Search

Objective: To determine whether there was any change in indices of asthma control in population-based samples of patients with asthma between 1997 and 2002., Design: We examined asthma control and treatment in the community using two cross-sectional studies carried out 5 years apart in 1997 and 2002. Pharmacists handed out the questionnaires to patients with asthma; patients completed the questionnaires themselves., Setting: Community pharmacies in Alberta., Participants: Patients with physician-confirmed asthma attending pharmacies to fill prescriptions for asthma medications., Main Outcome Measure: Asthma control., Results: In 1997 and 2002, 301 and 340 completed questionnaires were received, respectively. Mean age of respondents was 42 and 39 years and the female-to-male ratio was 1.3:1 and 1.4:1, respectively. Overall asthma control was achieved by 27% (1997) and 31% (2002) of subjects, a non-significant change. Regular inhaled corticosteroid use was reported by 63% (1997) and 65% (2002) of subjects; mean daily dose of inhaled corticosteroids reported decreased from 920 mug in 1997 to 765 mug in 2002 (P < .02), which might reflect adoption of the newer guideline recommendation for lower-dose inhaled corticosteroids in combination therapy rather than a decrease in severity of asthma. Fewer respondents reported being hospitalized for asthma in 2002 (P = .02). Self-management plans were used by 7% and 5% of subjects in 1997 and 2002, respectively., Conclusion: In general, asthma control and use of inhaled corticosteroids was similar in 1997 and 2002. There was no evidence that patient education on asthma had increased. Asthma control was poor in 1997 and had not improved by 2002.

Background: Despite significant improvements in asthma treatment and the dissemination of national and international guidelines for asthma management, there are ongoing concerns that suboptimal care is being provided for patients with asthma., Objective: To determine the current practice patterns of asthma care among primary care physicians., Design: A cross-sectional study., Setting: Province of Alberta, Canada (population: 3 million people)., Participants: Patients, 5 years of age or older, who had a physician's diagnosis of asthma, and had at least two visits for asthma between 1996 and 2001., Measurement and Results: Charts of 3072 distinct patients (from 45 unique primary care physicians) were reviewed. Previous emergency department visits or hospitalizations were experienced by 20% of the sample. A total of 25% of patients had documented evidence that they had performed spirometry. More than half of the patients had no documented evidence that they had received any form of asthma education; only 2% of the charts indicated that patients received a written action plan. Two thirds of the patients were prescribed an inhaled steroid within 6 months of the last clinic visit., Conclusions: Our study indicates a gap in the provision of asthma education, written action plans, and spirometric testing for patients diagnosed with asthma among primary care physicians.

Purpose: Many asthmatic patients discharged from emergency departments do not have timely follow-up visits with a primary care physician. This study was conducted to determine the effectiveness of a health professional-based intervention in improving process of care and health outcomes among asthmatic patients discharged from emergency departments., Methods: We enrolled 125 asthmatic patients, aged 5 through 50 years, from the emergency department of a community-based hospital; 62 patients were assigned to usual care and 63 to enhanced care. Enhanced care consisted of usual care plus employment of a coordinator to make follow-up appointments with the patient's primary care physician with at least one reminder telephone call to the patient., Results: At 6 months of follow-up, mean (+/- SD) asthma and pediatric quality-of-life scores were higher in the enhanced care group than in the usual care group (5.7 +/- 1.2 units vs. 5.0 +/- 1.3 units, P = 0.01). The enhanced care group also had a higher rate of follow-up office visits (78% [n = 44] vs. 60% [n = 33], P = 0.003), were more likely to have written action plans (46% [n = 26] vs. 25% [n = 14], P = 0.02), and had fewer asthma symptoms (1.8 +/- 1.1 units vs. 2.2 +/- 1.3 units, P = 0.09). However, these differences disappeared by 12 months of follow-up., Conclusion: A simple intervention wherein a health professional facilitates follow-up visits can improve the process of care and health outcomes of high-risk asthmatic patients. However, the effect of this intervention is time limited and largely wears off by 12 months.

