Asthma is described as a chronic inflammatory disorder of the airways. Recurrent episodes of acute attacks or exacerbation may occur in susceptible individuals. Asthma could be a controllable disorder and most people with asthma should be able to lead a n

In this thesis, I describe a series of studies of the prevalence, causes, and management of asthma in the Pacific. The core study of the thesis is Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). The ISAAC study is the largest worldwide epidemiological study on asthma prevalence and was established partly in response to the increases in asthma prevalence in most parts of the world over the last two to three decades. The ISAAC Phase I study found large variations in asthma prevalence globally, but no Pacific countries were involved. Thus, the situation in the Pacific was relatively unknown due to lack of standardised studies on prevalence and time trends. The burden and impact of other non-communicable diseases such as cardiovascular and other metabolic disorder on the other hand have been the target of various studies in the Pacific for the past few decades The ISAAC Phase III study was therefore conducted in eight Pacific countries to address the above issues, as well as to enhance Pacific participation and contribution to international research on the causes and control of asthma. The collaboration also served the purpose of encouraging and strengthening health research capacity in the Pacific. The ISAAC Phase III study was followed by an asthma self-management intervention trial conducted in Tonga by the ISAAC Tonga study team. Methods The work presented in this thesis involved: (i) the conduct of the ISAAC Phase III study in the six Pacific islands of Tokelau, Samoa, Fiji Islands, Tonga, Niue and the Cook Islands, as well as the incorporation into the analysis of data that had already been collected in French Polynesia and New Caledonia; (ii) analysis of the data from an environmental asthma risk factor questionnaire which was included in the ISAAC survey in three countries (Samoa, Fiji and Tokelau); (iii) the conduct of the Tonga Asthma Self-management Study which was intended to assess whether the introduction of asthma education, including asthma self-management plans, would reduce morbidity from asthma. Results A total of 20,876 13-14 year olds, in the eight countries involved, participated in the ISAAC Phase III survey, with an overall response rate of 92%. The survey showed that there was considerable variation in the prevalence of asthma symptoms between the eight countries, ranging from 5.8% for current wheeze in Samoa to 16.2% in Tonga. Tokelau reported the highest prevalence (19.7%) for current wheeze, but the number of participants was relatively small. The prevalences of asthma symptoms among Pacific children in the Pacific were lower than those reported for Pacific, Māori and European children living in New Zealand from a previous study (ISAAC Phase I) conducted ten years earlier using the same methodology. The prevalence of 'asthma ever' in Pacific children living in the Pacific was also lower than that found among Pacific, Māaori and European children in New Zealand. The ISAAC Phase III environmental questionnaire data was collected in Samoa, Fiji and Tokelau. The analyses indicated that the major factors associated with current wheeze (across the three countries) were paracetamol use in the previous year (odds ratio (OR) = 1.36, 95% CI 1 15-1.61), the use of open fires for cooking (OR = 1.34,95% CI 1.13-1.58), lack of physical activity as indicated by television viewing more than 3 hours per day (OR = 1.24,95% CI 1.04-1.47), regular meat consumption (OR = 1.30,95% CI 1.09-1.54) and regular cereal consumption (OR = 1.29,95% CI 1.07-1.54). However, these risk factors were not particular strong, and did not account for a large proportion of asthma cases (i.e. they had relatively low population attributable risks). The asthma self-management plan intervention study resulted in significant improvements in asthma morbidity and the management of asthma among individuals and the service provision. The success of the introduction of the self-management plan, in the context of an asthma clinic, was reflected by improvement in measures of asthma morbidity, such as peak expiratory flow rates and nights woken with asthma or coughing. There was also a reduction in the requirement for acute medical treatment, indicated by a decrease in emergency department hospital visits for asthma and hospital admissions. The programme was so successful that the intervention study evolved into a full regular asthma clinic for the main island of Tonga. It is now intended that the asthma self-management programme will be extended throughout the rest of Tonga, through the primary health care system. Conclusions The ISAAC Phase IIII survey has shown that, although there is a significant level of morbidity, asthma prevalence in Pacific countries is lower than those among Pacific people in New Zealand. Together with the large variations in prevalence between the six Pacific countries that participated, this further lends support for the role of environmental risk factors in asthma. The availability of data on eight countries using a standardised methodology also provides useful information on the burden of asthma in the Pacific that is comparable to other countries regionally and internationally as well as forming a basis for ascertaining trends in the future. The crucial role of asthma self-management plans in asthma management is supported by the findings of the Tonga study, and its implementation is essential in the resource-scarce Pacific health setting. The collaborative nature of ISAAC in the Pacific has further raised awareness of the need for capacity building and creating networks and environments that enhance health research in areas other than asthma. The study has also nurtured an environment and network that encourages and strengthens the establishment of health research as one of the vital tools for achieving better health.

