Аsthma

Asthma is one of the most common respiratory tract diseases (about 7% of adults and about 10% of adolescents and children suffer from asthma in the Russian Federation). Astma frequencies of occurrence dont depend from sex or age in population. Numbers of asthmatic patients in the world increase every year. The majority of patients suffering asthma well respond to conventional therapies and successful control disease, but 20-30% of the patients have severe phenotypes asthma resisting for known medicines, therefore they achieve control for asthma very rare. Patients with severe asthma frequently need hospitalizations (up to 30%) and intensive care (4-7%). The clinical asthma guideline has goals to optimize patient care, up-to-date information about the epidemiology, etiology and pathogenesis of the disease. The text contains actual data about asthma classification, its clinical signs, modern diagnostics (clinical, laboratory and instrumental) inclunded the differential diagnostics of astma. There are chapters about asthma treatment, rehabilitation and prevention in the guideline. Authors detailed describe existing healthcare options for asthmatic patients and the features of diasgnostics and care in partial groups of population (adolescents, pregnant or nursing women, persons with occupational or exercise-induced or severe phenotype asthma). The clinical guideline are recommended for medical doctors (independendently from qualification), under- and postgraduate students, universities tutors, residents and researchers.

Implementing asthma management guidelines in public primary care clinics in Malaysia

Implementing asthma guideline recommendations is challenging in low- and middle-income countries. We aimed to explore healthcare provider (HCP) perspectives on the provision of recommended care. Twenty-six HCPs from six public primary care clinics in a semi-urban district of Malaysia were purposively sampled based on roles and experience. Focus group discussions were guided by a semi-structured interview guide and analysed thematically. HCPs had access to guidelines and training but highlighted multiple infrastructure-related challenges to implementing recommended care. Diagnosis and review of asthma control were hampered by limited access to spirometry and limited asthma control test (ACT) use, respectively. Treatment decisions were limited by poor availability of inhaled combination therapy (ICS/LABA) and free spacer devices. Imposed Ministry of Health programmes involving other non-communicable diseases were prioritised over asthma. Ministerial policies need practical resources and organisational support if quality improvement programmes are to facilitate better management of asthma in public primary care clinics.

Asthma guidelines: which is the best of three?

Andrew Booth offers a comprehensive look into national and international guidelines surrounding the diagnosis and management of asthma National and international guidelines provide evidence-based advice on the diagnosis and management of asthma. There are now three potential asthma guidelines to follow, each taking its own unique, and sometimes conflicting direction, creating a total of over 700 pages of high-quality evidence. A puzzle is thus presented to the busy health professional: which guideline do I follow? This article compares and contrasts two national and one international asthma guideline, focusing particularly on diagnosis and pharmacological management. Mortality from asthma is increasing in the UK, making the need for a conjoined guideline more urgent than ever.

Asthma guidelines: the best of three

National and international guidelines provide evidence-based advice on the diagnosis and management of asthma. There are now three potential asthma guidelines to follow, each taking its own its own unique, and sometimes conflicting direction, creating a total of over 700 pages of high-quality evidence. A puzzle is thus presented to the busy health professional: which guideline do I follow? This article compares and contrasts two national and one international asthma guideline, focusing particularly on diagnosis and pharmacological management. Mortality from asthma is increasing in the UK, making the need for a conjoined guideline more urgent than ever.

Bridging the gap between evidence and practice in asthma management by developing a mobile-based clinical decision support system for GINA asthma guideline

Background Physicians’ compliance with clinical practice guidelines (CPG) remains insufficient. Guideline-based clinical decision support systems (CDSSs) can be beneficial to address this challenge. The principal objective of this research is to translate the Global Initiative for Asthma guideline (GINA) into a mobile-based CDSS to improve its utilization as a clinical decision-making tool.Methods Designing and development of our expert system were conducted in an iterative and stepwise approach by the multidisciplinary expert team. Translating and extracting the embedded knowledge in GINA was done according to the Knowledge to Action framework. Next, extracted knowledge was converted to decision tree models to design the knowledge-base of the desired system. The accuracy and proficiency of the expert system were calculated based on the predefined scenarios. The expert system usability was evaluated by the think-aloud protocol and the GUIDES questionnaire.Results Based on the analysis of the GINA guideline, more than 220 rules and 336 knowledge statements were extracted. Our knowledge-based expert system was devised based on production rules. After modification with feedback from six experts, the system was developed in the Android platform. The overall accuracy and efficiency of our CDSS were 100% and 100%, respectively.Conclusion The ginasthma mobile-based CDSS was developed for android smartphones to improve the adherence of health care providers to GINA guideline with high accuracy and efficiency. Further investigation is needed to evaluate the efficacy of this app in real practice.

Emergency department asthma guideline adherence, 72-h return rates and disposition trends: Comparing data 10 years apart

Objective: (1) To compare adherence of Ministry of Health Singapore Guidelines of Acute Asthma in the emergency department, in data 10 years apart, and ascertain if any difference observed impacted 72-h return rates and (2) to describe enhancement in hospital and community medical services for asthma, and its effect on disposition trends. Methods: A retrospective comparison in guideline adherence with regard to systemic steroids administration, anti-cholinergic administration in moderately severe exacerbations and patient education in discharged patients was done. Rates of unscheduled 72-h returns were compared. A description of new community and hospital services was described, and disposition trends were compared. Results In total, 630 patients 10 years ago and 635 patients in the current year were studied, after exclusions and systematic sampling applied. Steroid administration improved by 29% (adjusted p < 0.001). Steroids started in the emergency department improved by 43% (adjusted p < 0.001). Ipratropium addition to second nebulizer improved by 63% (adjusted p < 0.001). Patient education improved by 66% (adjusted p < 0.001). Unscheduled 72-h returns rate were unchanged at 4.2% (adjusted p = 0.912). Although there was no significant difference in the admission and discharge disposition (adjusted p = 0.173), there was a trend towards admission to the short stay unit as an admission option and referral to the primary healthcare provider for discharged patients. Conclusion: Although guideline adherence improved in the current year, rates of 72-h unscheduled returns were similar. Disposition trends reflected emphasis and availability of healthcare services in the community and hospital.

Guía Mexicana del Asma: GUIMA 2017

Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación.Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final.Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México.Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.