57,304 research outputs found

    Insights into frequent asthma exacerbations from a primary care perspective and the implications of UK National Review of Asthma Deaths recommendations

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    The United Kingdom National Review of Asthma Deaths (NRAD) recommends that patients who require ≥3 courses of oral corticosteroids (OCS) for exacerbations in the past year or those on British Thoracic Society (BTS) Step 4/5 treatment must be referred to a specialist asthma service. The aim of the study was to identify the proportion of asthma patients in primary care that fulfil NRAD criteria for specialist referral and factors associated with frequent exacerbations. A total of 2639 adult asthma patients from 10 primary care practices in Glasgow, UK were retrospectively studied between 2014 and 2015. Frequent exacerbators and short-acting β2-agonist (SABA) over-users were identified if they received ≥2 confirmed OCS courses for asthma and ≥13 SABA inhalers in the past year, respectively. Community dispensing data were used to assess treatment adherence defined as taking ≥75% of prescribed inhaled corticosteroid (ICS) dose. The study population included 185 (7%) frequent exacerbators, 137 (5%) SABA over-users, and 319 (12%) patients on BTS Step 4/5 treatment. Among frequent exacerbators, 41% required BTS Step 4/5 treatment, 46% had suboptimal ICS adherence, 42% had not attended an asthma review in the past year and 42% had no previous input from a specialist asthma service. Older age, female gender, BTS Step 4/5, SABA over-use and co-existing COPD diagnosis increased the risk of frequent exacerbations independently. Fourteen per 100 asthma patients would fulfil the NRAD criteria for specialist referral. Better collaboration between primary and secondary care asthma services is needed to improve chronic asthma care

    MCV/Q, Medical College of Virginia Quarterly, Vol. 11 No. 4

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    Difficult-to-treat asthma - an uncontrolled disease. Is there any relation to the experience from palliative medicine?

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    Background and aim. Difficult-to-treat asthma is characterized by uncontrolled symptoms occurring in spite of intensive treatment (corticosteroids and long-acting β2-agonists) for at least 6 months and is connected with severe obturation in the bronchotracheal tree. It still creates an important global medical and economical problem. The aim of the study was to evaluate the occurrence of persistent symptoms, exacerbating factors and co-morbidities in patients with difficult-to-treat asthma. It was also a challenging idea to apply palliative medicine to help patients with this type of asthma. Material and methods. Twenty-seven patients (21 women and 6 men, ages ranging from 23 to 60) diagnosed with difficult-to-treat asthma were included in the study. Data were collected from the internet database of severe, difficult-to-treat asthma, introduced to the Department of Allergology in 2005. All patients’ spirometries and additional factors were assessed. Results. The median predicted value of FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 lower than the 60% predicted value. All patients suffered from dyspnoea, chronic cough and wheezing and had additional factors escalating the symptoms of asthma. The most important factor which leads to exacerbation was long-term stress and rhinitis. Twelve (45%) patients from this group have poor tolerance of exercise. In spite of intensive treatment, 17 (65%) patients constantly overused short-acting beta-agonists (SABA) and all had long-term treatment with oral steroids. In most cases, co-morbidities were recognized: obesity and hypertension. Conclusions. This study showed that the role of additional factors and co-morbidities plays a significant part in the course of asthma. It seems to be necessary to introduce a unified system of registering and managing patients with severe and difficult-to-treat asthma. That palliative care is very important for selected patients with chronic uncontrolled cough or dyspnoea should be a subject for newly planned clinical trials.Background and aim. Difficult-to-treat asthma is characterized by uncontrolled symptoms occurring in spite of intensive treatment (corticosteroids and long-acting β2-agonists) for at least 6 months and is connected with severe obturation in the bronchotracheal tree. It still creates an important global medical and economical problem. The aim of the study was to evaluate the occurrence of persistent symptoms, exacerbating factors and co-morbidities in patients with difficult-to-treat asthma. It was also a challenging idea to apply palliative medicine to help patients with this type of asthma. Material and methods. Twenty-seven patients (21 women and 6 men, ages ranging from 23 to 60) diagnosed with difficult-to-treat asthma were included in the study. Data were collected from the internet database of severe, difficult-to-treat asthma, introduced to the Department of Allergology in 2005. All patients’ spirometries and additional factors were assessed. Results. The median predicted value of FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 lower than the 60% predicted value. All patients suffered from dyspnoea, chronic cough and wheezing and had additional factors escalating the symptoms of asthma. The most important factor which leads to exacerbation was long-term stress and rhinitis. Twelve (45%) patients from this group have poor tolerance of exercise. In spite of intensive treatment, 17 (65%) patients constantly overused short-acting beta-agonists (SABA) and all had long-term treatment with oral steroids. In most cases, co-morbidities were recognized: obesity and hypertension. Conclusions. This study showed that the role of additional factors and co-morbidities plays a significant part in the course of asthma. It seems to be necessary to introduce a unified system of registering and managing patients with severe and difficult-to-treat asthma. That palliative care is very important for selected patients with chronic uncontrolled cough or dyspnoea should be a subject for newly planned clinical trials

