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NPJ Primary Care Respiratory Medicine

Jieqiong Freda Yang, Rekha Chaudhuri, Neil C Thomson, Nitish Ramparsad, Hugh O'Pray, Stephen Barclay, Sean MacBride-Stewart, Craig McCallum, Varun Sharma, Charles McSharry, Dianne Murray, Malcolm Shepherd, Wai-Ting Nicola Lee
The United Kingdom National Review of Asthma Deaths (NRAD) recommends that patients who require ≥3 courses of oral corticosteroids (OCS) for exacerbations in the past year or those on British Thoracic Society (BTS) Step 4/5 treatment must be referred to a specialist asthma service. The aim of the study was to identify the proportion of asthma patients in primary care that fulfil NRAD criteria for specialist referral and factors associated with frequent exacerbations. A total of 2639 adult asthma patients from 10 primary care practices in Glasgow, UK were retrospectively studied between 2014 and 2015...
September 19, 2018: NPJ Primary Care Respiratory Medicine
Biljana Cvetkovski, Rachel Tan, Vicky Kritikos, Kwok Yan, Elizabeth Azzi, Pamela Srour, Sinthia Bosnic-Anticevich
Allergic rhinitis (AR) is increasingly becoming a patient self-managed disease. Just under 70% of patients purchasing pharmacotherapy self-select their treatment with no health-care professional intervention often resulting in poor choices, leading to suboptimal management and increased burden of AR on the individual and the community. However, no decision is made without external, influencing forces. This study aims to determine the key influences driving patients' decision-making around AR management. To accomplish this aim, we utilised a social network theory framework to map the patient's AR network and identify the strength of the influences within this network...
September 13, 2018: NPJ Primary Care Respiratory Medicine
Björn Ställberg, Christer Janson, Kjell Larsson, Gunnar Johansson, Konstantinos Kostikas, Jean-Bernard Gruenberger, Florian S Gutzwiller, Leif Jorgensen, Milica Uhde, Karin Lisspers
This study aimed to generate real-world evidence to assess the burden of comorbidities in COPD patients, to effectively manage these patients and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients using electronic medical record data collected between 2000 and 2014. These patients were studied for prevalence of various comorbidities and for association of these comorbidities with exacerbations, mortality, and healthcare costs compared with an age-, sex-, and comorbidities-matched non-COPD reference population...
September 10, 2018: NPJ Primary Care Respiratory Medicine
MeiLan K Han, Riju Ray, Jason Foo, Chaienna Morel, Beth Hahn
Dual bronchodilator maintenance therapy may benefit patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) versus long-acting muscarinic antagonist (LAMA) monotherapy. The efficacy and safety of US-approved LAMA/long-acting beta-agonist (LABA) combinations versus tiotropium (TIO), a LAMA, were assessed. This systematic review and meta-analysis (GSK: 206938), conducted in MEDLINE, MEDLINE In-process, and EMBASE following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, identified randomized clinical trials (>8 weeks) in moderate-to-severe COPD (per Global Initiative for Chronic Obstructive Lung Disease guidelines), receiving LAMA/LABA or TIO...
August 27, 2018: NPJ Primary Care Respiratory Medicine
Bhumika Aggarwal, Aruni Mulgirigama, Norbert Berend
Exercise-induced bronchoconstriction (EIB) can occur in individuals with and without asthma, and is prevalent among athletes of all levels. In patients with asthma, symptoms of EIB significantly increase the proportion reporting feelings of fearfulness, frustration, isolation, depression and embarrassment compared with those without symptoms. EIB can also prevent patients with asthma from participating in exercise and negatively impact their quality of life. Diagnosis of EIB is based on symptoms and spirometry or bronchial provocation tests; owing to low awareness of EIB and lack of simple, standardised diagnostic methods, under-diagnosis and mis-diagnosis of EIB are common...
August 14, 2018: NPJ Primary Care Respiratory Medicine
Frits M E Franssen, Dionne E Smid, Dorly J H Deeg, Martijn Huisman, Jan Poppelaars, Emiel F M Wouters, Martijn A Spruit
Chronic obstructive pulmonary disease (COPD) is associated with substantial health impact that may already become apparent in early disease. This study aims to examine the features of subjects with COPD in a Dutch population-based sample and compare their physical status, mental status, and social status to non-COPD subjects. This study made use of Longitudinal Aging Study Amsterdam (LASA) data. Demographics, clinical characteristics, self-reported diseases, post-bronchodilator spirometry, physical, mental, and social status were assessed...