Purpose: The purpose of this study was to explore the way(s) in which family management of childhood asthma is affected by contextual influences as described in the Family Management Style Framework (FMSF) and to explore additional factors that affect family asthma management. Specific Aims: The specific aims of this study were 1) to describe the everyday experiences of childhood asthma management within families, 2) to explore the way(s) in which family management of childhood asthma is affected by contextual influences (social network, care providers & systems and resources) as described in the FMSF, and 3) to explore additional sociocultural factors (supported by the literature but not currently described in the FMSF) that affect asthma management in families. Framework: The Family Management Style Framework guided this study. Design: A qualitative descriptive design was used to gather data from a purposive sample of female primary caregivers. Demographic data were collected, and individual interviews were conducted using a flexible interview guide. Results: The findings support the contextual influences as described in the FMSF. An additional three contextual themes were identified: environment, emerging threats to health and work-life conditions. The themes are interrelated demonstrating the complexity of asthma management. Conclusion: Family management of asthma is challenging and complex. The findings move towards understanding the connection between family asthma management and the social determinants of health. Nurses can support families managing childhood asthma by considering each of the contextual influences when planning interventions and working on policy initiatives that support the health of children with asthma.

En esta tesis se presenta un estudio bibliométrico sobre la producción nacional e internacional acerca de los avances terapéuticos del asma en el periodo 1955-2005, ambos años inclusive. El análisis cuantitativo nos ha permitido comprobar las principales leyes bibliométricas (Price, Bradford y Lorcka) y la información relacionada con la autoría y procedencia de los trabajos, la distribución geográfica de los artículos y su relación con el grado de desarrollo (medido por el PIB per cápìta) de cada país . El bloque occidental y sobre todo el mundo anglosajón obtienen el mayor nº de publicaciones. El estudio también se correlaciona con la producción no solo neta sino con la producción científica en nº de artículos por millón de habitantes. A nivel nacional, los artículos publicados sobre el tema en el Índice Médico Español muestran que la comunidad con mayor producción científica es Cataluña.Se ha hecho también un análisis de los principios activos más estudiados, con una predominio claro de los betamiméticos y esteroides. Se ha llevado a cabo una lectura crítica de un grupo seleccionado de revisiones sistemáticas valorado mediante un cuestionario específicos desarrollado por el grupo CASPe. / This thesis presents a bibliometric study of national and international research papers concerning advances in the treatment of asthma during the period 1955-2005. Quantitative analysis techniques allowed us to review the main bibliometric laws (Price, Bradford and Lodka) and information relating to the authorship and origin of the studies, along with the geographical distribution of articles and their relationship to the degree of development as measured by the per capita Gross Domestic Product of the country in which they were carried out. The largest number of publications appeared in Western countries, most notably in the Anglo-Saxon world. In addition to a correlation between number of studies and economic productivity, our analysis found a relationship between scientific production in particular and the number of articles published per million inhabitants. On the national level, the articles published on this topic in the Indice Médico Español (Spanish Medical Index) in dicate that Catalonia is the autonomous community with the highest scientific production.In addition, we conducted an analysis of the most commonly studied pharmacological principles and found a clear predominance of betamimetics and steroids. We also carried out a critical appraisal of a selected group of systematic reviews evaluated by means of specific questionnaires developed by the CASP (Critical Appraisal Skills Program) group.

No description available.

