Symptom control among asthmatics with a clinically significant smoking history : a cross-sectional study in Finland

Background Surprisingly little is known about asthma control among asthmatics who smoke. The aim of this cross-sectional study was to investigate asthma symptom control according to the GINA guidelines among asthmatics with a clinically significant smoking history. Methods One hundred ninety asthmatics from primary care in Finland were investigated. The patients were current or previous cigarette smokers with a history of 10 or more pack-years. They completed a questionnaire including questions on asthma symptoms and reliever use so that their level of asthma symptom control (well controlled, partly controlled, or uncontrolled) according to GINA could be determined. Results Sixty-six (34.7%) patients had their asthma well controlled, 81 (42.6%) had their asthma partly controlled, and 43 (22.6%) had uncontrolled asthma. Current smokers had uncontrolled asthma more often than ex-smokers, OR 2.54 (95% CI 1.25-5.14, p = 0.01). Patients with moderate to severe asthma exacerbation during the previous year had uncontrolled asthma more often than patients without an exacerbation, OR 2.17 (95% CI 1.06-4.47, p = 0.04), and patients with FEV1 80% of predicted, OR 2.04 (95% CI 1.02-4.08, p = 0.04). Conclusions Asthmatic patients with a clinically significant smoking history often do not have well controlled asthma. Poor asthma symptom control was associated with current smoking status, history of exacerbations and impaired lung function. Therefore, every attempt should be made to help asthmatics who smoke to quit smoking.Peer reviewe

Hengitysäänten kuuntelu ja suomenkieliset termit

Vertaisarvioitu. Näin tutkin.Hengitysäänten kuuntelulla saadaan helposti ja nopeasti tietoa keuhkojen tilasta. Hengitysäänten sanalliseen kuvaamiseen on kansainväliset suositukset, mutta suomenkieliset termit vaihtelevat. Teimme lääkäreille kyselyn hengitysäänten suomenkielisistä termeistä ja pyysimme niistä kannanoton Lääketieteen sanastolautakunnalta. Esitämme myös hengitysäänten kuunteluun ja tulkintaan liittyvät perusasiat. Kyselyyn vastasi kaikkiaan 154 lääkäriä. Vastaajat eivät olleet aivan yksimielisiä suomenkielisistä termeistä. Kyselyn ja sanastolautakunnan arvion perusteella ehdotamme käyttöön suomenkielisiä termejä kurkkuvinkuna (stridor), vinkuna (wheezing), rohina (rhonchus), ritinä (fine cracles), rahina (coarse cracles), vingahdus (squawk) ja keuhkopussin hankausääni (pleural friction rub). Samojen termien käyttäminen löydöksen kirjaamisessa parantaa hengitysäänten kuuntelun arvoa potilastyössä. Hengitysäänten kuuntelua voidaan jatkossa tarkentaa elektronisilla apuvälineillä ja tietokoneanalyysillä

Annual costs of chronic obstructive pulmonary disease in Finland during 1996–2006 and a prediction model for 2007–2030

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major burden for the health care system, but the exact costs are difficult to estimate and there are insufficient data available on past and future time trends of COPD-related costs. AIMS: The aim of the study was to calculate COPD-related costs in Finland during the years 1996-2006 and estimate future costs for the years 2007-2030. METHODS: COPD-related direct and indirect costs in the public health care sector of the whole of Finland during the years 1996-2006 were retrieved from national registers. In addition, we made a mathematical prediction model on COPD costs for the years 2007-2030 on the basis of population projection and changes in smoking habits. RESULTS: The total annual COPD-related costs amounted to about 100-110 million Euros in 1996-2006, with no obvious change, but there was a slight decrease in direct costs and an increase in indirect costs during these years. The estimation model predicted a 60% increase up to 166 million Euros in COPD-related annual costs by the year 2030. This is caused almost entirely by an increase in direct health care costs that reflect the predicted ageing of the Finnish population, as older age is a significant factor that increases the need for hospitalisation. CONCLUSIONS: The total annual COPD-related costs in Finland have been stable during the years 1996-2006, but if management strategies are not changed a significant increase in direct costs is expected by the year 2030 due to ageing of the population

Hengitysäänten kuuntelu ja suomenkieliset termit

publishedVersio

Prevalence of asthma-COPD overlap syndrome among primary care asthmatics with a smoking history: a cross-sectional study

BACKGROUND: The overlap between asthma and chronic obstructive pulmonary disease (COPD) is an important clinical phenomenon. However, the prevalence of asthma-COPD overlap syndrome (ACOS) is not known. AIMS: To investigate the prevalence of ACOS among asthmatic patients with a smoking history, and evaluate the factors predicting ACOS in this patient group. METHODS: We investigated 190 primary care asthma patients with no previous diagnosis of COPD, but who were either current or ex-smokers, with a smoking history of at least 10 pack-years. Spirometry was performed on all the patients while they were taking their normal asthma medication. Patients were considered to have ACOS if their postbronchodilator forced expiratory volume in 1 s/forced vital capacity was < 0.70. RESULTS: Fifty-two (27.4%) of the patients were found to have ACOS. Age ⩾ 60 years and smoking for ⩾ 20 pack-years were the best predictors of ACOS. If both of these criteria were met, the odds ratio (95% confidence interval) for ACOS was 6.08 (2.11-17.49), compared with the situation where neither of these criteria were fulfilled. CONCLUSIONS: There is a high prevalence of ACOS among primary health care asthmatics with a positive smoking history but no previous diagnosis of COPD. In this population, age over 60 years and a smoking history of more than 20 pack-years were the best predictors of ACOS