August 10, 2018: NPJ Primary Care Respiratory Medicine
Mark L Levy, Fiona Garnett, Adedayo Kuku, Inna Pertsovskaya, Eddie McKnight, John Haughney
The United Kingdom (UK) National Review of Asthma Deaths (NRAD) (2011-2014) identified a number of contributory risk factors which had not previously been recognized by those caring for people with asthma. Only one of the 19 NRAD recommendations has so far been implemented nationally, and that only partially, and as yet systems are not in place to identify patients at risk of attacks and dying from asthma. In 2015/2016 Bedfordshire Clinical Commissioning Group (CCG) in England, UK, initiated a quality asthma audit of people with asthma to identify some of the risk factors identified in the NRAD report with the aim of optimizing patient care...
July 26, 2018: NPJ Primary Care Respiratory Medicine
Steve W Turner, Clare Murray, Mike Thomas, Annie Burden, David B Price
Current understanding of risk factors for asthma attacks in children is based on studies of small but well-characterised populations or pharmaco-epidemiology studies of large but poorly characterised populations. We describe an observational study of factors linked to future asthma attacks in large number of well-characterised children. From two UK primary care databases (Clinical Practice Research Datalink and Optimum Patient Care research Database), a cohort of children was identified with asthma aged 5-12 years and where data were available for ≥2 consecutive years...
July 23, 2018: NPJ Primary Care Respiratory Medicine
Mome Mukherjee, Bright I Nwaru, Ireneous Soyiri, Ian Grant, Aziz Sheikh
Studies have shown that a small proportion of patients have particularly high needs and are responsible for disproportionally high disease burden. Estimates suggest that 2-5% of patients are high users of healthcare for their health gain. Such patients in Scotland are referred to as high health gain (HHG) patients. We wanted to investigate if there were HHG individuals with asthma in Scotland. We analysed data from the Scottish Health Survey (2010-11), and primary and National Health Survey (NHS) secondary healthcare and administrative data sets (2011-12)...
July 19, 2018: NPJ Primary Care Respiratory Medicine
Shauna McKibben, Andy Bush, Mike Thomas, Chris Griffiths
The National Review of Asthma Deaths (NRAD) identified high prescribing of short-acting beta2 -agonists (SABAs) as a key factor in over 40% of deaths. We interviewed asthma experts from both a hospital background (n = 5) and a primary care background (n = 8), and general practitioners delivering asthma care (n = 8), to identify how SABA use is defined and perceived. We identified disparity in how acceptable SABA use is defined, ranging from 0.5 (100 doses/year) to 12 SABA inhalers (2400 doses/year), and complacency in the perception that over-use did not represent a marker for risk of asthma death...
July 18, 2018: NPJ Primary Care Respiratory Medicine
Marianne Stubbe Østergaard, Jesper Kjærgaard, Mette Marie Kristensen, Susanne Reventlow, Anja Poulsen, Elvira Isaeva, Azamat Akylbekov, Talant Sooronbaev
The original version of this Article contained an error in the spelling of the author Mette Marie Kristensen, which was incorrectly given as Mette-Marie Kristensen. The affiliation details for Mette Marie Kristensen were also incorrect in this Article. This has now been corrected in both the PDF and HTML versions of this article.
June 28, 2018: NPJ Primary Care Respiratory Medicine
Job F M van Boven, Breda Cushen, Imran Sulaiman, Garrett Greene, Elaine MacHale, Matshediso C Mokoka, Frank Doyle, Richard B Reilly, Kathleen Bennett, Richard W Costello
Four inhaler adherence clusters have been identified using the INCA audio device in COPD patients: (1) regular use/good technique, (2) regular use/frequent technique errors, (3) irregular use/good technique, and (4) irregular use/frequent technique errors. Their relationship with healthcare utilization and mortality was established, but the cost-effectiveness of adherence-enhancing interventions is unknown. In this exploratory study, we aimed to estimate the potential cost-effectiveness of reaching optimal adherence in the three suboptimal adherence clusters, i...
June 27, 2018: NPJ Primary Care Respiratory Medicine
Magnus Ekström, Miriam J Johnson, Bridget Taylor, Mary Luszcz, Pia Wohland, Diana H Ferreira, David C Currow
Sexual activity is important to older adults (65 + ). Breathlessness affects about 25% of older adults but impact on sexual activity is unknown. We evaluated the relationships between breathlessness and sexual inactivity and self-reported health among older community-dwelling adults in the Australian Longitudinal Study of Ageing. Associations between self-reported breathlessness (hurrying on level ground or walking up a slight hill) at baseline, self-reported sexual activity, overall health and health compared to people of the same age were explored using logistic regression at baseline and 2 years, adjusted for potential confounders (age, sex, marital status, smoking status and co-morbidities)...
