NPJ Primary Care Respiratory Medicine最新文献

To achieve progression criteria for a definitive phase three randomised controlled trial (RCT). Prospective phase two multicentre parallel-group RCT. Participants recruited from secondary care respiratory clinics in two health boards in Scotland, United Kingdom. 110 adults with moderate-severe COPD and co-morbidities. Tailored Intervention for COPD and Co-morbidities by Pharmacists and Consultant Physicians (TICC-PCP): home visits (for a year) by generalist prescribing pharmacists collaborating with consultant respiratory physicians. Pharmacists assessed, prescribed, de-prescribed, and referred participants to health and social care services as appropriate, in addition to Usual Care (UC). Recruit ≥100 participants; deliver TICC-PCP to ≥70% intervention-arm participants; collect ≥90% in-person data; retain ≥80% participants until 21-months. Secondary outcomes include clinical and health service utilisation. Recruitment, data collection, retention and participant retention targets were achieved over 21 months. TICC-PCP delivery: the median number of contacts, nine per participant in one year, matched the a-priori target although fewer than expected (13 (27%)) received the planned schedule of contacts (monthly for six months then every other month for six months). Secondary outcomes included increased prescribing of bone strengthening medicines, de-prescribing of medicines associated with increasing falls risk; delayed time to emergency health care contacts, fewer exacerbations; improved health related quality of life and longer duration of hospitalisation. A definitive phase three RCT of TICC-PCP may improve outcomes for people with moderate-severe COPD and co-morbidities. Trial registration: The trial is registered with the UK Clinical Trials Registry ( https://doi.org/10.1186/ISRCTN43508703 ). Registration date: 3/1/2020.

Asthma is a leading chronic illness in children worldwide, and school staff are often the first responders when asthma emergencies occur at school. Despite their crucial role, many school staff lack adequate training in asthma management. Online training has emerged as a standardised and scalable solution, but its broader effectiveness remains uncertain. This systematic review aimed to evaluate the effectiveness of online asthma training programmes for school staff. A comprehensive search was conducted across six databases (PubMed, CINAHL, Scopus, Web of Science, ProQuest, and Education Research Complete) in June 2024. Eligible studies included those that evaluated online asthma training programmes targeting school staff (teachers, classroom assistants, and school nurses). The effectiveness of interventions was assessed using the Kirkpatrick evaluation model, which categorises outcomes into four levels: reaction, learning, behaviour, and results. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Eight studies met the inclusion criteria with quality scores ranging from 40 to 80%. Interventions identified included web-based modules (n = 4), online classrooms (n = 2), an eBook (n = 1), and a PowerPoint presentation (n = 1). All reported participants' positive satisfaction with the training and improvements in asthma knowledge (levels 1 and 2). However, none of the studies evaluated behavioural change or organisational outcomes (levels 3 and 4). Most studies had small sample sizes and lacked long-term follow-up, limiting assessment of real-world impact. Online asthma training programmes improve school staff's knowledge and satisfaction, and appear to be as effective as face-to-face training. However, their impact on behavioural or organisational change remains lacking. Future research should explore long-term effects to support real-world implementation.

Many patients with COPD use inhaled corticosteroids (ICS) without proper indication. We developed a multifaceted tailor-made de-implementation strategy-including a toolbox, communication plan, and training-to reduce inappropriate ICS use in general practice. We evaluated its effectiveness (i.e. decline in percentage of patients with COPD that use ICS) and other outcomes during a 15-month study in Drenthe, the Netherlands. Less patients (-4.7%,95%CI: 2.6-6.7%) used ICS at the end of follow-up and the percentage of ICS-users declined by 8.2% (95%CI: 2.9-13.4%) across the 14 practices that fully participated in the project. ICS user percentages declined significantly moreover time in the fully participation group than in the control group (beta-regression, β = -0.041,SE = 0.011, p < 0.01). While these findings are promising, further research is needed to assess additional penetration and sustainability of the strategy in the region and to explore the applicability of comparable regional ICS de-implementation plans.

