NPJ Primary Care Respiratory Medicine最新文献

This survey aimed to investigate the availability of drugs for stable chronic obstructive pulmonary disease (COPD) treatment in Chinese hospitals and to determine whether drug availability significantly varied among hospitals with different characteristics. A well-constructed questionnaire was designed according to the Chinese Guidelines for the Diagnosis and Management of COPD (revised version 2021). Both inhaled drugs (monotherapy, double therapy and triple therapy) and oral drugs (expectorants, theophylline, antibiotics, and bacterial lysates) were included in this survey. Doctors from different hospitals completed the survey via WeChat. The availability of each category and kind of drug was analyzed based on final valid responses. Subgroup analyses were also conducted to reveal drug availability in hospitals with different characteristics. A total of 1018 hospitals with different characteristics were enrolled in this survey, with 53.73% of which establishing independent respiratory departments. Insufficient supply of COPD-related drugs was observed, with only short-acting β2 agonists (80.6%), expectorants (88.2%) and antibiotics (84.3%) reaching 80%. Results of subgroup analyses suggested that primary hospitals were associated with poorer availability of all kinds of drugs than secondary and tertiary hospitals (all p < 0.001). Most inhaled drugs did not reach an availability of 20% in primary hospitals, except for salbutamol (59.7%), tiotropium bromide (20.0%) and beclometasone/formoterol (23.1%). Results of this survey suggested that the availability of drugs for COPD treatment in China is still an ongoing challenge for healthcare institutions. Insufficient drug supply and imbalanced drug availability among different hospitals are major barriers that warrant further improvements.

Chronic breathlessness is a debilitating symptom with detrimental impact on individuals and carers. However, little is known about the experiences of community-dwelling, frail, older adults living with chronic breathlessness. To explore, (i) the psychological impact of living with chronic breathlessness, (older frail adult patients, carers) and (ii) how patients, carers, and clinicians experience identification and assessment of chronic breathlessness in the primary care setting. In-depth semi-structured interviews with eligible older adults (≥65 years; moderate to severe frailty [electronic Frailty Index >0.36]), and carers recruited from a community-based Integrated Care Centre in England. Clinicians were recruited from the Centre and affiliated GP practices. Recorded in-person interviews were transcribed and subjected to reflexive thematic analysis using Total Dyspnoea and Breathing Space conceptual frameworks. 20 patients (9 females), carers (4 spouses, 1 daughter), and clinicians (5 GPs, 3 advanced clinical practitioners, 2 nurses) were interviewed. Four themes were identified: (1) Widespread negative impact of chronic breathlessness. Breathlessness adversely impacts physical and psychological wellbeing. (2) Barriers to optimal health-seeking and identification of chronic breathlessness. Breathlessness is 'one of many' symptoms, and not prioritised in 'one appointment, one problem' consultations. Clinicians do not routinely ask about breathlessness. Patients are unaware of breathlessness-specific therapies. (3) Variations in chronic breathlessness management. Management is limited; few are offered evidence-based treatments (e.g., handheld fan) and patients find their own strategies. (4) Need for education and information. Clinicians felt helpless about breathlessness management, and patients lacked understanding and had low expectations of receiving help for this symptom. Breathlessness adversely impacts the psychological wellbeing of older frail adults. Chronic breathlessness in older, frail adults is invisible, unidentified and unmanaged in primary care. Evidence-based breathlessness interventions are available, but not routinely implemented with few patients accessing them. Proactive identification, assessment and management of breathlessness in primary care is needed to support adults living with chronic breathlessness.

Asthma and allergic rhinitis (AR) are common disorders of the respiratory tract that often coincide. Control of AR symptoms can improve asthma outcomes in patients with co-existing diseases. Our aim is to produce a systematic review of the effectiveness of conventional anti-AR medication for asthma outcomes in patients with both diseases. The Embase, Medline and Cochrane databases were searched for publications up to October 2024. Randomised controlled trials (RCTs) that reported objective (OAO) or subjective asthma outcomes (SAO) and compared the efficacy of anti-AR medication to placebo or conventional asthma medication were included. Included medication interventions were antihistamines (AH), corticosteroids and leukotriene receptor antagonists (LRA). We included thirty-three RCTs. Six had an exclusively paediatric study population, 17 a partially paediatric study population. No clinically relevant improvements were seen in SAO. Quality of life (QoL) showed a significant and clinically relevant improvement in five studies. A significant and clinically relevant improvement of OAO was seen in four studies. LRAs did not show significant improvements from baseline. When compared, corticosteroids performed significantly better than LRAs. Significant improvements in both OAO and SAO were seen more often in studies with AHs than with corticosteroids. Anti-allergic initiated AHs and corticosteroids seemed to have a positive effect on asthma outcomes, with AHs having the tendency to elicit more changes in outcomes than the other studied medication groups. LRAs do not seem to influence asthma outcomes. Most significant improvements were seen in QoL and OAO. SAO did not show clinically relevant improvements.

