Le facteur le plus important de pronostic de l'asthme professionnel (AP) est la durée des symptômes avant le retrait de lʼexposition à lʼagent causant lʼAP. La qualité de vie réduite, la détresse psychologique et les maladies psychiatriques sont des conditions souvent associées à l'AP. Notre objectif était d'identifier les facteurs, incluant le statut socioéconomique, qui ont une influence sur lʼintervalle de temps nécessaire pour présenter une requête à une agence médicolégale à la suite de lʼapparition de symptômes dʼasthme et de confirmer qu'un tel délai est associé à un moins bon pronostic respiratoire et à des coûts directs plus élevés. En outre, nous avons examiné la relation entre les variables cliniques et socio-économiques dʼune part et leur influence sur les facteurs psychologiques et économiques dʼautre part chez des travailleurs atteints d'AP. Ensuite, nous avons voulu évaluer si les individus souffrant de détresse psychologique (DP) et de morbidité psychiatrique pourraient être identifiés en utilisant un instrument mesurant la qualité de vie (QV). Lʼétude a été effectuée auprès dʼindividus ayant déposé des demandes d'indemnisation pourʼAP auprès du Commission de la sécurité et de la santé du travail du Québec (CSST). Les données ont été recueillies au moment de la réévaluation, soit environ deux ans et demi après le diagnostic. Outre la collecte des marqueurs cliniques de l'asthme, les individus ont été soumis à une évaluation générale de leur histoire sociodémographique et médicale, à une brève entrevue psychiatrique (évaluation des soins primaires des troubles mentaux, PRIME-MD) et à un ensemble de questionnaires, incluant le Questionnaire sur la qualité de vie - AQLQ(S), le Questionnaire respiratoire de St. George (SGRQ) et le Psychiatric Symptom Index (PSI).Soixante personnes ont été incluses dans l'étude. Etre plus âgé, avoir un revenu supérieur à 30 000CAete^treatteintdʼAPdu^aˋunallergeˋnedehautpoidsmoleˊculaireontuneassociationpositiveaveclenombredʼanneˊesdʼexpositionavecsympto^mesavantleretrait.Aucoursdelapeˊriodedesuivi,lenombredʼanneˊesdʼexpositionavecsympto^meseˊtaitplusgrandchezlesindividusayantunehyperreˊactiviteˊbronchiquepersistante.Parailleurs,lapreˊsencedesympto^mesaupostedetravailpendantmoinsd′unanestassocieˊeaˋunereˊductiondescou^tsdirects.LesparameˋtresdeQVetdeDPavaientdescorreˊlationsmodeˊreˊesaveclesmarqueurscliniquesdelʼAP.Lesplusfortesassociationsaveccesvariablesontpue^treobserveˊesdanslescasdelaseˊveˊriteˊdel′asthme,desstatutsdʼemploietmatrimonial,durevenuetdeladureˊedelapeˊriodedetravailavecl′employeur.Unseuilde5,1auniveaudelasous−eˊchelledelafonctioneˊmotionnelledelʼAQLQ(S)sʼestaveˊreˊavoirlameilleurevaleurdiscriminantepourdistinguerlesindividusavecousansdeˊtressepsychiatriquecliniquementsignificativeselonlePSI.Nousavonseˊteˊenmesured′identifierlesvariablessocio−eˊconomiquesassocieˊesaˋunintervallepluslongdʼexpositionprofessionnelleenpreˊsencedesympto^mesdʼasthme.Deme^me,unepluslonguepeˊrioded′expositionaeˊteˊassocieˊeaˋunmoinsbonpronosticdelamaladieetaˋdescou^tsdecompensationpluseˊleveˊs.Cesreˊsultatss′aveˋrentutilespourlasurveillancedelʼAPquipourraitciblercessous−groupesd′individus.LaQVetlaPSsontfreˊquemmentreˊduiteschezlesindividusatteintsd′APquiperc\coiventunecompensation.Ellessontassocieˊesaˋdesmarqueurscliniquesdelʼasthmeetaˋdesfacteurssocio−eˊconomiques.Enoutre,nosreˊsultatssuggeˋrentquelequestionnairedelʼAQLQ(S)peute^treutiliseˊpouridentifierlesindividusavecunniveaudedeˊtressepsychologiquepotentiellementsignificatif.Themostimportantfactorintheprognosisofoccupationalasthma(OA)isthelengthofexposurewithsymptomspriortoremovalfromexposure.Impairedqualityoflife,psychologicaldistressandpsychiatricdiseaseareconditionsfrequentlyassociatedwithOA.Ourgoalwastoidentifyfactors,includingsocio−economicstatus,thatcaninfluencethedelayinsubmittingaclaimtoamedicolegalagencyaftertheonsetofasthmaticsymptoms,andtoconfirmthatsuchadelayisassociatedwithaworserespiratoryprognosisandhigherdirectcosts.Further,weexaminedtheassociationbetweenclinicalandsocio−economicvariablesandtheirinfluenceonpsychologicalandcostoutcomesinindividualswithOA.Next,wewantedtoevaluatewhetherindividualswithclinicallysignificantpsychologicaldistress(PD)andpsychiatricmorbiditycouldbeidentifiedbyusingaqualityoflife(QOL)measurementinstrument.ThisisastudyofindividualswhofiledclaimsforcompensationforoccupationalasthmafromtheWorkersʼCompensationBoardofQuebec(theCSST).Datawerecollectedatre−evaluation,approximatelytwoandahalfyearsafterdiagnosis.Besidescollectingclinicalmarkersofasthma,individualsunderwentageneralsocio−demographicandmedicalhistoryevaluation,abriefpsychiatricinterview(PrimaryCareEvaluationofMentalDisorders,PRIME−MD)andcompletedabatteryofquestionnaires,includingtheAsthmaQualityofLifeQuestionnaire−AQLQ(S),theSt.GeorgeʼsRespiratoryQuestionnaire(SGRQ),andthePsychiatricSymptomsIndex(PSI).Sixtyindividualswereincludedinthestudy.Beingolder,havingarevenueof>30,000 Can. (CAD$) and having OA due to high- molecular- weight agents were all positively associated with the number of years of exposure with symptoms before removal from exposure. Individuals with persistent airway hyperresponsiveness at follow-up had a higher number of years with symptoms. Experiencing symptoms in the workplace for less than one year generated lower direct costs. QOL and PD parameters had moderate correlations with clinical markers of OA. Asthma severity, employment and marital status, income and length of employment with the employer showed the strongest associations with QOL and PD. More impaired QOL was associated with higher direct costs for compensation. A cut-off of 5.1 on the AQLQ(S) emotional function subscale had the best discriminative value to distinguish individuals with or without clinically significant psychological distress according to the PSI. We were able to identify socio-economic variables that were associated with a longer interval during which individuals remained symptomatic in the workplace before being removed from exposure. This longer exposure time was associated with worse disease outcomes and higher compensation costs. These findings could prove to be useful in surveillance programs that could be preferentially targeted for these subgroups of individuals. Impaired QOL and PD are frequent among individuals with OA receiving compensation and are associated with clinical markers of OA and socio-economic factors. Further, our findings suggest that the AQLQ(S) questionnaire could be used to identify individuals with potentially clinically significant levels of psychological distress
Le facteur le plus important de pronostic de l'asthme professionnel (AP) est la durée des symptômes avant le retrait de lʼexposition à lʼagent causant lʼAP. La qualité de vie réduite, la détresse psychologique et les maladies psychiatriques sont des conditions souvent associées à l'AP. Notre objectif était d'identifier les facteurs, incluant le statut socioéconomique, qui ont une influence sur lʼintervalle de temps nécessaire pour présenter une requête à une agence médicolégale à la suite de lʼapparition de symptômes dʼasthme et de confirmer qu'un tel délai est associé à un moins bon pronostic respiratoire et à des coûts directs plus élevés. En outre, nous avons examiné la relation entre les variables cliniques et socio-économiques dʼune part et leur influence sur les facteurs psychologiques et économiques dʼautre part chez des travailleurs atteints d'AP. Ensuite, nous avons voulu évaluer si les individus souffrant de détresse psychologique (DP) et de morbidité psychiatrique pourraient être identifiés en utilisant un instrument mesurant la qualité de vie (QV). Lʼétude a été effectuée auprès dʼindividus ayant déposé des demandes d'indemnisation pourʼAP auprès du Commission de la sécurité et de la santé du travail du Québec (CSST). Les données ont été recueillies au moment de la réévaluation, soit environ deux ans et demi après le diagnostic. Outre la collecte des marqueurs cliniques de l'asthme, les individus ont été soumis à une évaluation générale de leur histoire sociodémographique et médicale, à une brève entrevue psychiatrique (évaluation des soins primaires des troubles mentaux, PRIME-MD) et à