科研之友
微信
新浪微博
Facebook
分享链接
摘要
Background and aims: The management of patients with mixed forms of bronchial asthma and COPD is not addressed in the major international guidelines which exclusively address pure forms. AIMAR thus undertook a survey to obtain information about: a) the perceived frequency of mixed forms of asthma/COPD and of different forms of asthma in the elderly; b) patient management regarding the mixed forms (focus on therapeutic goals and consequent treatment); c) the principal management problems perceived (guidelines, diagnosis, treatment, follow up, indices of appropriateness in pharmacological treatment).
Methods: The survey consisted of 13 multiple choice questions, completed by means of a web-based electronic form published in internet. All the data and responses inserted in the system were checked on-line for coherence and completeness directly during the phase of insertion and each participant had one only possibility of participating. The data thus collected were memorized directly within a relational database (based on consolidated open-source MySQL technology, the widespread standard in web applications) and thus were immediately available for examination during the course of the survey. Access to the data, mediated by a "back office" system of interrogation and report, enabled constant monitoring of the survey as it was being carried out, as well as extractions and verification, even on smaller data sets.
Results: The survey was carried out during the month of January and first week of February 2011.A total of 289 questionnaires were collected from the following physician groups: pneumologists (n = 198), general practitioners (GPs) (n = 42), allergologists (n = 16), internal medicine specialists (n = 15), other specialists (n = 13), geriatricians (n = 5).
Conclusions: Mixed forms of bronchial asthma and COPD are considered present in about 20% of patients visited and considered typical of patients with a previous history of asthma, particularly if smokers. Risk factors such as smoking, obesity and bronchial hyperreactivity are considered important. Diagnosis is difficult solely on the basis of symptoms in approximately 50% of cases, and a previous history of asthma, history of spirometry and presence of allergy are of help. Treating inflammation and reducing exacerbations are considered the key therapeutic goals and the combination of inhaled corticosteroid (ICS) and long acting beta(2)-agonist (LABA) and monotherapy with ICS are considered the fundamental pharmacological mode for treating patients with mixed forms of bronchial asthma and COPD. Treating with only a bronchodilator is considered to be moderately risky for this type of patient. The identification and management of mixed forms result more impeded by "logistic" aspects, e.g. long waiting lists and poor integration between GP and specialist, than by aspects intrinsic to the disease management itself, e.g. interpreting the outcome of the instrumental examinations. Treatment continuity and the integration between GP and specialist are the factors that most limit the management of mixed forms in the stable phase.
- 出版日期2011-6
