. COPD confirmation was classified into confirmed COPD, not confirmed-not rejected COPD, and diagnostic error (over-diagnosis). Descriptive and clinical characteristics, comorbidities, and treatments were collected in each group. RESULTS COPD was confirmed in 766 patients: 52.6% (95%CI: 49.9-55.2). Prevalence of over-diagnosis was 7.2% (95%CI: 5.9-8.6). There were statistically significant gender differences. In the COPD confirmed group age, tobacco consumption and severity according to FEV1 was higher. An average of 1.95 bronchial exacerbations during the last 4years was observed among diagnostic errors. Inhaled corticosteroids were prescribed in 74.9% of COPD confirmed patients, and in 41.9% of over-diagnosed patients. CONCLUSIONS The reliability of the COPD register was deficient, with only 52.6% with a confirmed diagnosis. Stable treatment for COPD was prescribed in all groups, highlighting the use of inhaled corticosteroids.
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Affiliation(s)
- R Garrastazu
- Centro de Salud de Gama, Servicio Cántabro de Salud, Bárcena de Cicero, España.
| | | | - M Ruiz-Nuñez
- Centro de Salud de Liérganes, Servicio Cántabro de Salud, Miera, España
| | - J M Helguera
- Centro de Salud Bajo Asón, Servicio Cántabro de Salud, Ampuero, España
| | - S Arenal
- Centro de Salud de Suances, Servicio Cántabro de Salud, Suances, España
| | - C Bonnardeux
- Centro de Salud Campoo-Los Valles, Servicio Cántabro de Salud, Mataporquera, España
| | - C León
- Centro de Salud de Suances, Servicio Cántabro de Salud, Suances, España
| | - M Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, España
| | - M Santibañez
- Área de Medicina Preventiva y Salud Pública, Universidad de Cantabria-IDIVAL, Santander, España
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Kasteleyn MJ, Bonten TN, Taube C, Chavannes NH. Coordination of care for patients with COPD: Clinical points of interest. INTERNATIONAL JOURNAL OF CARE COORDINATION 2015. [DOI: 10.1177/2053434515620223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The management of care of chronic obstructive pulmonary disease improved over the last years but is still very complex. Both over- and underdiagnosis are often reported and misclassification of disease severity is common. Differentiating between chronic obstructive pulmonary disease, asthma and asthma-chronic obstructive pulmonary disease overlap syndrome remains difficult. Much is known about the effectiveness of treatment approaches in chronic obstructive pulmonary disease, but patients are often not treated according to the guidelines, and we need more evidence on effectiveness in phenotypes of chronic obstructive pulmonary disease. Care coordination is of great importance and can help to further improve care for chronic obstructive pulmonary disease patients. Pulmonary rehabilitation and self-management are considered important aspects of chronic obstructive pulmonary disease care. In our opinion, there is a major role for eHealth to improve coordination of care of chronic obstructive pulmonary disease.
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Eusebio M, Kuna P, Kraszula L, Kupczyk M, Pietruczuk M. The relative values of CD8+CD25+Foxp3brigh Treg cells correlate with selected lung function parameters in asthma. Int J Immunopathol Pharmacol 2015; 28:218-26. [PMID: 25921629 DOI: 10.1177/0394632015584508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/02/2015] [Indexed: 11/15/2022] Open
Abstract
The study aimed to detect CD8(+)CD25(+)FoxP3(brigh) Tregs and investigate their possible association with selected lung function values. CD8(+)CD25(+)FoxP3(brigh) Tregs were detected by flow cytometry in the peripheral blood of 25 patients with severe asthma (SA), 25 patients with mild-to-moderate asthma (MA), and 25 age-matched healthy donors (NC). The percentages of CD8(+)CD25(+)FoxP3(brigh) Tregs of the patients with severe (3.4 ± 4.55), and mild-to-moderate asthma (7.5 ± 8.15), were markedly lower than those of controls (12.1 ± 13.2). The mean forced expiratory volume in 1 s (FEV1) % predicted value in severe asthma subpopulation was significantly lower (67.05 ± 15.98%) when compared with that of mild-to-moderate asthma subgroup (87.71 ± 16.12%). Interestingly, the percentages of CD8(+)CD25(+)FoxP3(brigh) Tregs correlate with mean peak expiratory flow (PEF)% predicted values in severe (r = 0.7, P <0.01) and mild-to-moderate (r = 0.73, P <0.01) asthma. In contrast, this parameter was positively correlated with FEV1% predicted values in the severe asthmatics only (r = 0.71, P <0.01). In summary, this study establishes a link between the percentage of CD8(+)CD25(+)FoxP3(brigh) Tregs and selected lung function parameters, suggesting that this parameter has potential as a marker for inflammation and airflow obstruction.
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Affiliation(s)
- M Eusebio
- Department of Laboratory Diagnostics, II Chair of Internal Medicine, Medical University of Lodz, Poland
| | - P Kuna
- Department of Internal Medicine, II Chair of Internal Medicine, Medical University of Lodz, Poland
| | - L Kraszula
- Department of Laboratory Diagnostics, II Chair of Internal Medicine, Medical University of Lodz, Poland
| | - M Kupczyk
- Department of Internal Medicine, II Chair of Internal Medicine, Medical University of Lodz, Poland
| | - M Pietruczuk
- Department of Laboratory Diagnostics, II Chair of Internal Medicine, Medical University of Lodz, Poland
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