NPJ Primary Care Respiratory Medicine最新文献

Patients are using more inhaled corticosteroids (ICS)-long-acting β2-agonist (LABA), with add-on short-acting β2-agonist (SABA) as reliever based on guidelines. The ICS-LABA inhalers are available in Singapore in either pressurized metered-dose (pMDI) or dry-power (DPI) inhalers. Both generate carbon emissions. This retrospective study aimed to determine the asthma control and quantify the carbon emissions resulting from the use of ICS-LABA inhalers by adults who were managed in primary care and comparing them between those with good versus suboptimal asthma control. Data of Asian patients aged >=21 years with a clinical diagnosis of asthma were extracted from their electronic medical records in nine Singapore primary care clinics from 2015-2023, including their demography, clinical diagnoses, asthma control test (ACT) scores and medications dispensed from in-house pharmacies. ACT ≥ 20 is regarded as good asthma control. The total carbon emissions from ICS-LABA and SABA (pMDI or DPI) were calculated respectively. Patients using ICS-LABA increased from 2021 (2015) to 6606 (2023); those with well-controlled asthma rose from 57.1-75.9%. Total carbon emissions increased from 106,871-367,832 kg CO2e/year and from 361,335 (2015) to 797,016 (2023) kg CO2e/year for ICS-LABA and ICS-LABA+SABA respectively. Each patient emitted average of 120.7 kg CO2e/year from ICS-LABA+SABA in 2023, a decline from 178.8 kg CO2e in 2015. Patients with suboptimal asthma control had significantly higher carbon emissions by 35 kg CO2e/year compared to those with good control (p < 0.001). More patients were treated with ICS-LABA from 2015-2023, but their total carbon emissions declined with better asthma control and reduced SABA usage.

Inhaled corticosteroid (ICS) is recommended by Global Initiative for Asthma 2022 Guidelines for patients to attain asthma control. However, inhalational short-acting β2-agonist (SABA) is needed for reliever therapy and emits greenhouse gases (GHG). Despite evidence supporting ICS-formoterol's superior effectiveness as both maintenance and reliever therapy, and more recent guidelines as the preferred treatment option, some patients continue to be prescribed with ICS. The study aimed to quantify GHG from adults on ICS inhalers treated in primary care in Singapore, including their SABA use, and compare good versus suboptimal asthma control. Data from nine public primary care clinics in eastern Singapore were retrieved from the electronic medical records, comprising asthma-diagnosed patients aged 21 years and older. Records contained their demography, clinical diagnoses, asthma control test (ACT) scores and ICS (beclomethasone pMDI, budesonide DPI and fluticasone pMDI) dispensed from in-house pharmacies. Patients with ACT ≥ 20 were classified as having good asthma control. Total GHG resulting from ICS and SABA were calculated for pMDI or DPI inhalers. Between 2015 and 2023, patients on ICS decreased from 3647-2265, while proportion of well-controlled asthma improved from 53.6-82.5%. Annual GHG emissions showed substantial reductions: ICS-only emissions fell from 101,685-71,899 kgCO₂e, and ICS+SABA emissions decreased from 629,989-316,283 kgCO₂e. Individual patient emissions dropped from 173 kgCO₂e (2015) to 140 kgCO₂e (2023). Patients using Fluticasone propionate inhalers had the highest GHG emissions (227 kgCO₂e/year). Patients with suboptimal asthma control produced significantly higher GHG emissions, exceeding those with good control by 30 kgCO₂e /year (p < 0.001). GHG emissions declined with fewer ICS-treated patients over the years, accompanied by a reduction in per patient GHG emission. Suboptimal asthma control was associated with higher GHG, demonstrating the interdependency between asthma outcomes and environmental sustainability.

