Subject(s)
Asthma , Pulmonary Medicine , Adult , Asthma/diagnosis , Asthma/therapy , Child , Follow-Up Studies , HumansABSTRACT
INTRODUCTION: In patients suffering from chronic obstructive pulmonary disease (COPD), the acceptance of the illness is probably a major factor in the improvement of quality of life. The aim of this study is to identify the criteria associated with a good or bad acceptance of the disease and to identify means of improving it. METHODS: We have undertaken a telephone enquiry among patients with COPD with the aid of a standardized questionnaire established by several health experts. RESULTS: Of the 1040 patients who have been contacted, 356 (34 %) replied to the questionnaire. Ninety-nine patients reported unacceptance of their disease (28 %). The patients who did not accept their disease were significantly more severe, with more difficulty in performing daily life activities, particularly exercising. These patients had significantly greater difficulty in understanding their disease and also reported more frequently a moralizing attitude among their family. CONCLUSION: The greater the handicap of the disease, the greater is the difficulty in accepting the disease by the patient. The doctor could have an impact in improving the therapeutic education and involving the family in the patient's care.
Subject(s)
Behavior , Patient Acceptance of Health Care , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/psychology , Aged , Attitude to Health , Cohort Studies , Exercise/physiology , Female , France/epidemiology , Humans , Male , Middle Aged , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Patient Education as Topic/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/therapy , Quality of Life , Severity of Illness Index , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
COPD is common but is under-diagnosed by general practitioners (GP). GP have a major role in the early diagnosis of this disease. GP could have access to spirometry. The aim of this study was to evaluate the quality and interpretation of spirometry performed by primary care residents following a short education session. Three residents were trained in spirometry for half a day. They then performed spirometry on all smokers over the age of 35 visiting five general practices. The results were reviewed blindly by an independent specialist pulmonologist to assess their quality and interpretation. Among 184 eligible patients, 89% agreed to participate and 66% (n=107) came for the second appointment. The pulmonologist evaluated the quality of spirometry as good in 72% of cases, of suboptimal but acceptable quality in 20% and of poor quality in 8%. Interpretation was accurate in 91% of tests. The Kappa concordance coefficient between GPs and the expert was 0.93. Airflow obstruction was detected in 17.5% of the screened subjects. The average time for a consultation with spirometry was 19minutes. The consultation dedicated to spirometry was well accepted by patients. A short training has to be structured to allow GPs to perform and interpret spirometry properly. This work needs to be extended to better assess reproducibility in cases of abnormal spirometry.
Subject(s)
General Practice/methods , Pulmonary Disease, Chronic Obstructive/diagnosis , Spirometry , Adult , Aged , Early Diagnosis , Family Practice , Feasibility Studies , Female , General Practice/instrumentation , General Practitioners , Humans , Internship and Residency , Male , Middle Aged , Primary Health Care/methods , Pulmonary Disease, Chronic Obstructive/epidemiology , Reproducibility of Results , Spirometry/instrumentation , Spirometry/methods , Students, MedicalABSTRACT
Renal complications of sarcoidosis are rare but they may lead to renal failure. The two most common mechanisms are interstitial nephritis and acute hypercalcaemic renal failure. We report the case of a woman who presented both of these complications.
