Improving the management of asthma in older adults.

Nurs Stand. 2013 Nov 27;28(13):50-8

Authors: Carnegie E, Jones A

Abstract
Older people with asthma are a discrete patient group that requires specialist nursing skills and knowledge. They have specific and sometimes hidden needs that will affect their quality of life unless these are addressed by caring and competent nurses who have an interest in asthma. It is necessary to focus on both asthma and ageing to help older people achieve good asthma outcomes. This article discusses the complex physical, social and psychological issues affecting people with asthma aged 64 or older, age-related risk factors for poor control, age-related barriers to assessment and treatment, the scope of pharmacological and non-pharmacological approaches, and principal treatment outcomes. Providing high quality services and information will equip older people to manage their asthma more effectively, attain physical and mental wellbeing, and lead to fewer hospitalisations and fatal episodes in this group.

PMID: 24279572 [PubMed - in process]

"The assessment and management of chronic cough in children according to the British Thoracic Society guidelines: Descriptive, prospective, clinical trial"

Clin Respir J. 2013 Nov 27;

Authors: Usta Guc B, Asilsoy S, Durmaz C

Abstract
BACKGROUND: Chronic cough is a common problem of various etiologies. While diagnosis may relatively be easy in the presence of some specific findings, it tends to be rather difficult when there are no clear symptoms. Therefore, practical guidelines are needed for management of patients with chronic cough. We aimed to evaluate assessment and management of chronic cough in children according to the British Thoracic Society guidelines published in 2008.
METHODS: Patients with chronic cough lasting longer than eight weeks between 5 to 16 years old were evaluated. Pulmonary function test and chest radiography were performed on all patients. Further workup was conducted on those requiring further investigation. Patients were re-evaluated at 2-4-week intervals and we followed our patients for 18 months until cough resolved.
RESULTS: 156 patients (52.5% female) aged 5-16 (8.42±2.6) years were included. Of the 156 patients, 19.2% (n=30) were diagnosed with postnasal drip syndrome plus asthma; 18.6% (n=29) with postnasal drip syndrome; 12.2% (n=19) with asthma, 12.2% (n=19) with protracted bacterial bronchitis; and 11.5% (n=18) with non-specific isolated cough; 9.6% (n=15) with cough variant asthma; 5.7 % (n=9) with psychogenic cough; and 3.2% (n=5) with Gastroesophageal reflux disease.
CONCLUSIONS: Postnasal drip syndrome and asthma was the most common cause of chronic cough. Asthma-associated findings were found in some of the patients diagnosed with postnasal drip syndrome. It has been observed that there could be more than one particular cause for cough concerning some patients. The gastro-esophageal reflux disease was not a common primary cause of chronic cough in children.

PMID: 24279754 [PubMed - as supplied by publisher]

Related Articles

The clinical impact of non-obstructive chronic bronchitis in current and former smokers.

Respir Med. 2013 Nov 15;

Authors: Martinez CH, Kim V, Chen Y, Kazerooni EA, Murray S, Criner GJ, Curtis JL, Regan EA, Wan E, Hersh CP, Silverman EK, Crapo JD, Martinez FJ, Han MK, The COPDGene Investigators

Abstract
BACKGROUND: As the clinical significance of chronic bronchitis among smokers without airflow obstruction is unclear, we sought to determine morbidity associated with this disorder.
METHODS: We examined subjects from the COPDGene study and compared those with FEV1/FVC ≥0.70, no diagnosis of asthma and chronic bronchitis as defined as a history of cough and phlegm production for ≥3 months/year for ≥2 years (NCB) to non-obstructed subjects without chronic bronchitis (CB-). Multivariate analysis was used to determine factors associated with and impact of NCB.
RESULTS: We identified 597 NCB and 4283 CB- subjects. NCB participants were younger (55.4 vs. 57.2 years, p < 0.001) with greater tobacco exposure (42.9 vs. 37.8 pack-years, p < 0.001) and more often current smokers; more frequently reported occupational exposure to fumes (52.8% vs. 42.2%, p < 0.001), dust for ≥1 year (55.3% vs. 42.0%, p < 0.001) and were less likely to be currently working. NCB subjects demonstrated worse quality-of-life (SGRQ 35.6 vs. 15.1, p < 0.001) and exercise capacity (walk distance 415 vs. 449 m, p < 0.001) and more frequently reported respiratory "flare-ups" requiring treatment with antibiotics or steroids (0.30 vs. 0.10 annual events/subject, p < 0.001) prior to enrollment and during follow-up (0.34 vs. 0.16 annual events/subject, p < 0.001). In multivariate analysis, current smoking, GERD, sleep apnea and occupational exposures were significantly associated with NCB.
CONCLUSIONS: While longitudinal data will be needed to determine whether NCB progresses to COPD, NCB patients have poorer quality-of-life, exercise capacity and frequent respiratory events. Beyond smoking cessation interventions, further research is warranted to determine the benefit of other therapeutics in this population. Clinical Trials Registration # NCT00608764 (http://clinicaltrials.gov/show/NCT00608764). Link to study protocol: http://www.copdgene.org/sites/default/files/COPDGeneProtocol-5-0_06-19-2009.pdf.

PMID: 24280543 [PubMed - as supplied by publisher]

Dispensation of long-acting β agonists with or without inhaled corticosteroids, and risk of asthma-related hospitalisation: a population-based study.

Thorax. 2013 Nov 26;

Authors: Sadatsafavi M, Lynd LD, Marra CA, Fitzgerald JM

Abstract
BACKGROUND: The role of long-acting β-agonists (LABA) added to inhaled corticosteroids (ICS) in the management of asthma is extensively debated. We thought to assess the risk of asthma-related hospitalisation in individuals who regularly filled prescriptions for ICS+LABA compared to those who regularly filled prescriptions for ICS alone or LABA alone, and compared to those who did not regularly fill such medications.
METHODS: Using administrative health databases of the province of British Columbia (BC), Canada, from 1997 to 2012, we conducted a nested case-control analysis of a cohort of asthma patients. Cases were defined as those who experienced asthma-related hospitalisation after the first year of their entry into the cohort. For each case, up to 20 controls were matched based on age, sex, date of cohort entry, and several measures of asthma severity. We categorised individuals as regularly exposed, irregularly exposed, or non-exposed to ICS alone, LABA alone, or ICS+LABA based on dispensation records in the past 12 months. The primary outcome measures were the rate ratio (RR) of the asthma-related hospitalisation among categories of regular exposure.
RESULTS: 3319 cases were matched to 43 023 controls. The RR for regular dispensation of ICS+LABA was 1.14 (95% CI 0.93 to 1.41) compared with regular dispensation of ICS alone and 0.45 (95% CI 0.29 to 0.70) compared with regular dispensation of LABA alone. Those who regularly dispensed LABA had to dispense an ICS for at least three quarters of a year to reduce their risk to that of those who did not dispense LABA.
CONCLUSIONS: Regular dispensation of ICS+LABA was not associated with an increased risk of asthma-related hospitalisation compared with regular dispensation of ICS alone. Adherence to ICS in patients who regularly receive ICS+LABA seems to be an important factor in the prevention of adverse asthma-related outcomes.

PMID: 24281327 [PubMed - as supplied by publisher]