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npj Primary Care Respiratory Medicine Articles

The new title for Primary Care Respiratory Journal following an agreement with Nature Publishing Group to re-launch the journal as part of the Nature Partner Journals series.

Insights into frequent asthma exacerbations from a primary care perspective and the implications of UK National Review of Asthma Deaths recommendations

Insights into frequent asthma exacerbations from a primary care perspective and the implications of UK National Review of Asthma Deaths recommendations, Published online: 19 September 2018; doi:10.1038/s41533-018-0103-9

An audit of asthma patients in Scotland reveals the need for better integration between primary care providers and secondary asthma specialists. The UK National Review of Asthma Deaths highlighted 19 recommendations to prevent avoidable asthma deaths, including specialist referrals for those who over-use reliever inhalers or are admitted to hospital regularly. Wai-Ting Lee at the University of Glasgow, Scotland, and co-workers conducted an audit of 2,639 adult asthma patients from across Glasgow between 2014 and 2015. Their data suggest around 15 per cent of active asthma sufferers would benefit from secondary specialist asthma referrals, yet 42 per cent of those with the most severe symptoms had not attended annual asthma reviews. The patients in this group were also more likely to expose themselves to avoidable asthma triggers such as smoking and over-use of reliever inhalers.

A patient-centric analysis to identify key influences in allergic rhinitis management

A patient-centric analysis to identify key influences in allergic rhinitis management, Published online: 13 September 2018; doi:10.1038/s41533-018-0100-z

In-depth interviews with allergy sufferers about their treatment decisions highlights a need for healthcare professionals to help optimize allergy management. Allergic rhinitis (AR), a set of conditions including hayfever, is often poorly managed by patients, partly due to the growing availability of over-the-counter medications. However, little is known about what influences patients’ self-management decisions. Biljana Cvetkovski at the University of Sydney, Australia, and co-workers interviewed 41 adults with AR. The participants also completed quality of life questionnaires and created network maps of key influencers. Cvetkovski found that patients followed many different influences when making treatment decisions, including online resources, family, friends and healthcare professionals. Three of the key influencers were general practitioners, pharmacists and patients’ own experience. Those with severe AR had a larger, more diverse network of influences and often reported treatment fatigue.

Real-world retrospective cohort study ARCTIC shows burden of comorbidities in Swedish COPD versus non-COPD patients

Real-world retrospective cohort study ARCTIC shows burden of comorbidities in Swedish COPD versus non-COPD patients, Published online: 10 September 2018; doi:10.1038/s41533-018-0101-y

Co-existing conditions should be taken into consideration when treating patients with chronic lung disease to ensure coherent and cost-effective disease management. In a large-scale study of the Swedish population, Björn Ställberg at Uppsala University and co-workers analyzed electronic medical records spanning fourteen years for 17,479 patients with chronic obstructive pulmonary disease (COPD) and compared their health status with 84,514 age-, sex- and comorbidity-matched non-COPD members of the population. Patients with COPD were significantly more likely to suffer from co-morbidities two years after initial diagnosis than their non-COPD counterparts, with cardiovascular diseases being the most common comorbidities. Lung cancer, hypertension, depression and sleep disorders were among other comorbidities more prevalent in the COPD population. These data support the need for fully integrated, targeted healthcare to reduce mortality and the economic burden associated with COPD.

Systematic literature review and meta-analysis of US-approved LAMA/LABA therapies versus tiotropium in moderate-to-severe COPD

Systematic literature review and meta-analysis of US-approved LAMA/LABA therapies versus tiotropium in moderate-to-severe COPD, Published online: 27 August 2018; doi:10.1038/s41533-018-0099-1

Dual maintenance therapies combining two types of long-acting bronchodilator appear to be effective and safe for treating moderate-to-severe chronic obstructive pulmonary disease (COPD). Given that patients with COPD often have poor quality of life and, in the US, incur substantial healthcare costs, it is vital to provide optimal symptom management to improve lung function and limit exacerbations over time. Beth Hahn at GSK, North Carolina, and co-workers carried out a literature review and meta-analysis of 8 clinical trials, which indicates that combined long-acting muscarinic antagonist (LAMA)/long-acting beta-agonist (LABA) treatments—currently prescribed in the US—are an effective and safe way of tackling COPD symptoms. The team compared patients using LAMA/LABA for 12 weeks with those on single LAMA (tiotropium) treatment and found LAMA/LABA significantly improved lung function and reduced exacerbation risk.

Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management

Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management, Published online: 14 August 2018; doi:10.1038/s41533-018-0098-2

Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management

The physical, mental, and social impact of COPD in a population-based sample: results from the Longitudinal Aging Study Amsterdam

The physical, mental, and social impact of COPD in a population-based sample: results from the Longitudinal Aging Study Amsterdam, Published online: 10 August 2018; doi:10.1038/s41533-018-0097-3

Patients with early-stage chronic lung disease need holistic support to limit the physical, mental and social impacts of the condition. There is more to chronic obstructive pulmonary disease (COPD) than persistent airflow limitation; systemic effects, including loss of muscle strength and higher risk of heart conditions, mental health and social problems can manifest from the early stages. Frits Franssen at CIRO, the Netherlands, and co-workers interviewed 810 participants aged 55–65 from the Longitudinal Aging Study Amsterdam to investigate the physical, mental and social status of COPD sufferers and compare them with healthy controls. Those with COPD were more likely to walk slower, tire easily and perceive themselves as having poor overall health. Socially, COPD patients were less likely to have long-term partners and felt the need for more emotional support than their healthy peers.

A review of asthma care in 50 general practices in Bedfordshire, United Kingdom

A review of asthma care in 50 general practices in Bedfordshire, United Kingdom, Published online: 26 July 2018; doi:10.1038/s41533-018-0093-7

Pro-active disease management for patients with asthma is crucial and could be vastly improved with an overhaul of computer systems in primary care. Following the UK National Review of Asthma Deaths (NRAD) in 2011–2014, multiple mortality risk factors were identified that have yet to be factored into asthma care. The NHS Bedfordshire Clinical Commissioning Group, with support from NSHI and Dr Mark L Levy (Harrow CCG), conducted a manual audit of 50 Bedfordshire doctors’ surgeries to identify relevant NRAD recommendations to optimize patient care. Levy’s team found marked variations in asthma care between the surgeries. Risk factors present included excessive short-acting reliever inhaler prescriptions and inadequate prescribing of preventer inhalers, together with limited implementation of personal asthma plans and annual reviews. The researchers highlight the limitations of existing computer systems for these purposes and recommend an overhaul of asthma tracking and automated alerts.