The Journal of asthma : official journal of the Association for the Care of Asthma
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Review Comparative Study
Clinical assessment of asthma symptom control: review of current assessment instruments.
Health care providers are increasingly shifting asthma management from treating acute attacks to achieving symptom control to return patients to full functioning and improve their quality of life. Assessment instruments have been developed that quantify asthma patients' symptom control and quality of life. Several instruments are described in this review in terms of domains, psychometric qualities, ease of use, and ability to accurately reflect patients' overall condition. Problems with applicability and feasibility have limited the use of currently available instruments mainly to research settings or sporadic use in selected practices, generally leaving clinicians without the potential benefits of such tools to aid their routine clinical management of patients.
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Information about predictors of decline in pulmonary function (forced expiratory volume in 1 second [FEV1]) or health-related quality of life (HRQoL) in patients with asthma or (chronic obstructive pulmonary disease [COPD]) might help to determine those who need additional care. A 2-year prospective cohort study was conducted among 380 asthma and 120 COPD patients. In both asthma and COPD patients, a 2-year change in FEV1 was only weakly associated with a 2-year change in HRQoL (r = .0.19 and 0.24, respectively). ⋯ Additional predictors of FEV1 decline were greater body weight, less chronic cough or sputum production, and less respiratory symptoms in asthma patients and current smoking in COPD patients. A decline in HRQoL was associated with older age, non-compliance with medication, more dyspnea, and a lower PEFR in asthma patients and with male gender, lower education, lower body weight, more dyspnea, and more respiratory symptoms in COPD patients. Our results show that FEV1 and HRQoL appear to represent different disease aspects influenced by different predictors.
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Clinical Trial
Quantifying preventive asthma care delivered at office visits: the Preventive Asthma Care-Composite Index (PAC-CI).
Our objective was to develop a composite index to measure and quantify preventive asthma care delivered in the primary care office. We documented preventive actions used for children with asthma at the time of an office visit and weighted actions based on their intensity to create a composite index. ⋯ The composite index also varied by visit type, with the highest scores noted for asthma-related visits, compared to well-child and other illness visits. This composite index has potential use for research and quality improvement efforts.