We seek to determine which dimensions of quality of care are most influenced by emergency department (ED) crowding for patients with acute asthma exacerbations. This cross-sectional study with retrospective data collection included patients aged 2 to 21 years treated for acute asthma during November 2007 to October 2008 at a ...

In the Western world, chronic obstructive pulmonary disease (COPD) is predominantly caused by long-term smoking, which results in pulmonary inflammation that is often associated with systemic inflammation. A number of co-morbid conditions, such as cardiovascular disease, muscle wasting, type 2 diabetes and asthma, may coexist with COPD; these and other ...

The objective of this study was to assess the facilities and resources available to support internationally endorsed standards of asthma care at tertiary hospitals (University teaching, Federal Medical Centre and State specialist Hospitals) in Nigeria. This cross sectional study was conducted among 68 tertiary hospitals (TH) in Nigeria from June ...

Objectives. The effectiveness of community health worker-delivered interventions to decrease environmental triggers for asthma in the home has been well documented in urban populations, but has had little evaluation in rural, Latino/a families. The purpose of this study was to evaluate the feasibility and acceptability of a home-visitation intervention designed ...

To develop evidence-based performance indicators that measure the quality of primary care for asthma. Cochrane Database of Systematic Reviews, MEDLINE, EMBASE and CINAHL for peer-reviewed articles published in 1998-2008 and five national/global asthma management guidelines. Articles with a focus on current asthma performance indicators recognized or used in community and ...

Aim:  Asthma treatment according to guidelines fails frequently, through patients' nonadherence to doctors' advice. This study aimed to explore how differences in asthma care influence parents' perceptions to inhaled corticosteroids (ICS). Methods:  We conducted six semistructured focus groups, including 44 parents of asthmatic children (2-12 years of age, treated in primary ...

Asthma is a chronic disease characterized by airway inflammation and hyperresponsiveness and is associated with significant yet avoidable mortality and morbidity resulting in considerable individual and societal burden. Inhaled corticosteroids are the most effective class of controller medication available today for treating persistent asthma and are the evidence-based guideline-recommended first-line ...

BACKGROUND: Quality management, evaluation, and surveillance of asthma may be enhanced by access to and utilization of an asthma electronic medical record (EMR) in primary care. PURPOSE: To describe the current status, support tools, and utility of asthma EMRs in primary care. METHODS: An integrative review of the literature published ...

OBJECTIVE: To evaluate whether systematic asthma care involving a register-recall system, postcard prompts for review, and education for general practitioners and staff in Australian general practice improves the quality of care and health outcomes for adult patients with moderate to severe asthma. DESIGN AND SETTING: Cluster randomised controlled trial in ...

OBJECTIVE: This study explores the use of spirometry in primary care settings. METHODS: A 4-page survey was mailed to a national, random sample of office-based family physicians and pediatricians. Survey items addressed knowledge, attitudes, and practices regarding spirometry and standardized clinical vignettes. Data were analyzed by using χ2 tests and ...

Rhinitis is a common problem in primary care which is often managed sub-optimally. It causes considerable morbidity and has been shown to have a detrimental impact on people's ability to concentrate at school and at work. Rhinitis and asthma often present together, and symptomatic rhinitis can be associated with poor ...

Recognition of chronic obstructive pulmonary disease (COPD) is often missed or delayed in primary care. Once recognized, COPD is often undertreated or episodically treated, focusing on acute exacerbations without establishing maintenance treatment to control ongoing disease. Diagnostic and therapeutic pessimism result in missed opportunities to reduce exacerbations, maintain physical functioning, ...

There is evidence that allergy to common indoor pets, particularly cats and dogs, is closely associated with symptomatic asthma in the United States. Because the presence of pets in a home is a potentially modifiable factor, it is important to consider how much asthma morbidity and health care cost might ...

Asthma is a common chronic illness among adults. National guidelines recommend comprehensive implementation of environmental control practices (ECP) for asthma management. The purpose of this study was to examine the association between preventive asthma care and comprehensive ECP use among adults with asthma. We used data from the Four-State National ...

OBJECTIVES: Few studies have explored pharmacists' perceptions of their potential role in asthma management. This study aimed to investigate community pharmacists' perceptions of their role in the provision of asthma care, to compare the perceptions of metropolitan and regional pharmacists with regards to their role, to identify barriers to the ...

Addressing pediatric asthma in the inner-city. Connecting uninsured patients with a medical home. Developing alternatives to emergency care for primary care. The winners of the AHA NOVA Awards make a difference in their communities.

BACKGROUND: Interest in disease self-management has increased as the US population ages, as health care costs skyrocket, and as more evidence is gathered on the etiologic basis of most chronic diseases. This study uses National Health Interview Survey (NHIS) data to analyze the association between asthma episode during the past ...

