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AIMAR survey on complex forms of bronchial asthma and COPD, their management and perception of critical issues.

Donner CF, Visconti A - Multidiscip Respir Med (2014)

Bottom Line: Treating with only a bronchodilator is considered to be moderately risky for this type of patient.The identification and management of mixed forms result more impeded by "logistic" aspects, e.g. long waiting lists and integration with the GP, than by aspects intrinsic to the disease management itself, e.g. selecting the assessment or interpreting the outcome of the instrumental examinations.Treatment continuity and the integration between GP and specialist are the factors that most limit the management of mixed forms in the stable phase.

View Article: PubMed Central - PubMed

Affiliation: AIMAR (Interdisciplinary Association for Research in Lung Disease), Mondo Medico, Borgomanero, NO Italy.

ABSTRACT

Background: The management of patients with complex forms of bronchial asthma and COPD is not usually addressed in the major international guidelines and management documents which exclusively address pure forms. AIMAR thus undertook a survey to obtain information about: a) the perceived frequency of complex forms of asthma/COPD in adult patients and in the elderly; b) patient management regarding the complex forms (focus on therapeutic goals and consequent treatment); c) the management problems perceived in diagnosis, management, monitoring, indices of appropriateness in pharmacological treatment and adherence to treatment.

Methods: The survey consisted of 18 multiple choice questions, completed by means of a web-based electronic form published in internet. All the data and responses inserted in the system were checked on-line for coherence and completeness directly during the phase of insertion and each participant had one only possibility of participating. The data thus collected were memorized directly within a relational database, based on consolidated open-source MySQL technology, and thus were immediately available for examination also during the course of the survey. Access to the data, mediated by a "back office" system of interrogation and report, enabled constant monitoring of the survey as it was being carried out, as well as extractions and verification, even on smaller data sets.

Results: The survey was carried out in the full month of December 2013 and first half of January 2014. A total of 252 questionnaires were collected from the following physician groups: pneumologists (n = 180), general practitioners (GPs) (n = 32), allergologists (n = 8), internal medicine specialists (n = 20), other specialists (n = 12).

Conclusions: Complex forms of bronchial asthma and COPD are frequently observed and considered present in variable percentages ranging from about 10% to about 50% of patients visited and considered typical of patients with a previous history of asthma. Risk factors such as smoking, obesity, bronchial hyperreactivity and genetic predisposition are considered important. Diagnosis is difficult solely on the basis of symptoms in approximately 50% of cases, and a previous history of asthma, history of spirometry and presence of allergy are of help. Treating inflammation and reducing exacerbations are considered the key therapeutic goals and the combination of inhaled corticosteroid (ICS) and long acting β2-agonist (LABA) and monotherapy with ICS are considered the fundamental pharmacological mode for treating patients with mixed forms of bronchial asthma and COPD. Treating with only a bronchodilator is considered to be moderately risky for this type of patient. The identification and management of mixed forms result more impeded by "logistic" aspects, e.g. long waiting lists and integration with the GP, than by aspects intrinsic to the disease management itself, e.g. selecting the assessment or interpreting the outcome of the instrumental examinations. Treatment continuity and the integration between GP and specialist are the factors that most limit the management of mixed forms in the stable phase.

No MeSH data available.


Related in: MedlinePlus

What importance do you ascribe to the current guidelines in the following cases?
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Fig12: What importance do you ascribe to the current guidelines in the following cases?

Mentions: The international guidelines (GINA for asthma and GOLD for COPD) deal with pure forms, excluding patients in whom there is an overlap of the two diseases from the specific management recommendations. In fact, in the GINA guidelines COPD is indicated as a comorbidity of asthma, along with other diseases such as rhinitis and gastroesophageal reflux disease [10], while in the GOLD guidelines asthma is indicated as a risk factor for the development of COPD [1]: in neither of the two documents, however, there are references to the therapeutic management. It should also be highlighted that patients with “complex” forms are often excluded from clinical studies for only asthmatic or only COPD patients, in that their etiopathological, clinical and functional characteristics fail to satisfy the inclusion criteria. It thus emerges the importance of carrying out trials designed specifically for this patient population, with distinct clinical outcomes, and the need to formulate specific recommendations for the management of the overlapping forms (Figure 12).Figure 12


AIMAR survey on complex forms of bronchial asthma and COPD, their management and perception of critical issues.

