Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry

Takala, Jaana; Ilmarinen, Pinja; Tuomisto, Leena E.; Vähätalo, Iida; Niemelä, Onni; Kankaanranta, Hannu

doi:10.1038/s41533-020-0166-2

Cited by 11 publications

(37 citation statements)

References 56 publications

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“… 14 Among asthmatics in Finland, the follow-ups occurred generally every third year. 31 However, follow-up visits were recently shown to be more common among those with GINA step 4/5 treatment and those with exacerbations compared to the lower treatment steps and those without exacerbations. 32 It is vital that all individuals with potentially severe asthma have regular contact with a healthcare provider because asthma symptoms and the risk of exacerbation vary with time.…”

Section: Discussionmentioning

confidence: 99%

Severe Asthma in a General Population Study: Prevalence and Clinical Characteristics

Rönnebjerg¹,

Axelsson²,

Kankaanranta³

et al. 2021

JAA

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Purpose: Current guidelines primarily use medication levels to distinguish severe asthma from other types of asthma. In addition, severe asthma must also be uncontrolled at highintensity treatment or become uncontrolled if treatment level is decreased. To date, only a few studies have used this definition to investigate the prevalence and clinical characteristics of severe asthma in population-based samples. Therefore, the aim of this study was to evaluate the prevalence and clinical characteristics of individuals with severe asthma in the population-representative West Sweden Asthma Study. Materials and Methods: In this cross-sectional population-based study, a randomly selected sample (n=1172) and a separate asthma sample (n=744) underwent clinical examinations, completed a structured interview and responded to questionnaires. Severe asthma was defined as at least one feature of uncontrolled asthma despite treatment in line with the Global Initiative for Asthma (GINA) steps 4/5. This treatment level required a minimum medium dose of inhaled corticosteroids (ICS) plus a second controller or oral corticosteroids. Results: The prevalence of severe asthma was 1.1% in the adult random sample and 9.5% within the asthma sample. Individuals with severe asthma were older and had more symptoms, activity limitations, heart disease and blood neutrophils compared to those with other asthma. They also had lower lung function and despite these impairments, 32% did not have annual contact with a healthcare provider. Conclusion:The prevalence of severe asthma was higher compared to previous studies, and many individuals with severe asthma did not have regular contact with healthcare providers. Due to the high burden of symptoms and impairments for individuals with severe asthma, it is important that the healthcare system implement strategies to improve follow-up and evaluate these patients according to existing guidelines.

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Section: Discussionmentioning

confidence: 99%

Severe Asthma in a General Population Study: Prevalence and Clinical Characteristics

Rönnebjerg¹,

Axelsson²,

Kankaanranta³

et al. 2021

JAA

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“…[ 21 ] After asthma diagnosis was confirmed and medication initiated the patients were managed by their personal physicians mostly in PHC according to the Finnish National Asthma Programme [ 22 ] unless asthma severity or other respiratory diseases required monitoring in specialized care. As described previously[ 2 , 4 , 15 , 21 ], after 12 years (mean 12.2, range 10.8–13.9) a total of 203 patients completed a follow-up visit where the participants gave written informed consent to the study protocol approved by the Ethics committee of Tampere University Hospital, Tampere, Finland (R12122). In addition to the data gathered at the diagnostic and follow-up visits, all data on asthma-related health care contacts during 12-year period was collected from PHC, occupational health care, private clinics and secondary care [ 2 , 4 , 15 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…As described previously[ 2 , 4 , 15 , 21 ], after 12 years (mean 12.2, range 10.8–13.9) a total of 203 patients completed a follow-up visit where the participants gave written informed consent to the study protocol approved by the Ethics committee of Tampere University Hospital, Tampere, Finland (R12122). In addition to the data gathered at the diagnostic and follow-up visits, all data on asthma-related health care contacts during 12-year period was collected from PHC, occupational health care, private clinics and secondary care [ 2 , 4 , 15 , 21 ]. The SAAS-study protocol has been published previously [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…Many factors may lead to poor asthma control including allergy, rhinitis, gastroesophageal reflux, smoking, obesity, problems in inhalation technique and poor adherence to asthma medication [ 1 , 11 – 14 ]. One possible reason to adverse treatment outcome is non-participation to asthma follow-up visits and it seems to be a problem in many countries [ 15 – 18 ]. Issues affecting the adherence to treatment and occurrence to asthma follow-up visits may include both patient-related and health care system-related factors [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Participation in scheduled asthma follow-up contacts and adherence to treatment during 12-year follow-up in patients with adult-onset asthma

