Pub Date : 2022-10-18DOI: 10.1038/s41533-022-00312-9
Mohamad M Saab, Megan McCarthy, Michelle O'Driscoll, Laura J Sahm, Patricia Leahy-Warren, Brendan Noonan, Serena FitzGerald, Maria O'Malley, Noreen Lyons, Heather E Burns, Una Kennedy, Áine Lyng, Josephine Hegarty
Patients with lung cancer (LC) often experience delay between symptom onset and treatment. Primary healthcare professionals (HCPs) can help facilitate early diagnosis of LC through recognising early signs and symptoms and making appropriate referrals. This systematic review describes the effect of interventions aimed at helping HCPs recognise and refer individuals with symptoms suggestive of LC. Seven studies were synthesised narratively. Outcomes were categorised into: Diagnostic intervals; referral and diagnosis patterns; stage distribution at diagnosis; and time interval from diagnosis to treatment. Rapid access pathways and continuing medical education for general practitioners can help reduce LC diagnostic and treatment delay. Awareness campaigns and HCP education can help inform primary HCPs about referral pathways. However, campaigns did not significantly impact LC referral rates or reduce diagnostic intervals. Disease outcomes, such as LC stage at diagnosis, recurrence, and survival were seldom measured. Review findings highlight the need for longitudinal, powered, and controlled studies.
{"title":"A systematic review of interventions to recognise, refer and diagnose patients with lung cancer symptoms.","authors":"Mohamad M Saab, Megan McCarthy, Michelle O'Driscoll, Laura J Sahm, Patricia Leahy-Warren, Brendan Noonan, Serena FitzGerald, Maria O'Malley, Noreen Lyons, Heather E Burns, Una Kennedy, Áine Lyng, Josephine Hegarty","doi":"10.1038/s41533-022-00312-9","DOIUrl":"https://doi.org/10.1038/s41533-022-00312-9","url":null,"abstract":"<p><p>Patients with lung cancer (LC) often experience delay between symptom onset and treatment. Primary healthcare professionals (HCPs) can help facilitate early diagnosis of LC through recognising early signs and symptoms and making appropriate referrals. This systematic review describes the effect of interventions aimed at helping HCPs recognise and refer individuals with symptoms suggestive of LC. Seven studies were synthesised narratively. Outcomes were categorised into: Diagnostic intervals; referral and diagnosis patterns; stage distribution at diagnosis; and time interval from diagnosis to treatment. Rapid access pathways and continuing medical education for general practitioners can help reduce LC diagnostic and treatment delay. Awareness campaigns and HCP education can help inform primary HCPs about referral pathways. However, campaigns did not significantly impact LC referral rates or reduce diagnostic intervals. Disease outcomes, such as LC stage at diagnosis, recurrence, and survival were seldom measured. Review findings highlight the need for longitudinal, powered, and controlled studies.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9579201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40340423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-17DOI: 10.1038/s41533-022-00307-6
Anna Khokhrina, Elena Andreeva, Jean-Marie Degryse
Sleep-disordered breathing (SDB) is characterized by repeated breathing pauses during sleep. The prevalence of SDB varies widely between studies. Some longitudinal studies have found an association of SDB with incident or recurrent cardiovascular events. We sought to systematically describe the current data on the correlation between SDB and cardiovascular pathology. Studies were included if they were original observational population-based studies in adults with clearly diagnosed SDB. The primary outcomes include all types of cardiovascular pathology. We carried out pooled analyses using a random effects model. Our systematic review was performed according to the PRISMA and MOOSE guidelines for systematic reviews and was registered with PROSPERO. In total, 2652 articles were detected in the databases, of which 76 articles were chosen for full-text review. Fourteen studies were focused on samples of an unselected population, and 8 studies were focused on a group of persons at risk for SDB. In 5 studies, the incidence of cardiovascular pathology in the population with SDB was examined. In total, 49 studies described SDB in patients with cardiovascular pathology. We found an association between SDB and prevalent /incident cardiovascular disease (pooled OR 1.76; 95% CI 1.38-2.26), and pooled HR (95% CI 1.78; 95% CI 1.34-2.45). Notably, in patients with existing SDB, the risk of new adverse cardiovascular events was high. However, the relationship between cardiovascular disease and SDB is likely to be bidirectional. Thus, more large-scale studies are needed to better understand this association and to decide whether screening for possible SDB in cardiovascular patients is reasonable and clinically significant.