Donner CF, Visconti A - Multidiscip Respir Med (2014)

What importance do you ascribe to the current guidelines in the following cases?
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4232615&req=5

Fig12: What importance do you ascribe to the current guidelines in the following cases?
Mentions: The international guidelines (GINA for asthma and GOLD for COPD) deal with pure forms, excluding patients in whom there is an overlap of the two diseases from the specific management recommendations. In fact, in the GINA guidelines COPD is indicated as a comorbidity of asthma, along with other diseases such as rhinitis and gastroesophageal reflux disease [10], while in the GOLD guidelines asthma is indicated as a risk factor for the development of COPD [1]: in neither of the two documents, however, there are references to the therapeutic management. It should also be highlighted that patients with “complex” forms are often excluded from clinical studies for only asthmatic or only COPD patients, in that their etiopathological, clinical and functional characteristics fail to satisfy the inclusion criteria. It thus emerges the importance of carrying out trials designed specifically for this patient population, with distinct clinical outcomes, and the need to formulate specific recommendations for the management of the overlapping forms (Figure 12).Figure 12

Bottom Line: Treating with only a bronchodilator is considered to be moderately risky for this type of patient.The identification and management of mixed forms result more impeded by "logistic" aspects, e.g. long waiting lists and integration with the GP, than by aspects intrinsic to the disease management itself, e.g. selecting the assessment or interpreting the outcome of the instrumental examinations.Treatment continuity and the integration between GP and specialist are the factors that most limit the management of mixed forms in the stable phase.

View Article: PubMed Central - PubMed

Affiliation: AIMAR (Interdisciplinary Association for Research in Lung Disease), Mondo Medico, Borgomanero, NO Italy.

ABSTRACT

Background: The management of patients with complex forms of bronchial asthma and COPD is not usually addressed in the major international guidelines and management documents which exclusively address pure forms. AIMAR thus undertook a survey to obtain information about: a) the perceived frequency of complex forms of asthma/COPD in adult patients and in the elderly; b) patient management regarding the complex forms (focus on therapeutic goals and consequent treatment); c) the management problems perceived in diagnosis, management, monitoring, indices of appropriateness in pharmacological treatment and adherence to treatment.

Methods: The survey consisted of 18 multiple choice questions, completed by means of a web-based electronic form published in internet. All the data and responses inserted in the system were checked on-line for coherence and completeness directly during the phase of insertion and each participant had one only possibility of participating. The data thus collected were memorized directly within a relational database, based on consolidated open-source MySQL technology, and thus were immediately available for examination also during the course of the survey. Access to the data, mediated by a "back office" system of interrogation and report, enabled constant monitoring of the survey as it was being carried out, as well as extractions and verification, even on smaller data sets.

Results: The survey was carried out in the full month of December 2013 and first half of January 2014. A total of 252 questionnaires were collected from the following physician groups: pneumologists (n = 180), general practitioners (GPs) (n = 32), allergologists (n = 8), internal medicine specialists (n = 20), other specialists (n = 12).

Conclusions: Complex forms of bronchial asthma and COPD are frequently observed and considered present in variable percentages ranging from about 10% to about 50% of patients visited and considered typical of patients with a previous history of asthma. Risk factors such as smoking, obesity, bronchial hyperreactivity and genetic predisposition are considered important. Diagnosis is difficult solely on the basis of symptoms in approximately 50% of cases, and a previous history of asthma, history of spirometry and presence of allergy are of help. Treating inflammation and reducing exacerbations are considered the key therapeutic goals and the combination of inhaled corticosteroid (ICS) and long acting β2-agonist (LABA) and monotherapy with ICS are considered the fundamental pharmacological mode for treating patients with mixed forms of bronchial asthma and COPD. Treating with only a bronchodilator is considered to be moderately risky for this type of patient. The identification and management of mixed forms result more impeded by "logistic" aspects, e.g. long waiting lists and integration with the GP, than by aspects intrinsic to the disease management itself, e.g. selecting the assessment or interpreting the outcome of the instrumental examinations. Treatment continuity and the integration between GP and specialist are the factors that most limit the management of mixed forms in the stable phase.

No MeSH data available.


Related in: MedlinePlus