Delays in diagnosing asthma in children are common and are known to delay asthma-specific treatment. Few studies have investigated whether a delay in asthma diagnosis impacts the use of health care services. This study was designed to assess whether a delay in diagnosis of asthma influences the use of health ...

Investigator-initiated research in both asthma and chronic obstructive pulmonary disease conducted at the Baylor Martha Foster Lung Care Center has sought to improve management throughout the continuum of respiratory care using a multidisciplinary approach. Respiratory care therapists employed in the primary care setting were shown to improve the quality of ...

To determine whether an asthma coaching program can improve parent and child asthma-related quality of life (QOL) and reduce urgent care events. Randomized controlled trial of usual care vs usual care with coaching. Comparisons were made between groups using mixed models. A Midwest city. A community-based sample of 362 families ...

Despite strong evidence for using clinical care pathways to manage acute pediatric asthma, adherence remains suboptimal. To elicit information from health care professionals regarding their knowledge, attitudes and use of a care pathway for acute childhood asthma. A cross-sectional, self-administered survey of physicians, nurses and respiratory therapists who worked in ...

The self-management of asthma can improve clinical outcomes. Recently, mobile telephones have been widely used as an efficient, instant personal communication tool. This study investigated whether a self-care system will achieve better asthma control through a mobile telephone-based interactive programme. This was a prospective, controlled study in outpatient clinics. From ...

Information is limited regarding adherence to the asthma guidelines in Asia, especially for children. The aim of the study was to estimate adherence to the asthma guidelines, and investigate reasons for nonadherence. We conducted a cross-sectional questionnaire survey on the primary care pediatricians practicing in Incheon, Korea. Surveys were returned ...

PURPOSE OF REVIEW: The purpose of this review is to describe recent evidence of the efficacy and effectiveness of clinical pathways for the assessment and management of severe acute asthma in children and adults in the emergency department (ED). The review will highlight examples of successful knowledge translation initiatives and ...

Asthma poses a significant burden on patients, families, health care providers, and the medical system. While efforts to standardize care through guidelines have expanded, difficulty in managing severe asthma has encouraged research about its pathobiology and treatment options. Novel biologic therapeutics are being developed for the treatment of asthma and ...

OBJECTIVE: To estimate savings to health care system of a best-practice asthma intervention in primary care for inner-city children. METHODS: Data were analyzed from National Heart, Lung and Blood Institute (NHLBI) Guidelines-based initial (n=244) and follow-up (n=202) asthma assessments of patients who received enhanced treatment in primary care. Savings were ...

BACKGROUND: The prevalence of asthma is high in Australia. Despite national guidelines recommending the use of an Asthma Action Plan only 22.5% of people with asthma had a plan in 2004-2005. METHODS: To ascertain the effect on attendance for an annual Asthma Cycle of Care resulting in an Asthma Action ...

We describe the clinical features of a 17-year-old girl with severe asthma exacerbations. On admission to the intensive care unit, she manifested expiratory dyspnea, cyanosis, and an unproductive cough. Her chest x-rays showed extensive pneumomediastinum (PM), mild subcutaneous emphysema at the right anterior triangle of the neck, and right upper-lobe ...

OBJECTIVE: To develop and test an online assessment referred to as the ASTHMA-CAT (computerized adaptive testing), a patient-based asthma impact, control, and generic health-related quality of life (HRQOL) measure. STUDY DESIGN: Cross-sectional pilot study of the ASTHMA-CAT's administrative feasibility in a disease management population. METHODS: The ASTHMA-CAT included a dynamic ...

Current management of acute asthma has been defined in clinical practice guidelines developed from systematic reviews and expert opinion. Initial treatment with inhaled high-dose beta-agonists and anticholinergics is recommended for severe exacerbations. Most patients treated in emergency departments should receive systemic corticosteroids. Adjunctive therapy for those not improving is less ...

OBJECTIVE: Asthma continues to be 1 of the most common chronic diseases of childhood and affects approximately 6 million US children. Although National Asthma Education Prevention Program guidelines exist and are widely accepted, previous studies have demonstrated poor clinician adherence across a variety of populations. We sought to determine if ...

The aims were to evaluate the profile of newly diagnosed adult asthma cases and the approach adopted to the secondary care management at the launch of the Finnish asthma programme in 1994 and seven years later, in 2001. A retrospective medical record audit was made of non-acutely referred patients with ...

AIM: To evaluate outcomes for patients attending primary care centres with and without asthma clinics. METHODS: A cross-sectional survey at 42 primary health care centres randomly selected according to organisation of asthma care, 14 with complete, 14 with incomplete and 14 with no asthma clinic according to national criteria. 1,477 ...