June 22, 2018: NPJ Primary Care Respiratory Medicine
Charlotte Scheerens, Luc Deliens, Simon Van Belle, Guy Joos, Peter Pype, Kenneth Chambaere
Early integration of palliative home care (PHC) might positively affect people with chronic obstructive pulmonary disease (COPD). However, PHC as a holistic approach is not well integrated in clinical practice at the end-stage COPD. General practitioners (GPs) and community nurses (CNs) are highly involved in primary and home care and could provide valuable perspectives about barriers to and facilitators for early integrated PHC in end-stage COPD. Three focus groups were organised with GPs (n = 28) and four with CNs (n = 28), transcribed verbatim and comparatively analysed...
June 20, 2018: NPJ Primary Care Respiratory Medicine
Mohammad A Al Sallakh, Sarah E Rodgers, Ronan A Lyons, Aziz Sheikh, Gwyneth A Davies
Asthma and chronic obstructive pulmonary disease (COPD) are two common different clinical diagnoses with overlapping clinical features. Both conditions have been increasingly studied using electronic health records (EHR). Asthma-COPD overlap syndrome (ACOS) is an emerging concept where clinical features from both conditions co-exist, and for which, however, there is no consensus definition. Nonetheless, we expect EHR data of people with ACOS to be systematically different from those with "asthma only" or "COPD only"...
June 20, 2018: NPJ Primary Care Respiratory Medicine
Jennifer K Quint, Elisabeth Moore, Adam Lewis, Maimoona Hashmi, Kirin Sultana, Mark Wright, Liam Smeeth, Lia Chatzidiakou, Roderic Jones, Sean Beevers, Sefki Kolozali, Frank Kelly, Benjamin Barratt
Databases of electronic health records (EHR) are not only a valuable source of data for health research but have also recently been used as a medium through which potential study participants can be screened, located and approached to take part in research. The aim was to assess whether it is feasible and practical to screen, locate and approach patients to take part in research through the Clinical Practice Research Datalink (CPRD). This is a cohort study in primary care. The CPRD anonymised EHR database was searched to screen patients with Chronic Obstructive Pulmonary Disease (COPD) to take part in a research study...
June 19, 2018: NPJ Primary Care Respiratory Medicine
Hayley Robinson, Veronika Williams, Ffion Curtis, Christopher Bridle, Arwel W Jones
Pulmonary rehabilitation has short-term benefits on dyspnea, exercise capacity and quality of life in COPD, but evidence suggests these do not always translate to increased daily physical activity on a patient level. This is attributed to a limited understanding of the determinants of physical activity maintenance following pulmonary rehabilitation. This systematic review of qualitative research was conducted to understand COPD patients' perceived facilitators and barriers to physical activity following pulmonary rehabilitation...
June 4, 2018: NPJ Primary Care Respiratory Medicine
Anthony D'Urzo, Giovanni Bader, Steven Shen, Pankaj Goyal, Pablo Altman
Glycopyrronium is a once-daily, inhaled long-acting muscarinic antagonist (LAMA) demonstrating similar efficacy to inhaled tiotropium in patients with moderate-to-severe COPD; however, the benefit of LAMAs on COPD symptoms has been variable. COPD is a progressive disease in which many patients develop an acute or sustained deterioration. Data on the prevention of clinically important deteriorations (CID) using LAMAs are limited. A pooled analysis was performed on four Phase III trials (n = 2936) that compared the efficacy of glycopyrronium (n = 1859) with tiotropium (n = 1077)...
May 24, 2018: NPJ Primary Care Respiratory Medicine
Tjard R Schermer, Maria Vatsolaki, Robbert Behr, Joke Grootens, Riet Cretier, Reinier Akkermans, Joke Denis, Patrick Poels, Lisette van den Bemt
We studied if pre-bronchodilator FEV1 /FEV6 determinations with microspirometers by GPs improve the diagnostic process for COPD in a 6-8 month clustered randomised controlled trial in Dutch general practices ( : NTR4041). GPs allocated to microspirometry (MI) used COPD-6® microspirometers in patients ≥50 years old with a smoking history and respiratory complaints that could indicate undiagnosed COPD and ask to refer patients for full spirometry if MI was positive (FEV1 /FEV6 <0...
May 22, 2018: NPJ Primary Care Respiratory Medicine
Mark L Levy, Angela Ward, Sara Nelson
An asthma attack or exacerbation signals treatment failure. Most attacks are preventable and failure to recognize risk of asthma attacks are well recognized as risk factors for future attacks and even death. Of the 19 recommendations made by the United Kingdom National Review of Asthma Deaths (NRAD) (1) only one has been partially implemented-a National Asthma Audit; however, this hasn't reported yet. The Harrow Clinical Commissioning Group (CCG) in London implemented a clinical asthma audit on 291 children and young people aged under 19 years (CYP) who had been treated for asthma attacks in 2016...
May 21, 2018: NPJ Primary Care Respiratory Medicine
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