For adolescents with asthma, adhering to asthma regimes implies not only taking medications to relieve asthma attacks, but also adjusting their life styles in order to prevent asthma attacks. These life style modifications, such as avoiding allergens or having to limit physical activity, sometimes force adolescents to compromise their social life. On the other hand, the impact of such life style modifications on their social life may in turn force adolescents to give up adhering to asthma regimes. Indeed, adolescents are learning to be more independent while they enjoy a more complicated social life at home and at school than previously, and this rapid social development may thus be a great life challenge to adolescents with asthma. This thesis reports four studies which investigated the relationship between multi-dimensional asthma management (in medication and life style regimes) and the social life of young people with asthma at the transitional age from childhood to adolescence (or early adolescence, age 9-14), which also marks the transition from primary school to secondary school. In line with the literature on other adolescent chronic illnesses, study 1 demonstrated a downward trend of multi-dimensional asthma management in early adolescence. This developmental change was further investigated in study 2, 3 and 4, in which theories in behavioural psychology were followed to emphasise human behaviour influenced by the social activities and social relationships in the living environment, or the social environment. This was supplemented by theories in developmental psychology to identify relevant aspects of the social environment in early adolescence, especially the social relationships with parents, school staff and peers. Using quantitative and qualitative approaches, the studies not only supported the direct influence of asthma-specific social support, but also explored some mechanisms with which social relationships influenced asthma management in a more subtle and context-dependent way. By approaching asthma management behaviour with theories from behavioural and developmental psychology, it is also hoped that this thesis could be an example that shows the importance of recognising and to understanding the social life of young adolescents when adolescent behaviour is concerned.

Objectives: To investigate the organisation of asthma care in primary care and evaluate outcomes for patients attending primary care centres with and without asthma clinics. Other objectives were to study the association between quality of life and asthma control in patients in primary care and to analyse sex differences regarding asthma outcomes related to menopausal status. Material and methods: Cross-sectional surveys and a patient record study. Results: Of all the primary health care centres, 77% had a spirometer and 53% an asthma clinic. At centres with asthma clinics 77% of the patients reported sufficient knowledge of asthma as compared with 65% at centres without asthma clinics (p<0.001). With more time allocated for the nurse, 44% of patients achieved asthma control as compared with 27% at asthma clinics with less time (p<0.003). Patients using short-acting beta-2 agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding also held for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (5.26 versus 5.64) and reported emergency consultations during the last six months (4.85 versus 5.71). Premenopausal women had significantly lower total MiniAQLQ scores than men in the same age group (5.44 versus 5.89, p<0.001), while no difference was found between postmenopausal women and men of similar ages. The adjusted odds for premenopausal women for asthma exacerbations was 2.0 (95%CI 1.22-3.43) as compared with men in the same age group. No differences were found when comparing postmenopausal women with men of similar ages. Conclusions: Half the primary health care centres had an asthma clinic and the majority had access to a spirometer. Patients at primary health care centres with asthma clinics reported better knowledge of their disease, and asthma control is more often achieved if the nurse is allocated more time. Achieving asthma control is associated with better quality of life in patients in primary care. Premenopausal women had lower quality of life and less often asthma control then men of the same ages, while no corresponding difference was found between postmenopausal women and men of similar ages.

No description available.

