Patient's experience of asthma exacerbation and management: a qualitative study of severe asthma

BackgroundExacerbation is a defining feature of severe asthma, and oral corticosteroids (OCSs) are frequently prescribed to manage exacerbations. This qualitative study was conducted to examine the experience of patients with severe asthma, with a focus on asthma exacerbation and OCS treatment.MethodsAdults with severe asthma were recruited from three tertiary hospitals in South Korea. Data were collected through in-depth qualitative interviews. Verbatim transcripts were analysed using Colaizzi's phenomenological method to uncover the meaning of the participants’ experience. Recruitment of participants continued until thematic saturation.ResultsFourteen patients with severe asthma were recruited. Four theme clusters emerged: 1) experience of asthma exacerbation, 2) impact on life, 3) OCS treatments, and 4) disease perception. The patients experienced severe physical and psychosocial distress from asthma exacerbations, felt helpless due to failed efforts to prevent exacerbation, and were living a restricted life due to fear of exacerbation. They feared OCS side effects but had no other choice but to rely on OCS because other interventions were ineffective. Most had poor knowledge and understanding of severe asthma and the longterm health consequences.ConclusionAsthma exacerbation affects wide aspects of life in patients with severe asthma. Several components may underlie OCS reliance, including experience of distress during exacerbation, fear of future exacerbation, and lack of proper knowledge about long-term health consequences of severe asthma and OCS treatments. Multi-disciplinary approach is warranted to support the patients and to provide systematic education about long-term health implications of severe asthma.

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The Long-Term Mental Health Consequences of Torture, Loss, and Insecurity: A Qualitative Study Among Survivors of Armed Conflict in the Dang District of Nepal

Frontiers in Psychiatry ◽

10.3389/fpsyt.2019.00941 ◽

2020 ◽

Vol 10 ◽

Author(s):

Hanna Kienzler ◽

Ram P. Sapkota

Keyword(s):

Mental Health ◽

Qualitative Study ◽

Armed Conflict ◽

Health Consequences

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Predicting pain and function outcomes in people consulting with shoulder pain: the PANDA-S clinical cohort and qualitative study protocol

BMJ Open ◽

10.1136/bmjopen-2021-052758 ◽

2021 ◽

Vol 11 (9) ◽

pp. e052758

Author(s):

Gwenllian Wynne-Jones ◽

Helen Myers ◽

Alison Hall ◽

Chris Littlewood ◽

S Hennings ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Shoulder Pain ◽

Prognostic Model ◽

Latent Class ◽

Qualitative Interviews ◽

Short Term ◽

Clinical Cohort ◽

Costs Of Care

IntroductionPeople presenting with shoulder pain considered to be of musculoskeletal origin is common in primary care but diagnosing the cause of the pain is contentious, leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (1) to investigate the short-term and long-term outcomes (overall prognosis) of shoulder pain, (2) estimate costs of care, (3) develop a prognostic model for predicting individuals’ level and risk of pain and disability at 6 months and (4) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis and management of shoulder pain.Methods and analysisThe Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S) study is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via Short Message Serevice (SMS) text or software application. Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (general practitioner or physiotherapist).Short-term and long-term trajectories of Shoulder Pain and Disability Index (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6 months using penalisation methods to adjust for overfitting. The added predictive value of prespecified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making, perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options.Ethics and disseminationThe PANDA-S study has ethical approval from Yorkshire and The Humber-Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites.Trial registration numberISRCTN46948079.

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P164 Is adequate monitoring being done for patients on long-term oral corticosteroids for severe asthma (adults)?

10.1136/thorax-2019-btsabstracts2019.307 ◽

2019 ◽

Author(s):

R Bhugra ◽

H Joplin ◽

K Mortimer ◽

H Burhan

Keyword(s):

Severe Asthma ◽

Oral Corticosteroids

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Patients with Severe Asthma: Analysis of Future Risks

10.53350/pjmhs21155893 ◽

2021 ◽

Vol 15 (5) ◽

pp. 893-897

Author(s):

Sajida Parveen ◽

Ghufran Zafar ◽

Rukhshanda Nosheen

Keyword(s):

Adverse Effect ◽

Severe Asthma ◽

Acute Asthma ◽

The Other ◽

Lung Damage ◽

Routine Practice ◽

Asthma Risk ◽

Oral Corticosteroids ◽

Keywords Asthma

The upcoming severe health problems can be due to the asthmatic burdens. Severe asthma can lead to dangerous exacerbation and damage of pulmonary function. It can also affect medication-related problems for example steroids. In routine practice, the risk of asthma is not easily detectable. The present tools for the measurement and diagnosis of asthma and asthma-related morbidity cannot surely predict the upcoming risks of morbidity due to medication. The article reviews the existing evidence of upcoming danger in people with asthma. This review is pivoted on the danger in people with “controlled” acute asthma. It is obvious from some studies that long-term use of corticosteroids cannot stop the progression of asthma and lung damage. The other results show that the adverse effect of the drugs increases even with the lesser dose of oral corticosteroids. So, there is a need for new therapies for the reduction of upcoming risks due to asthma. Keywords: Asthma, Risk, Severity.

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Returning to work after long term sickness absence due to low back pain – the struggle within: A qualitative study of the patient's experience

Work ◽

10.3233/wor-131646 ◽

2014 ◽

Vol 49 (3) ◽

pp. 433-444 ◽

Cited By ~ 6

Author(s):

Cormac G. Ryan ◽

Douglas Lauchlan ◽

Leigh Rooney ◽

Caroline Hollins Martins ◽

Heather Gray

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Qualitative Study ◽

Sickness Absence ◽

Low Back ◽

Patient’S Experience ◽

Returning To Work

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Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz028 ◽

2019 ◽

Vol 22 (5) ◽

pp. 722-727

Author(s):

Tamar M J Antin ◽

Catherine Hess ◽

Emily Kaner ◽

Sharon Lipperman-Kreda ◽

Rachelle Annechino ◽

...