Background: Asthma and chronic obstructive pulmonary disease (COPD) are increasing concerns for First Nations peoples in Canada. Although hospital utilization for asthma and COPD among First Nations peoples has been increasing, the prevalence of asthma or wheezing is comparable to national averages., Objectives: A pilot study was conducted to determine the prevalence of impaired lung function in school-aged First Nations children., Patients and Methods: A First Nations community in northern Alberta was selected to participate. Consent forms and a school health survey were completed by parents or guardians. Children with consent completed spirometry at school, and results were compared with predicted values., Results: A total of 36 children participated (response rate 70.6%). Of these, 19.4% of parents reported that their child had received a physician diagnosis of asthma at some point in their life; only 28.6% had a parental report of still having asthma. Parents smoked in 73.1% of the children's homes. The mean (+/- SD) percentage of forced expiratory volume in 1 s (FEV1) over forced vital capacity (FVC) was 82.6%+/-6.9% (94.4%+/-0.08% of predicted). Evidence of airflow obstruction was found in 25% of the children. Parental report of the child ever having asthma was associated with impaired lung function (OR 3.20; P=0.033). Children in a home with reported mold exposure were less likely to have impaired lung function (OR 0.68; P=0.030)., Conclusions: Many children in this study already have established airflow obstruction and may be at increased risk for asthma or COPD. Exposure to mold appeared to be protective. Further research is needed to evaluate the lung health concerns of this population.

Background: Because obesity promotes inflammation and imposes mechanical constraints to the airways, a high birth weight may be a risk factor for asthma in childhood. However, to our knowledge, few studies have examined this potential relationship., Objective: To determine the relationship between high birth weight and risk of emergency visits for asthma during childhood., Design: Population-based cohort study., Setting: Alberta, Canada., Participants: All neonates born at term (> or =37 weeks) between April 1, 1985, and March 31, 1988, in Alberta (N = 83,595). We divided the cohort into birth-weight categories: low (<2.5 kg), normal (2.5-4.5 kg), or high (>4.5 kg). The cohort was observed prospectively for 10 years.Main Outcome Measure Comparison of risk of emergency visits for asthma over 10 years across the birth-weight categories., Results: Neonates born with a high birth weight had a significantly increased risk of emergency visits for asthma during childhood compared with neonates born with a normal birth weight (relative risk [RR], 1.16; 95% confidence interval [CI], 1.04-1.29). The relationship between birth weight and emergency visits for asthma beyond a birth weight of 4.5 kg was linear, such that every increment of 0.10 kg in birth weight was associated with an additional 10% (95% CI, 2%-19%) increase in the risk of emergency visits for asthma. Other factors associated with an elevated risk for emergency asthma visits during childhood included male sex (RR, 1.26; 95% CI, 1.22-1.30), aboriginal status (RR, 1.20; 95% CI, 1.11-1.29), and low-income status (RR, 1.11; 95% CI, 1.06-1.16)., Conclusions: A high, but not low, birth weight is a risk factor for increased emergency visits during childhood. The risk increases linearly beyond a birth weight of 4.5 kg.

Background: Aboriginals in Canada bear a disproportionately higher burden of some chronic illnesses than nonaboriginals. Although there is a greater prevalence of smoking, poor housing, and overcrowding in aboriginal than nonaboriginal communities, the rates of office and emergency visits for asthma and COPD among aboriginals are not well known., Study Objective: To determine whether aboriginals require higher rates of asthma and COPD emergency and office visits than nonaboriginals., Setting: Population-based cohort of people residing in Alberta, Canada (population 2.8 million) between April 1, 1996, and March 31, 1997., Design: Retrospective cohort study., Results: We observed that aboriginals were 2.1 times (95% confidence interval [CI], 2.0 to 2.2) and 1.6 times (95% CI, 1.6 to 1.6) more likely to have an emergency and office visit for asthma or COPD, respectively, when compared to age-matched and sex-matched nonaboriginals. However, they were 55% (95% CI, 52 to 58%) less likely to see a specialist and 66% (95% CI, 63 to 70%) less likely to undergo spirometry than nonaboriginals., Conclusions: These findings indicate that aboriginals bear a disproportionately higher burden of asthma and COPD than nonaboriginals. However, lower use of spirometry and specialist services suggests that there might be access barriers to quality health care for aboriginals in Canada.

Area-based markers of deprivation (e.g., postal codes) are commonly used to identify groups of people with low socioeconomic status (SES); the validity of this approach, however, remains unknown. In this study, we determined the accuracy of using income quintile groups calculated on the basis of the median family income of each forward sortation area (1996 Canadian census) to identify those living in poverty (i.e., annual family income of < $12,620). The sensitivity and specificity of using the lowest income quintile to capture those in poverty were 26% and 83%, respectively (likelihood ratio (LR) of 1.49; 99% CI, 1.49 to 1.50). Among those in non-metropolitan and metropolitan areas, the LRs were 1.26 (99% CI, 1.26 to 1.27) and 2.01 (99% CI, 2.01 to 2.02), respectively. The use of postal codes as the only marker to identify people with low SES may result in substantial misclassification of personal poverty, particularly in non-metropolitan areas.