睡眠呼吸障碍(SDB)的特征是在睡眠中反复出现呼吸暂停。在不同的研究中,SDB的患病率差异很大。一些纵向研究发现SDB与心血管事件的发生或复发有关。我们试图系统地描述SDB与心血管病理之间相关性的当前数据。纳入明确诊断为SDB的成人的原始观察性人群研究。主要结局包括所有类型的心血管病理。我们使用随机效应模型进行了汇总分析。我们的系统评价按照PRISMA和MOOSE系统评价指南进行,并在PROSPERO注册。在数据库中共检测到2652篇文章,其中选择76篇文章进行全文综述。14项研究集中于未选择的人群样本,8项研究集中于有SDB风险的人群。在5项研究中,研究了SDB患者心血管病理的发生率。总共有49项研究描述了SDB在心血管病理患者中的表现。我们发现SDB与流行/发生率心血管疾病之间存在关联(汇总OR为1.76;95% CI 1.38-2.26),合并HR (95% CI 1.78;95% ci 1.34-2.45)。值得注意的是,在已有SDB的患者中,新的不良心血管事件的风险很高。然而,心血管疾病与SDB之间的关系可能是双向的。因此,需要更多的大规模研究来更好地了解这种关联,并确定在心血管患者中筛查可能的SDB是否合理和具有临床意义。
{"title":"A systematic review on the association of sleep-disordered breathing with cardiovascular pathology in adults.","authors":"Anna Khokhrina, Elena Andreeva, Jean-Marie Degryse","doi":"10.1038/s41533-022-00307-6","DOIUrl":"https://doi.org/10.1038/s41533-022-00307-6","url":null,"abstract":"<p><p>Sleep-disordered breathing (SDB) is characterized by repeated breathing pauses during sleep. The prevalence of SDB varies widely between studies. Some longitudinal studies have found an association of SDB with incident or recurrent cardiovascular events. We sought to systematically describe the current data on the correlation between SDB and cardiovascular pathology. Studies were included if they were original observational population-based studies in adults with clearly diagnosed SDB. The primary outcomes include all types of cardiovascular pathology. We carried out pooled analyses using a random effects model. Our systematic review was performed according to the PRISMA and MOOSE guidelines for systematic reviews and was registered with PROSPERO. In total, 2652 articles were detected in the databases, of which 76 articles were chosen for full-text review. Fourteen studies were focused on samples of an unselected population, and 8 studies were focused on a group of persons at risk for SDB. In 5 studies, the incidence of cardiovascular pathology in the population with SDB was examined. In total, 49 studies described SDB in patients with cardiovascular pathology. We found an association between SDB and prevalent /incident cardiovascular disease (pooled OR 1.76; 95% CI 1.38-2.26), and pooled HR (95% CI 1.78; 95% CI 1.34-2.45). Notably, in patients with existing SDB, the risk of new adverse cardiovascular events was high. However, the relationship between cardiovascular disease and SDB is likely to be bidirectional. Thus, more large-scale studies are needed to better understand this association and to decide whether screening for possible SDB in cardiovascular patients is reasonable and clinically significant.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9576790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40395453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-08DOI: 10.1038/s41533-022-00296-6
Maarten Beekman, Julie Hales, Mona Al-Ahmad, Ricardo Del Olmo, Tze Lee Tan
Asthma is associated with a significant burden of disease, especially for patients with severe or uncontrolled asthma. Many patients with severe asthma still receive treatment in primary care settings and despite the availability of effective options, inadequate asthma treatment remains a concern, particularly the use of systemic corticosteroids to treat exacerbations and severe asthma. Around the world, many patients are stuck in a vicious circle of misdiagnosis, undertreatment, and poor understanding of disease severity and management. In this manuscript, we describe the development of The Asthma Referral Identifier (ReferID) tool, a simple, 4-item questionnaire that healthcare providers can use to help identify patients with uncontrolled and/or potentially severe asthma. ReferID was developed specifically for use in primary care clinics in low- and middle-income countries and other clinics, where the optimisation of asthma assessments and treatment recommended for countries with well-established healthcare systems, are not possible. ReferID was developed through an informal collaborative process involving international asthma experts as well as general practitioners, nurses, and specialists throughout the Asia Pacific, Latin America and Middle East regions, in conjunction with current evidence and treatment guidelines. In collaboration with local and regional partners around the world, the developers have adapted ReferID and translated it into 21 languages, and implementation is ongoing in 30 countries. ReferID has the potential to help break the vicious circle, improving disease outcomes and health-related quality of life for patients with asthma.