L’atteinte d’une maîtrise optimale de l’asthme peut s’avérer difficile pour les patients, malgré l’accès à des traitements efficaces et la disponibilité de lignes directrices destinées aux professionnels de la santé pour les guider dans le choix de la pharmacothérapie et de la prise en charge de la maladie. Les pharmaciens communautaires peuvent jouer un rôle significatif dans la prise en charge de patients dont l’asthme est non-maîtrisé, en raison de leur expertise au niveau des médicaments, de leur rôle dans la délivrance et la surveillance des médicaments, de l’accès au dossier pharmaceutique des patients et de leur interaction fréquente avec les patients due aux renouvellements d’ordonnances. Il serait donc pertinent de développer une intervention adaptée aux besoins des pharmaciens communautaires et des patients asthmatiques afin de guider la prise en charge de l’asthme non-maîtrisé en pharmacie communautaire et de favoriser une implantation réussie de l’intervention. Pour ce faire, ce projet qui comprend deux volets a été mené selon un devis mixte. Dans le cadre du volet I, deux groupes de discussion et cinq entrevues individuelles avec des pharmaciens communautaires ainsi que trois entrevues individuelles avec des patients asthmatiques ont été réalisés afin de les questionner sur le développement de l’intervention. Les résultats de cette étude qualitative nous ont permis de développer une intervention composée de cinq étapes : 1) identification des patients dont l’asthme est modéré à sévère et possiblement non-maîtrisé, 2) évaluation de la maîtrise de l’asthme, 3) identification des causes de la non-maîtrise de l’asthme, s’il y a lieu, 4) prise en charge des patients en fonction des causes de la non-maîtrise de l’asthme, s’il y a lieu, et 5) suivi des patients. Dans le cadre du volet II, un devis de cohorte prospective a été utilisé afin d’évaluer la faisabilité d’implanter l’intervention à l’aide d’indicateurs d’implantation collectés par les pharmaciens participants lors des rendez-vous avec les patients et de questionnaires de satisfaction complétés par les pharmaciens et les patients à la fin de l’étude. L’intervention a été implantée par 12 des 35 (34,3%) pharmaciens recrutés pour l’étude. Parmi les 65 patients invités à participer à l’étude, 22 (33,9%) ont été inclus dans l’étude, et 20 d’entre eux (90,9%) ont eu un premier rendez-vous avec leur pharmacien. Les indicateurs d’implantation indiquent que les causes les plus fréquentes de la non-maîtrise de l’asthme étaient la faible adhésion aux médicaments d’entretien et la comorbidité. Les résultats des analyses ont démontré une amélioration significative de la maîtrise de l’asthme au deuxième rendez-vous et à six mois post-intervention comparativement au premier rendez-vous. En conclusion, l’intervention adaptée à la pratique et aux besoins des pharmaciens a été implantée avec succès dans certaines pharmacies et s’est avérée efficace pour améliorer la maîtrise de l’asthme, mais la pandémie de la COVID-19 a rendu plus difficile l’implantation de l’intervention dans les pharmacies communautaires. / Achieving optimal asthma control can be difficult for patients, despite the availability of effective medications and treatment guidelines for healthcare providers. Community pharmacists can play a significant role in the management of patients with uncontrolled asthma because of their pharmaceutical expertise, their role in dispensing and monitoring medications, their access to patients’ pharmacy file and their frequent contacts with patients due to prescription refills. It is therefore relevant to develop an intervention adapted to the needs of community pharmacists and asthma patients to guide the management of uncontrolled asthma in community pharmacies and test its implementation. This project, consisting in two parts, used a mixed methods research design. In part I, two focus groups and five individual interviews with community pharmacists as well as three individual interviews with asthma patients were conducted to develop the intervention. The results obtained from part I enabled us to develop an intervention including five steps: 1) screening of patients with potentially uncontrolled moderate to severe asthma, 2) assessment of asthma control, 3) identification of the cause(s) of uncontrolled asthma, 4) patients management according to the cause(s) of uncontrolled asthma, and 5) patients’ follow-up. During part II, we evaluated the feasibility of implementing the intervention with a prospective cohort design, using implementation indicators collected by participating pharmacists during the intervention and surveys completed by pharmacists and patients at the end of the study to assess their satisfaction with the intervention. The intervention was implemented by 12 pharmacists out of the 35 (34,3%) recruited for the study. Of the 65 patients invited to participate in the study by participating pharmacists, 22 (33,9%) were included in the study, and 20 (90,9%) had a first appointment with their pharmacist. Implementation indicators showed that the most common causes of uncontrolled asthma were poor adherence to controller medications and comorbidity. The results of part II also showed a significant improvement in asthma control at the second appointment and six months post-intervention when compared to the first appointment. In conclusion, the intervention adapted to pharmacists’ practice and needs has been successfully implemented in some pharmacies and was found efficacious to improve asthma control, but the COVID-19 pandemic made its implementation challenging.