Effectiveness of the Assessment of Burden of Chronic Obstructive Pulmonary Disease (ABC) tool: Study protocol of a cluster randomised trial in primary and secondary care

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) is a growing worldwide problem that imposes a great burden on the daily life of patients. Since there is no cure, the goal of treating COPD is to maintain or improve quality of life. We have developed a new tool, the Assessment of Burden of COPD (ABC) tool, to assess and visualize the integrated health status of patients with COPD, and to provide patients and healthcare providers with a treatment algorithm. This tool may be used during consultations to monitor the burden of COPD and to adjust treatment if necessary. The aim of the current study is to analyse the effectiveness of the ABC tool compared with usual care on health related quality of life among COPD patients over a period of 18 months. Methods/Design A cluster randomised controlled trial will be conducted in COPD patients in both primary and secondary care throughout the Netherlands. An intervention group, receiving care based on the ABC tool, will be compared with a control group receiving usual care. The primary outcome will be the change in score on a disease-specific-quality-of-life questionnaire, the Saint George Respiratory Questionnaire. Secondary outcomes will be a different questionnaire (the COPD Assessment Test), lung function and number of exacerbations. During the 18 months follow-up, seven measurements will be conducted, including a baseline and final measurement. Patients will receive questionnaires to be completed at home. Additional data, such as number of exacerbations, will be recorded by the patients’ healthcare providers. A total of 360 patients will be recruited by 40 general practitioners and 20 pulmonologists. Additionally, a process evaluation will be performed among patients and healthcare providers. Discussion The new ABC tool complies with the 2014 Global Initiative for Chronic Obstructive Lung Disease guidelines, which describe the necessity to classify patients on both their airway obstruction and a comprehensive symptom assessment. It has been developed to classify patients, but also to provide visual insight into the burden of COPD and to provide treatment advice. Trial registration Netherlands Trial Register, NTR3788

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma a

Respiratory symptoms in firefighters

BACKGROUND: The aim of the present study was to determine the prevalence and risk factors associated with respiratory symptoms in common firefighters in the Netherlands. METHODS: A total of 1,330 firefighters from the municipal fire brigades of three provinces of the Netherlands were included in the study. All subjects were administered a Dutch web-based version of the European Community Respiratory Health Survey questionnaire. RESULTS: General respiratory symptoms were associated with the number of fires fought in the last 12 months with odds ratios between 1.2 (95% CI 1.0-1.4) and 1.4 (95% CI 1.2-1.7) per 25 fires. A strong association was found between an inhalation incident and present respiratory symptoms with odds ratios between 1.7 (95% CI 1.1-2.7) and 3.0 (95% CI 1.9-4.7). Adjustments for smoking, sex, atopy, and age did not change any of the associations. After stratification, atopics showed elevated odds ratios. CONCLUSIONS: It is recommended that firefighters are aware of these elevated healthcare risks associated with exposure to fire smoke and that they increase as much as possible the use of self-contained breathing apparatus. Am. J. Ind. Med. 54:350-355, 2011. © 2011 Wiley-Liss, Inc

Selective acylation of primary amines in peptides and proteins

N-hydroxysuccinimide (NHS) esters are derivatizing agents that target primary amine groups. However, even a small molar excess of NHS may lead to acylation of hydroxyl-containing amino acids as a side reaction. We report a straightforward method for the selective removal of ester-linked acyl groups after NHS ester-mediated acylation of peptides and proteins. It is based on incubation in a boiling water bath and does not require a change in pH or the addition of chemicals. It is therefore particularly suited for proteomics samples that are often small in volume and contain low amounts of peptides. The method was optimized and evaluated with two peptides and one protein that were acetylated at a high excess of NHS-acetate. While the large molar excess resulted in complete acylation of all primary amines, hydroxyl-containing amino acids were shown to react as well. By incubating the peptide or protein solutions in a boiling water bath, acetyl-ester bonds were hydrolyzed, whereas acetyl-amide bonds remained stable. The reaction was also performed in 6 M guanidine-HCl, which prevented protein precipitation. In conclusion, the present method allows the selective acylation of primary amines by NHS esters and constitutes a valuable alternative to the treatment with hydroxylamine under alkaline conditions

Mini-Wright pealflow meters are reliable after 5 years use

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Risk of overtreatment with current peak flow criteria in self-management plans.

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