NPJ Primary Care Respiratory Medicine最新文献

Asthma is a common respiratory disease that leads to significant morbidity and mortality. Family physicians play a fundamental role alongside pulmonologists in the diagnosis, treatment, and follow-up of asthma. Our study aimed to evaluate the knowledge and attitudes of family physicians in Turkey regarding asthma management in light of the GINA Strategy Report. A total of 596 family physicians from all 12 NUTS regions in the country participated in our cross-sectional analytical study. Data were collected through an online survey prepared by the researchers, referencing the GINA Strategy Report. Descriptive data are presented as numbers and percentages, and differences between independent groups were analyzed using the chi-square test. The majority of participants (96.8%) knew that spirometry is used in the diagnosis of asthma. Regarding asthma control, 11.9% of physicians used the Asthma Control Test, and more than half (61.2%) checked the number of attacks. While only 37.4% correctly understood that the regular use of SABA alone is not part of stepwise treatment, 77.2% correctly indicated that the combination of ICS and formoterol can be used as a reliever and for maintenance in stepwise treatment. About half of the participants believed that high-dose SABA use does not increase the risk of exacerbations (49.7%). A total of 96.9% of physicians reported that they request training in asthma management. Our findings indicate that there are gaps in the implementation of asthma management in primary care and that adherence to the Strategy Report is insufficient.

Previous studies often focused on single pollutant source, failing to replicate real-world exposure scenarios for chronic respiratory disease (CRD) risk. We aimed to explore the mixed exposure patterns of CRD risk factors and investigate interactions with smoking and genetic risk. We identified air pollution exposure modes using latent class analysis (LCA) in the UK Biobank. Cox model assessed associations between exposure modes and lung cancer (LC), idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD) and asthma. Interactions among exposure modes, smoking and genetic risk were analyzed. LCA divided participants into five groups, and hazard ratios (HRs) for "High air pollution" group were 1.28 for LC (95% CI: 1.08-1.52), 1.23 for IPF (95% CI: 1.03-1.48), 1.28 for COPD (95% CI: 1.17-1.39) and 1.09 for asthma (95% CI: 1.01-1.18). Significant additive interactions between high air pollution and smoking were observed for LC and COPD. Individuals with high genetic risk exposed to both smoking and high air pollution showed the relative excess risk due to interaction (RERI) of 2.74 for LC, 3.93 for IPF, and 1.68 for COPD. Smoking and air pollution together accounted for over 40% of LC, IPF and COPD cases. Our findings highlight the complex interplay between environmental air pollution, smoking, and genetic risk in CRD development in real-world exposure scenarios.

National asthma prevalence data in Canada typically come from health surveys or administrative records. Since most asthma care is provided by family physicians, primary care electronic medical records (EMRs) may offer valuable insights into asthma epidemiology and treatment patterns. This study aimed to estimate the prevalence of adult asthma across Canada using national EMR data, examine the demographics and comorbidities of asthma patients, and review national prescribing practices. We used a validated EMR case definition for adult asthma applied to the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, which includes data from 12 networks across Canada. We identified patients with at least one encounter in a two-year period and estimated asthma prevalence, stratified by age, sex, and BMI. Comorbidity rates and medication prescriptions were assessed in patients with asthma. Among 854,567 adults, 94,410 were identified with confirmed/suspected asthma (11% prevalence). Asthma was more common in females (12 vs. 10%, p < 0.0001), across all age brackets except 18-29 years old. A chi-square test for trend showed a decrease in prevalence with increasing age (p < 0.0001). Females with asthma had a higher prevalence of ≥4 comorbidities than males (33 vs. 30%, p < 0.0001). Additionally, 13% of asthma patients were prescribed only as-needed short-acting bronchodilators, without a controller. The 11% asthma prevalence found in this study aligns with national survey estimates, providing support for the use of EMRs in disease and practice surveillance. Future efforts should focus on integrating tools within EMR to support asthma diagnosis and treatment adherence.