et al. 2022

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Background Poor treatment compliance is a common problem in the treatment of asthma. To our knowledge, no previous long-term follow-up studies exist on how scheduled asthma follow-up contacts occur in primary health care (PHC) versus secondary care and how these contacts relate to adherence to medication and in participation to further scheduled asthma contacts. The aim of this study was to evaluate occurrence of scheduled asthma contacts and treatment compliance in PHC versus secondary care, and to identify the factors associated with non-participation to scheduled contacts. Methods Patients with new adult-onset asthma (n = 203) were followed for 12 years in a real-life asthma cohort of the Seinäjoki Adult Asthma Study (SAAS). The first contacts were mainly carried out in secondary care and therefore the actual follow-up time including PHC visits was 10 years. Results A majority (71%) of the patients had ≥ 2 scheduled asthma contacts during 10-year follow-up and most of them (79%) mainly in PHC. Patients with follow-up contacts mainly in PHC had better adherence to inhaled corticosteroid (ICS) medication during the whole 12-year period compared to patients in secondary care. In the study population, 29% of the patients had only 0–1 scheduled asthma contacts during the follow-up. Heavy alcohol consumption predicted poor participation in scheduled contacts. Conclusions Patients with mainly PHC scheduled asthma contacts were more adherent to ICS medication than patients in the secondary care. Based on our results it is necessary to pay more attention to actualization of asthma follow-up visits and systematic assessment of asthma patients including evaluation of alcohol consumption. Trial registration Seinäjoki Adult Asthma Study is retrospectively registered at www.ClinicalTrials.gov with identifier number NCT02733016. Registered 11 April 2016.

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“…The REcognise Asthma and LInk to Symptoms and Experience survey of 8000 adults with asthma in 11 European countries, including Sweden, showed that acute exacerbations were common and that 12% of the patients with asthma had been hospitalized because of asthma during the previous year. 14 Also, a recent study from Finland showed that the frequency of asthma follow-up contacts is insufficient, with only 1 of 3 patients with asthma attending a planned visit each year, 15 as recommended by guidelines. 11 Although poor asthma control still leads to hospitalizations, few contemporary population-based studies have investigated the management, treatment patterns, and risk of rehospitalization and mortality in patients with asthma postdischarge.…”

Section: Introductionmentioning

confidence: 99%

Risk of Rehospitalization and Death in Patients Hospitalized Due to Asthma

Ekström

Nwaru

Wiklund

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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What is already known about this topic? Asthma causes considerable morbidity across the world.What does this article add to our knowledge? Rehospitalizations occurred in more than 1 of 10 patients with asthma, few were seen by specialists, and continuous inhaled corticosteroid use was rare.How does this study impact current management guidelines? Closer monitoring after asthma hospitalization is needed.BACKGROUND: Asthma is a heterogeneous inflammatory airway disease that continues to cause considerable morbidity across the world, with poor asthma control leading to hospitalizations. OBJECTIVE: The present study investigated the risk of rehospitalization, mortality, and the management of patients with asthma who had been hospitalized because of an asthma exacerbation. METHODS: National Swedish health registries were linked for patients 6 years or older who were admitted to hospital because of asthma (index date) between January 1, 2006, and December 31, 2015. Exacerbations were defined as asthma-related hospitalization, emergency visits, or collection of oral steroids. Patients were followed for rehospitalizations 12 months after the index date, health care resource utilization and treatment for 36 months, and mortality to study end. Regression models for timeto-event analyses were applied to assess risk factors for rehospitalization and mortality. RESULTS: A total of 15,691 patients (mean age, 51.5 years; 63% females) were included, of whom 1,892 (12%) were rehospitalized for asthma within 12 months. Rehospitalized patients had a markedly increased risk of subsequent asthmarelated mortality (adjusted hazard ratio, 2.80; 95% CI, 1.95-4.01) compared with those not rehospitalized. Two-third of the patients were not followed up by a hospital-based specialist, and 60% did not collect enough inhaled corticosteroid doses to cover daily treatment the year postindex. CONCLUSIONS: In this study, more than 1 in 10 patients were rehospitalized because of asthma within 12 months, and rehospitalizations were associated with asthma-related mortality. Few patients were seen by a hospital-based specialist, and few used inhaled corticosteroid continuously. Closer monitoring after hospitalization is needed.

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Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry

Cited by 11 publications

References 56 publications

Severe Asthma in a General Population Study: Prevalence and Clinical Characteristics

Severe Asthma in a General Population Study: Prevalence and Clinical Characteristics

Participation in scheduled asthma follow-up contacts and adherence to treatment during 12-year follow-up in patients with adult-onset asthma

Risk of Rehospitalization and Death in Patients Hospitalized Due to Asthma

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