The Obstructive Lung Diseases Program: Integrated obstructive lung disease services within primary care in Pakistan

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Saima Saeed ◽  
Madiha Siddiqui ◽  
Rahma Altaf
Keyword(s):  
Primary Care ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Lung Diseases ◽  
Univariate Analysis ◽  
Care Program ◽  
Treatment Modalities ◽  
Clinical Aspects ◽  
Obstructive Lung Diseases ◽  
Patient Reported

Objective: To assess the learning impact of e-curriculums on healthcare professionals (HCPs). The second objective was to report the screening, detection and clinical features of patients with obstructive lung diseases (OLD) through an integrated care program at The Indus Hospital & Health Network (IHHN), Karachi, Pakistan. Methods: A retrospective, observational study was conducted in the Family Medicine outpatient department from January 2019 till July 2021. HCPs were trained on the diagnosis and management of OLD through e-learning. Patients were screened clinically for OLD and had spirometry performed if suspect. Baseline characteristics, patient-reported outcome measures (PROMs), spirometry and treatment modalities were collected. Univariate analysis was done on Excel and paired t-testing was performed on Stata 16.  Results: Online training on clinical aspects of OLD was completed by 33 HCPs, amongst whom 77.9% demonstrated improved post-test evaluations of 26.8% (p=0.000). Of 1896 patients screened, 60.8% were diagnosed as OLD. Asthmatics accounted for 66.5% (60.9% females, median age 39 years). In 84.5% of patients who completed PROMs, poor control of symptoms was reported. Inhaler technique was taught in 66.5%. Breathless patients, with a high modified Medical Research Council score (mMRC ≥ 2, n=234), were referred for pulmonary rehabilitation in 92% of cases. Tobacco cessation advice was delivered to 61.1% of all current users (n=229). Conclusion: The OLD program uses capacity building, gold standard diagnostics and updated management strategies in primary care, allowing earlier diagnosis of suspected patients and implementation of evidence-based interventions, aiming to improve their morbidity and mortality. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5781 How to cite this:Saeed S, Siddiqui M, Altaf R. The Obstructive Lung Diseases Program: Integrated obstructive lung disease services within primary care in Pakistan. Pak J Med Sci. 2022;38(2):334-339. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5781 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Spirometry and Obstructive Lung Disease in Manitoba

2001 ◽  
Vol 8 (6) ◽  
pp. 421-426 ◽  
Author(s):  
NR Anthonisen ◽  
N Dik ◽  
J Manfreda ◽  
LL Roos
Keyword(s):  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Lung Diseases ◽  
Service Use ◽  
Present Report ◽  
Postal Code ◽  
Chronic Obstructive ◽  
Fee For Service ◽  
Physician Visits ◽  
Obstructive Lung Diseases

BACKGROUND: Spirometry, the measurement of forced expiratory volume in 1 s and forced vital capacity, is recommended in the diagnosis and management of the obstructive lung diseases asthma and chronic obstructive pulmonary disease (COPD). The present report describes spirometry use in Manitoba and tests the hypothesis that regional spirometry use correlates with the prevalence of physician-diagnosed obstructive lung diseases.METHODS: Spirometry is remunerated on a fee-for-service basis by Manitoba Health. Like other physician services, billing data include a diagnosis, patient identifiers, as well as the patient’s sex, date of birth and residential postal code. Physician billings for spirometry for 1991 to 1998 were analyzed, comparing data with billings for physician visits for obstructive diseases. Four age groups were examined, as were income quintiles in Winnipeg, Manitoba. In addition, the prevalence of physician-diagnosed obstructive diseases were compared with spirometry rates in 49 service use areas of the province.RESULTS: Annually, about 3% of the Manitoba population underwent spirometry, and in aggregate, about 14% underwent spirometry during the eight years of the study. Rates in Winnipeg were higher than in the remainder of the province. Spirometry rates did not increase with time, and people who underwent spirometry had 1.4 to 1.7 tests/year. In children, higher income quintiles were tested more than lower income quintiles, while in adults, income quintiles were tested with equal frequency. People with obstructive lung disease accounted for about 75% of those tested, and in people with these diagnoses, the likelihood of testing increased approximately linearly with the number of physician visits for asthma or COPD. Children with asthma were tested less often than adults, and adults with asthma or both asthma and COPD were tested more often than those with COPD alone. In adults with asthma or asthma and COPD who had more than 10 physician visits for these diagnoses, testing rates were more than 70%, and multiple tests were common. In patients labelled with COPD only and with more than 20 physician visits, about one-third did not undergo spirometry. In children aged five to 14 years and in adults 15 to 44 years old, regional spirometry rates correlated well with regional asthma rates. Regional spirometry rates also correlated significantly with regional rates of asthma and/or COPD in people older than 34 years old.INTERPRETATION: Spirometry use is considerably higher in patients with asthma than in patients with COPD, suggesting that guidelines are followed more closely in patients with asthma, and that many patients are labelled with COPD without appropriate documentation. Spirometry use is apparently indicative of physician interest in the problem of obstructive lung diseases.