Interstitial lung diseases (ILDs) are complex rare diseases that associate a delay in diagnosis and eventually poor prognosis. Early and accurate diagnosis could be crucial. This study aimed to evaluate the feasibility and benefits of a rapid diagnostic circuit for ILD. A training program for ILD identification and a direct referral diagnostic circuit to the ILD Unit of University Hospital of Bellvitge were established in primary care centers in the southern metropolitan area of Barcelona (Spain). ILD patients were diagnosed and followed-up until study completion, death or lung transplantation. Diagnostic, therapeutic and prognostic outcomes were compared to patients referred through the common circuit during the same period of time. Of 123 patients referred directly from the primary care, 112 had ILD. The most common diagnosis were idiopathic pulmonary fibrosis and fibrotic hypersensitivity pneumonitis. The main reasons for suspecting ILD were interstitial radiological features (74%) and abnormal lung auscultation (67%). Eighteen patients were asymptomatic. Compared with patients referred through the common circuit, there was a statistically significant reduction in the time from symptom onset to diagnosis (6 vs. 22.1 months, p < 0.01) and in the percentage of fibrosing ILD (55.9 vs 63.9%, p 0.36). Although patients from rapid circuit were older, they had better forced vital capacity and diffusing capacity for carbon monoxide at diagnosis (p 0.04) and lung biopsies were performed more frequently. More patients were elegible for lung transplant. Identifying potential patients with fibrotic ILD through rapid circuit working with primary care physicians is feasible and useful.

Introduction: Over-reliance on short-acting beta-agonists (SABAs) has been identified as a predictor of poor asthma control and increased asthma-related mortality. The aim of the study was to assess SABA over-reliance and its association with asthma control and the utility of the Reliever Reliance Test (RRT) in addressing SABA over-reliance in primary care patients.

Methods: A cross-sectional study was conducted with both quantitative and qualitative data on patients with asthma, in Crete, Greece. Participants completed the Asthma Control Test (ACT) assessing asthma control and were evaluated for their use of SABA. Those who reported SABA use, also completed the RRT which classified patients as low, medium or high-risk of over-reliance. A qualitative survey followed to evaluate the feedback obtained from patients and General Practitioners (GPs) to assess the applicability of RRT.

Results: The study included 145 patients (40 using SABA). Of 38 completing RRT, 82% showed a medium-to-high risk of over-reliance on SABAs, while 24% reported overuse (at least three times/week). The likelihood of poorly controlled asthma significantly increased with greater reliance and more frequent SABA use (OR: 20.209, p = 0.011), and with higher SABA canister use (for ≥1 SABA canister, OR: 2.645, p = 0.026 to ≥3 SABA canisters, OR: 8.372, p = 0.025). Preventive SABA use was reported by 63%, while 86% were unaware of side effects. RRT demonstrated good reliability (Cronbach's alpha 0.835) and validity. Qualitative data suggested that both patients (n = 27) and GPs (n = 11) found RRT acceptable and helpful in addressing SABA over-reliance. GPs also expressed their intention to incorporate the questionnaire into clinical practice, despite time constraints.

Conclusions: Our findings suggest that over-reliance on SABAs is significantly associated with poor asthma control. Moreover, RRT was successfully translated in Greek, and proved to be reliable; This suggests its potential to facilitate the development of more targeted strategies for identifying and addressing this issue, while also promoting collaborative patient-GP discussions with the aim of achieving optimal asthma outcomes.

