Management Of Asthma In General Practice Research Articles

Impact of COVID-19 on asthma management in general practice: A qualitative study.

The COVID-19 pandemic catalysed unprecedented changes to healthcare delivery in Australia, leading to a rapid transformation of asthma management, towhich healthcare providers and patients have had to adapt. Understanding the impact of these changes is critical as weemerge from pandemic-affected workflows. A qualitative study using semistructured interviews was conducted with 19 general practitioners across Sydney and regional New South Wales. Reflexive thematic analysis of interview data was undertaken. Four key themes were identified: disorganised asthma care before COVID‑19; chaotic asthma care during the pandemic; adapting to non-guideline-driven telehealth asthma care; and widening health agenda misalignment. This study highlights the triumphs and gaps in asthma management during the pandemic and the vulnerability of existing asthma care systems to disruption. These lessons can be used to re-evaluate how we deliver asthma care and inform future models of care as we transition towards a'post-COVID' landscape.

A randomised controlled trial of SMS reminders for routine asthma care in an Australian general practice.

Asthma self-management strategies remain core components of evidence-based asthma care. Despite this, only 14% of Australian adults with asthma have written action plans. We aimed to evaluate whether targeted SMS reminders to attend an asthma review could improve asthma action plan and spirometry completions for general practice patients who do not have current asthma action plans. A randomised controlled trial comparing targeted SMS reminders with usual care was performed from May to September, 2016, in a metropolitan general practice in South East Queensland. By the three-month follow-up, 35 of 79 patients allocated to intervention had completed action plans in comparison to five of 59 patients allocated to usual care (P < 0.0001). There were more recorded instances of spirometry per patient performed during the follow-up period for intervention (37/79), compared with usual care (8/59; P<0.0001). SMS reminders may be a useful tool in the spectrum of care needed for optimal asthma management in general practice.

Asthma management in general practice

Every asthmatic patient is different and needs to receive individually tailored evidence-based management advice and care to attain the best possible outcomes, says Amber Cornforth

Scheduled asthma management in general practice generally improve asthma control in those who attend

Successful asthma management involves guideline-based treatment and regular follow-up. We aimed to study the level of disease control in asthmatic individuals managed by their GP and a dedicated nurse when using a systematic asthma consultation guide based on Global Initiative of Asthma guidelines (GINA guidelines). Patients aged 18-79 years with doctor-diagnosed asthma were included. When managing the patients, the clinics were instructed to follow a consultation guide based on the principles of the GINA guidelines. This included evaluation of symptoms, treatment, compliance, lung function, and a scheduled follow-up appointment based on the level of asthma control: At the initial visit (baseline), 684 patients (36.8%) were classified as well-controlled, 740 (39.8%) as partly controlled and 434 (23.4%) as uncontrolled. 1784 patients had been offered a follow-up visit and 623 (35%) had attended. A response analysis was performed, and those participating were older (46 versus 45 years, p<0.01), whereas other variables were similar. A higher level of asthma control was found at the follow-up visit compared to the baseline visit (uncontrolled asthma 29.7% and 16.5%, respectively, p<0.001). At the time of the follow-up visit, changes in treatment strategies were found (p<0.01), and furthermore, level of lung function improved at the follow-up visit. Although most asthmatic individuals received asthma treatment, a substantial number still were partly or poorly controlled. The overall asthma control improved significantly when a systematic asthma management approach was introduced and applied by dedicated health care staff.

Profiles of asthma control in 12,488 patients in 30 practices in East Anglia

Introduction:Since the introduction of the British Thoracic Society Guidelines for Asthma Management in 1993, updated in 1997 and 2003, there have been substantial shifts in asthma management in general practice with improved patient care, but many reports indicate that for some patients, it is still difficult to maintain good control and improve quality of life. The ELEVATE study investigates asthma control and quality of life for adults in practices in East Anglia.Methods:Searches of computerised records of all active registered adult (age 16-80 years) patients at 30 practices participating in the ELEVATE study were performed using the search and report system in each practice's software. Patients who had prescriptions for inhaled salbutamol or terbutaline and who did not have prescriptions for Ipratropium containing products in the past 2 years received a screening questionnaire by post.The Asthma Control Questionnaire (ACQ) and Mini-Asthma Quality of Life Questionnaire (MiniAQLQ) were sent by the practices to each patient with a stamped return envelope. Cut-off points of scores =1 for the ACQ (0=well controlled, 6=extremely poor control) and =6 for the MiniAQLQ (7=no impairment, 1= severe impairment) were set as markers of inadequate asthma control and asthma related quality of life respectively.In 12 of the practices a further search was made of the registry to identify patients with a prescription or refill issue for inhaled cortico-steroids (ICS) in the past 4 months. This was used to categorise the patients from the first search into those most likely to be at step 1, and those likely to be at step 2 or higher (“2+”).Results:12488 patients were identified and sent questionnaires. Return rates were 60.3% overall with a range among practices from 52 to 69%. The ACQ score was >1 for 49.4% of the 7094 valid responses. The MiniAQLQ score was <6 for 56.6% of the 6751 valid responses. Cases with a combination of both an ACQ score=1 and MiniAQLQ score =6 were 43.7% of the 6574 valid casesFor the 6488 patients categorised as likely being either step 1 (3873) or step 2+ (2615), the ACQ score was =1 for 59.2 and 61.7% respectively of the 2132 step 1 and 1683 step 2+ valid responses. The MiniAQLQ score was =6 for 49.9 and 66.8% respectively of the 2040 step 1 and 1628 step 2+ valid responses.Conclusion:Examination of indicators of asthma control and quality of life among adult patients in general practice settings show a substantial level of inadequate asthma control and impaired quality of life. Further work to characterise the factors which influence these problems is needed.

NATIONAL ASTHMA ATTACK AUDIT, 1991 TO 1992

Purpose of the Study. This study takes the newly developed guidelines for asthma management and compares them to ongoing asthma management in general practice. Methods. A correspondence survey covering 218 general practices in the United Kingdom covered 1775 patients of all ages who had a total of 1805 attacks. Patient characteristics, place of management of attacks, and actual management were compared to recommended guidelines. The physicians from participating practices had attended a special one-half day course on the guidelines, largely derived from the British Thoracic Society and then took part in the survey for three consecutive months. Findings. There is extensive demographic data of interest, including level of care, incidence of hospitalization, age distribution, and other parameters—too lengthy for inclusion in this review. Hospital admissions peaked (16%) in the 0-to 9-and &amp;gt;69-year age ranges. Twenty-nine percent had their own peak flow meters (PPM), and 34% had been issued their own asthma self-management plan. Two deaths were reported—both were moribund upon arrival for treatment. On presentation PFM readings were obtained in 82% and asthma ratings in 97%. After this great start, things began to deteriorate when we examined therapy. Nebulization was given to only 35% of patients, and steroids to 55%. A sizable proportion of patients graded as "breathless and distressed" did not receive the recommended lifesaving antiasthma treatment with nebulization (46%) and steroids (48%). The authors stress that the standards or guidelines derived from hospital care may not necessarily be applicable to general practice. Thirty-five percent of the patients were given antibiotics.

Asthma management in general practice.

To provide guidelines for management of asthma in general practice. Selected articles, particularly those relating to general practice. Better management of asthma requires strategies for dealing with long-term management as well as acute attacks. Planning such strategies and implementing personal management plans for each patient requires assessment of asthma severity; determination and maintenance of best achievable lung function, with avoidance of trigger factors, regular monitoring, and appropriate drug therapy; a written self-management plan as a basis for patient and family education; and regular review.