scholarly journals Intravital microscopic optical coherence tomography imaging to assess mucus-mobilizing interventions for muco-obstructive lung disease in mice

2020 ◽  
Vol 318 (3) ◽  
pp. L518-L524 ◽  
Author(s):  
Mario Pieper ◽  
Hinnerk Schulz-Hildebrandt ◽  
Marcus A. Mall ◽  
Gereon Hüttmann ◽  
Peter König
Keyword(s):  
Optical Coherence Tomography ◽  
Transgenic Mice ◽  
Lung Disease ◽  
Hypertonic Saline ◽  
Obstructive Lung Disease ◽  
Lung Diseases ◽  
Isotonic Saline ◽  
Optical Coherence ◽  
Obstructive Lung Diseases

Airway mucus obstruction is a hallmark of chronic lung diseases such as cystic fibrosis, asthma, and COPD, and the development of more effective mucus-mobilizing therapies remains an important unmet need for patients with these muco-obstructive lung diseases. However, methods for sensitive visualization and quantitative assessment of immediate effects of therapeutic interventions on mucus clearance in vivo are lacking. In this study, we determined whether newly developed high-speed microscopic optical coherence tomography (mOCT) is sensitive to detect and compare in vivo effects of inhaled isotonic saline, hypertonic saline, and bicarbonate on mucus mobilization and clearance in Scnn1b-transgenic mice with muco-obstructive lung disease. In vivo mOCT imaging showed that inhaled isotonic saline-induced rapid mobilization of mucus that was mainly transported as chunks from the lower airways of Scnn1b-transgenic mice. Hypertonic saline mobilized a significantly greater amount of mucus that showed a more uniform distribution compared with isotonic saline. The addition of bicarbonate-to-isotonic saline had no effect on mucus mobilization, but also led to a more uniform mucus layer compared with treatment with isotonic saline alone. mOCT can detect differences in response to mucus-mobilizing interventions in vivo, and may thus support the development of more effective therapies for patients with muco-obstructive lung diseases.

scholarly journals Descriptors of dyspnea in obstructive lung diseases

2010 ◽  
Vol 5 ◽  
Author(s):  
Sabina A. Antoniu
Keyword(s):  
Clinical Practice ◽  
Lung Disease ◽  
Respiratory Symptom ◽  
Obstructive Lung Disease ◽  
Lung Diseases ◽  
Clinical Utility ◽  
Large Range ◽  
Airflow Obstruction ◽  
Obstructive Lung Diseases ◽  
Life Threatening

In obstructive lung diseases such as asthma and COPD dysp- nea is a common respiratory symptom with different charac- teristics given the different pathogenic mechanisms: in COPD initially it can occur during exertion but then it increases pro- gressively along with the airflow obstruction, whereas in asthma it occurs episodically and is caused by transient bron- choconstriction. The language of dyspnea includes a large range of clinical descriptors which have been evaluated for their correlation (of one or several descriptors) with underlying physiologic/phys- iopathologic mechanisms. These studies were done in asthma rather than in COPD, and dyspnea descriptors were found to be useful in identifying patients with life-threatening asthma. However further studies are needed to further explore such descriptors and their clinical utility. This review discusses dyspnea mechanisms in various obstructive lung disease subsets as well as the descriptors of dyspnea and their utility in clinical practice.