    Adverse Maternal Outcomes in Nevada: Does Asthma Matter?

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    Objective. Asthma is a common clinical complication of pregnancy and women with asthma are at greater risk of having complications. This study compared adverse maternal outcomes between women with asthma and women without asthma in Nevada. Methods. A total of 64,664 hospital discharges of delivery were abstracted from the Nevada 2003-2004 hospital discharges and thirteen adverse maternal outcomes were examined. Logistic regression was applied to compare the maternal outcomes between women with and without asthma. Results. Women with asthma were more likely to have pre-eclampsia (OR [CI] 1.73 [1.13, 2.65]), transient hypertension of pregnancy (OR [CI] 1.76 [1.11, 2.78]), pregnancy-induced hypertension (OR [CI] 1.89 [1.42, 2.53]), gestational diabetes (OR [CI] 1.89 [1.32, 2.72]), infection of the amniotic cavity (OR [CI] 2.15 [1.29, 3.58]), and cesarean section (OR [CI] 1.87 [1.56, 2.23] ). Conclusion. Women with asthma experienced a greater risk of having adverse maternal outcomes. Community-based education programs, as well as, services offered in traditional healthcare settings should be supported to educate pregnant women about the potential risk factors and the relationship between asthma and maternal outcomes

    The Price-Quality Paradox in Healthcare

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    This data brief compares average state-level prices against quality measures for asthma, diabetes and hypertension care and finds that higher prices for medical services are not always indicative of higher quality of care

    Comorbidities in aging patients with sickle cell disease.

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    Sickle cell disease (SCD) in general and sickle cell anemia in particular is a highly complex disorder both at the molecular and clinical levels. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of the disease. Moreover, despite the fact that SCD is a chronic malady, its manifestations are both acute and chronic. The former include, among other things, the recurrent vaso-occlusive crises (its hallmark) and acute chest syndrome. The chronic complications include most commonly avascular necrosis and leg ulcers. Currently, survival of patients with SCD has improved dramatically thanks to newborn screening, antibiotic prophylaxis, better vaccine, safer blood transfusion and the use of hydroxyurea. It is the advent of these therapies that improved the survival. This improvement, however, introduced a third dimension of the disease: comorbidities that occur in aging people in the general population. There is concern that the gain in survival may be offset by the comorbidities. Thus it is the purpose of this review to identify the comorbidities in the elderly with SCD and differentiate them from the basis disease to implement proper therapies so that better survival could be maintained

    Symptomatic adrenal insufficiency during inhaled corticosteroid treatment

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    Symptomatic adrenal insufficiency, presenting as hypoglycaemia or poor weight gain, may occur on withdrawal of corticosteroid treatment but has not previously been reported during inhaled corticosteroid treatment. This case series illustrates the occurence of clinically significant adrenal insufficiency in asthmatic children while patients were on inhaled corticosteroid treatment and the unexpected modes of presentation. General practitioners and paediatricians need to be aware that this unusual but acute serious complication may occur in patients treated

    Scaling up antiretroviral therapy in Malawi-implications for managing other chronic diseases in resource-limited countries.

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    The national scale-up of antiretroviral therapy (ART) in Malawi is based on the public health approach, with principles and practices borrowed from the successful DOTS (directly observed treatment, short course) tuberculosis control framework. The key principles include political commitment, free care, and standardized systems for case finding, treatment, recording and reporting, and drug procurement. Scale-up of ART started in June 2004, and by December 2008, 223,437 patients were registered for treatment within a health system that is severely underresourced. The Malawi model for delivering lifelong ART can be adapted and used for managing patients with chronic noncommunicable diseases, the burden of which is already high and continues to grow in low-income and middle-income countries. This article discusses how the principles behind the successful Malawi model of ART delivery can be applied to the management of other chronic diseases in resource-limited settings and how this paradigm can be used for health systems strengthening
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