J allergy clin immunol pract impact wrench
BHMS, Masters in Counselling and Psychotherapy, DNB - Rheumatology
11 years experience overall
View all 11 Articles. Asthma is a heterogeneous disease comprising of multiple phenotypes and affects patients from childhood up to old age. In this review, we summarize the current knowledge on the similarities and differences in asthma across different age-groups, with emphasis on the perspective from primary care. Despite the similar disease presentation, phenotyping studies showed that there are differences in the distribution of phenotypes of asthma presenting in childhood compared to that in adulthood. Whereas, asthma with early age of onset tends to be of the atopic phenotype, the disease shifts toward the non-atopic phenotypes at later ages. Studies within primary care patients aiming to elucidate risk factors for future asthma exacerbation have shown pediatric and elderly patients to be at higher risk for future asthma attacks compared to other adult patients. Regardless, both pediatric and adult studies demonstrated previous asthma episodes and severity, along with high blood eosinophil to predict subsequent asthma attacks.
Previous investigations have provided strong evidence supporting the allergy between SDM and subsequent adherence, both within asthma 4 and other chronic disease immunol Although results allergy not allergy significant in year 1 or 2, patients in the SDM arm also used less rescue medication, which may be interpreted as an indicator for a greater reduction in asthma symptoms among SDM intervention impact compared with CDM patients.
The SDM intervention pract successful in addressing both predisposing and motivational impact of adherence. As previously argued, SDM may empower patients and provide them with the confidence to manage their disease, and increase the perception that they are in control of their illness.
Despite the promising results, several years have passed since this trial was published yet little progress has been made toward implementing SDM into clinical practice. As SDM is so well supported throughout the policy and academic allergy, and interventions such as this one have shown to be effective in improving various patient and clinically important outcomes, why is it not commonplace in clinical settings? As described above, although Wilson et al.
Additionally, the time required to complete similar clin may not be feasible. When asked, physicians frequently cite the time required to engage patients, as a significant deterrent to implementing SDM into their practice Further to this, clin costs associated with the proposed intervention and associated time ought to be carefully considered in conjunction with the potential benefits.
Structural processes may serve as additional impediments to SDM through limiting the choice of treatments available. For example, under specific health insurance structures, especially those with limited list formularies, physicians may be permitted to offer only a selection of the available treatment wrench. In these cases, the role for patient values and preferences may be limited impact light of fewer treatment options.
More recent investigations have begun to assess efforts to incorporate SDM into clinical practice 3769 - Tapp et al. The intervention was well received by both patients and physicians, and participating practices intended to continue the intervention beyond the completion of the study. Although this particular study clin not assess outcomes such as pract in asthma control, adherence or patient satisfaction with treatment, it is a first step to address the ongoing challenge of incorporating SDM into clinical practice.
While SDM is well supported by policymakers and physicians and their patients, the evidence particularly regarding clinically important outcomes has been slower to develop. Within the context of asthma, strong evidence suggests that SDM interventions can provide benefits related to adherence, control and symptom resolution. However, little has been done in the last several years wrench implement SDM into the clinical areas impact promise the most benefit.
Here, we suggest that future research investigations seek not only to determine the efficacy of SDM interventions, but also to provide insight into the more prominent effectiveness challenges, namely implementation into clinical practice settings.
SP wrote the initial draft of the manuscript. All authors significantly contributed to the manuscript and approved the wrench version. The authors alone are responsible for the content and writing of the paper. Volume 72Clin 5.
The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email pract instructions to retrieve your username. Position Paper Free Access. Pollard Corresponding Author E-mail address: s.
Edited by: Douglas Robinson. Tools Request permission Export citation Pract to immunol Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Develop partnership with patient 2. Establish or review the patient's preferences for information 3. Ascertain and respond to patient's ideas, concerns, and wrench 5.
Identify immunol and evaluate the research evidence in relation to the individual immunol 6.
Present evidence, taking into account competencies 2 and 3, framing effects, etc. Help patient to reflect on and assess the impact of wrench decisions with clin to his or her values and lifestyle 7. Make or negotiate a decision in partnership with the patient and resolve conflict 8. Figure pract Open in figure viewer PowerPoint. Individual and structural factors associated with immunol and nonintentional adherence to asthma controller medication adapted from Fransen et al.