{"title":"Breaking the vicious circle-the Asthma Referral Identifier (ReferID) tool.","authors":"Maarten Beekman, Julie Hales, Mona Al-Ahmad, Ricardo Del Olmo, Tze Lee Tan","doi":"10.1038/s41533-022-00296-6","DOIUrl":"https://doi.org/10.1038/s41533-022-00296-6","url":null,"abstract":"<p><p>Asthma is associated with a significant burden of disease, especially for patients with severe or uncontrolled asthma. Many patients with severe asthma still receive treatment in primary care settings and despite the availability of effective options, inadequate asthma treatment remains a concern, particularly the use of systemic corticosteroids to treat exacerbations and severe asthma. Around the world, many patients are stuck in a vicious circle of misdiagnosis, undertreatment, and poor understanding of disease severity and management. In this manuscript, we describe the development of The Asthma Referral Identifier (ReferID) tool, a simple, 4-item questionnaire that healthcare providers can use to help identify patients with uncontrolled and/or potentially severe asthma. ReferID was developed specifically for use in primary care clinics in low- and middle-income countries and other clinics, where the optimisation of asthma assessments and treatment recommended for countries with well-established healthcare systems, are not possible. ReferID was developed through an informal collaborative process involving international asthma experts as well as general practitioners, nurses, and specialists throughout the Asia Pacific, Latin America and Middle East regions, in conjunction with current evidence and treatment guidelines. In collaboration with local and regional partners around the world, the developers have adapted ReferID and translated it into 21 languages, and implementation is ongoing in 30 countries. ReferID has the potential to help break the vicious circle, improving disease outcomes and health-related quality of life for patients with asthma.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9547879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33495203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-08DOI: 10.1038/s41533-022-00301-y
Dea Kejlberg Andelius, Ole Hilberg, Rikke Ibsen, Anders Løkke
The prevalence of active smokers has remained relatively stable around 20% for several years in Denmark despite knowledge of the harmful effects. Smoking cessation is the most effective way to limit progression and reduce mortality of chronic obstructive pulmonary disease (COPD). Therefore, smoking cessation is particularly important among adults with COPD. The aim of this study was to determine the extent to which adults 30-50 years of age with COPD redeem pharmacotherapy for smoking cessation, and to identify demographic factors that influence the use of smoking cessation medication. We conducted a national retrospective non-interventional registry study, including all Danish patients with COPD (ICD-10 code J.44: chronic obstructive pulmonary disease) aged 30-50 years in the period 2009-2015. We identified 7734 cases, who were matched with controls (15,307) 1:2 on age, sex, and geography. Smoking status was not registered. We found that 18% of cases (with an estimated smoking prevalence at 33-50%) redeemed pharmacological smoking cessation medication in the study period compared to 3% of the controls (with an estimated smoking prevalence at 23%). The OR for cases collecting pharmacological smoking cessation medication was 5.92 [95% CI 5.24-6.70]. Male sex, being unemployed, and receiving social benefits were factors associated with less probability of redeeming pharmacological smoking cessation medication. Our study indicates that attention is needed on smoking cessation in adults aged 30-50 years with COPD, especially if unemployed or receiving social benefits, as these individuals are less likely to redeem pharmacological smoking cessation medication.