The association between loneliness and chronic obstructive pulmonary disease (COPD) is unclear. This study aimed to investigate this association and, in particular, analyze the role of loneliness dynamics in COPD. The study population was middle-aged and older (≥45 years) participants without COPD from the China Health and Retirement Longitudinal Study (CHARLS), and the study outcome was the occurrence of COPD during follow-up. Loneliness was assessed by a single-item question score (0-3) addressing loneliness. We collected four loneliness values from 2011-2018 and used group-based trajectory modeling (GBTM) to identify loneliness trajectories. COX proportional risk regression modeling calculated the hazard ratios (HRs) of baseline loneliness and different loneliness trajectories to COPD incidence. In addition, we performed subgroup analyses and sensitivity analyses. A total of 8006 participants were included in this study, with a mean age of 57.4 years and 54.5% female. GBTM analysis identified three trajectories of loneliness: consistently low (76.14%), consistently high (10.60%), and increasing loneliness (13.26%). Participants in the consistently high (HR = 1.66, 95CI%: 1.29-2.12, P < 0.001) and increasing loneliness (HR = 1.65, 95CI%: 1.34-2.04, P < 0.001) groups had a significantly increased risk of COPD compared to the consistently low group. Lonely participants (scores 1-3) at baseline had a 24% increased risk of COPD compared with those not lonely (score 0). Both subgroup and sensitivity analyses confirmed the stability of the results. This study found a significant association between loneliness trajectories and risk of developing COPD, suggesting the importance of psychosocial factors in developing chronic respiratory diseases.

Asthma and intrinsic capacity (IC) decline were individually examined with mortality, yet the complex interplay between them remains largely unknown. This study aimed to examine the potential roles of IC decline in the association between asthma and all-cause mortality. We conducted a prospective cohort study using data from UK Biobank, where IC decline was defined as a decline in any domain of psychological, sensory, vitality, and locomotion. Cox proportional hazard models were used to examine the associations between asthma, IC decline, and all-cause mortality. The relative excess risk due to additive interaction (RERI) was calculated. Mediation analysis was performed to explore the mediating effect of IC decline. And a four-way decomposition method was utilized to quantify both the interaction and mediation role of IC decline. Among 439,973 participants, 51,558 (11.7%) had asthma, 290,964 (66.1%) experienced IC decline, and 37,204 deaths occurred during 5.92 million person-years follow-up. Significant multiplicative and additive interactions were observed between asthma and any IC domain decline on all-cause mortality (Multiplicative: HR = 1.14, 95% CI: 1.06-1.24; Additive: RERI = 0.20, 95% CI: 0.11-0.29). The proportion of the association between asthma and all-cause mortality mediated by decline in all four domains was 28.14% (95% CI: 23.84-34.92%). The results of four-way decomposition were similar. Asthma was associated with increased all-cause mortality, and this association may be partially accounted for by both the interaction and mediation effects of IC decline. These findings underscore the importance of comprehensive interventions that address both asthma management and preservation of IC function to enhance health outcomes in middle-late life.

Breathlessness is prevalent in societies worldwide, with widespread health and socioeconomic impacts. Breathlessness self-management interventions developed in high-income countries (HICs) are promising but require contextual adaptation for low- and middle-income countries (LMICs) like India, where cultural beliefs, language, and delivery systems differ. We co-designed breathlessness self-management resources for use in India using a programme theory approach and Community-Based Participatory Research methods. We convened three stakeholder groups (Doctors (n = 9), Nurses and allied health (n = 6) and lived experiences (n = 9)) and added a fourth group (community health workers (n = 6)) based on emerging findings. We re-analysed 104 academic and lay sources identified iteratively and systematically by the Breathe-India project and presented evidence to stakeholder groups for discussion and feedback. Three rounds of online/face-to-face stakeholder workshops. Stakeholders reviewed evidence, developed shared definitions, and iteratively co-designed intervention components. Stakeholder engagement and evidence synthesis led to identification of seven key domains informing the intervention: (1) Identifying breathlessness- teach the difference between acute and persistent breathlessness (and acute-on persistent breathlessness); (2) Developing shared language-emphasising lived experience of breathlessness in simple, translatable language; (3) Addressing fear-teaching accessible methods (e.g. facial cooling) for regaining control that build confidence; (4) Building resilience-reframing activity as safe and beneficial; (5) Daily coping strategies-aligning with local beliefs and behaviours, e.g. inclusion of nutritional 'dos and don'ts'; (6) Delivery through community infrastructure-teaching Accredited Social Health Activists (ASHAs) how to identify breathlessness in communities and challenge unhelpful beliefs-at the point of care. Outputs included training curricula, educational resources, and public-facing materials co-developed with ASHA trainers and stakeholders. We co-designed India's first multicomponent, community-deliverable breathlessness self-management intervention using participatory methods and theory-driven processes. Implementation-effectiveness hybrid evaluation is needed to test feasibility, acceptability, and impact on patients and families.

