Advances in Prevention and Education in Lung Disease

Abstract

In the past two decades there have been significant gains in our understanding of prevention and education related to lung disease, much of it enabled by research sponsored by the Division of Lung Diseases (DLD) of the National Heart, Lung, and Blood Institute (NHLBI). This paper will discuss the evolution of the prevention and education knowledge base through focus on three dimensions of research. First, it will use chronic obstructive pulmonary disease (COPD) as a case for examining advances in our ability to screen and identify patients at risk for developing disease. It will illustrate that COPD research has moved us closer to being able to identify populations that should benefit from early and targeted interventions. Second, it will examine the literature on smoking, perhaps the most damaging of all health-related behaviors because of its strong association with a range of respiratory conditions. The aim will be to assess recent contributions to intervention research on efforts to prevent or reduce smoking as a risk factor in lung disease. Third, it will explore the extant research related to asthma education and describe the development of the National Asthma Education and Prevention Program (NAEPP). It will discuss how research and educational initiatives in asthma have contributed to advances in disease management by patients, including changes in self-management behavior, health status, health care use, and the quality of life.The concluding section of the paper will consider future research directions. Given how far prevention and education research have taken us, where are the gaps in our knowledge and what are the priority areas for further investigation? SCREENING AND PREVENTION IN COPDChronic obstructive pulmonary disease is now the fourth common cause of death in the United States (1), and it is expected that 110,000 or more deaths from COPD will occur during 1997 alone. Chronic obstructive pulmonary disease is an extremely common disease, but because it is relatively asymptomatic early in its course, most would agree that the currently estimated prevalence of 16 million cases, based on physician diagnosis, probably represents less than half the cases that would be identified if screening spirometry were to be performed. The greatest cause of COPD is smoking, but many smokers do not develop COPD. If screening spirometry was performed on all smokers, those most likely to develop COPD could be identified early, and efforts to prevent and treat this disabling and lethal disease could then be focused on those individuals at greatest risk.Research over the past 30 years has increased our understanding of the basic mechanisms of COPD ( see review by Anthonisen and Senior, this issue, p. S139), its pathogenesis, the varying pathologic entities encompassing this disorder, including chronic obstructive bronchitis, emphysema, and asthmatic bronchitis, and much about the epidemiology of this disease. The natural history of COPD is characterized by a slow, progressive limitation of maximal expiratory airflow....

Disparities in Asthma Medication Dispensing Patterns: The Case of Pediatric Asthma in Puerto Rico

“…Research on physician education shows, that provider groups who have received training implement changes in their practices that result in improved disease control for patients. 35–37 Therefore, provider practices may be a key intervention area for reducing health disparities in asthma medication use.…”

Impacto de uma intervenção educacional de curta duração sobre a adesão ao tratamento e controle da asma

“…All parameters are expressed as the percentage of the predicted value for age, gender, and height. (20) We measured PEF using a portable peak flow monitor (Vitalograph; Boehringer Ingelheim, 22 Dalcin PTR, Grutcki DM, Laporte PP, Lima PB, Viana VP, Konzen GL et al…”

“…2011;37(1): [19][20][21][22][23][24][25][26][27] or less), and had a low family income (70% of the families received less than 3 times the national minimum wage). Regarding smoking status, 62.6% had never smoked, 35.7% were former smokers, and only 1.7% currently smoked.…”

“…2011;37(1): [19][20][21][22][23][24][25][26][27] educational intervention at a routine visit is the fact that there is no need for the patient to schedule another visit or go to the hospital again. Studies have shown that a certain percentage of patients do not return to the hospital for this purpose, even after having expressed a desire to do so.…”

“…More recently, research related to asthma education has examined interventions provided by various types of educators using different learning formats in a range of settings and focusing especially on socially disadvantaged minorities. (22) The present study is unique not only in that it adapted the learning process to the routine clinical care of a population of asthma patients, most of whom were classified as having severe asthma, had a low family income, and had a low level of education, but also in that it modeled a short-term format that allows the delivery of the educational intervention during routine care and thus makes it possible to include the maximum number of patients. One positive aspect of providing the β 2 agonist bronchodilators for use in metered dose inhalers are available in primary health care facilities in most cities.…”