尽管知道吸烟的有害影响,丹麦活跃吸烟者的流行率几年来一直相对稳定地保持在20%左右。戒烟是限制慢性阻塞性肺疾病(COPD)进展和降低死亡率的最有效方法。因此,戒烟对成人慢性阻塞性肺病患者尤为重要。本研究的目的是确定30-50岁患有慢性阻塞性肺病的成年人戒烟药物治疗的程度,并确定影响戒烟药物使用的人口统计学因素。我们进行了一项全国性的回顾性非介入性登记研究,包括2009-2015年期间年龄在30-50岁之间的所有丹麦COPD患者(ICD-10代码J.44:慢性阻塞性肺疾病)。我们确定了7734例病例,在年龄、性别和地理位置上与对照组(15307例)1:2匹配。未登记吸烟状况。我们发现,在研究期间,18%的病例(估计吸烟率为33-50%)使用了药物戒烟药物,而对照组的这一比例为3%(估计吸烟率为23%)。收集药物戒烟药物的OR为5.92 [95% CI 5.24-6.70]。男性、失业和接受社会福利是使用戒烟药物的可能性较低的相关因素。我们的研究表明,需要关注30-50岁COPD患者的戒烟,特别是失业或领取社会福利的成年人,因为这些人不太可能使用药物戒烟药物。
{"title":"Pharmacological smoking cessation of adults aged 30-50 years with COPD.","authors":"Dea Kejlberg Andelius, Ole Hilberg, Rikke Ibsen, Anders Løkke","doi":"10.1038/s41533-022-00301-y","DOIUrl":"https://doi.org/10.1038/s41533-022-00301-y","url":null,"abstract":"<p><p>The prevalence of active smokers has remained relatively stable around 20% for several years in Denmark despite knowledge of the harmful effects. Smoking cessation is the most effective way to limit progression and reduce mortality of chronic obstructive pulmonary disease (COPD). Therefore, smoking cessation is particularly important among adults with COPD. The aim of this study was to determine the extent to which adults 30-50 years of age with COPD redeem pharmacotherapy for smoking cessation, and to identify demographic factors that influence the use of smoking cessation medication. We conducted a national retrospective non-interventional registry study, including all Danish patients with COPD (ICD-10 code J.44: chronic obstructive pulmonary disease) aged 30-50 years in the period 2009-2015. We identified 7734 cases, who were matched with controls (15,307) 1:2 on age, sex, and geography. Smoking status was not registered. We found that 18% of cases (with an estimated smoking prevalence at 33-50%) redeemed pharmacological smoking cessation medication in the study period compared to 3% of the controls (with an estimated smoking prevalence at 23%). The OR for cases collecting pharmacological smoking cessation medication was 5.92 [95% CI 5.24-6.70]. Male sex, being unemployed, and receiving social benefits were factors associated with less probability of redeeming pharmacological smoking cessation medication. Our study indicates that attention is needed on smoking cessation in adults aged 30-50 years with COPD, especially if unemployed or receiving social benefits, as these individuals are less likely to redeem pharmacological smoking cessation medication.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9547921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33494452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-03DOI: 10.1038/s41533-022-00302-x
Liliana Silva, Tiago Maricoto, Patrício Costa, Joana Berger-Estilita, José Miguel Padilha
Pulmonary rehabilitation (PR) improves functional capacity, health-related quality of life (HRQoL) in COPD patients, and maintenance programmes are relevant in preserving those improvements. However, little is known about the structure of maintenance programmes after PR. We performed a systematic review and meta-analysis of experimental and quasi-experimental studies evaluating individuals with COPD admitted to a maintenance PR programme, delivered after an initial PR programme. We reported functional capacity evaluation (6-minute-walking-test), HRQoL, dyspnoea and symptom control. Searches were performed on the 11th April 2021 using MEDLINE, Embase, EBSCO, CINAHL, Web of Science and Cochrane Library. We extracted summary-level data from trial publications and used a random-effects model, predicting that severe heterogeneity was detected. The protocol was registered in PROSPERO (CRD42021247724). Fifteen studies were included in the meta-analysis, with 1151 participants. Maintenance programmes were associated with a pooled mean increase of 27.08 meters in 6mWT (CI: 10.39 to 43.77; I2 = 93%; p < 0.0001), being better in supervised, long (>12 month) home-based programmes; and having a potential MD of -4.20 pts in SGRQ (CI: -4.49 to -3.91; I2 = 0%; p = 0.74). Regarding dyspnoea and exacerbations, we found a nonsignificant trend for improvement after maintenance PR programmes. Severe COPD patients showed smaller improvements in programmes up to a year. Overall, the strength of the underlying evidence was moderate. Despite limitations of risk of bias and heterogeneity, our results support that home-based, supervised, long-term maintenance PR programmes may significantly improve functional capacity in COPD patients and HRQoL.
