Understanding beliefs about inhaled medication in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies.

Summary: Background. Identifying factors influencing adherence, such as patients' beliefs about medication, is essential for effective asthma management. This study aims to assess and gain insight into the beliefs of patients with asthma regarding inhaled medication. Methods. This is a secondary analysis of the INSPIRERS studies. Patients aged ≥ 13 y.o., with persistent asthma and a prescription for inhaled controller were recruited from 60 primary and secondary care centres in Portugal from 2017 to 2020. Demographic and clinical characteristics were collected in a face-to-face visit. The Specific-Beliefs about Medicine Questionnaire was administered 1-week later by telephone interview. Mann-Whitney U and Kruskal-Wallis tests were used to explore relations between patients' beliefs and characteristics. Results. A total of 552 participants (mean 32.8 ± 17.3 y.o.; 64.5% female) were analysed. The Necessity score (Median 19 [p25-p75 16,22]) was significantly higher than the Concerns score (15 [16,22], p less than 0.001), resulting in a positive Necessity-Concern differential (Median 4 [0,7]). Acceptance (high necessity, low concerns) characterized 61% of participants, while 19% were ambivalent (high necessity, high concerns). Adolescents exhibited lower Necessity (Median 16 vs 20; p less than 0.001) and Concerns scores (Median 11 vs 15; p = 0.002) than adults. In primary care setting, patients had significantly lower Necessity (Median 18 vs 19; p = 0.027) and Concerns (Median 14 vs 15; p = 0.05) compared to the secondary care. Conclusions. A predominantly positive perception of inhaled asthma medication necessity was found, although ambivalence or indifference exists in about 1/5 of patients. Our findings highlight the importance of personalized approaches to address beliefs and optimise patient education.

ConectAR: Collaborative network of patients with asthma and carers actively involved in health research: a protocol for patient and public involvement.

Summary: Background. Patients and Public Involvement in every stage of the patient-centered health research cycle is the key to the development of innovative solutions with an impact on patients' care. Methods. This protocol describes the development of ConectAR, a network to promote the involvement of patients with asthma and their carers in the health research cycle. Results. This protocol comprehends 4 tasks: 1) define the mission, vision, governance and activities of the network through focus groups; 2) establish the communication strategy and tools; 3) test the feasibility of the network in a Delphi study on the research priorities for asthma in Portugal; 4) coordination and dissemination activities. Conclusions. This network will improve research by ensuring that patients and carers have an active role in the co-creation of impactful solutions for asthma.

The use of remote care during the Coronavirus disease 2019 pandemic: a perspective of Portuguese and Spanish physicians.

Summary: This study aimed to characterise how the follow-up of outpatients was done during the first months of COVID-19 pandemic by a multidisciplinary group of physicians involved in an asthma mHealth project. A cross-sectional study based on a web survey was conducted. The survey was sent to 123 physicians working at secondary care centres of Portugal and Spain, that participate in the INSPIRERS project. A total of 65 physicians completed the survey (53% response rate). They had a mean of 18 (11) years of clinical practice and 14% were residents. More than half were allergists (58%), 22% pulmonologists and 20% paediatricians. Most were working in Portugal (89%) and in public hospitals (88%). All were conducting consultations: 71% presential (median [p25 , p75] duration 30 [20, 30] min), 91% telephonic (15 [10, 20] min) and 20% video consultations (20 [10, 28] min). The median duration of presential consultations was significantly higher than pre-COVID-19 (20 [20, 30] min; p = 0.021). From the physicians conducting video consultations, 92% were allergists and only 54% considered that their institution provided adequate conditions. The physicians of the INSPIRERS group used telephonic consultations as the main alternative to presential ones and 1/5 used video consultations. These results suggest the need to rethink clinical follow-up services for outpatients in the near future increasing the use of telemedicine, especially video consultations.

Predictive equations of maximum respiratory mouth pressures: A systematic review.