To explore opportunities for improving care based on the experiences and perspectives of different types of COPD patients based on the Information-Motivation-Behavioral skills (IMB) model with poor self-management behaviors. We used ethnographic methods (over 1000 h of observations for 30 participants), and conducted 34 semi-structured interviews with different patient profiles. Data were transcribed verbatim and analysed using thematic analysis. According to the IMB model, we divided participants into three categories, namely low-information and low motivation group, high information but low motivation group and low-information but strong motivation group. The first group had limited opportunities to acquire knowledge and decreased memory capacity. Also, patients did not feel the seriousness of COPD, or thought that self-management was not important, which led to the lack of self-management knowledge and motivation for this group of patients. In the second group, patients were pessimistic about the cure of the disease because of too much information or too much attention to the details of knowledge, which was also the reason why patients were unwilling to implement self-management although they had mastered enough knowledge. The third patient profile, with strong motivation, would seek health information resources through various channels. Because of this, they could easily acquire incorrect or unscientific information, which would make the situation worse. This qualitative study suggested COPD patients exhibited distinct self-management experiences, barriers, and recommendations due to variations in information processing and motivational characteristics. Future research should tailor precise self-management strategies based on individual patient profiles.

This paper is a detailed methodological analysis of how the PBA approach was used as part of the DEFINE programme, in the planning and development of a behavioural intervention to support the use of Fractional Exhaled Nitric Oxide (FeNO) in informing asthma management in primary care asthma reviews. It offers detailed research insights into how using the PBA approach facilitates the development of methodologies for stakeholder engagement and intervention development research, in line with the recent MRC framework. Two stakeholder workshops were organised during the intervention planning and development phases. The patient stakeholders were diverse in age, gender, and asthma severity, while the clinical stakeholders were diverse in clinical role and level of experience using FeNO. The research team mapped how the stakeholders' feedback complemented the core research team-based activities during the two stages of intervention planning and development, and what the outcomes of such engagement were. The five PBA intervention development activities in which stakeholderswere involved were: (1) Understanding target behaviours; (2) Identifying how to promote engagement with target behaviours; (3) Ensuring anticipated mechanisms of action are taken into account in planning intervention components; (4) Developing intervention content; and (5) Identifying the best intervention content and implementation. Outcomes of involving stakeholder in the 5 intervention development activities were: in depth interpretation on the qualitative work,new barriers and facilitators to the target behaviour of adoption and use of FeNO test during asthma reviews, and optimisation of intervention materials through in-depth tailoring of the online training and patient leaflet.

This meta-analysis aims to examine the association between maternal asthma and autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) in offspring. A literature search was performed in PubMed, Web of Science, Embase, and the Cochrane Library from electronic database inception to October 2024 for studies on the relationship between asthma and ASD/ADHD. The definition of maternal asthma was "asthma existing prior to childbirth". The primary outcome was the incidence of ASD/ADHD in the offspring. This meta-analysis incorporated 5 cohort studies and 7 case-control studies. The statistical results suggested that there is a higher incidence of ASD (odds ratio (OR) = 1.36, 95% confidence interval (95%CI) = 1.28-1.44, P < 0.001) and ADHD (OR = 1.43, 95% CI = 1.37-1.51, P < 0.001) in offspring with maternal asthma compared to the control group. The subgroup analysis revealed that there was no difference in ASD incidence between maternal asthma group and control group in subgroup of female (OR = 1.81, 95%CI = 0.72-4.25, P = 0.205). However, in subgroup of male, the incidence of ASD was higher in the maternal asthma group than the control group (OR = 1.28, 95%CI = 1.01-1.61, P = 0.04). Furthermore, an elevated incidence of ADHD was observed in the maternal asthma group compared to the control group, both in male offspring (OR = 1.36, 95%CI = 1.30-1.42, P < 0.001) and female offspring (OR = 1.45, 95%CI = 1.38-1.53, P < 0.001) subgroups. This study indicates that maternal asthma may have a potential association with ASD and ADHD in the offspring.

