Patients' and carers' preferences in two models of care for acute exacerbations of COPD: results of a randomised controlled trial

Abstract

Background: A study was undertaken to investigate quality of life in asthma, defined by differing criteria, to see which may be most appropriate in epidemiological studies. Methods: The 426 adults were participants in the follow up phase of the European Community Respiratory Health Survey (ECRHS) in Melbourne. As part of the laboratory visit, participants completed the SF-36 quality of life questionnaire, a detailed respiratory questionnaire, and underwent lung function testing. Results: Both the physical component summary and the mental component summary scores were significantly worse in those with wheeze in the previous 12 months than in those without wheeze. Only the mental component summary score was significantly worse in those with current asthma than in those without. In contrast, in those with current asthma or bronchial hyperreactivity only, neither of the summary scales was significantly different between cases and controls. Conclusions: Quality of life is severely impaired in individuals with wheeze in the previous 12 months while individuals with current asthma or bronchial hyperreactivity alone did not appear to have significantly reduced quality of life. B ronchial hyperreactivity (BHR) to histamine or methacholine has been used as an objective physiological marker of asthma and, in combination with wheeze in the previous 12 months, has been used to define "current asthma" in epidemiological studies. It has been claimed that this definition discriminates a group with more severe asthma than subjective definitions based on self-reported asthma symptoms alone.1 2 However, subjective measures of asthma severity have been found to correlate much better with measures of quality of life (QoL) than objective physiological measures such as BHR and forced expiratory volume in 1 second (FEV 1 ).3 The purpose of this study was to examine the relationship between QoL and symptom based and physiological definitions of asthma in a community setting to determine which definition might be most appropriate. METHODSThe subjects were participants in the follow up phase of the ECRHS conducted in Melbourne in 1998/9. Full details of the original sampling protocol have been described elsewhere. 4 Participants completed the detailed ECRHS questionnaire, spirometric tests, and a methacholine challenge. QoL was evaluated by the short form (SF-36) health survey which was completed by participants upon arrival at the laboratory. All questionnaires were checked for missing data by one of the trained interviewers after completion. Only the physical component summary (PCS) score and the mental component summary (MCS) score are reported in this analysis which were calculated using the three step procedure recommended by the developer. 5 A total of 426 participants completed the methacholine challenge and were included in this analysis.Wheeze only was defined as a positive response to the question: "Have you had wheezing or whistling in your chest at any time in the last 12 months?".1 The ECRHS defined asthma as a positive r...

Hospital at Home for Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…A first feasibility analysis of home-based services to prevent conventional hospitalization of COPD exacerbations was reported in 1999 by Gravil and collegues (Gravil et al, 1998). Subsequent controlled trials confirmed both safety and cost reduction when these types of services were applied to selected COPD patients (Cotton et al, 2000;Davies et al, 2000;Hernandez et al, 2003;Ojoo et al, 2002;Skwarska et al, 2000).…”

Evaluating hospital at home and early discharge schemes for patients with an acute exacerbation of COPD

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The necessity for spirometry in the primary care management of COPD

“…A majority of patients prefer domiciliary over hospital care [12], leading to greater patient satisfaction [13]. Thus, spirometry in the primary care setting can be an important example of this demand-driven care.…”