BACKGROUND: Maximum inspiratory (Pimax) and expiratory (Pemax) mouth pressures are commonly used to detect respiratory muscle weakness resorting to predictive equations established for healthy people. There are several predictive equations, but they are widespread in the literature. This study aimed to review the existent predictive equations of maximum inspiratory (Pimax) and expiratory (Pemax) mouth pressures for adults. Additionally, we aimed to identify which ones were generated based on international standards. METHODS: A systematic review of predictive equations of Pimax and Pemax for healthy adults was conducted. A comprehensive search was performed of Cochrane Library, EBSCO, PubMed, Scopus and Web of Science to identify studies that presented at least one equation for Pimax or Pemax developed for healthy adults. The quality of studies was assessed by two reviewers with the Quality Assessment of Diagnostic Accuracy Studies (Quadas-2). RESULTS: Risk of bias was high in 8 of the 20 studies included. Forty-two Pimax and 34 Pemax equations were found, mostly using the variables age (n=39), weight (n=20) and height (n=8). These equations explained 3 to 96% of the Pimax/Pemax variance. They were developed with individuals from 11 countries (Portugal not included). Twelve Pimax and eight Pemax equations complied with international standards. CONCLUSIONS: This review gathered the predictive equations that have been developed for both Pimax and Pemax, however most were generated from unstandardized procedures. Future studies should explore the suitability of these equations for populations for which specific ones are not available, such as the Portuguese population, and develop new equations if necessary.

Opinions of patients with persistent asthma regarding the use of mobile applications for disease monitoring.

SUMMARY: Background.We assessed adherence to treatment and management needs of adults with persistent asthma and their interest in using apps for asthma management. Secondarily, we explored opinions of patients about an app to assess and improve adherence to treatment. Methods. A cross-sectional study was conducted with 40 adults with persistent asthma (49.9 ± 15.8 years) recruited at outpatient clinics from a district hospital. Participants answered a survey on sociodemographic, asthma control, treatment adherence and use of mobile devices, social networks and apps. Four patients participated in a prospective extension of the study, in which they were invited to use the InspirerMundi app. Results. 48 percent of the participants had at least greater-equal than 1 exacerbation in the previous year and 85 percent had uncontrolled asthma. Self-reported adherence to treatment showed that one in four participants had low adherence. At least daily, 55 percent of participants navigated on the internet with their smartphone-tablet, 35 percent used apps and 93 percent social networks. Nine (22 percent) participants had previously used health-fitness apps and 65 percent would like to use apps to improve inhaler adherence. Conclusions. Most participants had uncontrolled asthma, reported high adherence to treatment and were daily users of social networks and the internet. Only 1/4 used apps but 2/3 would like to use apps to support asthma management.

Enhancing the assessment of cardiorespiratory fitness using field tests.

OBJECTIVE: To establish normative values and reference equations of the 6-minute walk test (6MWT), incremental shuttle walk test (ISWT) and unsupported upper limb exercise test (UULEX) for Portuguese adults. DESIGN: Cross-sectional study. Descriptive statistics and differences between age decades and genders were explored using univariate general linear models to compute reference values. Reference equations were established with a forward stepwise multiple regression. SETTING: General community. PARTICIPANTS: In total, 645 adult volunteers without disabilities [43% male, mean age 55.1 (standard deviation 23.6) years] were recruited from the university campus and surrounding community. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Data on age, gender, height, weight, body mass index and smoking status were collected using a structured questionnaire. Physical activity was evaluated using the Brief Physical Activity Assessment Tool. Participants performed two repetitions of the 6MWT, ISWT and UULEX, and the best repetition was used for analysis. RESULTS: Overall, performance was better in males than in females, and decreased with age. Participants' performance was significantly reduced after the sixth decade of life compared with the other decades (P<0.001). Reference equations were: 6MWT=226.93-(5.00×age)+(360.41×height), R2=71%; ISWT=393.81-(17.98×age)+(185.64×gender)+(775.88×height), R2=83%; and UULEX=16.71-(0.14×age)+(2.66×gender), R2=57%. CONCLUSION: Leg or arm exercise field tests are affected significantly by age and gender. These results will aid health professionals to interpret the results of field tests obtained from healthy or diseased adult populations.