Chronic Obstructive Pulmonary Disease (COPD) is a global health concern, primarily linked to cigarette smoking. The potential role of electronic cigarettes (e-cigarettes) in COPD development remains unclear. Despite growing popularity as a smoking alternative, evidence suggests e-cigarettes may have harmful respiratory effects. This systematic review and meta-analysis assess the relationship between e-cigarette use and odds of having COPD. A comprehensive search of Web of Science, Embase, and PubMed was conducted to identify observational studies that assessed the association between e-cigarette use and the risk of COPD, providing risk estimates (hazard ratios, risk ratios, or odds ratios) for current, former, and ever e-cigarette users. Random-effects meta-analysis was performed using R software (V 4.4), and heterogeneity was assessed with the I² statistic. Sensitivity analyses were conducted to test the robustness of the findings. Publication bias was evaluated using Egger's test and funnel plots. Seventeen studies (1087 records screened) were included. E-cigarette use was associated with significantly higher odds of COPD compared to non-use. The pooled odds ratios were 1.48 (95% CI: 1.36-1.61) for current users, 1.84 (95% CI: 1.51-2.23) for former users, and 1.79 (95% CI: 1.42-2.25) for ever users. Sensitivity analysis confirmed the robustness of the findings. E-cigarette use is associated with higher odds of having COPD. Public health efforts should consider raising awareness of the potential respiratory risks associated with e-cigarette use.

National applications (apps) for adults with asthma were implemented as part of a respiratory toolkit across Wales from 2020. Data were collected on patient recorded asthma control including the Royal College of Physicians three questions. All general practices in Wales had patients registered on the asthma app and by September 2024, 12,567 (57.8%) of patients who downloaded the app went on to register. Analysis comparing baseline with four or more months of app use demonstrated improvements in the percent of those having a Royal College of Physicians asthma score of 0 (26.5% vs 40.7%, p = 0.0011), together with improvements in those not using a reliever inhaler at all (29.1% vs 39.2%, p = 0.0001). Where we had paired data one year apart, the improvements in asthma control were greater in those from most deprived areas. For those who used the app there were improvements across important metrics of asthma control consistent with better patient self-management.

Acute respiratory infections (ARI) are the most common infections in the general population and represent an important socio-economic burden. Characterizing ARIs in primary care in patients of all ages in terms of clinical presentation, and virological results. We conducted a prospective multicenter study in primary care: 36 French general practitioners (GPs) included patients from all ages presenting with symptoms of ARI, and performed a nasopharyngeal swab, which was analyzed by Multiplex RT-PCR. 685 patients of all ages were included in the cohort. We found associations between clinical diagnosis and respiratory viruses: influenza was associated with the diagnosis of flu-like syndrome (p < 0.001), HRV with rhinitis (p < 0.05), and RSV with bronchiolitis (p < 0.001) and bronchitis (p < 0.05). Respiratory distress was associated with RSV (p = 0.002), and a cough at the inclusion was significantly not associated with the influenza virus (p = 0.009). Antibiotic prescriptions were not associated with any specific virus. By day 7, persistent cough was significantly associated with active and passive smoking (respectively p = 0.01 and p < 0.001), influenza and RSV-positive samples (p < 0.05) and an age of less than 2 years (p < 0.01). With this prospective cohort performed in primary care including patients of all ages, we characterized viral respiratory infections, to better understand correlations between clinical data and virological results.

Psychological distress is highly prevalent in people with chronic obstructive pulmonary disease (COPD), however, remains under-recognised and under-treated. A qualitative study using semi-structured interviews was undertaken to explore lived experiences of psychological distress of people with COPD and their informal carers, as well as barriers and facilitators to uptake of mental health treatments. Participants were recruited via purposive sampling from respiratory clinics at two Australian tertiary hospitals. Thirteen people with COPD and comorbid mental illnesses and two informal carers participated. Interview transcripts were analysed using the Theoretical Domains Framework (TDF). Barriers to patients' acceptance of structured management for psychological distress in COPD included: limited understanding of overlapping symptoms, high burden of care from physical issues, stigma, and healthcare that did not align with individual preferences. Increased psychoeducation, supported self-management, and individualised care were possible facilitators. Multidisciplinary care integrating mental health services within primary care and pulmonary rehabilitation settings are required to overcome current challenges and improve patient outcomes.