No consensus exists on clinical or epidemiologic
|
|
- Wilfrid Lynch
- 6 years ago
- Views:
Transcription
1 Lack of Correlation of Symptoms With Specialist-Assessed Long-term Asthma Severity* Molly L. Osborne, MD, FCCP; William M. Vollmer, PhD; Kathryn L. Pedula, MS; John Wilkins, MD; A. Sonia Buist, MD; and Mark O Hollaren, MD, FCCP Study objectives: To validate three indicators of asthma severity as defined in the National Asthma Education Program (NAEP) guidelines (ie, frequency of symptoms, degree of airflow obstruction, and frequency of use of oral glucocorticoids), alone and in combination, against severity as assessed by pulmonary specialists provided with 24-month medical chart data. Design: Cross-sectional comparison of questionnaire and clinical-based markers of asthma severity with physician-assessed severity based on chart review. The pulmonologists did not have access to the results of the baseline evaluations when making their severity assessments. Setting and participants: Study participants were 193 asthmatic members (age range, 6 to 55 years) of a large health maintenance organization who underwent a baseline evaluation as part of a separate longitudinal study. This evaluation consisted of spirometry, skin prick testing, and a survey that included questions on symptoms and medication use. The participants in the ancillary study were selected, based on their baseline evaluation, to reflect a broad range of asthma severity. Results: Based on the chart review, 86 of the study subjects (45%) had mild disease, 90 (45%) had moderate disease, and 17 (9%) had severe disease. This physician-assessed severity correlated highly (p < 0.013) with NAEP-based indices of severity based on oral glucocorticoid use (never, infrequently for attacks, frequently for attacks, and daily use) and on spirometry (FEV 1 > 80% predicted, 60 to 80% predicted, and <60% predicted). It did not, however, correlate with current asthma symptoms (< once/week, 2 to 6 times/week, daily) (p 0.87). A composite severity score based on spirometry and the glucocorticoid use data still provided an overall agreement of 63%, with a weighted kappa of Conclusions: While current symptoms are the most important concern of patients with asthma, they reflect the current level of asthma control more than underlying disease severity. Investigators must therefore use caution when comparing groups of patients for whom severity categorization is based largely on symptomatology. This observation, that symptoms alone do not reflect disease severity, becomes even more important as health-care delivery moves closer to protocols/practice guidelines and best treatment programs that rely heavily on symptoms to guide subsequent treatment decisions. (CHEST 1999; 115:85 91) Key words: asthma; asthma severity; asthma symptoms; chart review Abbreviations: ED emergency department; NAEP National Asthma Education Program *From the Division of Pulmonary and Critical Care Medicine (Drs. Osborne and Wilkins), Portland Veterans Administration Medical Center; Kaiser Permanente Center for Health Research (Dr. Vollmer and Ms. Pedula), Division of Pulmonary and Critical Care Medicine (Dr. Buist), Oregon Health Sciences University; and the Department of Medicine (Dr. O Hollaren), Oregon Health Sciences University, Portland, Oregon. This project was supported by NIH grant HL Manuscript received June 16, 1997; revision accepted May 6, Correspondence to: Molly Osborne, MD, FCCP, P3 Pulm Pulmonary/Critical Care, VA Medical Center, 3710 SW US Veterans Hospital Rd, Portland, OR No consensus exists on clinical or epidemiologic measures that can be used to classify patients based on disease severity. 1 4 This may be related in part to confusion in the literature between the underlying severity of disease and current level of control. The term severity is sometimes used to refer to both concepts. Conceptually, however, level of control may correlate only weakly with the underlying severity of disease. 5 As an example, a patient with severe asthma taking daily steroids and exercising appropriate allergen avoidance may be well-con- CHEST / 115 / 1/ JANUARY,
2 trolled, while a noncompliant patient with mild to moderate disease may have more severe, disruptive symptoms. Recognizing these difficulties, most efforts to characterize severity have incorporated multiple indicators, including poor symptom control, type and amount of medication use, and objective measurements of lung function. 1,5 For example, 1991 National Asthma Education Program (NAEP) guidelines 6 characterize mild, moderate, and severe asthma according to frequency of symptoms; pulmonary function; school or work absences; methacholine sensitivity; drug regimen and response to medications; degree of exercise tolerance; and healthcare utilization. Despite the usefulness of these guidelines from a conceptual perspective, they do not readily translate into a simple severity index that could be used in clinical and epidemiologic settings. In fact, the guidelines point out that, because of the highly variable nature of asthma, classification of patients into mild, moderate, and severe disease categories is necessarily imperfect, and that the categories may overlap. The problem is further compounded by the fact an individual s underlying disease severity may vary over time. The frequency and/or severity of self-reported symptoms of asthma would seem an intuitively appealing gauge of disease severity, and, as noted above, have been used to help define severity in a variety of settings. 1,5,7 While current symptoms are important, they may more closely reflect the current level of control and/or compliance with medical treatment than underlying disease severity. In support of this concept, the literature reflects a poor correlation between reported symptoms and objective measures of lung function. 5,8,9 This report summarizes our efforts to validate the usefulness of three specific dimensions for assessing asthma severity: frequency of symptoms, degree of airflow obstruction, and self-reported frequency of use of oral glucocorticoids. This analysis was undertaken as part of a larger longitudinal study to define predictors of hospital-based care in asthma. Physician-assessed severity assessments (based on chart review) served as our gold standard. Materials and Methods We report on baseline, cross-sectional data collected as part of a longitudinal study to characterize risk factors for hospital-based care in asthma. All subjects gave informed consent. In the case of minors, both the children and their parents consented to the study. Sample and Research Setting Participants were members of a large health maintenance organization (Kaiser Permanente, Northwest Division) who either were hospitalized for asthma during the 2 years prior to recruitment or had antiasthma medications dispensed at least twice in the year prior to recruitment. At the time of recruitment, all participants reported having physician-diagnosed asthma and indicated that they experienced ongoing symptoms consistent with asthma. By design, participants ranged in age from 6 to 55 years. From the original cohort of 914 subjects, we randomly selected 193 for chart review. In order to provide a good mix of patients with mild, moderate, and severe asthma, participant selection was stratified based on an a priori severity index computed from