Spirometry in chronic obstructive pulmonary disease.
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Early Diagnosis↗
Biomedical subjects
Tjard R J Schermer
Publications and source records attributed to Tjard R J Schermer.
Patterns of inflammation and the use of reversibility testing in smokers with airway complaints.
BACKGROUND: Although both smoking and respiratory complaints are very common, tools to improve diagnostic accuracy are scarce in primary care. This study aimed to reveal what inflammatory patterns prevail in clinically established diagnosis groups, and what factors are associated with eosinophilia. METHOD: Induced sputum and blood plasma of 59 primary care patients with COPD (n = 17), asthma (n = 11), chronic bronchitis (CB, n = 14) and smokers with no respiratory complaints ('healthy smokers', n = 17) were collected, as well as lung function, smoking history and clinical work-up. Patterns of inflammatory markers per clinical diagnosis and factors associated with eosinophilia were analyzed by multiple regression analyses, the differences expressed in odds ratios (OR) with 95% confidence intervals. RESULTS: Multivariately, COPD was significantly associated with raised plasma-LBP (OR 1.2 [1.04-1.37]) and sTNF-R55 in sputum (OR 1.01 [1.001-1.01]), while HS expressed significantly lowered plasma-LBP (OR 0.8 [0.72-0.95]). Asthma was characterized by higher sputum eosinophilic counts (OR 1.3 [1.05-1.54]), while CB showed a significantly higher proportion of sputum lymphocytic counts (OR 1.5 [1.12-1.9]). Sputum eosinophilia was significantly associated with reversibility after adjusting for smoking, lung function, age, gender and allergy. CONCLUSION: Patterns of inflammatory markers in a panel of blood plasma and sputum cells and mediators were discernable in clinical diagnosis groups of respiratory disease. COPD and so-called healthy smokers showed consistent opposite associations with plasma LBP, while chronic bronchitics showed relatively predominant lymphocytic inflammation compared to other diagnosis groups. Only sputum eosinophilia remained significantly associated with reversibility across the spectrum of respiratory disease in smokers with airway complaints.
Adult↗
Severity distribution of chronic obstructive pulmonary disease (COPD) in Dutch general practice.
The actual burden of chronic obstructive pulmonary disease (COPD) in terms of health care use and costs strongly depends on the distribution of disease severity. For the Netherlands, the distribution of diagnosed COPD was estimated by classifying all patients with a physician diagnosis of COPD from two different sources of general practitioners (GP)-data into mild (27%), moderate (55%), severe (15%) or very severe COPD (3%) based on their post-bronchodilator FEV1% predicted, according to the GOLD-guidelines. This distribution will most likely shift to the less severe stages when under-reporting and under-diagnosis are reduced.
Aged↗
Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer.
OBJECTIVE: To explore spirometry utilization among general practitioners and identify practitioner and practice-related factors associated with spirometry utilization. DESIGN: Multivariate multilevel cross-sectional analysis of a questionnaire survey. SETTING: Some 61 general practices involved in a spirometry evaluation programme in the Netherlands. All practices owned a spirometer and were trained to perform spirometry. SUBJECTS: A total of 144 general practitioners and 179 practice assistants. MAIN OUTCOME MEASURES: Extent of spirometry utilization for five indications from national COPD/asthma guidelines, practitioner and practice-related factors associated with spirometry utilization. RESULTS: The response rate was 97%. General practitioners used spirometry mostly to evaluate treatment with inhaled steroids (58%). Significant practitioner-related factors associated with spirometry utilization were: general practitioners' job satisfaction, general practitioners' general interest in research, and prior participation in spirometry training. Practice-related factors associated with spirometry utilization were: presence of a practice nurse, delegation of medical tasks to practice assistants, use of spirometry in different rooms, and use of protocols in practice. CONCLUSION: Practitioner- as well as practice-related factors were associated with the extent of spirometry utilization. In particular, it is essential to improve practice-related factors (e.g. presence of a practice nurse, more delegation of medical tasks to the practice assistant).
Adult↗
Vocational and working career of asthmatic adolescents is only slightly affected.
INTRODUCTION: The aim of this study was to investigate whether teenagers and adolescents (10-22 years) with asthma or asymptomatic bronchial hyperresponsiveness, were more likely to experience vocational or professional career limitations in the future, as compared to non-asthmatic contemporaries. METHODS: Data were used from a 14-year follow-up study in general practice, investigating the relationship between respiratory health in childhood and adolescence. At follow-up, the respiratory health status and information about career limitations were obtained. RESULTS: There were no statistical significant differences between asthmatics (n=52) and non-asthmatics (n=154) in the proportion currently employed subjects, or contract type. Most examined career limitations were infrequently reported in both groups, but seemed to occur slightly more frequent among asthmatics. Asthmatics seemed to have an increased risk for limitations in daily activities both attributable to their respiratory health (OR=2.6, 95% CI [1.0; 7.0]) and all-cause (OR=1.8, 95% CI [0.9; 3.3]), and for absence from work all-cause (OR=1.7, 95% CI [0.9; 3.3]). However, the differences were in most cases in the magnitude of only a few days per year. Neither lung function nor bronchial hyperresponsiveness did predict absence from work, or limitations in daily activities. CONCLUSION: Asthmatic young adults seem to experience somewhat more limitations in their vocational and professional careers. Nonetheless, the majority of the young asthmatics seem to be only slightly limited in their careers. In non-asthmatic young adults the presence of asymptomatic bronchial hyperresponsiveness does not seem to lead to career limitations.
Activities of Daily Living↗
Asthma education tailored to individual patient needs can optimise partnerships in asthma self-management.
This paper studies the effects of patient education, tailored to individual needs of patients as part of an asthma self-management program. A tailored education program was designed which took into account individual information needs of patients by using a feedback instrument. Totally 98 steroid dependent asthmatics entered the tailored education program, 95 patients received usual care. Outcome measures were information exchanged and patient satisfaction. Study duration was 6 months. Patients in the tailored education group showed a significant reduction in information need (P=0.005). Patient satisfaction increased from 87.9 to 93.7 in this group while this did not change in the usual care group (P=0.000). Use of this tailored education program improved the GP-patient interaction within the context of a clinically effective asthma self-management program. Findings from this study may be applicable to other chronic conditions as well.
Acute Disease↗
Willingness of patients to perform self-management of asthma and the role of inhaled steroids.
OBJECTIVE: Asthma self-management is a generally accepted effective treatment strategy for asthma patients. Acceptance by patients may be a barrier for successful implementation. In this study, the role of inhaled steroids in starting asthma self-management is described. DESIGN: Cross-sectional explorative study. SETTING: General practice. SUBJECTS: 283 adult steroid-requiring asthma patients were invited by their GP to participate in a self-management programme. MAIN OUTCOME MEASURES: In a multivariate logistic regression model, the relation between baseline dosage of inhaled steroids, occupational status, age and sex as independent variables and willingness to participate as dependent variables was explored. RESULTS: Of all invited, 148 (52%) were willing to participate. Subjects not using inhaled steroids were least willing to participate (43/143 = 30%). Subjects with low doses of inhaled steroids ( < 400 mcg daily) were most willing to participate (44/54 = 81%). Unemployed asthmatics had a higher tendency to participate than patients with a regular job. CONCLUSION: Acceptance of self-management by patients is not a limiting issue in promoting self-management of asthma in general practice. High acceptance in patients taking low or intermediate doses of inhaled steroids makes general practice the most appropriate setting for self-management. A selection procedure is recommended.
Administration, Inhalation↗