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Asthma Clinics (asthma + clinic)
Selected AbstractsReliability of a new hand-held device for the measurement of exhaled nitric oxideALLERGY, Issue 10 2007B. Khalili Background:, Given the importance of airway inflammation in asthma, there has been an effort to incorporate inflammatory markers into its management. Measurement of fractional exhaled nitric oxide (FeNO) is a noninvasive marker of airway inflammation; however, the use of the available FeNO analyzer is limited by several factors including its cost and lack of transportability. The aim of this study was to compare the performance of a new hand-held FeNO measuring device (NIOX MINO) to the current clinical standard , the chemiluminescence FeNO analyzer (NIOX). Methods:, Subjects 6 years and older presenting to an allergy and asthma clinic underwent FeNO evaluation by NIOX and each of three NIOX MINOs. The mean of two acceptable measurements from the NIOX and the first approved measurement from each NIOX MINO were used for analysis. Results:, One hundred ten patients aged 6,86 years completed the study. Intrasubject FeNO levels obtained by each of the three NIOX MINOs revealed no significant difference between the measurements (P = 0.59). There was a very strong correlation between FeNO measurements by NIOX and by NIOX MINO (r = 0.98, P < 0.0001). The mean intrasubject FeNO difference between NIOX and NIOX MINO was ,0.5 p.p.b. which was not statistically significantly different from zero (P = 0.21). Conclusions:, Fractional exhaled nitric oxide measurements by the NIOX MINO showed a strong correlation and a high degree of agreement with the current standard stationary device. The NIOX MINO may be reliably used in clinical practice. [source] Trial of nurse-run asthma clinics based in general practice versus usual medical careRESPIROLOGY, Issue 3 2004Louis S. PILOTTO Objective: The aim of this study was to assess the ability of nurse-run asthma clinics based in general practice compared with usual medical care to produce at least a moderate improvement in the quality of life of adults with asthma. Methodology: A randomized controlled trial involving 80 asthma clinic and 90 usual medical care asthma participants, aged 18 years and older was conducted in 11 general practices in Adelaide. The main outcome measure was the St George's respiratory questionnaire (SGRQ), from which quality-of-life scores were used to assess therapeutic benefit. Lung function measurements and health services utilization data were also collected. Results: One hundred and fifty-three participants (90%) were reviewed at follow up after 6,9 months. There was little difference between groups in baseline measures or for the 6-month follow-up, outcomes,, including, the, mean, difference, in, total, SGRQ, scores, (,0.5,, 95%, confidence, interval, (CI) ,4.0, 2.9) and the mean difference in percentage predicted FEV1 (2.3%, 95% CI ,0.7, 5.3 pre-bronchodilator; 0.4%, 95% CI ,5.1, 5.9 post-bronchodilator). Trends in health services utilization were noted. Conclusions: Nurse-run asthma clinics based in general practice and usual medical care were similar in their effects on quality of life and lung function in adults. These findings cannot be generalized to hospital outpatients and other clinics that manage more severe asthmatic patients. [source] Association between asthma control and bronchial hyperresponsiveness and airways inflammation: a cross-sectional study in daily practiceCLINICAL & EXPERIMENTAL ALLERGY, Issue 12 2009V. Quaedvlieg Summary Background The primary end-point in the management of asthma is to obtain optimal control. The aim of this study was to assess the relationships between the markers of airway inflammation (sputum eosinophilia and exhaled nitric oxide), bronchial hyperresponsiveness (BHR) and asthma control. Methods One hundred and thirty-four patients were recruited from our asthma clinic between January 2004 and September 2005 [mean age: 42 years, mean forced expiratory volume in 1 s (FEV1): 86% predicted]. Eighty-six of them were treated by inhaled corticosteroids, 99 were atopic and 23 were current smokers. They all underwent detailed investigations including fractional-exhaled nitric oxide (FENO) measurement, sputum induction and methacholine challenge when FEV1 was >70% predicted, and filled in a validated asthma control questionnaire (ACQ6 Juniper). Results When dividing patients into the three groups according to their level of asthma control determined by ACQ [well-controlled asthma (ACQ score 0.75), borderline (0.75 Trial of nurse-run asthma clinics based in general practice versus usual medical careRESPIROLOGY, Issue 3 2004Louis S. PILOTTO Objective: The aim of this study was to assess the ability of nurse-run asthma clinics based in general practice compared with usual medical care to produce at least a moderate improvement in the quality of life of adults with asthma. Methodology: A randomized controlled trial involving 80 asthma clinic and 90 usual medical care asthma participants, aged 18 years and older was conducted in 11 general practices in Adelaide. The main outcome measure was the St George's respiratory questionnaire (SGRQ), from which quality-of-life scores were used to assess therapeutic benefit. Lung function measurements and health services utilization data were also collected. Results: One hundred and fifty-three participants (90%) were reviewed at follow up after 6,9 months. There was little difference between groups in baseline measures or for the 6-month follow-up, outcomes,, including, the, mean, difference, in, total, SGRQ, scores, (,0.5,, 95%, confidence, interval, (CI) ,4.0, 2.9) and the mean difference in percentage predicted FEV1 (2.3%, 95% CI ,0.7, 5.3 pre-bronchodilator; 0.4%, 95% CI ,5.1, 5.9 post-bronchodilator). Trends in health services utilization were noted. Conclusions: Nurse-run asthma clinics based in general practice and usual medical care were similar in their effects on quality of life and lung function in adults. These findings cannot be generalized to hospital outpatients and other clinics that manage more severe asthmatic patients. [source] A randomised controlled trial of clinics in secondary schools for adolescents with asthmaCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2004Cliona Ni Bhrolchain Aim To test the hypothesis that delivery of a programme of asthma care in nurse-led clinics in school would improve access to care and health outcomes compared with care in general practice. Methods Pupils at four secondary schools in Bristol, North Somerset and South Gloucestershire, UK, were included in the randomized controlled trial. Another two schools were included to control for any cross-contamination between school clinic attenders and general practice attenders in the trial schools. Pupils in trial schools were randomly assigned to receive an invitation for an asthma review at school or in general practice. Schools were stratified for deprivation and covered rural, urban and suburban populations. Pupils with asthma were identified using a screening questionnaire and then cross-referenced with practice prescribing records. Four school nurses with additional specialist asthma training ran the school clinics weekly. Consultations concentrated on the needs and interests of adolescents and followed national guidelines for treatment changes. Reviews were arranged at 1 and 6 months, with an additional 3-month review if needed. The pupil's GP was kept informed. General practice care was according to the practice's usual treatment protocols. Primary outcomes were the proportion of pupils who had had an asthma review in 6 months, health-related quality of life and level of symptoms. Secondary outcomes were pupil knowledge and attitude to asthma, inhaler technique, the proportion taking inhaled steroids daily, school absence due to asthma, PEFR and pupil preference for the setting of care. Sample size was calculated to have an 80% chance of showing an increase from 40% to 60% having a review in 6 months and half a standard deviation improvement on the quality of life measure. Analysis was on an intention to treat basis. Results School clinic pupils were more likely to attend (91% vs. 51%). However, symptom control or quality of life were no better. School clinic pupils knew more about asthma, had a more positive attitude and better inhaler technique. Absence and PEFR showed no difference. 63% who attended school clinics preferred this model but, taking both groups together, just over half would prefer to attend their GP for follow-up. Cost of care (including practice, school clinic, hospital and medication) was £32.10 at school, £19.80 at the trial practices and £18.00 at control practices. Conclusions Previous evaluations of nurse-led asthma clinics in practice have also failed to show improvements in outcomes, though process measures do improve. This may be due to the need for nurses to refer patients to doctors for changes in medication, rather than doing this themselves. Some weaknesses in study design that may have affected outcome, but the essential conclusion is that nurse-led asthma clinics in school are not cost effective. The study does suggest that such clinics can reach a high proportion of adolescents, but for asthma at least this does not result in any measurable improvement in outcome. [source]
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