scholarly journals Accuracy of diagnosis of COPD and factors associated with misdiagnosis in primary care setting. E-DIAL (Early DIAgnosis of obstructive lung disease) study group

2018 ◽  
Vol 143 ◽  
pp. 61-66
Author(s):  
Stefano Nardini ◽  
Isabella Annesi-Maesano ◽  
Marzia Simoni ◽  
Adriana del Ponte ◽  
Claudio Maria Sanguinetti ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Diagnosis ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Care Setting ◽  
Primary Care Setting ◽  
Study Group ◽  
Factors Associated ◽  
Disease Study

Pulmonary Evaluation

2016 ◽  
pp. 747-766
Author(s):  
Vivek N. Iyer
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cystic Fibrosis ◽  
Lung Disease ◽  
Lung Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Airway Stenosis ◽  
Obstructive Lung Diseases ◽  
Diffuse Panbronchiolitis ◽  
Antitrypsin Deficiency

Obstructive lung diseases include chronic obstructive pulmonary disease (COPD) (eg, chronic bronchitis and emphysema), asthma, bronchiectasis, cystic fibrosis, obliterative bronchiolitis, and diffuse panbronchiolitis (eg, bullous lung disease, α‎1-antitrypsin deficiency, and airway stenosis). The 2 most prevalent obstructive lung diseases are COPD and asthma.

Obstructive Lung Diseases

2016 ◽  
pp. 741-746
Author(s):  
Vivek N. Iyer
Keyword(s):  
Differential Diagnosis ◽  
Interstitial Lung Disease ◽  
General Population ◽  
Lung Disease ◽  
Pulmonary Edema ◽  
Lung Diseases ◽  
Lung Parenchyma ◽  
Obstructive Lung Diseases ◽  
Lung Malignancies

An estimated 1 in 3,000 to 1 in 4,000 persons in the general population have a diagnosis of interstitial lung disease (ILD), and ILDs account for about 15% of all consultations for general pulmonologists. These diseases encompass a group of heterogeneous lung conditions characterized by diffuse involvement of the lung parenchyma and pulmonary interstitium. By convention, infections, pulmonary edema, lung malignancies, and emphysema are excluded, but they should be carefully considered as part of the differential diagnosis.

LATE-BREAKING ABSTRACT: Early DIAgnosis of obstructive Lung disease at primary care level. The E-DIAL study

2016 ◽  
Author(s):  
Stefano Nardini ◽  
Fernando De Benedetto ◽  
Giorgio Reggiardo ◽  
Valentina Mirisola ◽  
Claudio M. Sanguinetti ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Diagnosis ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Care Level ◽  
Primary Care Level

scholarly journals Vitamin D Deficiency and Chronic Lung Disease

2009 ◽  
Vol 16 (3) ◽  
pp. 75-80 ◽  
Author(s):  
Christopher R Gilbert ◽  
Seth M Arum ◽  
Cecilia M Smith
Keyword(s):  
Vitamin D ◽  
Pulmonary Function ◽  
Lung Disease ◽  
Vitamin D Deficiency ◽  
Chronic Lung Disease ◽  
Obstructive Lung Disease ◽  
Lung Diseases ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Chronic Lung Diseases

Vitamin D deficiency is increasingly being recognized as a prevalent problem in the general population. Patients with chronic lung diseases such as asthma, cystic fibrosis, chronic obstructive lung disease and interstitial pneumonia appear to be at increased risk for vitamin D deficiency for reasons that are not clear.Several studies indicate that vitamin D possesses a range of anti-inflammatory properties and may be involved in processes other than the previously believed functions of calcium and phosphate homeostasis. Various cytokines, cellular elements, oxidative stress and protease/antiprotease levels appear to affect lung fibroproliferation, remodelling and function, which may be influenced by vitamin D levels. Chronic lung diseases such as asthma and chronic obstructive lung disease have also been linked to vitamin D on a genetic basis. This immune and genetic influence of vitamin D may influence the pathogenesis of chronic lung diseases. A recent observational study notes a significant association between vitamin D deficiency and decreased pulmonary function tests in a large ambulatory population.The present review will examine the current literature regarding vitamin D deficiency, its prevalence in patients with chronic lung disease, vitamin D anti-inflammatory properties and the role of vitamin D in pulmonary function.

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