Comparison of clinical management of young and elderly asthmatics by respiratory specialists and general practitioners

Tada, Mitsuhiro; Kuraki, Takashige; Taooka, Yasuyuki; Fuchita, Hiroshi; Karino, Fumi; Miura, Kiyotaka; Hamaguchi, Shunichi; Ohe, Miki; Sutani, Akihisa; Isobe, Takeshi

doi:10.3109/02770903.2014.928311

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…Differences in process and clinical outcomes of patients managed by a specialist or a generalist: Aim 3 Diagnosis, assessment and/or management of long-term asthma by specialists (respiratory physicians or allergists) compared to generalists (general physicians or general practitioners) was evaluated in two RCTs (both at high risk of bias) totalling 617 participants [104,105], and 14 observational studies, including six large studies using routine health databases (three cross-sectional and three longitudinal studies) [106][107][108][109][110][111], and smaller cross-sectional studies, including audits (figure 4, table e7) [112][113][114][115][116]. Management of acute asthma attacks was evaluated in three audits, totalling 1838 participants [117][118][119].…”

Section: Guideline Adherence Clinical Outcomes Interventionmentioning

confidence: 99%

ERS/EAACI statement on adherence to international adult asthma guidelines

et al. 2021

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Guidelines aim to standardise and optimise asthma diagnosis and management. Nevertheless, adherence to guidelines is suboptimal and may vary across different healthcare professional (HCP) groups.Further to these concerns, this European Respiratory Society (ERS)/European Academy of Allergy and Clinical Immunology (EAACI) statement aims to: 1) evaluate the understanding of and adherence to international asthma guidelines by HCPs of different specialties via an international online survey; and 2) assess strategies focused at improving implementation of guideline-recommended interventions, and compare process and clinical outcomes in patients managed by HCPs of different specialties via systematic reviews.The online survey identified discrepancies between HCPs of different specialties which may be due to poor dissemination or lack of knowledge of the guidelines but also a reflection of the adaptations made in different clinical settings, based on available resources. The systematic reviews demonstrated that multifaceted quality improvement initiatives addressing multiple challenges to guidelines adherence are most effective in improving guidelines adherence. Differences in outcomes between patients managed by generalists or specialists should be further evaluated.Guidelines need to consider the heterogeneity of real-life settings for asthma management and tailor their recommendations accordingly. Continuous, multifaceted quality improvement processes are required to optimise and maintain guidelines adherence. Validated referral pathways for uncontrolled asthma or uncertain diagnosis are needed.

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Section: Guideline Adherence Clinical Outcomes Interventionmentioning

confidence: 99%

ERS/EAACI statement on adherence to international adult asthma guidelines

et al. 2021

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“…It is clear that elderly people are more vulnerable to infections including viral in origin, therefore more frequent and patient tailored follow-ups that assess immunity and vaccination status of patients is beneficial in elderly for better control. Another cause of high ERV might be low adherence to treatment but it was not well documented in our files and there are conflicting results of the adherence in the elderly in different studies (27,28). Pnenotyping eldely asthmatics may be different than whole asthma patients in our country, demonstated in PHENOTuRK Study (29).…”

Section: Emergency Room Visits (Erv) and Hospitalizationmentioning

confidence: 71%

Clinical challenges in elderly asthma

et al. 2019

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Clinical challenges in elderly asthma Introduction: Understanding the difference of elderly asthma is essential to provide better healthcare for this vulnerable population. The aim of this study was to evaluate the differences between young and elderly asthma patients. Materials and Methods: This real-life study was designed as a cross-sectional analysis. All data collected with structured web based asthma program. In sum, 373 (89.9%) young asthma (YA, age < 65) and 42 (10.1%) elderly asthma (EA, age ≥ 65) patients followed at least one year and compared statistically. results: Cough is found higher in EA (p< 0.01) despite lower smoking rate in EA (p< 0.001). Allergic rhinitis and allergic conjunctivitis were more common in YA (p< 0.05, p< 0.01) which is consistent with higher allergy rate in YA (p< 0.05). On the other hand, diabetes and hypertension were determined significantly higher in EA (p< 0.01, p< 0.01). 52.4% of EA patients were found to have low diffusion capacity (DLCO < 80%). Although EA patients use combined therapies with inhaled corticosteroids and long acting beta agonists more than YA patients (p< 0.01), both emergency room visit (ERV) and hospitalization ratios are founded significantly higher in EA (p< 0.001, p< 0.001). Conclusion: EA patients were presented with cough in general. They possess an increased risk of hypertension, diabetes and low levels of diffusion capacity. ERV and hospitalization ratios have founded higher despite higher usage of combined therapies.

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“…On the other hand, the observation that the prevalence of drugs in the respiratory system group decreased with age suggests that certain respiratory disorders may be under treated in older people. Potential reasons include inappropriate education and insufficient clinical skills in general practitioners [22] or lack of teamwork between general practitioners and DNs or others involved in patient care. Closer investigation into this finding may be warranted, particularly into potential undertreatment of older people with asthma, as poor adherence to asthma treatment guidelines in adults correlate with poor outcomes and an increased number of hospitalisations [23].…”

Section: Extent Of Drug Usementioning

confidence: 99%

Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study

Lagerin

Törnkvist

Nilsson

et al. 2017

Scand J Public Health

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Aims: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups. Methods: Data from 2013 on people aged ≥75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged ≥75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare. Results: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs. Conclusions: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses’ role in continuing to promote safe medication management at higher ages.

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Comparison of clinical management of young and elderly asthmatics by respiratory specialists and general practitioners

Abstract: Elderly asthmatics treated by GPs underestimated the severity of their asthma and asthmatics seen by GPs were undertreated. The results stress the need to engage patients in educational activities, to adhere to guidelines, and to improve the coordination between GP and RS.

Cited by 8 publications

References 20 publications

ERS/EAACI statement on adherence to international adult asthma guidelines

ERS/EAACI statement on adherence to international adult asthma guidelines

Clinical challenges in elderly asthma

Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study

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