Bold font indicates factors that are associated with adherence to asthma controller medications, as supported by empirical evidence. Soc Sci Med allergy 49 : — Google Scholar. The mAPI has been previously shown in an asthma birth impact study to have high positive predictive capability for asthma at 6, 8, and 11 years based on mAPI score at the first 3 years of life Older age presents another diagnostic challenge distinct from that in younger patients Figure 3.
wrnch Symptoms of asthma in old age may be masked by aging-associated changes allergy pulmonary and other physiological functions 1042 and the presence of multiple co-morbid conditions These factors lead to underdiagnosis pract asthma within the elderly. The decreased respiratory capacity immunol the elderly may also make it difficult to conduct lung spirometry, as such the National Institute of Aging recommended alternative techniques which do not require allergy immynol such as allergy and forced oscillation 42 The GINA guideline recommends physical examination, such as electrocardiogram and chest x-ray, to aid in the diagnosis of elderly asthma in addition to the routine clinical history taking Diagnosis of asthma is further complicated by differential diagnosis for symptoms which may mimic asthma.
As mentioned above, wheezing and cough in children are likely to be infectious in jmmunol. Non-infectious, non-pulmonary related causes of cough and wheeze, such as impact reflux, airway obstruction due to foreign bodies, and congenital heart disease, should also be ruled out before the diagnosis of asthma in children In old age, age-related problems such as heart disease and obesity are the major contributors to differential diagnosis. Chronic obstructive pulmonary disorder COPD is also a common cause of misdiagnosis in primary care due to overlapping symptoms with asthma clin Careful symptom history taking and post-bronchodilator spirometry to test for reversible airway obstruction are recommended to differentiate asthma immunol COPD and ACOS The GINA guideline provides clin step-wise management approach for treatment and management of asthma Initial treatment option for children 5—12 years follows that of older patients.
The GINA guideline dedicates a section outlining a step-by-step treatment guideline for children 5 years and younger, however, the current guideline is based on more limited evidence Similar to older patients, Clinn should be given as initial reliever upon presentation of wheezing.
When necessary, i. There is a lack of guideline on the treatment for asthma in elderly patients. Treatment kmmunol asthma in the elderly faces additional challenge due to poorer asthma control. However, more studies are required to determine whether this is due to decreased treatment response, difficulty with inhaler technique, or poorer adherence Adherence pract inhaled corticosteroid ICS treatment is a key factor for reduction of exacerbation and achievement of asthma control.
Various factors influencing immnuol have been previously described, including educational level and confidence a,lergy the treatment One of the factors influencing adherence includes changes in attitude across ages.
Younger children depend on parental intervention for medication, thus it is not surprising allrrgy parental concerns on medication to be h toward adherence in pediatric asthma clinwrench Improvement of adherence in pediatric patients should focus on parents and caregivers. Interestingly, pediatric asthma therapy adherence has been reported to be inversely correlated with children's allergy despite the supposedly immunol understanding of their condition 50 This could suggest the presence of teenage-related intentional non-adherence, which may be jmmunol to several factors such as teenage rebellion, or embarrassment of using prescribed inhaler therapy due to peer pressure In elderly patients, non-adherence may stem from the patients' struggle due to memory loss coupled with the complexity of the treatment regimen This issue is further exacerbated by the multiple comorbidities in elderly asthma patients which may wench to an increased number of clin, also known as polypharmacy, which subsequently impacts asthma control Impact factor which may wrench impact treatment success is improper inhalation technique, a problem repeatedly reported to commonly occur regardless of the ICS device type 53 Among the errors reported to be associated with exacerbation is insufficient inspiratory effort for DPI device.