the available baseline data (see below). Each participant underwent a single clinical evaluation that included spirometry and an interviewer-administered questionnaire requesting information about current respiratory symptoms and medication use. Because of the spirometry protocol, participants were required to be relatively asymptomatic at the time of clinical evaluation, although each could have had an exacerbation requiring steroids up to 2 weeks before the evaluation. The clinical evaluations of 914 participants were performed systematically throughout a 13-month period (January 1993 through January 1994; about 70 participants/month) in order to collect data uniformly throughout the year. For logistical reasons, we did not attempt to assess variation in peak expiratory flow rate as part of the baseline assessment. Questionnaires We developed two questionnaires for use in the study. The first was developed for participants in the 6- to 14-year-old age group and was completed by a parent. A second questionnaire was used for participants aged 15 to 55 years. Both were administered in interview format. The questionnaires covered a wide variety of factors affecting patients with asthma, including respiratory symptoms, asthma and allergy characteristics, and medication use. They were adapted from relevant sections of the American Thoracic Society Division of Lung Disease Respiratory Symptom Questionnaire and the International Union Against Tuberculosis and Lung Disease Bronchial Symptoms Questionnaire The two questions used to define our symptom index were: (1) During the last 4 weeks, have you been wheezing or had coughing or shortness of breath? (2) Have you had nighttime asthma symptoms (awoke with wheezing, shortness of breath, or cough)? Spirometry Subjects performed spirometry using standardized methods and equipment that met or exceeded American Thoracic Society requirements 13,14 (Spirotech S 550 dry rolling seal spirometer [Graseby Andersen, Spirotech Div; Smyrna, GA] using a digital shaft encoder with 10-mL volume resolution). The best FEV 1 was chosen for analysis and expressed as a percent of predicted FEV 1 using the prediction equations of Knudson et al. 15 NAEP-based Asthma Severity Scale The study questionnaire incorporated several facets of severity assessment as defined in the NAEP Expert Panel Report. 6 These included the previously noted questions on frequency of both daytime and nocturnal symptoms and the frequency of oral glucocorticoid use. We combined this information with baseline spirometry to construct three scaled severity indices (Table 1). The symptoms index combined the information on daytime and nocturnal symptom frequency and divided patients into three 86 Clinical Investigations
3 Table 1 Components of Asthma Severity based on NAEP Guidelines Score Value Full Sample (N 914), % Chart Review Sample (N 193), % Symptoms 1/wk 0 38* 24 2 to 6/wk Daily Oral Steroids Not used % of time % of time Daily Spirometry FEV 1 80% predicted FEV 1 60 to 80% predicted FEV 1 60% predicted *Percentages do not add up to 100% due to rounding. Spirometry available for only 831 subjects in full sample. had also intended to abstract data on symptoms, we found that they were seldom mentioned in the chart. Similarly, there was little objective information on pulmonary function; 79% of patients had no information on peak flow, 12% had a measurement recorded during an acute exacerbation, and 9% had measurements recorded on an ongoing basis. Spirometry was rarely performed. Because we felt comfortable that the NAEP-based severity score performed well in the extreme cases, we purposely oversampled subjects with severity in the range less likely to be appropriately classified (eg, severity scores of 2 to 5). Sixty percent of our chart review sample came from this group, and an additional 20% was selected from above and below this range. Within each of these three ranges, we further stratified our selection to be balanced by sex and age (6 to 18 years vs 19 to 55 years). We also required all participants to have performed spirometry at the baseline evaluation. A total of 200 charts were identified in this manner, of which we were able to review 193. We hoped that the chart review would not only validate the severity score, but would help us to identify the component(s) of the score, if any, that warranted revision. groups based on overall frequency of asthma symptoms: less than once a week; 2 to 6 times a week; or daily. The individual categories for each index correspond approximately to the cut points for mild, moderate, and severe asthma as defined in the NAEP guidelines. We summed these three indices to provide an overall severity score, which was then used to categorize subjects as mild (0 to 2), moderate (3 to 4), or severe (5 to 7). We shall refer to this as our NAEP-based severity scale. Because hospitalization and emergency room use were primary outcome variables for our larger longitudinal study, we did not include them in constructing our severity scale. In order to evaluate this scoring system, we conducted a chart review for a subset of the participants and determined a physician-assessed severity rating that served as our gold standard. The pulmonologists who conducted the medical record review used their best clinical judgment, based on information available in the record, to assign their severity ratings. Details of the chart review process are outlined below. Chart Review We performed the chart review using previously established methodology. 16 An initial pilot review of 12 charts was performed by two pulmonologists (JW and MO), who also conducted the subsequent chart reviews. Their independent ratings of asthma severity agreed in 11 of the 12 charts, which were not used in the final analysis. Although we did not perform a formal interrater reliability analysis, the process used to develop our assessment of severity was designed to help ensure a high level of reliability. In addition, we were careful to resolve any uncertainty in the assessment of severity throughout the chart review by discussing the categorization in detail, using both inpatient and outpatient charts. In these cases, classifications were made by consensus of both physicians. In reaching their assessments, the reviewers only used chart information for the 2 years prior to baseline evaluation, and they were blinded to the study data. As part of their chart review, the two pulmonologists collected information on frequency of exacerbations of asthma over the 2-year period (requiring a therapeutic intervention such as increased medical treatment for asthma or addition of an antibiotic), visits to the emergency department (ED) or urgent-care clinic, hospitalizations, and medication prescribing. Although we Statistical Methods All analyses were performed using the SAS software package (SAS Institute; Cary, NC). Standard methods were used to analyze contingency tables. For 2 2 tables, p values are based on the continuity-adjusted 2 statistic. Where appropriate, we used the Mantel-Haenszel 2 statistic to test for trends in contingency tables. The weighted kappa statistic 17 was used to evaluate the agreement between the NAEP-based and chartbased severity scales. An intermediate weight of 1 2 was assigned to mild vs moderate and moderate vs severe disagreements. vs severe disagreements had weights of 