OBJECTIVE: To review the literature for any promising strategies for the primary care management of mild-to-moderate asthma and chronic obstructive pulmonary disease (COPD) in adults. METHODS: Using "MeSH" terms for COPD, asthma and primary health care, we conducted an extensive literature search for relevant meta-analyses, systematic reviews, narrative reviews, reports and individual studies. Grey literature was also included. We chose a narrative review approach because of substantial heterogeneity of study designs in the literature. RESULTS: 1119 articles of potential relevance were retained, of which 246 were included in our review. There was insufficient evidence to determine whether general practitioners with a special interest (GPwSI) in respiratory care improved the diagnosis and management of mild-to-moderate COPD. An asthma service involving GPwSI increased respiratory drug costs but reduced the costs for less specific drugs. No clear benefit has been shown for practice nurse-run asthma clinics in primary care compared with usual care in altering asthma morbidity, quality of life, lung function or medication use. Evidence to determine the effectiveness of practice nurse-run COPD clinics could not be found. Self-management education, GP review and action plans may produce short-term benefits for asthma patients, particularly those with moderate-to-severe disease, but the evidence for a similar approach to patients with mild-to-moderate COPD is equivocal. There has been poor uptake of respiratory clinical guidelines relevant to primary care - partly because most guidelines are based on moderate-to-severe disease. Spirometry programs in primary care are useful for differential diagnosis of asthma and COPD. Spirometry may alter the management of mild asthma, but there is a lack of evidence that it alters the management of COPD in primary care. CONCLUSION: The role of primary health care in management of mild-to-moderate asthma and COPD requires further investigation using randomised controlled trials.
OBJECTIVE: To review the literature for any promising strategies for the primary care management of mild-to-moderate asthma and chronic obstructive pulmonary disease (COPD) in adults. METHODS: Using "MeSH" terms for COPD, asthma and primary health care, we conducted an extensive literature search for relevant meta-analyses, systematic reviews, narrative reviews, reports and individual studies. Grey literature was also included. We chose a narrative review approach because of substantial heterogeneity of study designs in the literature. RESULTS: 1119 articles of potential relevance were retained, of which 246 were included in our review. There was insufficient evidence to determine whether general practitioners with a special interest (GPwSI) in respiratory care improved the diagnosis and management of mild-to-moderate COPD. An asthma service involving GPwSI increased respiratory drug costs but reduced the costs for less specific drugs. No clear benefit has been shown for practice nurse-run asthma clinics in primary care compared with usual care in altering asthma morbidity, quality of life, lung function or medication use. Evidence to determine the effectiveness of practice nurse-run COPD clinics could not be found. Self-management education, GP review and action plans may produce short-term benefits for asthmapatients, particularly those with moderate-to-severe disease, but the evidence for a similar approach to patients with mild-to-moderate COPD is equivocal. There has been poor uptake of respiratory clinical guidelines relevant to primary care - partly because most guidelines are based on moderate-to-severe disease. Spirometry programs in primary care are useful for differential diagnosis of asthma and COPD. Spirometry may alter the management of mild asthma, but there is a lack of evidence that it alters the management of COPD in primary care. CONCLUSION: The role of primary health care in management of mild-to-moderate asthma and COPD requires further investigation using randomised controlled trials.
Authors: Kristjana Einarsdóttir; David B Preen; Jon D Emery; Christopher Kelman; C D'Arcy J Holman Journal: J Gen Intern Med Date: 2010-04-28 Impact factor: 5.128
Authors: Kristjana Einarsdóttir; David B Preen; Frank M Sanfilippo; Raylene Reeve; Jon D Emery; C D'Arcy J Holman Journal: BMC Public Health Date: 2010-07-01 Impact factor: 3.295
Authors: Lucas E M Annelies; Derckx W C C Emmy; Meulepas A Marianne; Smeele J M Ivo; Smeenk W J M Frank; van Schayck P Onno Journal: BMC Res Notes Date: 2012-07-23
Authors: Jianzhen Zhang; Letitia Burridge; Kimberley A Baxter; Maria Donald; Michele M Foster; Samantha A Hollingworth; Robert S Ware; Anthony W Russell; Claire L Jackson Journal: Trials Date: 2013-11-12 Impact factor: 2.279