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Suboptimal asthma control: prevalence, detection and consequences in general practice.

https://arctichealth.org/en/permalink/ahliterature160627
Source
Eur Respir J. 2008 Feb;31(2):320-5
Publication Type
Article
Date
Feb-2008
Author
K R Chapman
L P Boulet
R M Rea
E. Franssen
Author Affiliation
University of Toronto, Canada. kchapman@ca.inter.net
Source
Eur Respir J. 2008 Feb;31(2):320-5
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - drug therapy - epidemiology
Attitude of Health Personnel
Bronchodilator Agents - therapeutic use
Chi-Square Distribution
Confidence Intervals
Cross-Sectional Studies
Family Practice - standards - trends
Female
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Office visits - statistics & numerical data
Ontario - epidemiology
Patient satisfaction
Physician's Practice Patterns - statistics & numerical data
Physician-Patient Relations
Prevalence
Questionnaires
Respiratory Function Tests
Risk assessment
Severity of Illness Index
Treatment Outcome
Abstract
Telephone surveys describing suboptimal asthma control may be biased by low response rates. In order to obtain an unbiased assessment of asthma control and assess its impact in primary care, primary care physicians used a 1-page control questionnaire in 50 consecutive asthma patients. Of the 10,428 patients assessed by 354 physicians, 59% were uncontrolled, 19% well-controlled and 23% totally controlled. Physicians overestimated control, regarding only 42% of patients as uncontrolled. Physicians were more likely to report plans to alter the regimens of uncontrolled patients than controlled patients (1.29 versus 0.20 medication changes per patient) doing so in a fashion consistent with guideline recommendations. Of the uncontrolled patients, 59% required one or more urgent care or specialist visits versus 26 and 15% of well-controlled or totally controlled patients, respectively. Patients were more likely to report short-term symptom control when they had not required urgent or specialist care (odds ratio 5.68; 95% confidence interval 4.91-6.58). The majority of asthma patients treated in general practice are uncontrolled. Lack of control can be recognised by physicians who are likely to consider appropriate changes to therapy. A lack of short-term symptom control of asthma is associated with excess healthcare utilisation.
Notes
Comment In: Eur Respir J. 2008 Feb;31(2):229-3118238943
PubMed ID
17959642 View in PubMed
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What is new since the last (1999) Canadian Asthma Consensus Guidelines?

https://arctichealth.org/en/permalink/ahliterature194639
Source
Can Respir J. 2001 Mar-Apr;8 Suppl A:5A-27A
Publication Type
Article
Author
L P Boulet
T R Bai
A. Becker
D. Bérubé
R. Beveridge
D M Bowie
K R Chapman
J. Côté
D. Cockcroft
F M Ducharme
P. Ernst
J M FitzGerald
T. Kovesi
R V Hodder
P. O'Byrne
B. Rowe
M R Sears
F E Simons
S. Spier
Author Affiliation
Hôpital Laval, Sainte-Foy, Canada. lpboulet@med.ulaval.ca
Source
Can Respir J. 2001 Mar-Apr;8 Suppl A:5A-27A
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Agonists - therapeutic use
Adult
Allergens
Animals
Anti-Asthmatic Agents - therapeutic use
Anti-Inflammatory Agents - therapeutic use
Asthma - immunology - prevention & control - therapy
Canada
Emergency medical services
Glucocorticoids - therapeutic use
Humans
Leukotriene Antagonists - therapeutic use
Mites - immunology
Patient Education as Topic
Practice Guidelines as Topic
Steroids
Abstract
The objective of the present document is to review the impact of new information on the recommendations made in the last (1999) Canadian Asthma Consensus Guidelines. It includes relevant published studies and observations or comments regarding what are considered to be the main issues in asthma management in children and adults in office, emergency department, hospital and clinical settings. Asthma is still insufficiently controlled in a large number of patients, and practice guidelines need to be integrated better with current care. This report re-emphasises the need for the following: objective measures of airflow obstruction to confirm the diagnosis of asthma suggested by the clinical evaluation; identification of contributing factors; and the establishment of a treatment plan to rapidly obtain and maintain optimal asthma control according to specific criteria. Recent publications support the essential role of asthma education and environmental control in asthma management. They further support the role of inhaled corticosteroids as the mainstay of anti-inflammatory therapy of asthma, and of both long acting beta2-agonists and leukotriene antagonists as effective means to improve asthma control when inhaled corticosteroids are insufficient. New developments, such as combination therapy, and recent major trials, such as the Children's Asthma Management Project (CAMP) study, are discussed.
Notes
Comment In: Can Respir J. 2001 Mar-Apr;8(2):65-811320395
Comment In: Can Respir J. 2001 Sep-Oct;8(5):38211694919
PubMed ID
11360044 View in PubMed
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