Monitoring the patient with asthma: An evidence-based approach

Gibson, Peter G.

doi:10.1067/mai.2000.108307

Cited by 78 publications

(42 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Improvement in asthma control through improved disease management could potentially result in significant savings, in patient morbidity and costs to society [25]. The findings also confirm that information obtained directly from patients is a useful addition to database information [3].…”

Section: Discussionsupporting

confidence: 71%

Persistent asthma: disease control, resource utilisation and direct costs

Ganse

Laforest²,

Pietri³

et al. 2002

Eur Respir J

121

View full text Add to dashboard Cite

Despite evidence that adverse outcomes are less frequent when asthma management is optimised, the link between the level of control, disease severity and medical resource utilisation (MRU) is poorly documented. This relationship was investigated in a group of patients suffering from persistent asthma (Global Initiative for Asthma (GINA) o2) in France.In 1998 a computerised family practice database was used to identify asthma patients aged 17-50 yrs. Information from the database was complemented by a patient survey to retrospectively assess the level of asthma control and hospital contacts. Costs of MRU over a 12-month study period were related to demographics, medical history, asthma control, and doses of inhaled corticosteroids prescribed during the prestudy period.A review of the computerised medical database identified 1,038 adult patients with persistent asthma, who completed the survey questionnaire. Over a 12-month period, the mean cost of MRU was 549.8 J for well-controlled patients, 746.3 J per patient with moderate control, and 1,451.3 J per patient with poor control. Costs also increased significantly with age, access to free asthma care, comorbid conditions, asthma symptoms in the past year and whether inhaled corticosteroids had been prescribed before the study period.In patients with persistent asthma, large differences were observed in the use of medical resources according to control and severity. Therefore, if patients appropriately use prescribed control therapy, their use of medical resources may be reduced. Eur Respir J 2002; 20: 260-267

show abstract

Section: Discussionsupporting

confidence: 71%

Persistent asthma: disease control, resource utilisation and direct costs

Ganse

Laforest²,

Pietri³

et al. 2002

Eur Respir J

121

View full text Add to dashboard Cite

show abstract

“…Regular monitoring by physicians improves health outcomes, provided it includes monitoring of control of asthma, medication and skills at regular intervals [205]. Bronchial responsiveness can be assessed at regular clinic visits and is related to asthma severity and airway inflammation [205]. It has been demonstrated repeatedly that, despite significantly improving symptoms and decreasing airway inflammation, inhaled corticosteroids produce, at best, a modest decrease in bronchial hyperresponsiveness as measured by histamine or methacholine challenges.…”

Section: Direct Versus Indirect Airway Challenges To Monitor Asthmamentioning

confidence: 99%

Section: Direct Versus Indirect Airway Challenges To Monitor Asthmamentioning

confidence: 99%

Indirect airway challenges

Joos

O’Connor²,

Anderson³

et al. 2003

Eur Respir J

327

274

View full text Add to dashboard Cite

Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle.Direct airway challenges have been used widely and are well standardised. They are highly sensitive, but not specific to asthma and can be used to exclude current asthma in a clinic population. Indirect bronchial stimuli, in particular exercise, hyperventilation, hypertonic aerosols, as well as adenosine, may reflect more directly the ongoing airway inflammation and are therefore more specific to identify active asthma. They are increasingly used to evaluate the prevalence of bronchial hyperresponsiveness and to assess specific problems in patients with known asthma, e.g. exercise-induced bronchoconstriction, evaluation before scuba diving.Direct bronchial responsiveness is only slowly and to a modest extent, influenced by repeated administration of inhaled steroids. Indirect challenges may reflect more closely acute changes in airway inflammation and a change in responsiveness to an indirect stimulus may be a clinically relevant marker to assess the clinical course of asthma. Moreover, some of the indirect challenges, e.g. hypertonic saline and mannitol, can be combined with the assessment of inflammatory cells by induction of sputum.

show abstract

“…Adherence to PEF monitoring is a challenge 25 and is often the reason it is not widely used in clinical practice. Overall, PEF monitoring alone has not been shown to be more effective than symptom monitoring on influencing asthma outcomes 26 and is no longer recommended. 1 24 forced vital capacity (FVC), and FEV 1 /FVC ratio, are an integral part of the assessment of asthma severity, control, and response to treatment.…”

Section: Peak Flowmentioning

confidence: 99%

Clinical Tools to Assess Asthma Control in Children

Dinakar¹,

Chipps²,

Allergy³

2017

Pediatrics

View full text Add to dashboard Cite

Asthma affects an estimated 7 million children and causes significant health care and disease burden. The most recent iteration of the National Heart, Lung and Blood Institute asthma guidelines, the Expert Panel Report 3, emphasizes the assessment and monitoring of asthma control in the management of asthma. Asthma control refers to the degree to which the manifestations of asthma are minimized by therapeutic interventions and the goals of therapy are met. Although assessment of asthma severity is used to guide initiation of therapy, monitoring of asthma control helps determine whether therapy should be maintained or adjusted. The nuances of estimation of asthma control include understanding concepts of current impairment and future risk and incorporating their measurement into clinical practice. Impairment is assessed on the basis of frequency and intensity of symptoms, variations in lung function, and limitations of daily activities. “Risk” refers to the likelihood of exacerbations, progressive loss of lung function, or adverse effects from medications. Currently available ambulatory tools to measure asthma control range are subjective measures, such as patient-reported composite asthma control score instruments or objective measures of lung function, airway hyperreactivity, and biomarkers. Because asthma control exhibits short- and long-term variability, health care providers need to be vigilant regarding the fluctuations in the factors that can create discordance between subjective and objective assessment of asthma control. Familiarity with the properties, application, and relative value of these measures will enable health care providers to choose the optimal set of measures that will adhere to national standards of care and ensure delivery of high-quality care customized to their patients.

show abstract

Monitoring the patient with asthma: An evidence-based approach

Cited by 78 publications

References 60 publications

Persistent asthma: disease control, resource utilisation and direct costs

Persistent asthma: disease control, resource utilisation and direct costs

Indirect airway challenges

Clinical Tools to Assess Asthma Control in Children

Contact Info

Product

Resources

About