Guideline-defined asthma control: a challenge for primary care

Levy, M. L.

doi:10.1183/09031936.00157507

Cited by 20 publications

(12 citation statements)

References 22 publications

(23 reference statements)

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“…10 However, many physicians are not aware of the practice guidelines. 11,12 By and large, they use subjective measures to assess asthma control which are often individualised and may not truly reflect the clinical severity of the disease. 13,14 Specialists tend to supplement their assessment with objective measures like forced expiratory volume in one second (FEV1) or peak expiratory flow rate (PEFR) compared to general practitioners who use PEFR measurements infrequently.…”

Section: Is Clinical Judgment Of Asthma Controlmentioning

confidence: 99%

Is Clinical Judgment of Asthma Control Adequate ? : A Prospective Survey in a Tertiary Hospital Pulmonary Clinic = هل يكفي الحكم السريري لتقدير مدى السيطرة على مرض الربو ؟

Baddar¹,

Jayakrishnan²,

Al-Rawas³

et al. 2013

SQUMJ

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abstract:Objectives: Asthma control is often difficult to measure. The aim of this study was to compare physicians' personal clinical assessments of asthma control with the Global Initiative for Asthma (GINA) scoring. Methods: Physicians in the adult pulmonary clinics of a tertiary hospital in Oman first documented their subjective judgment of asthma control on 157 consecutive patients. Immediately after that and in the same proforma, they selected the individual components from the GINA asthma control table as applicable to each patient. Results: The same classification of asthma control was achieved by physicians' clinical judgment and GINA classification in 106 cases (67.5%). In the other 32.5% (n = 51), the degree of control by clinical judgment was one level higher than the GINA classification. The agreement was higher for the pulmonologists (72%) as compared to non-pulmonologists (47%; P = 0.009). Physicians classified 76 patients (48.4%) as well-controlled by clinical judgment compared to 48 (30.6%) using GINA criteria (P <0.001). Conversely, they classified 34 patients (21.7%) as uncontrolled as compared to 57 (36.3%) by GINA criteria (P <0.001). In the 28 patients who were clinically judged as well-controlled but, by GINA criteria, were only partially controlled, low peak expiratory flow rate (PEFR) (46.7%) and limitation of activity (21.4%) were the most frequent parameters for downgrading the level of control. Conclusion: Using clinical judgment, physicians overestimated the level of asthma control and underestimated the uncontrolled disease. Since management decisions are based on the perceived level of control, this could potentially lead to under-treatment and therefore sub-optimal asthma control.

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Section: Is Clinical Judgment Of Asthma Controlmentioning

confidence: 99%

Is Clinical Judgment of Asthma Control Adequate ? : A Prospective Survey in a Tertiary Hospital Pulmonary Clinic = هل يكفي الحكم السريري لتقدير مدى السيطرة على مرض الربو ؟

Baddar¹,

Jayakrishnan²,

Al-Rawas³

et al. 2013

SQUMJ

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“…1,16 The major reasons for this are summarised in Table 1. 17,18 It is beyond the scope of this article to discuss in detail the evidence for each factor associated with inadequate asthma control.…”

Section: 15mentioning

confidence: 99%

Poor asthma control? — then look up the nose. The importance of co-morbid rhinitis in patients with asthma

Scadding

Walker

2012

Primary Care Respiratory Journal

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SummaryMany factors can impair asthma control. One which is frequently overlooked is rhinitis. Asthma patients with significant rhinitis are over four times more likely to have poorly controlled asthma than those without. Over 80% of patients with asthma have rhinitis, which may be allergic or inflammatory/non-allergic. Both types of rhinitis share pathophysiological similarities with eosinophilic asthma, cause bronchial hyper-reactivity, and are predisposing factors for the subsequent development of asthma. Nasal allergen challenge in allergic rhinitis results in inflammation in the bronchi as well as the nose, and the reverse is also true. This article reviews briefly the evidence for the link between asthma and rhinitis, advocates looking for rhinitis when patients present with poorly controlled asthma, and provides guidance for the diagnosis and treatment of rhinitis.

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“…Sometimes decisions by general practitioners to refer their patient to a specialist are made within a very narrow consultation time, within a duration of 6–12 min. 16 In addition, respiratory tract infections are the most common reason for consultation in primary health care (PHC) resulting in 15% of the total primary care consultations. 17 Under such circumstances and given that CAP is a potentially life-threatening condition, the identification of CAP patients in need of immediate treatment seems to be quite imperative.…”

Section: Introductionmentioning

confidence: 99%

Studying the burden of community-acquired pneumonia in adults aged ⩾50 years in primary health care: an observational study in rural Crete, Greece

Bertsias

Tsiligianni

Duijker

et al. 2014

npj Prim Care Resp Med

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Background:Community-acquired pneumonia (CAP) is a potentially life-threatening condition that often requires hospitalisation particularly in the elderly population or in patients with comorbidities.Aims:The aims of this study were to estimate the CAP frequency and severity in a well-defined primary healthcare setting in rural Crete, to record patient characteristics, their immunisation status and to estimate hospitalisation frequency and determinants.Methods:An observational study was designed and implemented in a rural setting within the prefecture of Heraklion in the island of Crete, Greece. Eligible patients were those aged 50 years or above, presenting with CAP based on signs and symptoms and positive X-ray findings.Results:A total of 124 CAP cases were recorded, 40 of which (32.3%) were hospitalised. Τhe age-standardised CAP incidence was estimated to be 236.7 cases per 100,000 persons aged ⩾50 years. Forty-three patients (35.2%) were vaccinated against pneumococcus. The most frequent chronic illnesses were heart disease (64.5%), chronic obstructive pulmonary disease (32.5%), and type 2 diabetes (21%). Hospitalisation determinants included advanced age (⩾74 years, Odds ratio (OR) 7.13; P value=0.001; 95% confidence interval (CI), 2.23–22.79), obesity (OR 3.36, P=0.037; 95% CI, 1.08–10.52), ⩾40 pack-years of smoking (OR 3.82, P value=0.040; 95% CI, 1.07–18.42), presence of multimorbidity (OR 5.77, P value=0.003; 95% CI, 1.81–18.42) and pneumococcal vaccination (OR 0.29, P value=0.041; 95% CI, 0.09–0.95).Conclusions:This study highlighted patient characteristics and aspects of CAP epidemiology in the context of a rural primary care setting in southern Europe where limited data have been published until now.

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Guideline-defined asthma control: a challenge for primary care

Cited by 20 publications

References 22 publications

Is Clinical Judgment of Asthma Control Adequate ? : A Prospective Survey in a Tertiary Hospital Pulmonary Clinic = هل يكفي الحكم السريري لتقدير مدى السيطرة على مرض الربو ؟

Is Clinical Judgment of Asthma Control Adequate ? : A Prospective Survey in a Tertiary Hospital Pulmonary Clinic = هل يكفي الحكم السريري لتقدير مدى السيطرة على مرض الربو ؟

Poor asthma control? — then look up the nose. The importance of co-morbid rhinitis in patients with asthma

Studying the burden of community-acquired pneumonia in adults aged ⩾50 years in primary health care: an observational study in rural Crete, Greece

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