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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peak flow meters provide physicians and patients with objective measures about changes in pulmonary obstruction. We evaluated eight models of peak flowmeters and measured their accuracy and reproducibility with methods recently recommended by the National Asthma Education Program (NAEP). Waveforms from the American Thoracic Society's spirometer testing set were used to drive a computer-controlled syringe. Testing was done at Salt Lake City at an altitude 1,400 m. It appears that the original Wright peak flowmeter has been used as the "de facto" standard. We found that the original Wright peak flowmeter overestimated flows in its midrange; and, as a consequence, most of the other peak flowmeters also overestimated peak flows. The overestimation of peak flows may have been understated because of the 1,400-m altitude testing site. To the credit of the instrument manufacturers, we were pleasantly surprised with the quality, accuracy, and reproducibility of presently available peak flowmeters; however, as a result of our testing, we suspect that with little effort, manufacturers of peak flowmeters could improve the accuracy of their devices. Standardized testing methods and equipment should make the task of peak flowmeter design, manufacture, and testing even easier. We trust that manufacturers of peak flowmeters will respond appropriately and improve their instruments.
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PMID:Evaluation of accuracy and reproducibility of peak flowmeters at 1,400 m. 153 49

A postal survey of selected general practitioners from Brisbane, Melbourne, Sydney and rural New South Wales was conducted to compare general practitioners' self-reported asthma management practices with the Asthma Management Plan (1989) of the Thoracic Society of Australia and New Zealand. The results suggest that most general practitioners know and practise appropriate asthma management. Room for improvement, however, was detected in the following areas: 1. appropriate understanding of the use of theophyllines, 2. the use of preventive medications such as inhaled steroid and sodium cromoglycate, 3. use of crisis planning for severe asthma attacks, 4. lung function measurement.
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PMID:Asthma management in general practice. 168 25

Asthma continues to cause unacceptably high rates of disability and death, largely because the severity of disease is underestimated and patients are inadequately educated about their disease. When patients understand what happens during an asthma attack and its aftermath, they are more likely to notice important symptoms and to start or increase self-treatment appropriately. Physicians are responsible for teaching patients how to avoid precipitating factors and for discussing and writing down a self-treatment plan to follow in specific circumstances. The British Thoracic Society has suggested a stepwise protocol for drug treatment of asthma. Each patient must be evaluated individually and started at the appropriate step.
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PMID:New concepts in treatment of chronic persistent asthma. Using a stepwise protocol to control inflammation. 188 60

Mortality due to asthma was recognised by Thomas Willis in 1671 though it was not until the early 1960s that an epidemic of death raised major concern in the United Kingdom. Initially over-treatment with beta agonist aerosols was blamed as the cause both here and in Australia and New Zealand. Further studies in London, Cardiff and Birmingham suggested this was not the case, rather than under diagnosis, under appreciation and under treatment were a more common cause of asthma mortality. The British Thoracic Society's confidential survey in 1979 confirmed these findings and further suggested that wrong certification was a potential source of inaccuracy in older age groups. More recently the New Zealand Asthma Task Force have reported the results of a two year national survey of deaths, revealing similar results to the UK studies, also finding little evidence of beta agonist over usage, little effect of nebulized drug administration and no significant theophylline drug over usage. An examination of trends in Asthma Mortality in the United Kingdom by Stewart and Nunn shows that the changes in the World Health Organisation I.C.D. coding of 1967 and 1978 had little overall effect on asthma death certification in the 15-44 year old age group. When this is taken into account they found that asthma mortality has declined from 1958 to 1982 in females but that there has been no change in males despite therapeutic advances over the period. Asthma mortality date derived since; however, does suggest a small but significant annual incremental rise in the 15 to 44 year age group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Asthma deaths in the United Kingdom. 350 2

Nonspecific bronchial hyperresponsiveness (BHR) is a hallmark of clinical asthma, but can be present in nonasthmatics as well. The diagnosis of asthma is based on clinical grounds, and no laboratory procedure can definitely establish its presence. This poses a problem in studies of asthma. If epidemiological studies are to provide valid information, the tools used must have a relative degree of predictive or diagnostic ability. This report determined whether the American Thoracic Society-Division of Lung Disease (ATS-DLD) respiratory questionnaire has the ability to predict different degrees of non-specific BHR. In the years 1983-1990, when the ATS-DLD questionnaire was used in our Natural History of Asthma study, 192 subjects completed the ATS-DLD questionnaire and underwent a standardized methacholine challenge. A recursive partitioning analysis of the ATS-DLD questionnaire was able to predict which questions would likely be answered if the subject had nonspecific bronchial reactivity to inhaled methacholine of 100 and 200 breath units. Positive responses for questions concerning treatment for asthma, wheezing, or shortness of breath, and emergency treatment for asthma predicted the presence of increased bronchial reactivity.
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PMID:The usefulness of questionnaire-derived information to predict the degree of nonspecific bronchial hyperresponsiveness. 755 71