Medication adherence is critical for successful tuberculosis (TB) treatment, yet non-adherence remains a major barrier to TB control globally. Digital adherence technologies (DAT) have emerged as promising tools to support adherence, but their effectiveness remains variably reported across settings and intervention types. To evaluate the effectiveness of DAT compared to directly observed therapy (DOT) in improving TB medication adherence through a systematic review and meta-analysis of randomized controlled trials (RCTs). A comprehensive literature search was conducted across PubMed, Scopus, EBSCO, and ScienceDirect from inception through November 7, 2024. RCTs comparing DAT (e.g., SMS reminders, video-observed therapy [VOT], medication event reminder monitors [MERM], biometric monitoring systems [BMS], ingestion sensors [IS]) with DOT were included. Study selection, data extraction, and quality appraisal were performed independently by multiple reviewers. Meta-analyses were conducted using a random-effects model, with subgroup and sensitivity analyses. This review followed the PRISMA 2020 reporting guidelines. Nineteen RCTs involving over 10,000 TB patients were included. Overall, DAT significantly improved medication adherence compared to DOT, with a pooled odds ratio (OR) of 2.853 (95% CI: 2.144-3.796; p < 0.001). Subgroup analyses indicated that VOT, MERM, and SMS reminder were consistently effective, while the highest effect sizes were seen in IS and BMS, albeit with wider confidence intervals. Effectiveness varied by country income level: DAT were more effective in high- and upper-middle-income countries, while findings in lower-income settings remained inconclusive, partly due to the limited number of studies. Sensitivity analysis confirmed the robustness of findings, and no significant publication bias was detected (Egger's test p = 0.979). DAT are significantly more effective than DOT in improving medication adherence among TB patients. Tailored implementation strategies are needed to ensure optimal selection and integration of DATs across diverse health systems. These findings support the scaling-up of context-appropriate digital tools as part of global TB control efforts.

Introduction: When high-risk patients present lung cancer symptoms (LCSs) in general practice, Computed Tomography of the thorax (CT thorax) is recommended, but chest X-ray (CXR) may still be used often. This population-based study aims to 1) compare the proportion of patients who completed diagnostic evaluation, and 2) analyse the associations between smoking status, symptom burden and first choice of imaging among patients who presented LCS to their general practitioner (GP) in 2012 and 2022.

Methods: Two random samples of 100,000 individuals ≥20 years were invited to a survey about symptoms and healthcare seeking in 2012 and 2022, respectively, with subsequently linkage to register data. We included individuals ≥40 years old who reported GP contact with LCSs. Descriptive statistics and multivariable regression models were applied.

Results: A total of 5910 (16%) and 4883 (22%) individuals reported at least one LCS in 2012 and 2022, respectively, and 2538 (43%) and 2229 (46%), respectively, had contacted their GP. Diagnostic imaging was completed by 2538 (24%) in 2012 and 2229 (22%) in 2022. CXR was the most common first choice of imaging in both years (22% and 15%, respectively), although CT thorax as first choice increased from 2% to 7%. Higher symptom burden and former smoking increased the odds of completing diagnostic imaging while current smoking did not.

Conclusion: One out of five patients with lung cancer symptoms completed diagnostic evaluation. CXR remained first choice, although more completed CT thorax in 2022. GPs may need tools to support risk stratification and choice of imaging.