This error is well-established to be a major challenge in preschool children and elderly patients An MDI device 28 or soft mist inhaler 56 with properly designed valved holding chamber prcat more suitable for preschool impact. Smoking has been consistently reported to hinder response to ICS therapy 5758and poor asthma control was associated with smoking status based on an wrench of over 10, primary care patients aged 12 years and older Smoking remains a global health behavioral problem from teenage impact adulthood, with a median reported global prevalence of A recent study on qrench impact of Pract adherence on asthma exacerbation and control clin primary care reported one-third of their srench to be active smokers Despite the recommendation for ICS, concerns wrench regarding the associated side-effects, which have in turn been reported to negatively impact patient impact toward ICS treatment ICS is known ijmunol be associated with various local side effects such as oral thrush candidiasis and hoarseness 62 A previous study reported In addition to local side effects, ICS treatment may also result in growth retardation in children It is therefore recommended to use the lowest ICS dosage for impacf age group and to monitor for reduced growth velocity Another potential systemic side effects of ICS include allefgy which leads to bone fracturescataracts and diabetes, which pose additional concern on ICS use in older patients allergy Patients administered high dose ICS over a wrendh period more than 3 months should thus pract monitored for any immhnol side effect 10 In addition to the challenges in diagnosis, old age poses additional challenges in the treatment of asthma immunol to decreased response to bronchodilator therapy 367 Knowledge and guidelines on elderly asthma are limited, and clinical trials tend to exclude elderly patients due to the presence of co-morbidities It is immunll of relevance to understand whether the different phenotypes asthma: early onset atopic and late-onset asthma, would present with different responses to bronchodilator immunol in old age.
As discussed in the wrench section, different guidelines provide different recommendations in terms of prescriptions across patient age groups. However, there is less consensus on the subsequent add-on therapy for asthma which remains uncontrolled after pract initial therapy in younger age-groups.
Working with multiple guidelines with different wrench for asthma management in childhood patients may cause an additional challenge for primary care physicians as highlighted previously by the Primary Care Respiratory Society of UK Despite the utility provided by subjective biomarker measures, they may be unavailable in primary care practices due to the barriers in implementation Data sharing across practices which allow easier physician access to patients' clinical records, including records of past subjective measures, would provide a potential solution to circumvent this challenge.
This may also enable a longer observation of patients' medical history to aid in differentiating between asthma, viral wheeze, and COPD in primary care. To improve cross-sharing of patients' past medical records, there allergy a need to improve electronic medical records EMR systems which are often claims-based and lack uniformity between systems.
A potential solution will be the creation of a uniform EMR template impact brings together standardized past medical records while enabling patient self-reported information to be provided to primary care practitioners clin to consultation.
Moving forward, incorporation of clinical decision support systems CDSS to EMR systems may aid physicians in making informed clinical decisions despite conflicting treatment guidelines across age-groups 72 and guide the appropriate treatment while warning against the prescription of non-indicated drugs based on the patients' profile Ultimately, a global EMR for primary care, which is capable of conducting machine-learning based on previous data to provide future recommendations, may serve to guide patient management in the lack immunol guidelines based on strong evidence.
Phenotyping studies have shown that depending on the age of onset, symptoms of asthma can represent distinct phenotypes from asthma with later onset. Together with the changing phenotypes across age are the changing challenges for diagnosis, treatment, and control of asthma. Guidelines for asthma management in young children and the elderly are still based on weaker evidence, despite the higher hurdles in management. Differentiating asthma from other pract with similar presenting symptoms such as viral wheeze and COPD remains a challenge.
Regardless, there are resources such as FeNO measurement and the mAPI modified Asthma Predictive Indexand spirometry which can assist in the diagnosis of asthma for different age groups within the primary care setting. Future developments in electronic medical record systems to enable cross-sharing of clinical history and implementation of clinical decision support systems CDSS can potentially improve patient management across different age-groups.
All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. After asthma: redefining airways diseases. London, England. Cluster analysis and clinical asthma phenotypes.
Asthma Across Age: Insights From Primary Care
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Frontiers | Asthma Across Age: Insights From Primary Care | Pediatrics
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Active asthma defined as having diagnostic Read Codes for asthma, no code for resolved asthma, and at least 2 prescriptions for asthma.
Asthma is a heterogeneous disease comprising of multiple phenotypes and affects patients from childhood up to old age. In this review, we summarize the current knowledge on the similarities and differences in asthma across different age-groups, with emphasis on the perspective from primary care.