0. Unless otherwise stated, all p values are two-sided and a p value 0.05 indicates significance. Results Selected demographic characteristics of the chart review sample are presented in Table 2. The chart review sample was deliberately stratified by age and sex. Overall, 107 of the patients (55%) in the chart review sample had a physician-assessed severity rating of moderate or severe. Table 3 contrasts these 107 subjects and the 86 mild subjects with respect to several factors noted during the chart review. As expected, patients classified as having moderate to severe disease based on the chart review were more likely than those with mild disease to have exacerbations and ED care noted in their charts and were more likely to have been prescribed inhaled antiinflammatory agents and burst oral steroids. Table 3 also shows, however, that no single factor provided perfect separation of the two groups. The use of bursts of oral glucocorticoids provided the best separation between the groups, and would appear to correlate well with factors that influenced physicianassessed severity rankings. Nonetheless, bursts of oral glucocorticoids were prescribed for 19% of CHEST / 115 / 1/ JANUARY,
4 Table 2 Demographic Information patients classified as having mild asthma and were not prescribed for 24% of patients in the moderate to severe groups. Although the type and frequency of asthma symptoms were not routinely noted for most office visits, asthma exacerbations, defined as a change in symptoms requiring intervention by a health-care provider, did appear to be reliably documented. Exacerbations reflected in Table 3 include telephone contacts for acute asthma symptoms as well as urgent care and ED visits. Table 3 Summary of Chart-based Information for Participants Stratified by Physician-assessed Severity Physician-assessed Severity (N 86), % Moderate/ (N 107), % Exacerbations in past 2 years None or more 0 52 ED visit in past 2 years No Yes Taking cromolyn or inhaled corticosteroids No Yes Burst oral steroids No Yes Chart Review Sample (N 193), % Age Group, yrs 3to to to Sex Male 48 Female 52 Smoking Status Never 75 Former 19 Current 6 Race Caucasian 92 Other 8 Socioeconomic status* Upper middle/upper class 22 Middle class 57 Working/lower class 21 *Categories by self-report. Concordance of the physician-assessed and NAEPbased severity scores is presented in Table 4. Though highly correlated, substantial disagreement between them still exists. For example, the two scales agreed exactly in only 53% of the cases. This discordance is reflected in the weighted kappa score of Of particular concern were the few cases in which mild subjects were classified as severe and vice versa. Even with modification of the questionnaire-based cut points to maximize agreement between the two rating systems, the weighted kappa statistic only increased to Similar results were observed when stratifying for age or sex (data not shown). In an attempt to determine possible reasons for the lack of agreement between the NAEP-based and physician-assessed severity scores, we cross-tabulated the component indices of the NAEP-based score with the physician-assessed rating (Table 5). Although the level of oral glucocorticoid use and baseline spirometry values both significantly correlated with the level of physician-assessed severity, we found no correlation between the level of current asthma symptoms and physician-assessed severity. This lack of correlation between physician-assessed asthma severity and patients symptoms also persisted after further analysis in which symptoms were separated into daytime and nocturnal asthma symptoms. As a result of these findings, we computed a revised severity score based only on lung function data and glucocorticoid treatment information. Cut points were determined empirically to provide maximum agreement with the physician-assessed measure of severity. This improved the overall agreement with the physician-assessed severity scale to 63%, with a weighted kappa of 0.40 (Table 6). Discussion This analysis grew out of our efforts to develop a simple index of asthma severity for use in a longitudinal study of 914 individuals, aged 3 to 55 years, Table 4 Concordance of Original NAEP-based Severity and Physician-assessed Severity Original NAEP-based Severity Score (Cutpoints) Physician-assessed Severity, % (N 86) Moderate (N 90) (N 17) Total (0 to 2) Moderate (3 to 4) (5 to 7) Clinical Investigations
5 Table 5 NAEP-based Severity Components Stratified by Physician-assessed Severity Physician-assessed Severity, % (N 86) Moderate/ (N 107) Symptoms 1/wk to 6/wk Daily Oral steroids Don t use % of time % of time 6 28 Daily 0 5 Spirometry FEV 1 80% predicted FEV 1 60 to 80% predicted FEV 1 60% predicted with asthma. Our initial scale incorporated three dimensions of severity suggested by the National Asthma Education Program (symptoms, corticosteroid use, and lung function. 6 Attempts to validate this scale against expert physician opinion based on medical record review did not show significant correlation between current symptom frequency and the physician-assessed severity score. A revised score omitting self-reported symptoms served to marginally improve agreement with the physician-assessed severity score. Our findings are consistent with several recent reports. Severity of disease has been shown in one study to correlate with airway obstruction, 3 while several other investigators have found weak correlations with asthma symptoms and severity. 5,8,9 A recent review highlights some of the difficulties in this process, in which the authors emphasize the various approaches that have been tried, without arrival at an agreed-upon best approach. 5 Although several methods, including questionnaire-based assessment, were discussed in the review, no single method integrated symptoms (eg, wheeze, dyspnea, cough, sputum production) with duration or intensity. Several studies have looked at the correlation between asthma symptoms and objective measures of lung function, including both FEV 1 and peak expiratory flow rate, 1,7,8,18 and have failed to note a correlation. Some have proposed that patients develop a perception tolerance to their asthma symptoms, noticing them less over time, and thus symptoms become a less accurate yardstick of disease severity. 