Keyword(s):

Young Adults ◽

Qualitative Study ◽

Qualitative Interviews ◽

Delivery Systems ◽

Health Consequences ◽

Product Use ◽

Relative Risks ◽

Nicotine Delivery ◽

Youth And Young Adults

Abstract Introduction Existing research on youth’s adoption of alternative nicotine delivery systems (ANDS) has focused on identifying pathways of nicotine product use, specifically examining whether vaping encourages progression to smoking. Few studies have considered other pathways of initiation. Qualitative studies suggest that meanings of vaping vary significantly, suggestive of the need for a more nuanced understanding of the role of vaping for youth with different pathways into vaping and smoking. Methods We conducted in-depth qualitative interviews with 49 Californian youth between 15 and 25 years old who reported ever vaping nicotine to gain a deeper understanding of their initiation pathways of vaping and smoking, paying special attention to youth’s experiences and reasons for ANDS initiation and use. Categorizing participants into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, we then compared the meaning and role of vaping across three distinct pathways of use: (1) smoking to vaping, (2) vaping to smoking, and (3) vaping only. Results The most common pathway reported was smoking to vaping (74%), eight participants began vaping before smoking, and five participants reported only vaping but never smoking. Analysis of participants’ narratives emphasized that youth in our study, regardless of initiation pathway, were generally aware of the health consequences of smoking and negotiated their use of nicotine products considering relative risks. Conclusion Findings from this study suggest that ANDS serve as a transitional tool for youth who are keenly aware of the health consequences of smoking, thus challenging conventional discourses about ANDS as a threat to youth’s health. Implications This qualitative study queries concerns about the potential of alternative nicotine delivery systems (ANDS) to serve as a gateway into cigarette smoking for youth and young adults. Findings suggest that most of the youth participants discussed and considered relative risks in their pathways of initiation, highlighting the need to acknowledge harm reduction in constructing public health messaging and policies for smoking cessation.

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A qualitative study of adjustment to caring for an older spouse with psychiatric illness

Ageing and Society ◽

10.1017/s0144686x98007120 ◽

1998 ◽

Vol 18 (6) ◽

pp. 659-671 ◽

Cited By ~ 17

Author(s):

JOANNA MURRAY ◽

GILL LIVINGSTON

Keyword(s):

Mental Illness ◽

Qualitative Study ◽

Psychiatric Illness ◽

Qualitative Interviews ◽

Community Study ◽

Care Giving ◽

History Of ◽

The Relationship

An understanding of ways in which older carers' perceptions of their marital relationship and duty to their spouse underlie adjustment to care-giving is required for the development of acceptable and efficacious services for spouse carers. With this aim we conducted qualitative interviews with 20 spouses of older people with a mental illness identified in a representative community study. While carers acknowledged distressing changes in their spouse, a history of reciprocity and intimacy emerged, comprising positive themes and perceived continuity which favourably influenced adjustment to care-giving. Those who still experience closeness in the relationship see themselves as coping and are reluctant to accept formal help. Others describe long-term unhappiness in marriage and experience feelings of entrapment in the role of carer. They require early and comprehensive services. Hypotheses regarding these themes are proposed.

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Predicting pain and function outcomes in people consulting with shoulder pain: The PANDA-S clinical cohort and qualitative study protocol (ISRCTN 46948079)

10.1101/2021.05.26.21257208 ◽

2021 ◽

Author(s):

Gwenllian Wynne-Jones ◽

Helen Myers ◽

Alison Hall ◽

Chris Littlewood ◽

Susie Hennings ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Shoulder Pain ◽

Prognostic Model ◽

Latent Class ◽

Qualitative Interviews ◽

Clinical Cohort ◽

Costs Of Care ◽

Short And Long Term

Introduction Shoulder pain is common in primary care but achieving definitive diagnosis is contentious leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (i) to investigate the short- and long-term outcomes (overall prognosis) of shoulder pain, (ii) estimate costs of care, (iii) develop a prognostic model for predicting individuals level and risk of pain and disability at 6 months, (iv) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis, and management of shoulder pain. Methods and analysis PANDA-S is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via SMS text or software application (App). Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with 15 dyads of patients and their healthcare professional (GP or physiotherapist). Short and long-term trajectories of shoulder pain and disability (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6-months using penalisation methods to adjust for overfitting. The added predictive value of pre-specified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making and perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options.

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Management of difficult to treat severe asthma—what's the evidence?

Drug and Therapeutics Bulletin ◽

10.1136/dtb.2016.11.0435 ◽

2016 ◽

Vol 54 (11) ◽

pp. 126-129

Keyword(s):

Severe Asthma ◽

Systemic Corticosteroid ◽

Treatment Options ◽

Corticosteroid Treatment ◽

High Dose ◽

Safety And Efficacy ◽

International Guidelines ◽

Frequent Use ◽

Oral Corticosteroids

The management of adults with asthma that remains uncontrolled despite treatment with high-dose therapies poses a challenge to clinicians and patients. National and international guidelines recommend intensification of treatment that typically involves the use of oral corticosteroids.1,2 The risks associated with long-term systemic corticosteroid treatment are well documented, and have led to the search for alternatives. Recent advances in the understanding of the pathology of asthma have prompted the development of other treatment options. Here, we consider the options available for people who require continuous or frequent use of oral corticosteroids and review the safety and efficacy of such treatments.

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