Management of asthma in general practice

T Th he e r re el la at ti io on ns sh hi ip p b be et tw we ee en n a as st th hm ma a a ad dm mi is ss si io on n r ra at te es s, , r ro ou ut te es s o of f a ad dm mi is ss si io on n, , a an nd d s so oc ci io oe ec co on no om mi ic c d de ep pr ri iv va at ti io on n ABSTRACT: This study aimed to explore the relationship between hospital admissions for asthma and socioeconomic deprivation. A retrospective study examined one year of hospital admissions for asthma in the West Midlands region of England (n=10,044), and in one of the region's wealthier districts, Worcester (n=251). Age standardized admission ratios (SARs) for asthma, and the routes of hospital admission, were compared with the Townsend Deprivation Index for the place of residence.Asthma SAR was strongly associated with deprivation as measured by the Townsend Index for the district of residence (Spearman rank correlation coefficient ρ=0.65; p=0.004). Asthma admission rates for all age groups, except those aged over 65 yrs, were higher in poorer districts. A significantly greater proportion of emergency admissions in poorer districts came via Accident and Emergency departments, rather than general practitioner referrals (ρ=0.76; p<0.001). Within Worcester District, SAR was associated with Townsend Index for the ward of residence (ρ=0.39; p<0.001). This remained significant after excluding repeat admissions (ρ=0.45; p<0.001).We conclude that asthma admissions are strongly associated with deprivation in the community. Differences in the health care received during acute exacerbations by asthma patients from different economic backgrounds is likely to be an important factor in this relationship.

Section: Discussionmentioning

confidence: 99%

The relationship between asthma admission rates, routes of admission, and socioeconomic deprivation

Watson¹,

Cowen²,

Lewis³

1996

“…For example, delays in diagnosis are common [21] and lead to inappropriate treatments being given. In other cases, severity is underestimated with the result that preventive therapy is under-used [22,23]. One study showed that 74% of patients admitted to hospital with severe asthma could have had the admission prevented by different prior care [24].…”

Section: Is Underdiagnosis a Real Problem In Daily Care?mentioning

confidence: 99%

Detection of asthma and chronic obstructive pulmonary disease in primary care

Schayck¹,

Chavannes²

2003

Chronic obstructive pulmonary disease (COPD) and asthma are major health problems, the number of patients with these diseases is still rising and only 25–50% of these patients are known to their doctors.Lung function gradually decreases in COPD and asthmatic patients during their lives. Due to adaptation of the patients or due to the doctor being unaware of the symptoms, COPD is often diagnosed late in its course and when finally diagnosed, lung function is often relatively poor. Underdiagnosis and consequently undertreatment might play an important role in the increase in morbidity and mortality as a result of COPD and asthma. Early detection and treatment might improve the long-term prognosis of these patients and this secondary prevention may also prevent irreversible loss of function.The identification of patients is useless if no effective preventive measures are available. In asthma, inhaled corticosteroids have been shown to have distinct effects on the progression of the disease. However, in COPD inhaled corticosteroids have only been shown to have some effects and the long-term effects on lung function have been disappointing. At present, the most effective treatment available for COPD is the cessation of smoking. It appears that a smoker at risk of developing COPD is more motivated to stop smoking than someone who is not at risk and this may help a physician in encouraging an attempt to quit.General practitioners appear to be already using this knowledge, as they seem more likely to advise smokers to quit smoking if they perceive their problems to be smoking related.

“…The older literature suggests that there may be delays in the making of the correct diagnosis, perhaps now as much in the elderly [7,8] as in children [9], and audit has suggested that even amongst those with the more severe asthma only 50% are receiving the correct inhaled steroids [10,11].…”

Section: Health Professionals and The Organization Of Carementioning

confidence: 99%

Delivering optimal care to the person with asthma: what are the key components and what do we mean by patient education?

Partridge¹

1995

D De el li iv ve er ri in ng g o op pt ti im ma al l c ca ar re e t to o t th he e p pe er rs so on n w wi it th h a as st th hm ma a: : w wh ha at t a ar re e t th he e k ke ey y c co om mp po on ne en nt ts s a an nd d w wh ha at t d do o w we e m me ea an n b by y p pa at ti ie en nt t e ed du uc ca at ti io on n? ? ABSTRACT: The new understanding of the pathogenesis of asthma has led to an increasing perception of the disease as a chronic condition, rather than one consisting of acute exacerbations. Health professionals need to help patients to accept this new understanding, and this involves a consideration of how best to deliver care and how best to enhance compliance.Good communication is essential, and structured patient education has now been shown to be cost effective. All health professionals need to think how education may best be incorporated into their care. Such care will involve the development of a partnership between health professional and the patient and their loved ones, and the acquisition by patients of skills in self-management.Several unknowns remain regarding who benefits more from group education as opposed to individual education, and some details of guided self-management. However, in the face of clear evidence of the benefits of patient education, these areas for further study should not delay the adoption of a strong commitment to education by all of those who care for those with asthma.