Chronic obstructive pulmonary disease (COPD) is a respiratory disease which may significantly impact health status. To reduce symptoms and improve quality of life, pharmacological treatment should be complemented by addressing extrapulmonary traits and lifestyle- and psychosocial factors, such as physical deconditioning, decrease in muscle mass, smoking or depression. Treatment of these non-pharmacological traits is commonly conducted in a primary care setting and often requires multiple healthcare providers (HCPs). To provide complementary care, high quality interprofessional collaboration (IPC) is required. Therefore, our aim was to develop an IPC model for COPD patients treated in primary care. To achieve our aims, we used co-creation sessions (CCS), a recognised method within the participatory action research (PAR) approach. Co-creation, characterised by collaboration and a bottom-up strategy, has repeatedly shown to be suitable for developing care improvements. We recruited two independent groups of stakeholders to participate in six CCS in parallel. They were purposefully sampled and included patients and HCPs from both primary and secondary/tertiary care. Given the considerable overlap in results between the two independent teams, we developed a joint model which is ready to be pilot tested. Our model is based on current and local work methods and can be implemented in existing local contexts and structures. We noted some differences between the teams: the choice of the routing and timing of IPC commencement, and the choice for the communication platform. Using the PAR approach and co-creation, we developed an actionable IPC model in primary care for COPD patients.

Despite its importance in global TB elimination, tuberculosis preventive treatment (TPT) remains underutilized. Psychosocial barriers significantly contribute to this issue. This systematic review aims primarily to synthesize psychosocial interventions to improve the initiation of TPT. We analyzed psychosocial outcomes as secondary objectives when relevant data were available. This review included studies indexed in PubMed, Scopus, and PsycInfo until August 25, 2025. Original studies addressing psychosocial interventions for people with latent tuberculosis infection (LTBI) indicated for TPT were included in this review. The risk of bias was assessed via the Crowe Critical Appraisal Tool (CCAT). A narrative synthesis summarized the characteristics of interventions, including the format of delivery, settings, intervention providers, psychosocial content, duration, and outcomes. Among the 1725 identified studies, nine (14,428 participants) met the inclusion criteria. The CCAT classification was moderate to high quality, with strengths in clearly articulated study rationales but weaknesses in study design. Most studies were from upper-middle-income countries with a high burden of TB; none were from Asia. Health education is a core component, often incorporating culturally adapted survivor testimonials to reduce stigma and increase motivation. Interventions were mostly community-based and led by multidisciplinary healthcare professionals and community workers. TPT initiation improved in all included studies, with risk differences ranging from 10-52%. This review emphasizes the potential of psychosocial interventions in supporting behavior change and increasing TPT initiation. Methodological limitations and a lack of research in high-burden Asian contexts restrict the current evidence. Future studies should focus on developing rigorous, contextually appropriate strategies for scalable psychosocial interventions that are effective and sustainable.

At-home spirometry could provide added value for the diagnosis and monitoring of obstructive pulmonary disease in primary care. However, it is unknown whether implementation in a real-world setting is practicable and produces good quality spirometry. We studied feasibility, quality and added value of at-home spirometry in primary care practices in the Netherlands and Sweden. Adults with an asthma- or COPD-related spirometry indication were provided with equipment to perform unsupervised spirometry at-home. Differences in FEV₁ and FVC-values from home and general practice were compared, and questionnaires on feasibility were completed by participants and healthcare professionals (HCPs). Of 140 participants, 89.3% completed a home spirometry session, of whom 59.2% produced acceptable spirometry. Overall, HCPs and participants rated home spirometry as feasible and of added value for asthma and COPD monitoring in primary care, though less helpful for diagnostic purposes. A small mean difference in spirometry results was observed, with FEV₁ and FVC at-home being 0.076 and 0.094 L higher than at the GP office, respectively.

