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Follow-up of asthma in primary care

Presented by Jaana Takala, Finland

Summary: Uncontrolled asthma is a common problem throughout all treatment steps in asthma1. Various factors, such as lifestyle, adherence, inhalation techniques and other comorbidities may influence respiratory symtoms2 and therefore systematic follow-ups may be needed to address these factors. A 12 year long study revealed there is great potential for improvement both when it comes to frequency and quality of follow-ups.  

Why checkups matter

Regular checkups of asthma are associated with improvement in asthma control3. Continuity of care in asthma is associated with higher adherence to medication4 and with better knowledge of asthma and self-care.5

The occurrence of planned asthma follow-up contacts and quality of these visits in primary health care in Finland was studied in a real-life retrospective setting. Results has been reported in at least three scientific papers.6,7,8

Documentation gaps

The most frequently recorded asthma detail were respiratory symptoms, which was documented in 79% of the consultations and in 86,8% of the consultations if both a nurse and GP attended.7 Interestingly, comorbidities associated with asthma (including obesity, nasal conditions and obstructive sleep apnoea), life-style factors (including exercise habits, diet and alcohol use), asthma symptoms and patient guidance were in general rarely documented at scheduled asthma contacts in primary health care.

Weight loss, a rare advice

The study population mean age was 59 years and had a BMI average over 28. Even though obesity is associated with uncontrolled asthma and with increased risk of exacerbations2, information on BMI was only found in 1.5% of the cases. Exercise habits were more frequently documented, specifically in 16% of the cases and more likely to be documented if a nurse attended the consultation. Recommendation to lose weight or increase the activity levels were only given in 0.9% and 0.6% of consultations, respectively7.

Lifestyle and inhalation techniques

Other life-style factors such as diet and alcohol consumption were documented in <1% of the cases.7 When taking into account that approximately 1/3 of the patients did not have asthma control, it is surprising that inhalation technique was not mentioned in more often than 2.2% of the visits and revised in 2.2% of the visits. Nurses were however significantly better at addressing inhalation technique (mentioned in 8.7% of the visits and revised in 7.8%).7

Allergies

Allergic rhinitis contributes to poorer asthma control and risk of exacerbations. Treating coexisting allergic rhinitis can improve asthma control and reduce healthcare utilization.8 Rhinitis which was only recorded in less than 10% of the patients, even though 70% of the study population rhinitis.7

Summary:

Results from this longitudinal study shows advantages when GP’s and nurses are involved in the care of asthma patients and results may help to identify potential health-care practice-related causes of uncontrolled and difficult-to-treat asthma, and which areas require more urgent training and attention.

Simon Patrzalek

Medical Science Liaison

References

  1. Busse WW, Fang J, Marvel J, Tian H, Altman P, Cao H. Uncontrolled asthma across GINA treatment steps 2 - 5 in a large US patient cohort. J Asthma. 2022 May;59(5):1051-1062. doi: 10.1080/02770903.2021.1897834. Epub 2021 Mar 31. PMID: 33709871.
  2. Global Initiative for Asthma Management and Prevention (GINA), 2024 GINA Main Report
  3. Backer V, Bornemann M, Knudsen D, Ommen H. Scheduled asthma management in general practice generally improve asthma control in those who attend. Respir Med. 2012 May;106(5):635-41. doi: 10.1016/j.rmed.2012.01.005. Epub 2012 Feb 18. PMID: 22349066.
  4. Axelsson M, Ekerljung L, Lundbäck B. The Significance of Asthma Follow-Up Consultations for Adherence to Asthma Medication, Asthma Medication Beliefs, and Asthma Control. Nurs Res Pract. 2015;2015:139070. doi: 10.1155/2015/139070. Epub 2015 Dec 7. PMID: 26770823; PMCID: PMC4685132.
  5. Wireklint P, Hasselgren M, Montgomery S, Lisspers K, Ställberg B, Janson C, Sundh J. Factors associated with knowledge of self-management of worsening asthma in primary care patients: a cross-sectional study. J Asthma. 2021 Aug;58(8):1087-1093. doi: 10.1080/02770903.2020.1753209. Epub 2020 May 5. PMID: 32283944.
  6. Takala J, Ilmarinen P, Tuomisto LE, Vähätalo I, Niemelä O, Kankaanranta H. Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry. NPJ Prim Care Respir Med. 2020 Mar 20;30(1):8. doi: 10.1038/s41533-020-0166-2. PMID: 32198357; PMCID: PMC7083866.
  7. Takala J, Vähätalo I, Tuomisto LE, Niemelä O, Ilmarinen P, Kankaanranta H. Documentation of comorbidities, lifestyle factors, and asthma management during primary care scheduled asthma contacts. NPJ Prim Care Respir Med. 2024 Mar 9;34(1):2. doi: 10.1038/s41533-024-00360-3. PMID: 38461294; PMCID: PMC10925028.
  8. Takala J, Vähätalo I, Tuomisto LE, Niemelä O, Ilmarinen P, Kankaanranta H. Participation in scheduled asthma follow-up contacts and adherence to treatment during 12-year follow-up in patients with adult-onset asthma. BMC Pulm Med. 2022 Feb 15;22(1):63. doi: 10.1186/s12890-022-01850-1. PMID: 35168565; PMCID: PMC8845345.

ID 8699-18.06.2024