Background: There have so far been only partial studies or studies in fairly small groups of Raynaud’s patients to systematically analyse the clinical features, the beginning of first Raynaud’s attacks, the interval between first Raynaud’s attacks and the first clinical examination, the duration of Raynaud’s attacks, inducing factors, frequency of attacks, localization, coloration, accompanying symptoms, laboratory parameters, instrument-based examinational findings on the first examination, fitness for work, and development of the diagnostic classification in the long term. Such studies are, however, necessary for reasons of differential diagnostics and therapeutics. Patients and methods: The disease data of 900 patients with established Raynaud’s symptoms, who underwent an examination between 1973 and 2002, were at first analysed in retrospect on the basis of their case history. This was followed, in 2002 to 2003, by a mail inquiry of all 900 patients, who were sent a comprehensive questionnaire to confirm history data and supplement clinical findings. Answers were received from 419 patients. In addition, 177 of the 900 patients underwent at least one follow-up examination after 2.8 years (1 month – 18 years), on the average, which allowed checking whether and how the diagnostic classification into primary, secondary and suspected secondary Raynaud’s syndrome had changed. All data were analysed statistically. Results: Of the 900 patients, 77% were women and 23% were men. The mean age on the first examination was 45.1 ± 15.5 years. Calculated on all patients, the first Raynaud’s attacks occurred at the age of 39.5 ± 16.9 years. The beginning of Raynaud’s attacks fell mostly between the 21st and 60th year of life (minimum 3rd year, maximum 88th year). There was no statistical difference between primary, secondary and suspected secondary Raynaud’s syndromes as to the time, ranging from 38.8 to 44.3 years of age, when the symptoms began. The duration of Raynaud’s attacks averaged 23.6 ± 23.5 min.; they occurred every day in 59.1%, once to three times a day in 26.8%, and more than three times a day in 31.1% of the cases. Factors inducing Raynaud’s attacks were cold in 96.8% and stress in 19.2%. Raynaud’s phenomenon was observed in both hands in 90.9% and in one hand only in 8.6% of the cases. A white discoloration only was observed in 39.0%, a white-blue discoloration sequence, in 19.3%, a purely blue discoloration, in 7.6%, and a triphasic colour response, in 19.1%. The latter sign was significantly more frequent in women and secondary Raynaud’s syndrome than in men and primary Raynaud’s syndrome. At 64.6%, secondary Raynaud’s syndrome was significantly more often associated with pain than primary Raynaud’s syndrome (47.9%). The mean systolic blood pressure was 125.6 ± 20.9 mmHg, the mean diastolic pressure, 78.3 ± 10.6 mmHg. Concomitant diseases were equally frequent in primary, secondary and suspected secondary Raynaud’s syndrome. Finger, hand and arm artery occlusions were equally often seen in all three forms of Raynaud’s syndrome. The results of the first examination showed that 72.9% of the 900 patients suffered from primary, 5.3% from secondary, and 21.3% from suspected secondary Raynaud’s syndrome. In the long term, primary and suspected secondary Raynaud’s syndromes showed a diagnostic transition in 19.2% of the cases after 2.8 years, on the average, while secondary Raynaud’s syndromes did not. The clinical symptoms of the groups, as found on the first examination, were not altered by this transition, though. Conclusion: The clinical characteristics of Raynaud’s syndromes (age when first Raynaud’s attacks are observed, inducing factors of Raynaud’s attacks, duration frequency of attacks, localization, coloration, and accompanying symptoms of an attack) are not specific and therefore not suitable to distinguish between primary and secondary Raynaud’s syndrome. The case history, a general clinical examination, immunoserologic and capillaroscopic findings, and repeated examinations during 5 or more years are necessary to differentiate between primary, secondary and suspected secondary Raynaud’s syndromes.
Purpose Real-word evidence on the effectiveness of switching from dual therapies or triple therapies (multiple inhalers) to extrafine single-inhaler triple therapy (efSITT), which consists of the inhaled corticosteroid (ICS) beclomethasone, the long-acting β 2 -agonist (LABA) formoterol and the long-acting muscarinic antagonist (LAMA) glycopyrronium, in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) is limited. The impact of switching to efSITT on health-related quality of life (HRQoL), COPD specific symptoms, lung function and treatment adherence were assessed in routine clinical care. Patients and Methods Patients were recruited at 148 sites in Germany between 2017 and 2020 in this multicenter, non-interventional observational study. Demographics, clinical data and treatment history were collected at baseline. HRQoL (measured by COPD Assessment Test [CAT]), lung function and adherence (measured by Test of Adherence to Inhalers [TAI]) were assessed at baseline and after six months. Descriptive analyses were conducted by prior treatment and GOLD groups as well as for the overall population. Results 55.1% of the 2623 included patients were male. Mean age was 65.8 years. 57.5% of the patients were previously treated with ICS+LABA+LAMA (multiple inhalers), 23.9% with ICS/LABA (single or two inhalers) and 18.6% with LAMA/LABA (single or two inhalers). After six months, largest mean improvements in the total CAT score were observed in the ICS/LABA (−3.9) and LAMA/LABA (−3.9) prior treatment groups as well as in patients in GOLD group B (−2.9). In the overall population, the CAT items for cough, phlegm, and dyspnea decreased on average by −0.4 points each. After six months, FEV 1 increased by 2.0 percentage points in relation to predicted values. The percentages of measured sRtot and RV of predicted values decreased by 24.5 and 4.4 percentage points, respectively. The percentage of patients with good adherence increased from 67.8% to 76.5%. Conclusion Treatment switch to efSITT resulted in an improvement of HRQoL, COPD specific symptoms, lung function parameters and adherence under real-world conditions.
In the present study, patients with asthma were interviewed with regard to their treatment adherence. It was shown that adherence is significantly influenced by age, occupation, quality of information about the disease and interest of the patient in disease, mode of action and use of the inhalation device. Younger, working patients who do not feel "completely adequately" informed are more likely to be not-adherent. Each aspect should be noted separately.The characterization enables forming target groups for appropriate counselling initiatives in pulmonology practice and allows the effectiveness of the measures to be examined. The results confirm the importance of doctor/patient communication for achieving a high level of adherence and thus therapeutic success.It is suggested that, in addition to questionnaires already in use, asthma patients should be given the following questions in writing during routine monitoring of therapy; based on the results of the survey, the extent of advice necessary can be determined -Do you feel sufficiently informed about your illness? -Do you feel sufficiently informed about the effect of the drug therapy? -Do you feel sufficiently informed about the handling of the inhalation drugs? -Are you satisfied with the handling of your inhalation medication? The following options to answer the questions should be available: completely - mainly - somewhat - not at all. There were significant differences in adherence between patients who were completely satisfied with the handling of their device and those that were not. However, there was no significant difference between the devices. Therefore, the same therapy adherence can be predicted for all devices when the device is suitable for the patient and also provides complete satisfaction in handling. Since it is the subjective perception of patients, the data show significant differences between study centres. These were mirrored in a blind benchmark to stimulate improvements.
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