{"title":"A meta-analysis on the structure of pulmonary rehabilitation maintenance programmes on COPD patients' functional capacity.","authors":"Liliana Silva, Tiago Maricoto, Patrício Costa, Joana Berger-Estilita, José Miguel Padilha","doi":"10.1038/s41533-022-00302-x","DOIUrl":"10.1038/s41533-022-00302-x","url":null,"abstract":"<p><p>Pulmonary rehabilitation (PR) improves functional capacity, health-related quality of life (HRQoL) in COPD patients, and maintenance programmes are relevant in preserving those improvements. However, little is known about the structure of maintenance programmes after PR. We performed a systematic review and meta-analysis of experimental and quasi-experimental studies evaluating individuals with COPD admitted to a maintenance PR programme, delivered after an initial PR programme. We reported functional capacity evaluation (6-minute-walking-test), HRQoL, dyspnoea and symptom control. Searches were performed on the 11<sup>th</sup> April 2021 using MEDLINE, Embase, EBSCO, CINAHL, Web of Science and Cochrane Library. We extracted summary-level data from trial publications and used a random-effects model, predicting that severe heterogeneity was detected. The protocol was registered in PROSPERO (CRD42021247724). Fifteen studies were included in the meta-analysis, with 1151 participants. Maintenance programmes were associated with a pooled mean increase of 27.08 meters in 6mWT (CI: 10.39 to 43.77; I<sup>2</sup> = 93%; p < 0.0001), being better in supervised, long (>12 month) home-based programmes; and having a potential MD of -4.20 pts in SGRQ (CI: -4.49 to -3.91; I<sup>2</sup> = 0%; p = 0.74). Regarding dyspnoea and exacerbations, we found a nonsignificant trend for improvement after maintenance PR programmes. Severe COPD patients showed smaller improvements in programmes up to a year. Overall, the strength of the underlying evidence was moderate. Despite limitations of risk of bias and heterogeneity, our results support that home-based, supervised, long-term maintenance PR programmes may significantly improve functional capacity in COPD patients and HRQoL.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9530215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40394889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-29DOI: 10.1038/s41533-022-00295-7
David Price, Kerry Hancock, Joseph Doan, Sri Wahyu Taher, Chakaya J Muhwa, Hisham Farouk, Maarten J H I Beekman
Short-acting β2-agonist (SABA) prescriptions and associated outcomes were assessed in 1440 patients with asthma from the SABA use IN Asthma (SABINA) III study treated in primary care. Data on asthma medications were collected, and multivariable regression models analysed the association of SABA prescriptions with clinical outcomes. Patients (mean age, 47.9 years) were mostly female (68.6%); 58.3% had uncontrolled/partly controlled asthma and 38.8% experienced ≥1 severe exacerbation (reported in 39% of patients with mild asthma). Overall, 44.9% of patients were prescribed ≥3 SABA canisters (over-prescription) and 21.5% purchased SABA over-the-counter. Higher SABA prescriptions (vs 1-2 canisters) were associated with significantly decreased odds of having at least partly controlled asthma (6-9 and 10-12 canisters) and an increased incidence rate of severe exacerbations (10-12 and ≥13 canisters). Findings revealed a high disease burden, even in patients with 'mild' asthma, emphasising the need for local primary care guidelines based on international recommendations.
{"title":"Short-acting β<sub>2</sub>-agonist prescription patterns for asthma management in the SABINA III primary care cohort.","authors":"David Price, Kerry Hancock, Joseph Doan, Sri Wahyu Taher, Chakaya J Muhwa, Hisham Farouk, Maarten J H I Beekman","doi":"10.1038/s41533-022-00295-7","DOIUrl":"https://doi.org/10.1038/s41533-022-00295-7","url":null,"abstract":"<p><p>Short-acting β<sub>2</sub>-agonist (SABA) prescriptions and associated outcomes were assessed in 1440 patients with asthma from the SABA use IN Asthma (SABINA) III study treated in primary care. Data on asthma medications were collected, and multivariable regression models analysed the association of SABA prescriptions with clinical outcomes. Patients (mean age, 47.9 years) were mostly female (68.6%); 58.3% had uncontrolled/partly controlled asthma and 38.8% experienced ≥1 severe exacerbation (reported in 39% of patients with mild asthma). Overall, 44.9% of patients were prescribed ≥3 SABA canisters (over-prescription) and 21.5% purchased SABA over-the-counter. Higher SABA prescriptions (vs 1-2 canisters) were associated with significantly decreased odds of having at least partly controlled asthma (6-9 and 10-12 canisters) and an increased incidence rate of severe exacerbations (10-12 and ≥13 canisters). Findings revealed a high disease burden, even in patients with 'mild' asthma, emphasising the need for local primary care guidelines based on international recommendations.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40382952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-29DOI: 10.1038/s41533-022-00293-9
Xiaolin Liang, Yanqing Xie, Yi Gao, Yumin Zhou, Wenhua Jian, Mei Jiang, Hongyu Wang, Jinping Zheng
Lung age is a simplified concept that makes spirometry data easier to understand, but it is not widely used due to limitations in estimation methods. The aim of this study was to develop new equations to estimate lung age and to explore the application value of lung age in chronic respiratory diseases. Retrospective spirometric data of 18- to 80-year-old healthy subjects were used to develop the lung age estimation equations. Models were respectively built by multiple linear regression, piecewise linear regression, and the natural cubic spline method. Patients with chronic obstructive pulmonary disease (COPD) and asthma were subdivided into stages I-IV according to the severity of airflow limitation under the recommendation of the Global Initiative for Chronic Obstructive Lung Disease. Propensity score matching was performed to balance age, height and sex between healthy subjects and patients. The difference between lung age and chronological age (∆ lung age) of patients with COPD and asthma was analyzed. A total of 3409 healthy subjects, 280 patients with COPD and 285 patients with asthma data were included in the analysis. The lung age estimation equation with the best goodness of fit was built by the spline method and composed of FEV1, FEF50%, FEF75% and height as explanatory variables. ∆ lung age progressively increased with the degree of airflow limitation in patients with COPD or asthma. Lung age estimation equations were developed by a spline modeling method. Lung age may be used in the assessment of chronic respiratory patients.