The objective of this study was to audit the care of patients after discharge from hospital, following admission for acute severe asthma, using the British Thoracic Society guidelines (1) as a standard. Discharge prescriptions and questionnaires sent to patients at home were analyzed for 51 patients who had been admitted to a teaching hospital with acute severe asthma. Main outcome measures were Peak flow measurements, written instructions, prescription of steroids, and outpatient follow-up. Of the 34 patients responding to the questionnaires, 15 (44%) had no peak flow meter, 23 (68%) had no written instructions, 13 (38%) had no supply of oral steroids at home, and 32 (94%) were prescribed a beta-agonist regularly of whom 12 (35%) were not on an inhaled steroid. Four (9%) patients were not followed up as outpatients; appointments ranged from 2 to 56 days following discharge. In over 60% of asthmatic patients discharged from hospital the guidelines recommended by the British Thoracic Society were not followed. The method used is an inexpensive, efficient way of auditing hospital practice.
J Asthma 1995
PMID:Care of asthmatics on discharge from hospital: a hospital audit. 755 68

The accuracy, reproducibility, and variability of seven commercially available peak flowmeters were assessed using the pulmonary waveform generator as recommended by the American Thoracic Society. The standard models were tested for peak flows of 100, 200, 320, 500, and 700 L/min. The low-range models were tested for peak flows of 80, 150, 200, 250, and 320 L/min. Most of the units provided highly repeatable estimates of peak flow. However, the accuracy of several devices (Assess [Healthscan Products, Cedar Grove, NJ] and Mini-Wright [Clement Clarke International, Harlow, Essex, UK] low-range models, and the Ferraris [Ferraris Medical, Holland, NY] and Mini-Wright standard-range models) did not meet the National Asthma Education Program (NAEP) recommendations. The device with the best performance in terms of accuracy, variability, and reproducibility, and the only one in which all units tested met the NAEP recommendations, was the Astech (Center Laboratories, Port Washington, NY) full-range model.
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PMID:Accuracy, reproducibility, and variability of portable peak flowmeters. 787 31

Since asthma is the most common chronic illness in childhood, many of the problems associated with this condition will impact on the child's education. Because of widespread concerns regarding the management of asthma in schools, a subcommittee of the Thoracic Society of Australia and New Zealand, Asthma Special Interest Group, was convened to draw up national guidelines for school staff in order to provide optimal management of asthma in the school setting. We used current medial literature and the clinical experience of the authors who have dealt with children and adolescents suffering from asthma in the hospital, community and school environment. A number of issues had been identified, including: the availability of an asthma first aid kit; correct use of bronchodilator aerosols by puffer and spacer devices; and clear instructions as to when to notify parents and when to call an ambulance to the school.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A national policy on asthma management for schools. The Asthma Special Interest Group, Thoracic Society of Australia and New Zealand. 786 76

Asthma is a chronic disease estimated to affect 6-7% of the total UK population. In addition, a number of studies have shown that asthma has become commoner since the 1970s, especially in children. The diagnosis of asthma can be difficult and its management requires the involvement of patients in a long-term treatment plan, something which general practitioners may be unable to achieve easily in the average 10-min consultation. As a consequence, asthma is underdiagnosed and undertreated. Deaths from the disease are often avoidable with timely and sufficient use of the available medication. In order to support this, the British Thoracic Society (BTS) has published guidelines for asthma management based upon a stepwise approach, in which a patient is categorized as being on one of five steps according to the severity of his or her asthma. The guidelines give "rules of thumb" for deciding when the patient should move up or down the steps. The most recent version of the guidelines also included special rules for children. Within a recent European Community project on Advanced Informatics in Medicine (AIM), we developed a prototype decision support system for asthma management targeted at the primary care setting and based on the British Thoracic Society guidelines. This paper reports this development, and describes the further work needed on the prototype. Plans for evaluation of the knowledge bases and for future full application production are also described.
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PMID:A prototype computer decision support system for the management of asthma. 870 91

The aim of the study was to assess the effect of treatment on health-related quality of life (HRQoL) in patients with asthma. We used the Japanese version of the Living With Asthma Questionnaire (LWAQ) as an asthma-specific HRQoL measure. Thirty-four new patients were enrolled and treated according to Guidelines on the Management of Asthma by the British Thoracic Society. The LWAQ and spirometry were evaluated on the initial visit, and three and six months after treatment. The LWAQ score, forced expiratory volume in one second (FEV1), and forced vital capacity (FVC) were significantly improved three months after treatment. The Japanese version of the LWAQ was reliable. For the first three months, there were no correlations between changes in FEV1 or FVC and LWAQ scores (Rs = 0.11-0.25). Pulmonary functions could not predict HRQoL well. Therefore, HRQoL should be measured directly to assess HRQoL in asthmatics.
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PMID:[Effect of treatment on health-related quality of life in patients with asthma]. 961 75


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