19 Table 6 Concordance of Final NAEP-based Severity Score (Excluding Symptoms Component) and Physician-assessed Severity Final NAEP-based Severity Score (Cutpoints) Physician-assessed Severity, % (N 86) Moderate (N 90) (N 17) (0 to 1) Moderate (2 to 3) (4 to 5) Studies demonstrate both the heterogeneity of dyspnea perception in patients and the disparity in dyspnea perception between physicians and their patients. For example, Kikuchi et al 20 asked whether dyspnea and chemosensitivity to hypoxia and hypercapnia are factors in fatal asthma attacks. They studied 11 patients with asthma who had near-fatal attacks, 11 patients with asthma who had not had near-fatal attacks, and 16 normal subjects. Their results suggested that reduced chemosensitivity to hypoxia and blunted perception of dyspnea may predispose patients to fatal asthma attacks. Another study suggested that at least some patients are more accurate in guessing peak flow rate than physicians. Specifically, Shim et al 21 demonstrated that physicians were quite inaccurate in estimating the peak expiratory flow rate by examining patients, whereas the patients themselves were far more accurate in guessing the measurement. In addition, patients were able to tell whether the peak expiratory flow rate was better, the same, or worse from day to day. One interpretation of these data is that patients symptoms reflect changes in airflow obstruction rather than absolute lung function. Despite the evidence from these studies, several recently developed, multidimensional asthma severity scales have incorporated symptoms. Bailey et al 1 developed a severity scale after analyzing data from 199 adult asthmatic patients. The authors used standard multivariate and psychometric techniques with data from asthma patients to develop and evaluate a series of scaled questions, in order to address the broad issue of underlying asthma severity. Specifically, they used measures of asthma duration and pulmonary function combined with simple questionnaire scales (assessment by physicians, incidence of various respiratory symptoms and disease, subjective measures of bother with respect to symptoms, medications used and their side effects, and healthcare utilization). In that study, three factors were shown to correlate with physician-assessed severity: symptom intensity, airflow impairment, and management intensity. In that study symptom intensity CHEST / 115 / 1/ JANUARY,
6 Figure 1. Interplay of severity, management, and control in asthma. Case A; moderate disease, poor control: easily controlled with inhaled corticosteroids and -agonist as needed; winds up in ED 2 to 3 times yearly because of noncompliance. Case B; severe disease, good control: well-controlled with low-dose oral corticosteroid, leukotriene modifier, long-acting -agonist and short-acting bronchodilator as needed; no unscheduled health-care utilization. reflected more than symptom frequency, which may contribute to the differences between their observations and ours. Blanc et al 7 developed another severity scale that used parameters of respiratory symptom frequency, asthma history, and past and present use of asthma medications. Rosier et al 22 developed a pediatric functional asthma severity scale based on responses to six survey questions quantifying symptoms and activity restriction due to asthma. These investigators correlated this score with school absence due to asthma, functional impairment, medical visits for asthma, and use of asthma medications. Our data and others suggest that asthma symptoms are better suited to quantifying the level of current control than for assessment of underlying disease severity. This is a very useful concept for the clinician. Level of control incorporates a short-term assessment (ie, days to weeks) of a patient s asthma. This is typically measured in terms of lung function and/or symptoms. We know that the level of asthma control can vary markedly over time. If care is protocol-based, then a knowledge of the regimen, plus symptom frequency, would be a good indicator of severity (barring issues of patient noncompliance). Indeed, the new NAEP guidelines, 23 which divide pharmacologic therapy into quick-relief medications and long-term control medications, allow protocol-based therapy to identify the level of severity for a given patient. Level of control is different from severity, although it is certainly correlated with severity. Figure 1 illustrates this. Global severity is a determinant of level of control, but its impact is modulated by medical management, self-management, and environmental exposures. Similarly, level of control, in conjunction with a wide array of person factors, determines various health outcomes, including health-care utilization, quality of life, and functional status. In conclusion, it is not yet clear what role quantification of asthma symptoms may have in assessing asthma severity. Symptoms are the most important concern of patients with asthma, and they are also an important focus for physicians treating patients with asthma. Inevitably, however, symptoms reflect both level of current control and disease severity. Clinical investigators must therefore use caution when comparing groups of patients in whom severity categorization is largely based on symptomatology. This observation that symptoms alone do not reflect disease severity becomes even more important as health-care delivery moves closer to utilizing protocols, practice guidelines, and best-treatment programs that rely heavily on symptoms to guide subsequent treatment decisions. Simple formulas are not likely to replace physician judgment in assessing the disease severity level in patients with asthma. References 1 Bailey WC, Higgins DM, Richards BM, et al. Asthma severity: a factor analytic investigation. Am J Med 1992; 93: Busse W, Maisiak R, Young K. Treatment regimen and side effects of treatment measures. Am J Respir Crit Care Med 1994; 149: Clinical Investigations
7 3 Enright PL, Lebowitz MD, Cockcroft DW. Physiologic measures: pulmonary function tests. Asthma outcome. Am J Respir Crit Care Med 1994; 149(2 pt 2):S9 S18 4 Bailey W, Wilson S, Weiss K, et al. Measures for use in asthma clinical research: overview of NIH Workshop. Am J Respir Crit Care Med 1994; 149(2 pt 2): S1 S8 5 O Connor GT, Weiss ST. Clinical and symptom measures. Am J Respir Crit Care Med 1994; 149:S21 S28 6 National Asthma Education Program. Guidelines for the diagnosis and management of asthma. Publication no Bethesda, MD: National Institutes of Health, Blanc PD, Jones M, Besson C, et al. Work disability among adults with asthma. Chest 1993; 104: Apter AJ, ZuWallack RL, Clive J. Common measures of asthma severity lack association for describing its clinical course. J Allergy Clin Immunol 1994; 94: Juniper EF, Kline PA, Vanzieleghem MA, et al. Effect of long-term treatment with an inhaled corticosteroid (budesonide) on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics. Am Rev Respir Dis 1990; 142: Burney PG, Chinn S, Britton JR, et al. What symptoms predict the bronchial response to histamine? Evaluation in a community survey of the bronchial symptoms questionnaire (1984) of the International Union Against Tuberculosis and Lung Disease. Int J Epidemiol 1989; 18: Burney PG, Laitinen LA, Perdrizet S, et al. Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison. Eur Respir J 1989; 2: Samet JM. Epidemiologic approaches for the identification of asthma. Chest 1987; 91:74S 78S 13 Becklake M, Crapo RO. Lung function testing: selection of reference values and interpretive strategies. Am Rev Respir Dis 1991; 144: Enright PI, Johnson LJ, Connett JOE, et al. Spirometry in the Lung Health Study: I. Methods and quality control. Am Rev Respir Dis 1991; 143: Knudson RJ, Lebowitz MD, Holberg CJ, et al. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis 1983; 127: Osborne ML, Vollmer WM, Buist AS. Diagnostic accuracy of asthma within a health maintenance organization. J Clin Epidemiol 1992; 45: Fleiss JL, Cohen J, Everitt BS. Large-sample standard errors of kappa and weighted kappa. Psychol Bull 1969; 72: Li D, German D, Lulla S, et al. Prospective study of hospitalization for asthma: a preliminary risk factor model. Am J Respir Crit Care Med 1995; 151: van Schayck CP, Dompeling P, Rutten MPM, et al. The influence of an inhaled steroid on quality of life in patients with asthma or COPD. Chest 1995; 107: Kikuchi Y, Okabe S, Tamura G, et al. Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma. N Engl J Med 1994; 330: Shim CS, Williams MH Jr. Evaluation of the severity of asthma: patients versus physicians. Am J Med 1980; 68: Rosier MJ, Bishop J, Nolan T, et al. Measurement of functional severity of asthma in children. Am J Respir Crit Care Med 1994; 149: National Asthma Education and Prevention Program Expert Panel. Clinical Practice Guidelines. Expert Panel report 2: Guidelines for the diagnosis and management of asthma. Publication no Bethesda, MD: National Institutes of Health/National Heart, Lung, and Blood Institute, 1997 CHEST / 115 / 1/ JANUARY,