This study aims to investigate the association between lung function and various types of sensory impairments (specifically visual and hearing impairments) in the elderly population in the middle-aged and older adults in China. This study utilizes data from the China Health and Retirement Longitudinal Study (CHARLS) from the 2011 and 2015 waves of interviews. Participants aged 45 and older with complete data were included in the study. Lung function was assessed using peak expiratory flow (PEF). Multivariable logistic regression and trend regression models analyzed the cross-sectional relationships between PEF, predicted PEF values, and various sensory impairments (SI) The study also examined the prospective relationship between baseline PEF and sensory impairment deterioration using restricted cubic splines for visualization. Finally, subgroup analyses were performed to validate the results' stability. The cross-sectional analysis, after adjusting for confounders, revealed that higher baseline and predicted PEF values were associated with a lower prevalence of SI. This inverse relationship was consistent across various types of impairments, including visual impairment, distance vision impairment, near vision impairment, and hearing impairment. The trend ORs were as follows: (Baseline PEF: 0.894 [0.846, 0.945], 0.881 [0.839, 0.926], 0.922 [0.878, 0.969], and 0.916 [0.873, 0.961]; Predicted PEF %: 0.829 [0.786, 0.874], 0.755 [0.719, 0.791], 0.872 [0.831, 0.914], and 0.770 [0.735, 0.806]). In the combined analysis of sensory impairment types, including single sensory impairment (SSI) and dual sensory impairment (DSI), higher PEF values were also linked to lower prevalence rates. The trend ORs for baseline PEF were 0.924 [0.862, 0.990] and 0.884 [0.826, 0.945], and for predicted PEF % values, the trend ORs were 0.915[0.853, 0.981] and 0.775 [0.725, 0.829]. During follow-up, baseline PEF was significantly associated with the deterioration of Non-SI to DSI. Specifically, the adjusted OR for Q4 relative to Q1 was 0.609 [0.397, 0.933], with a trend OR of 0.862 [0.751, 0.988]. Changes in PEF and predicted PEF percentage values during follow-up were not significantly associated with worsening SI. Subgroup analyses indicated that the inverse relationship between PEF and sensory impairments was significant across various age groups, genders, smoking statuses, and lung disease backgrounds, though the correlation was weaker in non-smokers and individuals with lung diseases. Higher PEF values are associated with a lower prevalence of various sensory impairments and a reduced risk of worsening these impairments in middle-aged and older adults. This study supports the effective screening of SI, particularly in identifying high-risk individuals who may experience the progression of DSI.

Smoking and other forms of tobacco use are prevalent in many middle and low-income countries and are a leading preventable cause of non-communicable diseases (NCDs). Primary care is uniquely positioned to deliver support and services for tobacco cessation. However, despite being a cost-effective intervention and globally recognised and mandated by the World Health Organization, tobacco cessation services, such as Very Brief Advice (VBA) are currently underprovided. Scalable capacity building programmes are needed to strengthen the knowledge, confidence and competence of practising clinicians. The International Primary Care Respiratory Group designed and implemented a three-tiered "Teach the Teacher" (TtT) programme to build teaching capacity in treating tobacco dependence in Romania, Bulgaria. North Macedonia, and the Kyrgyz Republic. The TtT model engaged national educators in adapting a core VBA+ curriculum-designed to reflect limited access to pharmacotherapy and specialist services-and cascaded teaching through local networks of primary care professionals. Evaluation of the TtT model showed that while co-developing context-specific curricula for treating tobacco dependence is feasible and effective, sustained success requires structural reforms-such as improving access to cessation support, incentivising providers, and embedding tobacco dependence treatment into national education and policy frameworks. The TtT approach offers a replicable model for rapid capacity-building, but its full potential depends on alignment with broader health system priorities.

Adolescents with asthma are at heightened risk of somatic and mental health challenges, particularly during large-scale stressors such as the COVID-19 pandemic. This study explored the self-reported prevalence of asthma, co-occurring somatic complaints, psychological distress, and perceived pandemic impact in a multinational sample of 4802 upper secondary school students (aged 15-19) from Sweden, the United States, Serbia, Morocco, and Vietnam. Participants completed a web-based survey between November 2020 and June 2021. Approximately 9% reported having a physician-diagnosed asthma condition, with prevalence varying across countries. An additional 3.2% of the total sample reported uncertainty about whether they had asthma, with this uncertainty most frequently observed in Vietnam and Morocco. Adolescents with asthma reported slightly higher psychological distress than their peers without asthma, particularly among females, yet paradoxically reported a lower perceived impact of the pandemic on daily life. Physical activity levels were comparable between groups. Asthma was found to be associated with several co-occurring somatic complaints, with one gender-specific pattern observed in relation to thyroid disease. The observed variability in asthma prevalence and diagnostic uncertainty underscores the influence of national healthcare systems, health literacy, and communication practices. These findings highlight the need for gender-sensitive and context-aware approaches in adolescent health care, especially during global public health disruptions.