肺年龄是一个简化的概念,使肺活量测定数据更容易理解,但由于估计方法的局限性,它没有被广泛使用。本研究旨在建立新的肺年龄估算方程,探讨肺年龄在慢性呼吸系统疾病中的应用价值。采用18- 80岁健康受试者的回顾性肺活量测定数据建立肺年龄估计方程。分别采用多元线性回归、分段线性回归和自然三次样条法建立模型。根据全球慢性阻塞性肺疾病倡议(Global Initiative for chronic obstructive Lung disease)的建议,将慢性阻塞性肺疾病(COPD)和哮喘患者根据气流限制的严重程度细分为I-IV期。在健康受试者和患者之间进行倾向评分匹配以平衡年龄、身高和性别。分析COPD合并哮喘患者肺年龄与实足年龄(∆肺年龄)的差异。共有3409名健康受试者、280名COPD患者和285名哮喘患者的数据被纳入分析。以FEV1、FEF50%、FEF75%和身高为解释变量,采用样条法建立拟合优度最佳的肺龄估计方程。∆肺年龄随着COPD或哮喘患者气流受限程度的增加而逐渐增加。采用样条建模方法建立了肺龄估计方程。肺年龄可用于慢性呼吸系统患者的评估。
{"title":"Estimation of lung age via a spline method and its application in chronic respiratory diseases.","authors":"Xiaolin Liang, Yanqing Xie, Yi Gao, Yumin Zhou, Wenhua Jian, Mei Jiang, Hongyu Wang, Jinping Zheng","doi":"10.1038/s41533-022-00293-9","DOIUrl":"https://doi.org/10.1038/s41533-022-00293-9","url":null,"abstract":"<p><p>Lung age is a simplified concept that makes spirometry data easier to understand, but it is not widely used due to limitations in estimation methods. The aim of this study was to develop new equations to estimate lung age and to explore the application value of lung age in chronic respiratory diseases. Retrospective spirometric data of 18- to 80-year-old healthy subjects were used to develop the lung age estimation equations. Models were respectively built by multiple linear regression, piecewise linear regression, and the natural cubic spline method. Patients with chronic obstructive pulmonary disease (COPD) and asthma were subdivided into stages I-IV according to the severity of airflow limitation under the recommendation of the Global Initiative for Chronic Obstructive Lung Disease. Propensity score matching was performed to balance age, height and sex between healthy subjects and patients. The difference between lung age and chronological age (∆ lung age) of patients with COPD and asthma was analyzed. A total of 3409 healthy subjects, 280 patients with COPD and 285 patients with asthma data were included in the analysis. The lung age estimation equation with the best goodness of fit was built by the spline method and composed of FEV<sub>1</sub>, FEF<sub>50%</sub>, FEF<sub>75%</sub> and height as explanatory variables. ∆ lung age progressively increased with the degree of airflow limitation in patients with COPD or asthma. Lung age estimation equations were developed by a spline modeling method. Lung age may be used in the assessment of chronic respiratory patients.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40383548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-21DOI: 10.1038/s41533-022-00300-z
Pamela Kushner, Bill H McCarberg, Laurent Grange, Anton Kolosov, Anela Lihic Haveric, Vincent Zucal, Richard Petruschke, Stephane Bissonnette
Early in the COVID-19 pandemic, anecdotal reports emerged suggesting non-steroidal anti-inflammatory drugs (NSAIDs) may increase susceptibility to infection and adversely impact clinical outcomes. This narrative literature review (March 2020-July 2021) attempted to clarify the relationship between NSAID use and COVID-19 outcomes related to disease susceptibility or severity. Twenty-four relevant publications (covering 25 studies) reporting original research data were identified; all were observational cohort studies, and eight were described as retrospective. Overall, these studies are consistent in showing that NSAIDs neither increase the likelihood of SARS-CoV-2 infection nor worsen outcomes in patients with COVID-19. This is reflected in current recommendations from major public health authorities across the world, which support NSAID use for analgesic or antipyretic treatment during COVID-19. Thus, there is no basis on which to restrict or prohibit use of these drugs by consumers or patients to manage their health conditions and symptoms during the pandemic.