Globally, asthma morbidity remains unacceptably high. If outcomes are to be improved, it is crucial that routine review consultations in primary care are performed to a high standard. Key components of a review include: * Assessment of control using specific morbidity questions to elucidate the presence of symptoms, in conjunction ...

Rhinitis and asthma share epidemiological, pathophysiological, and clinical features. The aim of the RINOASMAIR study was to examine the prevalence and characteristics of rhinitis in asthmatics in a Primary Care setting in Spain. A prospective epidemiological study was conducted with the participation of 1,027 Primary Care Physicians (PCP). A total ...

BACKGROUND: Provision of asthma education is associated with decreased hospitalizations and emergency department visits for patients with asthma. Our objective was to describe national trends in the provision of asthma education by primary care physicians in office settings. METHODS: We used the National Ambulatory Medical Care Survey, a nationally representative ...

Several comprehensive community-based asthma management programs have been developed in recent years. Their central goal is to provide access to quality asthma care to achieve successful long-term disease management. The Kansas City Children's Asthma Management Program (KC CAMP) and the Asthma Network of West Michigan (ANWM) share many of the ...

BACKGROUND: Treatment of asthma and rhinitis patients is often provided by both generalists (GPs) and specialists (SPs). Studies have shown differences in clinical outcomes of treatment between these settings. The aim of this study was to evaluate the effect of GP and SP care on health-related quality of life (HRQoL). ...

The objective of this survey was to assess adult primary care physicians' and pediatricians' perceptions of asthma exacerbation management, including beliefs concerning the discharge of patients from the emergency department (ED) following asthma exacerbations. This was a cross-sectional survey of primary care physicians (PCPs) treating adult or pediatric patients. Surveys ...

Healthcare systems internationally need to consider new models of care to cater for the increasing numbers of people with asthma. Telehealthcare interventions are increasingly being seen by policymakers as a potential means of delivering asthma care. We defined telehealthcare as being healthcare delivered from a distance, facilitated electronically and involving ...

BACKGROUND: Asthma is a common and important health condition in the UK, predominantly managed in primary care. Little is known about how characteristics of practices and patients are associated with achievement of quality indicators (QIs) for asthma. OBJECTIVE: To measure the recorded quality of primary care for asthma and to ...

AIM: The aim of this exploratory study was to identify those factors associated with asthma control assessed according to GINA Guidelines. METHOD: 809 (56% female) subjects with asthma were recruited consecutively from both specialist and primary care centres. Asthma control was assessed over a 4-week follow-up period using a composite ...

AIM: To compare the degree of asthma control in 2001 and 2005 in a primary care setting in Sweden. METHOD: Two similar questionnaire surveys were performed in 2001 and 2005 with 1,012 and 224 asthma patients aged 18-45 randomly selected from 42 and 56 primary health care centres, respectively. A ...

The incidence of asthma is increasing worldwide, but morbidity and mortality are decreasing because of improvements in medical care. Although the incidence of severe perioperative bronchospasm is relatively low in asthmatics undergoing anaesthesia, when it does occur it may be life-threatening. The keys to an uncomplicated perioperative course are assiduous ...

Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in adults and adolescents in the Western ...

PURPOSE: A prospective follow-up of adolescents with asthma designed to identify risk factors for deterioration during and after transfer from paediatric to adult healthcare. METHODS: Adolescents (n=150) with asthma being transferred from paediatric to adult healthcare were recruited consecutively and those with mild/moderate asthma assigned randomly to primary care or ...

BACKGROUND: Entry to the Australian Defence Force (ADF) for candidates with asthma has recently changed. OBJECTIVE: This article summarises the ADF entry standards for candidates with asthma. It also explains the role of general practitioners in the safe and smooth transition to the military training environment for patients with asthma. ...

BACKGROUND: There is no comprehensive information available concerning the way in which care is provided for those with allergic conditions in Europe. OBJECTIVE: To determine who cares for those with asthma, allergic dermatitis, and rhinitis in Europe and to determine the involvement of primary care and other healthcare professionals and ...

BACKGROUND: Allergy contributes significantly to asthma exacerbation, yet avoidance of triggers, in particular allergens, is rarely addressed in detail in regular asthma review in primary care. OBJECTIVE: To determine whether structured, individually tailored allergen and trigger avoidance advice, given as part of a primary care asthma review, improves lung function ...

BACKGROUND: In clinical trials of asthma, the outcomes are often good, but when the same treatment regimens are implemented in primary care, equally good results are not obtained. Objective: To investigate if addition of structured patient information and monitoring by an asthma diary in primary care improves asthma control. METHODS: ...