un ensemble de questionnaires, incluant le Questionnaire sur la qualité de vie - AQLQ(S), le Questionnaire respiratoire de St. George (SGRQ) et le Psychiatric Symptom Index (PSI).Soixante personnes ont été incluses dans l'étude. Etre plus âgé, avoir un revenu supérieur à 30 000CAete^treatteintdʼAPdu^aˋunallergeˋnedehautpoidsmoleˊculaireontuneassociationpositiveaveclenombredʼanneˊesdʼexpositionavecsympto^mesavantleretrait.Aucoursdelapeˊriodedesuivi,lenombredʼanneˊesdʼexpositionavecsympto^meseˊtaitplusgrandchezlesindividusayantunehyperreˊactiviteˊbronchiquepersistante.Parailleurs,lapreˊsencedesympto^mesaupostedetravailpendantmoinsd′unanestassocieˊeaˋunereˊductiondescou^tsdirects.LesparameˋtresdeQVetdeDPavaientdescorreˊlationsmodeˊreˊesaveclesmarqueurscliniquesdelʼAP.Lesplusfortesassociationsaveccesvariablesontpue^treobserveˊesdanslescasdelaseˊveˊriteˊdel′asthme,desstatutsdʼemploietmatrimonial,durevenuetdeladureˊedelapeˊriodedetravailavecl′employeur.Unseuilde5,1auniveaudelasous−eˊchelledelafonctioneˊmotionnelledelʼAQLQ(S)sʼestaveˊreˊavoirlameilleurevaleurdiscriminantepourdistinguerlesindividusavecousansdeˊtressepsychiatriquecliniquementsignificativeselonlePSI.Nousavonseˊteˊenmesured′identifierlesvariablessocio−eˊconomiquesassocieˊesaˋunintervallepluslongdʼexpositionprofessionnelleenpreˊsencedesympto^mesdʼasthme.Deme^me,unepluslonguepeˊrioded′expositionaeˊteˊassocieˊeaˋunmoinsbonpronosticdelamaladieetaˋdescou^tsdecompensationpluseˊleveˊs.Cesreˊsultatss′aveˋrentutilespourlasurveillancedelʼAPquipourraitciblercessous−groupesd′individus.LaQVetlaPSsontfreˊquemmentreˊduiteschezlesindividusatteintsd′APquiperc\coiventunecompensation.Ellessontassocieˊesaˋdesmarqueurscliniquesdelʼasthmeetaˋdesfacteurssocio−eˊconomiques.Enoutre,nosreˊsultatssuggeˋrentquelequestionnairedelʼAQLQ(S)peute^treutiliseˊpouridentifierlesindividusavecunniveaudedeˊtressepsychologiquepotentiellementsignificatif.Themostimportantfactorintheprognosisofoccupationalasthma(OA)isthelengthofexposurewithsymptomspriortoremovalfromexposure.Impairedqualityoflife,psychologicaldistressandpsychiatricdiseaseareconditionsfrequentlyassociatedwithOA.Ourgoalwastoidentifyfactors,includingsocio−economicstatus,thatcaninfluencethedelayinsubmittingaclaimtoamedicolegalagencyaftertheonsetofasthmaticsymptoms,andtoconfirmthatsuchadelayisassociatedwithaworserespiratoryprognosisandhigherdirectcosts.Further,weexaminedtheassociationbetweenclinicalandsocio−economicvariablesandtheirinfluenceonpsychologicalandcostoutcomesinindividualswithOA.Next,wewantedtoevaluatewhetherindividualswithclinicallysignificantpsychologicaldistress(PD)andpsychiatricmorbiditycouldbeidentifiedbyusingaqualityoflife(QOL)measurementinstrument.ThisisastudyofindividualswhofiledclaimsforcompensationforoccupationalasthmafromtheWorkersʼCompensationBoardofQuebec(theCSST).Datawerecollectedatre−evaluation,approximatelytwoandahalfyearsafterdiagnosis.Besidescollectingclinicalmarkersofasthma,individualsunderwentageneralsocio−demographicandmedicalhistoryevaluation,abriefpsychiatricinterview(PrimaryCareEvaluationofMentalDisorders,PRIME−MD)andcompletedabatteryofquestionnaires,includingtheAsthmaQualityofLifeQuestionnaire−AQLQ(S),theSt.GeorgeʼsRespiratoryQuestionnaire(SGRQ),andthePsychiatricSymptomsIndex(PSI).Sixtyindividualswereincludedinthestudy.Beingolder,havingarevenueof>30,000 Can. (CAD$) and having OA due to high- molecular- weight agents were all positively associated with the number of years of exposure with symptoms before removal from exposure. Individuals with persistent airway hyperresponsiveness at follow-up had a higher number of years with symptoms. Experiencing symptoms in the workplace for less than one year generated lower direct costs. QOL and PD parameters had moderate correlations with clinical markers of OA. Asthma severity, employment and marital status, income and length of employment with the employer showed the strongest associations with QOL and PD. More impaired QOL was associated with higher direct costs for compensation. A cut-off of 5.1 on the AQLQ(S) emotional function subscale had the best discriminative value to distinguish