{"title":"The use of non-steroidal anti-inflammatory drugs (NSAIDs) in COVID-19.","authors":"Pamela Kushner, Bill H McCarberg, Laurent Grange, Anton Kolosov, Anela Lihic Haveric, Vincent Zucal, Richard Petruschke, Stephane Bissonnette","doi":"10.1038/s41533-022-00300-z","DOIUrl":"https://doi.org/10.1038/s41533-022-00300-z","url":null,"abstract":"<p><p>Early in the COVID-19 pandemic, anecdotal reports emerged suggesting non-steroidal anti-inflammatory drugs (NSAIDs) may increase susceptibility to infection and adversely impact clinical outcomes. This narrative literature review (March 2020-July 2021) attempted to clarify the relationship between NSAID use and COVID-19 outcomes related to disease susceptibility or severity. Twenty-four relevant publications (covering 25 studies) reporting original research data were identified; all were observational cohort studies, and eight were described as retrospective. Overall, these studies are consistent in showing that NSAIDs neither increase the likelihood of SARS-CoV-2 infection nor worsen outcomes in patients with COVID-19. This is reflected in current recommendations from major public health authorities across the world, which support NSAID use for analgesic or antipyretic treatment during COVID-19. Thus, there is no basis on which to restrict or prohibit use of these drugs by consumers or patients to manage their health conditions and symptoms during the pandemic.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9489480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-20DOI: 10.1038/s41533-022-00294-8
Shariff Ghazali Sazlina, Ping Yein Lee, Ai Theng Cheong, Norita Hussein, Hilary Pinnock, Hani Salim, Su May Liew, Nik Sherina Hanafi, Ahmad Ihsan Abu Bakar, Chiu-Wan Ng, Rizawati Ramli, Azainorsuzila Mohd Ahad, Bee Kiau Ho, Salbiah Mohamed Isa, Richard A Parker, Andrew Stoddart, Yong Kek Pang, Karuthan Chinna, Aziz Sheikh, Ee Ming Khoo
Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre-post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference -19.7; 95% CI -34.7 to -3.1; 6 months: % difference -20.3; 95% CI -5.8 to -3.2), one or more emergency visit (1 month: % difference -28.6; 95% CI -41.2 to -15.5; 3 months: % difference -18.0; 95% CI -32.2 to -3.0; 6 months: % difference -20.3; 95% CI -34.9 to -4.6), and one or more asthma admission (1 month: % difference -14.3; 95% CI -25.2 to -5.3; 6 months: % difference -11.9; 95% CI -23.2 to -1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530 .
支持自我管理可降低与哮喘有关的发病率和死亡率。本文是一项可行性研究,观察使用图解行动计划在临床和成本结果方面的变化是评估可行性的一部分,因为这将有助于我们确定完全有效的 RCT 的结果测量指标。我们在马来西亚的一家公立初级保健诊所对医生诊断为哮喘并正在吸入皮质类固醇的成人进行了一项前后可行性研究。我们对现有的图解哮喘行动计划进行了改编。主要结果是哮喘控制情况,在 1 个月、3 个月和 6 个月时进行评估。次要结果包括缓解剂的使用、控制药物的依从性、哮喘加重、急诊就诊、住院、工作/日常活动损失天数以及行动计划的使用。我们估算了使用行动计划后在哮喘相关护理方面可能节省的成本。约 84% 的患者(n = 59/70)完成了 6 个月的随访。哮喘得到良好控制的比例从基线时的 18 人(30.4%)增加到 6 个月随访时的 38 人(64.4%)。至少出现过一次急性加重的比例(3 个月:3 个月:差异率为 -19.7;95% CI 为 -34.7 至 -3.1;6 个月:差异率为 -20.3;95% CI 为 -3.1:差异率为 -20.3;95% CI -5.8 至 -3.2)、一次或多次急诊就诊(1 个月:差异率为 -28.6;95% CI -5.8 至 -3.2)的比例:1个月:差异百分比-28.6;95% CI -41.2至-15.5;3个月:差异百分比-18.0;95% CI -5.8至-3.2):1个月:差异率-28.6;95% CI -41.2至-15.5;3个月:差异率-18.0;95% CI -32.2至-3.0;6个月:差异率-20.3;95% CI -41.2至-15.53个月:差异率-18.0;95% CI -32.2至-3.0;6个月:差异率-20.3;95% CI -34.9至-4.6),以及一次或多次哮喘入院(1个月:差异率-14.3;95% CI -34.9至-4.6):1个月:差异百分比-14.3;95% CI -25.2至-5.3;6个月:差异百分比-11.9;95% CI -34.9至-4.6):随着时间的推移,差异率为 -11.9;95% CI -23.2 至 -1.8)有所改善。59名患者在6个月随访时和6个月内每位患者的估计节省费用分别为15866.22马币(3755.36美元)和268.92马币(63.65美元)。使用图形化哮喘行动计划支持自我管理与马来西亚初级保健患者的哮喘控制改善和潜在成本节约相关:2019年9月5日,http://www.isrctn.com/ISRCTN87128530 。