Clinical Issues Research Implemented April 2010 Asthma Major Recommendations Goals of asthma: - 1) reduction of impairment freedom from symptoms,
Asthma Major Recommendations Goals of : - 1) reduction of impairment freedom from symptoms, such as cough, shortness of breath, wheezing, and disturbed sleep minimal need (< 2 times per week) of short
More informationTARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS
TARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS Recommendation PULMONARY FUNCTION TESTING (SPIROMETRY) Conditional: The Expert Panel that spirometry measurements FEV1,
More informationNG80. Asthma: diagnosis, monitoring and chronic asthma management (NG80)
Asthma: diagnosis, monitoring and chronic asthma management (NG80) NG80 NICE has checked the use of its content in this product and the sponsor has had no influence on the content of this booklet. NICE
More informationONLINE DATA SUPPLEMENT - ASTHMA INTERVENTION PROGRAM PREVENTS READMISSIONS IN HIGH HEALTHCARE UTILIZERS
R2 (REVISED MANUSCRIPT BLUE 200208-877OC) ONLINE DATA SUPPLEMENT - ASTHMA INTERVENTION PROGRAM PREVENTS READMISSIONS IN HIGH HEALTHCARE UTILIZERS Mario Castro, M.D., M.P.H. Nina A. Zimmermann R.N. Sue
More information(Asthma) Diagnosis, monitoring and chronic asthma management
Dubai Standards of Care 2018 (Asthma) Diagnosis, monitoring and chronic asthma management Preface Asthma is one of the most common problem dealt with in daily practice. In Dubai, the management of chronic
More informationASTHMA CARE FOR CHILDREN BASKET OF CARE SUBCOMMITTEE Report to: Minnesota Department of Health. June 22, 2009
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp ASTHMA CARE FOR CHILDREN
More informationIn 2002, it was reported that 72 of 1000
REPORTS Aligning Patient Care and Asthma Treatment Guidelines Eric Cannon, PharmD Abstract This article describes how the National Asthma Education and Prevention Program Guidelines for the Diagnosis and
More informationNew data from the Centers for Disease
MANAGEMENT OF ASTHMA IN THE UNITED STATES: WHERE DO WE STAND? William J. Calhoun, MD ABSTRACT One of the most common respiratory diseases, asthma has been extensively studied. With increases in knowledge
More informationLife-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton
Life-long asthma and its relationship to COPD Stephen T Holgate School of Medicine University of Southampton Definitions COPD is a preventable and treatable disease with some significant extrapulmonary
More informationDiagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma
Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma Magnitude of Asthma - India Delhi Childhood asthma: 10.9% Adults: 8% Other Cities 3 to 18% Chhabra SK et al Ann Allergy Asthma
More informationGINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017
GINA At-A-Glance Asthma Management Reference for adults, adolescents and children 6 11 years Updated 2017 This resource should be used in conjunction with the Global Strategy for Asthma Management and
More informationSGRQ Questionnaire assessing respiratory disease-specific quality of life. Questionnaire assessing general quality of life
SUPPLEMENTARY MATERIAL e-table 1: Outcomes studied in present analysis. Outcome Abbreviation Definition Nature of data, direction indicating adverse effect (continuous only) Clinical outcomes- subjective
More informationASSOCIATION OF ASTHMA CONTROL WITH HEALTH CARE UTILIZATION A PROSPECTIVE EVALUATION
Online Supplement for: ASSOCIATION OF ASTHMA CONTROL WITH HEALTH CARE UTILIZATION A PROSPECTIVE EVALUATION METHODS Population The Northwest Region of Kaiser Permanente (KPNW) is a large, federally qualified,
More informationSupplementary Online Content
Supplementary Online Content Regan EA, Lynch DA, Curran-Everett D, et al; Genetic Epidemiology of COPD (COPDGene) Investigators. Clinical and radiologic disease in smokers with normal spirometry. Published
More informationDiagnosis, Treatment and Management of Asthma
Diagnosis, Treatment and Management of Asthma Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation.
More informationA comparison of global questions versus health status questionnaires as measures of the severity and impact of asthma
Eur Respir J 1999; 1: 591±596 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 93-1936 A comparison of global questions versus health status questionnaires
More informationTHE NHLBI GUIDELINES: WHERE DO WE STAND AND WHAT IS THE NEW DIRECTION FROM THE NAEPP?
THE NHLBI GUIDELINES: WHERE DO WE STAND AND WHAT IS THE NEW DIRECTION FROM THE NAEPP? Peter S. Creticos, MD ABSTRACT In 1991 and 1997, the National Heart, Lung, and Blood Institute s National Asthma Education
More informationMeenu Singh, Joseph L. Mathew, Prabhjot Malhi, B.R. Srinivas and Lata Kumar
Comparison of Improvement in Quality of Life Score with Objective Parameters of Pulmonary Function in Indian Asthmatic Children Receiving Inhaled Corticosteroid Therapy Meenu Singh, Joseph L. Mathew, Prabhjot
More informationThis is a cross-sectional analysis of the National Health and Nutrition Examination
SUPPLEMENTAL METHODS Study Design and Setting This is a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, and 2011-2012. The NHANES is
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss? Randall W. Brown, MD MPH AE-C Association of Asthma Educators Annual Conference July 20, 2018 Phoenix, Arizona FACULTY/DISCLOSURES Randall Brown,
More informationSCREENING AND PREVENTION
These protocols are designed to implement standard guidelines, based on the best evidence, that provide a consistent clinical experience for AHC II Integrated Clinical Delivery Network patients and allow
More informationOver the last several years various national and
Recommendations for the Management of COPD* Gary T. Ferguson, MD, FCCP Three sets of guidelines for the management of COPD that are widely recognized (from the European Respiratory Society [ERS], American
More informationThe Asthma Guidelines: Diagnosis and Assessment of Asthma
The Asthma Guidelines: Diagnosis and Assessment of Asthma Christopher H. Fanta, M.D. Partners Asthma Center Brigham and Women s Hospital Harvard Medical School Objectives Know how the diagnosis of asthma
More informationChronic Obstructive Pulmonary Disease (COPD) Clinical Guideline
Chronic Obstructive Pulmonary Disease (COPD) Clinical These clinical guidelines are designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients. They
More informationComparison of the Effect of Short Course of Oral Prednisone in Patients with Acute Asthma
ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 7 Number 1 Comparison of the Effect of Short Course of Oral Prednisone in Patients with Acute Asthma E Razi, G Moosavi Citation E Razi, G Moosavi.