individuals with or without clinically significant psychological distress according to the PSI. We were able to identify socio-economic variables that were associated with a longer interval during which individuals remained symptomatic in the workplace before being removed from exposure. This longer exposure time was associated with worse disease outcomes and higher compensation costs. These findings could prove to be useful in surveillance programs that could be preferentially targeted for these subgroups of individuals. Impaired QOL and PD are frequent among individuals with OA receiving compensation and are associated with clinical markers of OA and socio-economic factors. Further, our findings suggest that the AQLQ(S) questionnaire could be used to identify individuals with potentially clinically significant levels of psychological distress
The Global Initiative for Asthma (GINA) is a network of individuals, organizations, and public health officials that was established to disseminate information about the care of patients with asthma and to improve asthma care. The GINA (“Global Strategy for Asthma Management and Prevention”) report has been updated annually since 2002. Due to new knowledge and therapeutic development in the field, the Swiss Respiratory Society felt the need to provide a new document that is based on both the available literature and the recommendations of the 2016 GINA report. Key new features of the 2016 GINA report include a “new” definition of asthma, underscoring its heterogeneous nature, and the core elements of variable symptoms and variable expiratory airflow limitation; the importance of confirming the diagnosis of asthma in order to minimize both under- and overtreatment; practical tools for the assessment of symptom control and risk factors for adverse outcomes; a comprehensive approach to asthma management that acknowledges the foundational role of inhaled corticosteroid therapy, but also provides a framework for individualizing patient care; an emphasis on maximizing the benefit of available medications by addressing common problems such as incorrect inhaler technique and poor adherence; a continuum of care for worsening asthma, starting with early self-management and progressing to primary care or acute care management; and diagnosis of the asthma/chronic obstructive pulmonary disease overlap syndrome. This document is meant to advice the key stakeholders on the diagnosis and management of asthma and highlights the need to individualize the care of each and every asthmatic patient.</jats:p
OBJECTIVES: To assess the use and appropriateness of medical advice for smoking cessation provided by registrars in a General Medicine Outpatient Department to an unselected patient population in Switzerland. METHODS: A prospective observational study in which 314 consecutive outpatients were contacted by phone within 24h after their consultation. Questions and information concerning smoking asked and/or provided by the registrar to patients were collected. RESULTS: Eleven registrars (mean age 34 years (range 29-40), 54% females, mean of 5 years (range 3.5-6 years) postgraduate medical training) worked in the Basel University Hospital Medical Outpatient Department during the study period from 01.01.2006 to 31.03.2006. In total 314 participants (mean 48 years, age range 16-71 years, 50% females) completed the study. Registrars queried 81% of the patients about smoking, but inquired about smoking duration only in 44% of the patients. Twenty-eight percent of the patients received information about the risks related to smoking, whereas cessation was discussed only with 10% and offered to 9% of the patients. CONCLUSION: Though most junior physicians in the survey asked about smoking, they failed to appropriately address tobacco-related health issues and offer cessation advice in the majority of cases. Extended regular training for physicians on smoking-related issues will be necessary in order to improve counselling of smokers and meet the global tobacco challenge
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