| 1. |
- Kull, Inger, et al.
(author)
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Astma/KOL-mottagningar i primärvård ger effektivt omhändertagande
- 2008
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 105:42, s. 2937-2940
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Journal article (peer-reviewed)abstract
- Astma och KOL (kroniskt obstruktiv lungsjukdom) har blivit allt vanligare, och möjligheterna till både korrekt diagnos och förbättrad behandling har ökat under det senaste decenniet, vilket ställer nya krav på hälso- och sjukvården. Korrekt diagnos, adekvat patientutbildning och rökslutarstöd är högt prioriterade åtgärder. Ett strukturerat omhändertagande med en välfungerande astma/KOL-mottagning i primärvården underlättar och förbättrar vården av denna stora patientgrupp. I artikeln föreslås nya kriterier för astma/KOL-mottagningar i primärvård.
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| 2. |
- Stridh, Björn, et al.
(author)
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Många överbehandlas med astmamedicin
- 2018
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In: Läkartidningen. - 0023-7205. ; 115:13-14
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Journal article (peer-reviewed)abstract
- Swedish asthma guidelines recommend treating asthma with the lowest effective dose possible. These recommendations are both hard to follow and seldom considered enough in asthma care today. As an example, combination therapy with inhaled corticosteroids (ICS) and long acting beta agonists (LABA) should only be considered if asthma control is not achieved with low to medium dose ICS daily. However, the Swedish National Board of Health and Welfare estimates that 120 000 asthma patients are overmedicated with combination therapy. Guidelines are clear in instructions of when and how to step up asthma treatment, while instructions for stepping down are not that obvious. In this article, we present an asthma treatment algorithm for step 1-3 in adults for use in clinical practice (Fig. 1), where stepping down asthma treatment is considered as an alternative. Included are also instructions of how to step down asthma treatment (Fig. 2). We conclude that stepping down is possible to do in a safe way in certain patient groups while maintaining asthma control. If possible risks are taken into consideration, stepping down asthma treatment can be done in every clinical setting.
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| 3. |
- Stridh, Björn, et al.
(author)
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Många överbehandlas med astmamedicin : [When and how to step down asthma treatment]
- 2018
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In: Läkartidningen. - : Läkartidningen Förlag. - 0023-7205 .- 1652-7518. ; 115
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Journal article (peer-reviewed)abstract
- Swedish asthma guidelines recommend treating asthma with the lowest effective dose possible. These recommendations are both hard to follow and seldom considered enough in asthma care today. As an example, combination therapy with inhaled corticosteroids (ICS) and long acting beta agonists (LABA) should only be considered if asthma control is not achieved with low to medium dose ICS daily. However, the Swedish National Board of Health and Welfare estimates that 120 000 asthma patients are overmedicated with combination therapy. Guidelines are clear in instructions of when and how to step up asthma treatment, while instructions for stepping down are not that obvious. In this article, we present an asthma treatment algorithm for step 1-3 in adults for use in clinical practice (Fig. 1), where stepping down asthma treatment is considered as an alternative. Included are also instructions of how to step down asthma treatment (Fig. 2). We conclude that stepping down is possible to do in a safe way in certain patient groups while maintaining asthma control. If possible risks are taken into consideration, stepping down asthma treatment can be done in every clinical setting.
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| 4. |
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| 5. |
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| 6. |
- Abdel-Aal, Arwa, et al.
(author)
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Prioritising primary care respiratory research needs : results from the 2020 International Primary Care Respiratory Group (IPCRG) global e-Delphi exercise
- 2022
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In: npj Primary Care Respiratory Medicine. - : Springer Nature. - 2055-1010. ; 32:1
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Journal article (peer-reviewed)abstract
- Respiratory diseases remain a significant cause of global morbidity and mortality and primary care plays a central role in their prevention, diagnosis and management. An e-Delphi process was employed to identify and prioritise the current respiratory research needs of primary care health professionals worldwide. One hundred and twelve community-based physicians, nurses and other healthcare professionals from 27 high-, middle- and low-income countries suggested 608 initial research questions, reduced after evidence review by 27 academic experts to 176 questions covering diagnosis, management, monitoring, self-management and prognosis of asthma, COPD and other respiratory conditions (including infections, lung cancer, tobacco control, sleep apnoea). Forty-nine questions reached 80% consensus for importance. Cross-cutting themes identified were: a need for more effective training of primary care clinicians; evidence and guidelines specifically relevant to primary care, adaption for local and low-resource settings; empowerment of patients to improve self-management; and the role of the multidisciplinary healthcare team.
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| 7. |
- Ahlroth Pind, Caroline, et al.