More informationDiagnosis and Management of Asthma in Children based on the British Thoracic Society and Scottish Intercollegiate Guidelines Network September 2016
Diagnosis and Management of Asthma in Children based on the British Thoracic Society and Scottish Intercollegiate Guidelines Network September 2016 Diagnosis: There is no lower limit to the age at which
More informationAssociation of Asthma Control with Health Care Utilization and Quality of Life
Association of Asthma Control with Health Care Utilization and Quality of Life WILLIAM M. VOLLMER, LEONA E. MARKSON, ELIZABETH O CONNOR, LESLY L. SANOCKI, LESLYE FITTERMAN, MARC BERGER, and A. SONIA BUIST
More informationPresented by the California Academy of Family Physicians 2013/California Academy of Family Physicians
Family Medicine and Patient-Centered Asthma Care Presented by the California Academy of Family Physicians Faculty: Hobart Lee, MD Disclosures: Jeffrey Luther, MD, Program Director, Memorial Family Medicine
More informationCase-Compare Impact Report
Case-Compare Impact Report October 8, 20 For CME Activity: Developed through an independent educational grant from Genentech: Moderate to Severe Persistent Asthma: A Case-Based Panel Discussion (March
More informationOffice Based Spirometry
Osteopathic Family Physician (2014)1, 14-18 Scott Klosterman, DO; Woodson Crenshaw, OMS4 Spartanburg Regional Family Medicine Residency Program; Edward Via College of Osteopathic Medicine - Virginia Campus
More information#1 cause of school absenteeism in children 13 million missed days annually
Asthma Update 2013 Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Pulmonary & Critical Care Medicine The Ohio State University Wexner Medical Center Disclosures None 2 Objectives Review burden
More informationRESPIRATORY CARE IN GENERAL PRACTICE
RESPIRATORY CARE IN GENERAL PRACTICE Definitions of Asthma and COPD Asthma is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they
More informationDual-Controller Asthma Therapy: Rationale and Clinical Benefits
B/1 Dual-Controller Asthma Therapy: Rationale and Clinical Benefits MODULE B The 1997 National Heart, Lung, and Blood Institute (NHLBI) Expert Panel guidelines on asthma management recommend a 4-step approach
More informationPulmonary Function Testing: Concepts and Clinical Applications. Potential Conflict Of Interest. Objectives. Rationale: Why Test?
Pulmonary Function Testing: Concepts and Clinical Applications David M Systrom, MD Potential Conflict Of Interest Nothing to disclose pertinent to this presentation BRIGHAM AND WOMEN S HOSPITAL Harvard
More informationExhaled nitric oxide levels correlate with measures of disease control in asthma
Exhaled nitric oxide levels correlate with measures of disease control in asthma Jeffrey M. Sippel, MD, MPH, a William E. Holden, MD, a Stephen A. Tilles, MD, b Mark O Hollaren, MD, c Justin Cook, BS,
More informationAsthma: Chronic Management. Yung-Yang Liu, MD Attending physician, Chest Department Taipei Veterans General Hospital April 26, 2015
Asthma: Chronic Management Yung-Yang Liu, MD Attending physician, Chest Department Taipei Veterans General Hospital April 26, 2015 Global Strategy for Asthma Management and Prevention Evidence-based Implementation
More informationAsthma Management for the Athlete
Asthma Management for the Athlete Khanh Lai, MD Assistant Professor Division of Pediatric Pulmonary and Sleep Medicine University of Utah School of Medicine 2 nd Annual Sports Medicine Symposium: The Pediatric
More informationAssessing Future Need for Acute Care in Adult Asthmatics* The Profile of Asthma Risk Study: A Prospective Health Maintenance Organization-Based Study
CHEST Assessing Future Need for Acute Care in Adult Asthmatics* The Profile of Asthma Risk Study: A Prospective Health Maintenance Organization-Based Study Original Research Molly L. Osborne, MD, PhD,
More informationTHE ROLE OF INDOOR ALLERGEN SENSITIZATION AND EXPOSURE IN CAUSING MORBIDITY IN WOMEN WITH ASTHMA
Online Supplement for: THE ROLE OF INDOOR ALLERGEN SENSITIZATION AND EXPOSURE IN CAUSING MORBIDITY IN WOMEN WITH ASTHMA METHODS More Complete Description of Study Subjects This study involves the mothers
More informationSpirometry is the most frequently performed. Obstructive and restrictive spirometric patterns: fixed cut-offs for FEV1/FEV6 and FEV6
Eur Respir J 2006; 27: 378 383 DOI: 10.1183/09031936.06.00036005 CopyrightßERS Journals Ltd 2006 Obstructive and restrictive spirometric patterns: fixed cut-offs for FEV1/ and J. Vandevoorde*, S. Verbanck
More informationChronic obstructive pulmonary disease
0 Chronic obstructive pulmonary disease Implementing NICE guidance June 2010 NICE clinical guideline 101 What this presentation covers Background Scope Key priorities for implementation Discussion Find
More informationADULT ASTHMA GUIDE SUMMARY. This summary provides busy health professionals with key guidance for assessing and treating adult asthma.
ADULT ASTHMA GUIDE SUMMARY This summary provides busy health professionals with key guidance for assessing and treating adult asthma. Its source document Asthma and Respiratory Foundation NZ Adult Asthma
More informationCOPD in Korea. Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center Park Yong Bum
COPD in Korea Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center Park Yong Bum Mortality Rate 1970-2002, USA JAMA,2005 Global Burden of Disease: COPD WHO & World
More informationDo current treatment protocols adequately prevent airway remodeling in children with mild intermittent asthma?
Respiratory Medicine (2006) 100, 458 462 Do current treatment protocols adequately prevent airway remodeling in children with mild intermittent asthma? Haim S. Bibi a,, David Feigenbaum a, Mariana Hessen
More informationAsthma in Pediatric Patients. DanThuy Dao, D.O., FAAP. Disclosures. None
Asthma in Pediatric Patients DanThuy Dao, D.O., FAAP Disclosures None Objectives 1. Discuss the evaluation and management of asthma in a pediatric patient 2. Accurately assess asthma severity and level
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationCurrent Asthma Management: Opportunities for a Nutrition-Based Intervention
Current Asthma Management: Opportunities for a Nutrition-Based Intervention Stanley J. Szefler, MD Approximately 22 million Americans, including 6 million children, have asthma. It is one of the most prevalent
More informationChronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease 07 Contributor Dr David Tan Hsien Yung Definition, Diagnosis and Risk Factors for (COPD) Differential Diagnoses Goals of Management Management of COPD THERAPY AT EACH
More informationCOPD is characterized by airflow limitation
The Importance of Spirometry in COPD and Asthma* Effect on Approach to Management Bartolome R. Celli, MD, FCCP COPD is characterized by airflow limitation. The diagnosis is suggested by history and physical
More informationRobert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network
Robert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network Robert.kruklitis@lvh.com Correlation of a Asthma pathophyisology with basic science Asthma (Physiology) Bronchodilators
More informationUNIT TWO: OVERVIEW OF SPIROMETRY. A. Definition of Spirometry
UNIT TWO: OVERVIEW OF SPIROMETRY A. Definition of Spirometry Spirometry is a medical screening test that measures various aspects of breathing and lung function. It is performed by using a spirometer,
More informationPerforming a Methacholine Challenge Test
powder for solution, for inhalation Performing a Methacholine Challenge Test Provocholine is a registered trademark of Methapharm Inc. Copyright Methapharm Inc. 2016. All rights reserved. Healthcare professionals
More informationPublic Dissemination
1. THE ASTHMA CONDITION 9 18 3 30 A. Pathophysiology 4 6 0 10 1. Teach an individual with asthma and their family using simple language by illustrating the following with appropriate educational aids a.