{"title":"Feasibility of supported self-management with a pictorial action plan to improve asthma control.","authors":"Shariff Ghazali Sazlina, Ping Yein Lee, Ai Theng Cheong, Norita Hussein, Hilary Pinnock, Hani Salim, Su May Liew, Nik Sherina Hanafi, Ahmad Ihsan Abu Bakar, Chiu-Wan Ng, Rizawati Ramli, Azainorsuzila Mohd Ahad, Bee Kiau Ho, Salbiah Mohamed Isa, Richard A Parker, Andrew Stoddart, Yong Kek Pang, Karuthan Chinna, Aziz Sheikh, Ee Ming Khoo","doi":"10.1038/s41533-022-00294-8","DOIUrl":"10.1038/s41533-022-00294-8","url":null,"abstract":"<p><p>Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre-post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference -19.7; 95% CI -34.7 to -3.1; 6 months: % difference -20.3; 95% CI -5.8 to -3.2), one or more emergency visit (1 month: % difference -28.6; 95% CI -41.2 to -15.5; 3 months: % difference -18.0; 95% CI -32.2 to -3.0; 6 months: % difference -20.3; 95% CI -34.9 to -4.6), and one or more asthma admission (1 month: % difference -14.3; 95% CI -25.2 to -5.3; 6 months: % difference -11.9; 95% CI -23.2 to -1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530 .</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-08DOI: 10.1038/s41533-022-00297-5
Miguel Angel Martinez-Garcia, Alberto Garcia-Ortega, Grace Oscullo
Bronchiectasis is the third most common chronic inflammatory airway disease, after chronic obstructive pulmonary disease (COPD) and asthma with a prevalence clearly underestimated probably because of its clinical similitudes with other chronic airway diseases. Bronchiectasis can be caused by a dozen of pulmonary and extra-pulmonary diseases and a variable number and severity of exacerbations can appear throughout its natural history, usually with an infectious profile. The dilation of the airway and the inflammation/infection is their radiological and pathophysiological hallmarks. Primary Care should play an important play in many aspects of the bronchiectasis assessment. In this article, we will try to offer a series of important concepts and practical tips on some key aspects of the diagnosis and management of bronchiectasis in Primary Care: clinical suspicion, diagnostic methods, severity assessment, overlap with asthma and COPD and microbiological and therapeutic aspects.
{"title":"Practical tips in bronchiectasis for Primary Care.","authors":"Miguel Angel Martinez-Garcia, Alberto Garcia-Ortega, Grace Oscullo","doi":"10.1038/s41533-022-00297-5","DOIUrl":"10.1038/s41533-022-00297-5","url":null,"abstract":"<p><p>Bronchiectasis is the third most common chronic inflammatory airway disease, after chronic obstructive pulmonary disease (COPD) and asthma with a prevalence clearly underestimated probably because of its clinical similitudes with other chronic airway diseases. Bronchiectasis can be caused by a dozen of pulmonary and extra-pulmonary diseases and a variable number and severity of exacerbations can appear throughout its natural history, usually with an infectious profile. The dilation of the airway and the inflammation/infection is their radiological and pathophysiological hallmarks. Primary Care should play an important play in many aspects of the bronchiectasis assessment. In this article, we will try to offer a series of important concepts and practical tips on some key aspects of the diagnosis and management of bronchiectasis in Primary Care: clinical suspicion, diagnostic methods, severity assessment, overlap with asthma and COPD and microbiological and therapeutic aspects.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9453736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9180679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}