(author)
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Pharmacological treatment of asthma in Sweden from 2005 to 2015
- 2024
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In: Journal of Asthma. - : Marcel Dekker. - 0277-0903 .- 1532-4303. ; 61:4, s. 313-321
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Despite access to effective therapies many asthma patients still do not have well-controlled disease. This is possibly related to underuse of inhaled corticosteroids (ICS) and overuse of short-acting β2-agonists (SABA). Our aim was to investigate longitudinal trends and associated factors in asthma treatment.METHODS: Two separate cohorts of adults with physician-diagnosed asthma were randomly selected from 14 hospitals and 56 primary health centers in Sweden in 2005 (n = 1182) and 2015 (n = 1225). Information about symptoms, maintenance treatment, and use of rescue medication was collected by questionnaires. Associations between treatment and sex, age, smoking, education, body mass index (BMI), physical activity, allergic asthma, and symptom control were analyzed using Pearson's chi2-test. Odds ratios (ORs) were calculated using logistic regression.RESULTS: Maintenance treatment with ICS together with long-acting β2-agonists (LABA) and/or montelukast increased from 39.2% to 44.2% (p = 0.012). The use of ICS + LABA as-needed increased (11.1-18.9%, p < 0.001), while SABA use decreased (46.4- 41.8%, p = 0.023). Regular treatment with ICS did not change notably (54.2-57.2%, p = 0.14). Older age, former smoking, and poor symptom control were related to treatment with ICS + LABA/montelukast. In 2015, 22.7% reported daily use of SABA. A higher step of maintenance treatment, older age, obesity, shorter education, current smoking, allergic asthma, low or very high physical activity, and a history of exacerbations were associated with daily SABA use.CONCLUSIONS: The use of ICS + LABA both for maintenance treatment and symptom relief has increased over time. Despite this, the problem of low use of ICS and high use of SABA remains.
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| 8. |
- Al-Hadrawi, Zainab, et al.
(author)
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Comorbid allergy and rhinitis and patient-related outcomes in asthma and COPD : a cross-sectional study
- 2024
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In: European Clinical Respiratory Journal. - : Co-Action Publishing. - 2001-8525. ; 11:1
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Journal article (peer-reviewed)abstract
- INTRODUCTION: The study aimed to compare prevalence of comorbid allergic manifestations and rhinitis, allergy testing and associations with patient-related outcomes in patients with asthma and COPD.METHODS: Cross-sectional study of randomly selected Swedish patients with a doctor's diagnosis of asthma (n = 1291) or COPD (n = 1329). Self-completion questionnaires from 2014 provided data on demographics, rhinitis, allergic symptoms at exposure to pollen or furry pets, exacerbations, self-assessed severity of disease and scores from the Asthma Control Test (ACT) and the COPD Assessment Test (CAT), and records were reviewed for allergy tests.RESULTS: Allergic manifestations were more common in asthma (75%) compared with COPD (38%). Rhinitis was reported in 70% of asthma and 58% of COPD patients. Allergy tests had been performed during the previous decade in 28% of patients with asthma and in 8% of patients with COPD. In patients with asthma; comorbid allergy and rhinitis were both independently associated with increased risk for poor asthma symptom control (ACT < 20) (OR [95% CI] 1.41 [1.05 to 1.87] and 2.13 [1.60 to 2.83]), exacerbations (1.58 [1.15 to 2.17] and 1.38 [1.02 to 1.86]), and self-assessed moderate/severe disease (1.64 [1.22 to 2.18] and 1.75 [1.33 to 2.30]). In patients with COPD, comorbid allergy and rhinitis were both independently associated with increased risk for low health status (CAT ≥ 10) (OR [95% CI] 1.46 [1.20 to 1.95] and 2.59 [1.97 to 3.41]) respectively, with exacerbations during the previous six months (1.91 [1.49 to 2.45] and 1.57 [1.23 to 2.01]), and with self-assessed moderate/severe disease (1.70 [1.31 to 2.22] and 2.13 [1.66 to 2.74]).CONCLUSION: Allergic manifestations and rhinitis are more common in asthma than COPD but associated with worse outcomes in both diseases. This highlights the importance of examining and treating comorbid allergy and rhinitis, not only in asthma but also in COPD.
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| 9. |
- Annema, Jouke T, et al.
(author)
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Clinical highlights from Amsterdam.
- 2016
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In: ERJ open research. - : European Respiratory Society (ERS). - 2312-0541. ; 2:3
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Journal article (peer-reviewed)abstract
- This article contains highlights and a selection of the scientific advances from the Clinical Assembly that were presented at the 2015 European Respiratory Society International Congress in Amsterdam, the Netherlands. The most relevant topics for clinicians will be discussed, covering a wide range of areas including interventional pulmonology, rehabilitation and chronic care, thoracic imaging, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, exciting novel data will be discussed and put into perspective.
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| 10. |
- Annika, Lindh, 1984-, et al.
(author)
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Description of inhalation technique in patients with COPD in primary care
- 2018
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In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52:Suppl. 62
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Journal article (other academic/artistic)abstract
- Introduction: A recent systematic review showed that only about one third of the patients had a correct inhalation technique and the number had not improved the last 40 years¹.Aim: The aim was to describe errors, separated into errors related to devices and errors related to inhalation technique, that occur when patients with COPD inhale medications.Method: In this descriptive study, patients with a COPD diagnosis were recruited from a randomized controlled trial performed 2015-2016 in primary care in four county councils in Sweden. A COPD nurse assessed the inhalation technique using a checklist with errors related to devices and to inhalation technique with possibility to write additional comments.Results: In total, 167 patients using 287 inhalers were assessed, 52% (n = 86) were female, mean age 71 years. A total of 163 errors were noted in the checklist, of which 87 were related to inhalation technique and 76 were related to devices. Except from this the COPD nurse had written comments regarding 53 errors that were not included in the checklist. At least one error (range: 1-7 errors) was made by 46% (n = 76) of the patients.Conclusion: The results show that many patients do not use the device correctly. Both errors related to inhalation technique and related to devices were present. This implies that there is a need to focus on both aspects when teaching patients how to inhale their medication. The checklist used in this study needs to be further improved.
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