More informationAccuracy of Parental and Child s Reports of Changes in Symptoms of Childhood Asthma
7. Cecka JM, Gjertson DW, Terasaki PI. Pediatric renal transplantation - a review of the UNOS data. Pediatr Transplant 1997; 1: 55-64. 8. Alexander SR. Pediatric end stage renal disease. Am J Kidney Dis
More informationMethacholine versus Mannitol Challenge in the Evaluation of Asthma Clinical applications of methacholine and mannitol challenges
Methacholine versus Mannitol Challenge in the Evaluation of Asthma Clinical applications of methacholine and mannitol challenges AAAAI San Antonio Tx February 2013 Catherine Lemière MD, MSc Hôpital du
More informationE pidemiologic studies of adults rely on selfadministered. Questionnaire Items That Predict Asthma and Other Respiratory Conditions in Adults*
Questionnaire Items That Predict Asthma and Other Respiratory Conditions in Adults* fun Bai, MPH; Jennifer K. Peat, PhD; Geoffrey Berry, PhD; Guy B. Marks, PhD; and Ann]. Woolcock, MD, FCCP The International
More informationAsthma: Evaluate and Improve Your Practice
Potential Barriers and Suggested Ideas for Change Key Activity: Initial assessment and management Rationale: The history and physical examination obtained from the patient and family interviews form the
More informationAvailable online at Scholars Research Library
Available online at www.scholarsresearchlibrary.com Annals of Biological Research, 2010, 1 (4) : 248-253 (http://scholarsresearchlibrary.com/archive.html) ISSN 0976-1233 CODEN (USA): ABRNBW A study on
More informationLearning the Asthma Guidelines by Case Studies
Learning the Asthma Guidelines by Case Studies Timothy Craig, DO Professor of Medicine and Pediatrics Distinguished Educator Penn State University Hershey Medical Center Objectives 1. Learn the Asthma
More informationClinical Practice Guideline: Asthma
Clinical Practice Guideline: Asthma INTRODUCTION A critical aspect of the diagnosis and management of asthma is the precise and periodic measurement of lung function both before and after bronchodilator
More informationLung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects
Lung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects Use of GOLD and ATS Criteria Connie Paladenech, RRT, RCP, FAARC Benefits and Limitations of Pulmonary Function Testing Benefits
More informationPharmacological Management of Obstructive Airways in Humans. Introduction to Scientific Research. Submitted: 12/4/08
Pharmacological Management of Obstructive Airways in Humans Introduction to Scientific Research Submitted: 12/4/08 Introduction: Obstructive airways can be characterized as inflammation or structural changes
More informationAsthma Population Management: Identifying Persistent Asthma, Defining High Risk Asthma, and Measuring Quality of Asthma Care
Asthma Population Management: Identifying Persistent Asthma, Defining High Risk Asthma, and Measuring Quality of Asthma Care Michael Schatz, MD, MS Allergy Department Kaiser Permanente, San Diego, CA Constructs
More informationHow far are we from adhering to national asthma guidelines: The awareness factor
Egyptian Journal of Ear, Nose, Throat and Allied Sciences (2013) 14, 1 6 Egyptian Society of Ear, Nose, Throat and Allied Sciences Egyptian Journal of Ear, Nose, Throat and Allied Sciences www.ejentas.com
More informationSeverity assessment in asthma: An evolving concept
Severity assessment in asthma: An evolving concept Mary K. Miller, MS, a Charles Johnson, MBChB, a Dave P. Miller, MS, b Yamo Deniz, MD, a Eugene R. Bleecker, MD, c and Sally E. Wenzel, MD, d for the TENOR
More informationAsthma Tutorial. Trainer MRW. Consider the two scenarios, make an attempt at the questions, what guidance have you used?
Registrar: LG PR RS Topic Asthma and COPD Asthma Tutorial Trainer MRW Date of Tutorial 18 th Jan 2007 Objectives of the tutorial How to diagnose What investigations and when Treatment guidelines QoF Criteria
More informationExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007
Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007 TARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS Selecting Initial Therapy
More informationCARE OF THE ADULT COPD PATIENT
CARE OF THE ADULT COPD PATIENT Target Audience: The target audience for this clinical guideline is all MultiCare providers and staff including those associated with our Clinically Integrated Network. The
More informationUnderstanding the Basics of Spirometry It s not just about yelling blow
Understanding the Basics of Spirometry It s not just about yelling blow Carl D. Mottram, RRT RPFT FAARC Technical Director - Pulmonary Function Labs and Rehabilitation Associate Professor of Medicine -
More informationAir Flow Limitation. In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation.
Asthma Air Flow Limitation In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation. True whether reversible, asthma and exercise-induced bronchospasm,
More informationLong Term Care Formulary RS -29
RESTRICTED USE Asthma/COPD Management 1 of 6 PROTOCOL: Asthma Glossary of Medication Acronyms: SABA: short-acting beta agonist (e.g. salbutamol) SABD: short-acting bronchodilator (e.g. ipratropium or SABA)
More informationUnderuse of spirometry by general practitioners for the diagnosis of COPD in Italy
Monaldi Arch Chest Dis 2005; 63: 1, 6-12 ORIGINAL ARTICLE Underuse of spirometry by general practitioners for the diagnosis of COPD in Italy G. Caramori 1, G. Bettoncelli 2, R. Tosatto 3, F. Arpinelli
More informationEvolution of asthma from childhood. Carlos Nunes Center of Allergy and Immunology of Algarve, PT
Evolution of asthma from childhood Carlos Nunes Center of Allergy and Immunology of Algarve, PT allergy@mail.telepac.pt Questionnaire data Symptoms occurring once or several times at follow-up (wheeze,
More information2017 Chronic Respiratory. Program Evaluation. Our mission is to improve the health and quality of life of our members
2017 Chronic Respiratory Program Evaluation Our mission is to improve the health and quality of life of our members 2017 Chronic Respiratory Program Evaluation Program Title: Chronic Respiratory Program
More informationUsing an Asthma Control Questionnaire and Administrative Data To Predict Health-Care Utilization*
Original Research ASTHMA Using an Asthma Control Questionnaire and Administrative Data To Predict Health-Care Utilization* Dawn Peters, PhD; Chuhe Chen, PhD; Leona E. Markson, ScD; Felicia C. Allen-Ramey,
More information2017 Blue Cross and Blue Shield of Louisiana
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationAsthma in the Athlete
Asthma in the Athlete Jorge E. Gomez, MD Associate Professor Texas Children s Hospital Baylor College of Medicine Assist Team Physician UH Understand how we diagnose asthma Objectives Be familiar with
More informationHow to treat COPD? What is the mechanism of dyspnea? Smoking cessation
: The Increasing Role of the FP Alan Kaplan, MD, CCFP(EM) Presented at the Primary Care Today: Education Conference and Medical Exposition, Toronto, Ontario, May 2006. Chronic obstructive pulmonary disease
More informationS P I R O M E T R Y. Objectives. Objectives 2/5/2019
S P I R O M E T R Y Dewey Hahlbohm, PA-C, AE-C Objectives To understand the uses and importance of spirometry testing To perform spirometry testing including reversibility testing To identify normal and
More informationWorld Journal of Pharmaceutical and Life Sciences WJPLS
wjpls, 2018, Vol. 4, Issue 10, 01-08 Research Article ISSN 2454-2229 Firas et al. WJPLS www.wjpls.org SJIF Impact Factor: 5.088 ASTHMA CONTROL Dr. Yaarub Madhloom Abbas 1, Dr. Firas Raad Shihab* 2 and
More informationStandardised mortality rates in females and males with COPD and asthma
Eur Respir J 2005; 25: 891 895 DOI: 10.1183/09031936.05.00099204 CopyrightßERS Journals Ltd 2005 Standardised mortality rates in females and males with COPD and asthma T. Ringbaek*, N. Seersholm # and
More informationBronchial hyperresponsiveness in asthmatic adults A long-term correlation study
European Review for Medical and Pharmacological Sciences 2005; 9: 125-131 Bronchial hyperresponsiveness in asthmatic adults A long-term correlation study R. CARBONE, F. LUPPI *, A. MONSELISE **, G. BOTTINO
More informationNational Asthma Educator Certification Board Detailed Content Outline
I. THE ASTHMA CONDITION 9 20 1 30 A. Pathophysiology 4 6 0 10 1. Teach an individual with asthma and their family using simple language by illustrating the following with appropriate educational aids a.