This study analyses the associations between smoking status and perceived symptom significance (concern and influence on daily activity) among individuals with possible lung cancer symptoms and investigate the influence of symptom significance on healthcare seeking among individuals with different smoking status. A nationwide survey with 21,920 randomly selected individuals aged ≥40 years included questions about lung cancer symptoms, symptom concern and influence on daily activities, GP contact, and smoking status. Descriptive statistics and multivariable regression models were applied. Overall, individuals who currently smoked were more likely to perceive their lung cancer symptoms as significant, and individuals who reported high symptom significance were more likely to seek healthcare with both specific and non-specific symptoms. The significance of symptoms appeared to have less pronounced effect on prompting healthcare seeking among individuals with a history of current smoking. This implies that they may benefit from support and encouragement to seek care.

Streptococcus pneumoniae (SP) remains an important cause of community acquired pneumonia (CAP). We aimed to describe the prevalence and characteristics of outpatients with radiologically confirmed pneumococcal CAP. Between November 2017 and December 2019, a French network of general practitioners enrolled CAP-suspected adults, with ≥1 clinical signs of infection and ≥1 signs of pulmonary localization in an observational study. Pneumococcal CAP was defined by the combination of a chest X-ray (CXR) compatible with CAP and SP detection by any of four microbiological tests (blood culture, sputum culture, pneumococcal urinary antigen test [BinaxNow®] and serotype-specific multiplex urinary antigen detection test [Pfizer Inc®]. To identify other pathogens, next to cultures, nasopharyngeal multiplex PCR was performed. Three hundred and forty-eight patients were included, of whom 144 had a positive CXR, 135/144 (93.8%) had not received antibiotics prior to inclusion, 21/144 (14.6%) had ≥1 positive microbiological test for SP, and 66/144 (45.8%) were negative for all four microbiological tests and were considered as non-pneumococcal CAP. Pneumococcal serotypes were identified for 12 patients. This study assessing the prevalence of SP among CAP outpatients using comprehensive microbiologic testing shows that SP is still the most frequently identified microorganism.

Digital health platforms for asthma self-management have demonstrated promise in improving clinical and quality of life outcomes. However, few studies have examined such an approach in a real-world, fully remote setting. As such, we evaluated the benefit of an evidence-based digital self-management platform for asthma-both on its own and when integrated into an established virtual clinical service. We compared six-month outcomes of a digital self-management program plus virtual clinical oversight, called a therapeutic resource center, (DP + TRC) with a digital self-management-only (DP) program in patients with uncontrolled asthma. The DP included electronic medication sensors that captured the date and time of both short-acting beta agonist (SABA) and controller medication usage. The TRC included remote care oversight to promote inhaler adherence and address symptom worsening. SABA usage, controller adherence and program retention were assessed retrospectively using regression models controlling for age, enrollment year, controller/SABA use, and baseline asthma control status.18,584 DP patients (mean age (SD): 33 (14.6) yrs; 89.9% uncontrolled asthma) and 3440 DP + TRC patients (mean age (SD): 43.7 (15.6) yrs); 48.6% uncontrolled) were assessed. We observed significantly better six-month program retention (55% vs. 41%, p < 0.001) and controller adherence (54% vs. 45%, p < 0.001), but no statistically significant differences in mean SABA use (0.76 vs. 0.87 mean puffs/day; p = 0.158) for the DP + TRC vs. DP groups, respectively. From baseline to six months, both groups had similar reductions in mean daily SABA use (both p < 0.001) and improvements in the percent of SABA-free days (both p < 0.001). The proportion of patients with ≥80% controller adherence declined in both groups, but a larger relative decline was noted in the DP vs. DP + TRC group. A digital self-management platform for asthma management combined with virtual clinical oversight may offer a scalable solution that not only achieves reduced SABA use, but also promotes medication adherence and increases program retention.

