No abstract

A chronic disease management programme for COPD patients that incorporated a variety of interventions, including pulmonary rehabilitation and implemented by primary care, reduced admissions and hospital bed days. Key elements were patient participation and information sharing among healthcare providers.

A population based case control-study was We report the results of a population based case control study of fatal asthma, which was initiated as part of our investigation into the recent epidemic of deaths from asthma in New Zealand.1 The objectives of this study were to describe more fully the patients who die of asthma and to examine the significance of characteristics previously suggested as being associated with death in descriptive studies.2`9 MethodsThe cases were all people less than 60 years of age, who had died from 1 January 1981 to 31 December 1982 of asthma that was deemed to have been usefully reversible in the year before death, and who were normally resident in the Auckland region (March 1981 Census population 825 958, about a quarter of the total New Zealand population). Usefully reversible asthma was said to have been present if, in the year before death, there were recordings of swings in peak Address for reprint requests: Dr H H Rea, Department of Respiratory Medicine, Greenlane Hospital, Auckland, New Zealand. Accepted 19 May 1986 flow or FEVY of more than 20%. If this information was not available then a subjective assessment of reversibility from hospital notes, the general practitioner, or a relative was accepted. Forty seven people died from asthma in Auckland over the two years in the age group being studied and 44 (94%) of these were categorised as having had usefully reversible asthma.Two sets of asthmatic patients were selected as matched controls for those who died. A hospital control patient was randomly selected from all patients discharged from Auckland hospitals after admission for acute asthma. Controls were matched for age (+ 5 years), sex, race, and date of hospital admission. Community controls were identified by asking a random sample of Auckland general practitioners to submit lists of all patients known to have asthma who consulted them over a four week period. This was repeated each quarter so that a control could be found for each patient who died close to the date of death. Like the hospital controls, they were matched for age, sex, and race. All the controls satisfied the definition of "usefully reversible asthma" in the year before their index event. 833 on 11 May 2018 by guest. Protected by copyright.

Long-term humidification therapy significantly reduced exacerbation days, increased time to first exacerbation, improved lung function and quality of life in patients with COPD and bronchiectasis. Clinical trial registered with www.actr.org.au; Number ACTRN2605000623695.

Aims: To explore how patients with COPD experience helplessness. Methods:In-depth interviews with 29 patients with moderate to very severe COPD. Data were analysed using a general inductive approach.Results: All patients focused on acute symptoms and expressed feelings of helplessness in the management of their condition; little attention was paid to longer-term strategies. For one group of patients, mostly European, self blame appeared to intensify feelings of helplessness. For a second group, mostly Pacific, a focus on faith in God, Church and family provided a more positive affect and existed alongside helplessness.Conclusions: Clinicians seeking to support patients to include longer term strategies in their self management will need to coach patients to experiences of short-term success, and be aware of the ways that patients experience and interpret their helplessness. Clinicians need to address self blame, and recognise patients' priorities of faith and family.