More informationAsthma in Iranian Schoolchildren: Comparison of ISAAC Video and Written Questionnaires
IJMS Vol 30, No 3, September 2005 Original Article Asthma in Iranian Schoolchildren: Comparison of ISAAC Video and Written Questionnaires G. Mortazavi Moghaddam, H. Akbari, A.R. Saadatjoo Abstract Background:
More informationIndian Journal of Basic & Applied Medical Research; September 2013: Issue-8, Vol.-2, P
Original article: Study of pulmonary function in different age groups Dr.Geeta J Jagia*,Dr.Lalita Chandan Department of Physiology, Seth GS Medical College, Mumbai, India *Author for correspondence: drgrhegde@gmail.com
More informationRelationship Between FEV1& PEF in Patients with Obstructive Airway Diseases
OBSTRUCTIVE THE IRAQI POSTGRADUATE AIRWAY MEDICAL DISEASES JOURNAL Relationship Between FEV1& PEF in Patients with Obstructive Airway Diseases Muhammed.W.AL.Obaidy *, Kassim Mhamed Sultan*,Basil Fawzi
More informationSYNOPSIS A two-stage randomized, open-label, parallel group, phase III, multicenter, 7-month study to assess the efficacy and safety of SYMBICORT
Drug product: Drug substance(s): Edition No.: Study code: SYMBICORT pmdi 160/4.5 g Budesonide/formoterol D5896C00005 Date: 8 May 2006 SYNOPSIS A two-stage randomized, open-label, parallel group, phase
More informationCOPD: early detection, screening and case-finding: what is the evidence? Prof. Jan-Willem Lammers, Md PhD Department of Respiratory Diseases
COPD: early detection, screening and case-finding: what is the evidence? Prof. Jan-Willem Lammers, Md PhD Department of Respiratory Diseases «If you test one smoker with cough every day You will diagnose
More informationOptimal Assessment of Asthma Control in Clinical Practice: Is there a role for biomarkers?
Disclosures: Optimal Assessment of Asthma Control in Clinical Practice: Is there a role for biomarkers? Stanley Fineman, MD Past-President, American College of Allergy, Asthma & Immunology Adjunct Associate
More informationPathology of Asthma Epidemiology
Asthma A Presentation on Asthma Management and Prevention What Is Asthma? A chronic disease of the airways that may cause Wheezing Breathlessness Chest tightness Nighttime or early morning coughing Pathology
More informationUpdate on heterogeneity of COPD, evaluation of COPD severity and exacerbation
Update on heterogeneity of COPD, evaluation of COPD severity and exacerbation Yung-Yang Liu, MD Taipei Veterans General Hospital Aug 29, 2015 G O lobal Initiative for Chronic bstructive L D ung isease
More informationStudy No.: Title: Rationale: Phase: Study Period Study Design: Centres: Indication: Treatment: Objectives : Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationUNDERSTANDING COPD MEDIA BACKGROUNDER
UNDERSTANDING COPD MEDIA BACKGROUNDER What is COPD? Chronic Obstructive Pulmonary Disease (COPD) also called emphysema and/or chronic obstructive bronchitis* is a preventable lung disease caused by the
More informationLong-Term Management of Bronchial Asthma and Wheezy Chest in Children
Long-Term Management of Bronchial Asthma and Wheezy Chest in Children Ali Al-Giurnazi,* Taher Ben-Ahameida**, Elham Al-Karewi,** Awatef Al-Bouacshi*** A. Dau Masaud,**** Abstract: This paper represents
More informationAsthma in Pregnancy. Asthma. Chronic Airway Inflammation. Objective Measures of Airflow. Peak exp. flow rate (PEFR)
Chronic Airway Inflammation Asthma in Pregnancy Robin Field, MD Maternal Fetal Medicine Kaiser Permanente San Francisco Asthma Chronic airway inflammation increased airway responsiveness to a variety of
More informationUsing subjective and objective measures to estimate respiratory health in a population of working older Kentucky farmers, Part 2.
Using subjective and objective measures to estimate respiratory health in a population of working older Kentucky farmers, Part 2. Reliability of symptom report in older farmers Nancy E. Johnson, DrPH,
More informationAsthma: diagnosis and monitoring
Asthma: diagnosis and monitoring NICE guideline: short version Draft for second consultation, July 01 This guideline covers assessing, diagnosing and monitoring suspected or confirmed asthma in adults,
More informationaclidinium 322 micrograms inhalation powder (Eklira Genuair ) SMC No. (810/12) Almirall S.A.
aclidinium 322 micrograms inhalation powder (Eklira Genuair ) SMC No. (810/12) Almirall S.A. 05 October 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: bronchial_thermoplasty 10/2010 3/2018 3/2019 3/2018 Description of Procedure or Service Bronchial thermoplasty
More information