Non-tuberculous Mycobacterial Pulmonary Disease (NTM-PD) is a chronic disease characterised by progressive inflammatory lung damage due to infection by non-tuberculous mycobacteria (NTM). Global prevalence of NTM-PD is generally low but is rising, likely due to a combination of increased surveillance, increasing multimorbidity and improved diagnostic techniques. Most disease is caused by Mycobacterium avium complex species. NTM-PD can be challenging to both diagnose and manage but given the risk of untreated disease and the challenges around drug treatments, it is vital that all healthcare professionals involved in primary care consider NTM-PD at the earliest opportunity. In particular, NTM-PD should be considered where there are respiratory symptoms in the setting of pre-existing chronic lung disease such as chronic obstructive pulmonary disease (COPD) and bronchiectasis. Early suspicion should lead to appropriate primary screening measures. This article discusses the relevance of NTM-PD today, risk factors for developing disease, pathways from clinical presentation to referral to specialist care, and discusses management and drug treatments. A flow diagram of a screening process is presented as a guideline for best practice from a United Kingdom perspective.

Acute exacerbations of COPD (ECOPD) are an important event in the life of a COPD patient as it causes significant deterioration of physical, mental, and social health, hastens disease progression, increases the risk of dying and causes a huge economic loss. Preventing ECOPD is therefore one of the most important goals in the management of COPD. Before the patient is discharged after hospitalization for ECOPD, it is crucial to offer an evidence-based care bundle protocol that will help minimize the future risk of readmissions and death. To develop the content of this quality care bundle, an Expert Working Group was formed, which performed a systematic review of literature, brainstormed, and debated on key clinical issues before arriving at a consensus strategy that could help physicians achieve this goal. A 7-point consensus strategy was prepared, which included: (1) enhancing awareness and seriousness of ECOPD, (2) identifying patients at risk for future exacerbations, (3) optimizing pharmacologic treatment of COPD, (4) identifying and treating comorbidities, (5) preventing bacterial and viral infections, (6) pulmonary rehabilitation, and (7) palliative care. Physicians may find this 7-point care bundle useful to minimize the risk of future exacerbations and reduce morbidity and mortality.

Baduanjin has been shown to be an effective method of exercise for promoting body function in patients with chronic obstructive pulmonary disease (COPD). However, this method is rarely used by rural doctors in rural communities. The aim of this study was to compare the therapeutic effects of Baduanjin exercise with those of conventional pulmonary rehabilitation (CPR) implemented by rural doctors in patients with COPD. A total of 472 COPD patients from 18 village clinics were randomly allocated to the Baduanjin group (n = 158), CPR group (n = 154), or control group (n = 160). The Baduanjin group received six months of Baduanjin training, the CPR group received six months of rehabilitation training, and the control group received usual care. The primary outcomes were changes in health status, as measured by the COPD Assessment Test (CAT), and dyspnoea, as assessed via the modified Medical Research Council (mMRC) dyspnoea scale. The secondary outcomes included six-minute walking distance (6MWD) performance and anxiety and depression scores on the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively). Baseline data were collected before randomization, and outcomes were ascertained at the six-month follow-up by blinded assessors. After six months of training, compared with the control group, the Baduanjin group presented significant improvements in CAT scores (t = 5.121, P < 0.001), mMRC scale scores (t = 5.719, P < 0.001), 6MWD performance (t = 12.608, P < 0.001), HADS-A scores (t = 6.210, P < 0.001), and HADS-D scores (t = 2.945, P = 0.010). The CPR group also presented significant improvements in CAT scores (t = 4.725, P < 0.001), mMRC scale scores (t = 5.499, P < 0.001), 6MWD performance (t = 11.662, P < 0.001), HADS-A scores (t = 5.697, P < 0.001), and HADS-D scores (t = 2.671, P = 0.023). In contrast, the control group participants showed no significant changes in CAT scores (t = -0.252, P = 0.801), mMRC scale scores (t = -0.085, P = 0.932), 6MWD performance (t = -0.463, P = 0.644), HADS-A scores (t = -2.75, P = 0.783), or HADS-D scores (t = -0.281, P = 0.779). No adverse events were reported during the study. The positive effects of Baduanjin exercise on the subjective symptoms of COPD patients are similar to those of CPR. The trial was registered with the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958) (22/02/2012).