Asthma app use and interest among patients with asthma: a multicenter study

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Prevalence and clinical associations of wheezes and crackles in the general population: the Tromsø study.

BACKGROUND: Wheezes and crackles are well-known signs of lung diseases, but can also be heard in apparently healthy adults. However, their prevalence in a general population has been sparsely described. The objective of this study was to determine the prevalence of wheezes and crackles in a large general adult population and explore associations with self-reported disease, smoking status and lung function. METHODS: We recorded lung sounds in 4033 individuals 40 years or older and collected information on self-reported disease. Pulse oximetry and spirometry were carried out. We estimated age-standardized prevalence of wheezes and crackles and associations between wheezes and crackles and variables of interest were analyzed with univariable and multivariable logistic regressions. RESULTS: Twenty-eight percent of individuals had wheezes or crackles. The age-standardized prevalence of wheezes was 18.6% in women and 15.3% in men, and of crackles, 10.8 and 9.4%, respectively. Wheezes were mostly found during expiration and crackles during inspiration. Significant predictors of expiratory wheezes in multivariable analyses were age (10 years increase - OR 1.18, 95%CI 1.09-1.30), female gender (1.45, 1.2-1.8), self-reported asthma (1.36, 1.00-1.83), and current smoking (1.70, 1.28-2.23). The most important predictors of inspiratory crackles were age (1.76, 1.57-1.99), current smoking, (1.94, 1.40-2.69), mMRC ≥2 (1.79, 1.18-2.65), SpO2 (0.88, 0.81-0.96), and FEV1 Z-score (0.86, 0.77-0.95). CONCLUSIONS: Nearly over a quarter of adults present adventitious lung sounds on auscultation. Age was the most important predictor of adventitious sounds, particularly crackles. The adventitious sounds were also associated with self-reported disease, current smoking and measures of lung function. The presence of findings in two or more auscultation sites was associated with a higher risk of decreased lung function than solitary findings.

Reference equation for the incremental shuttle walk test in Portuguese children and adolescents.

BACKGROUND: The incremental shuttle walk test (ISWT) is one of the most widely used field tests to assess cardiorespiratory fitness in clinical and research settings. Reference equations to predict ISWT distance in different populations and age cohorts have been established. However, an equation for the Portuguese pediatric population is not available. This study aimed to develop a reference equation for predicting ISWT in Portuguese children and adolescents. METHOD: Healthy children and adolescents aged between 5 and 17 years old were recruited. Sociodemographic (sex, age), anthropometric (height, weight) and physical activity (Physical Activity Index) data were collected. Lung function was assessed through spirometry and quadriceps muscular strength through hand-held dynamometry. The ISWT was performed twice. A reference equation was established with a multiple linear regression. RESULTS: 130 (60 male; 13.66±2.61y) participants with normal lung function (forced expiratory volume in one second 102.73±15.09% predicted), body mass index (BMI) (20.27±3.59kg/m2) and quadriceps muscular strength (19.75±6.84kgf), completed the assessment. 50.8% (n=66) of the participants were moderately active. Participants walked on average 1165.08±327.19m in the ISWT. Sex, age and BMI were independent contributors to the ISWT, explaining 54% of its variability (p<0.001). The derived reference equation was: ISWT=342.06+(283.07×sex)+(83.61×age)-(22.22×BMI), with female=0 and male=1. CONCLUSION: Sex, age and BMI were found to be contributors to the ISWT predictive equation for pediatric population, providing a simple reference to assess their cardiorespiratory fitness.

Measurement validity of an electronic inspiratory loading device during a loaded breathing task in patients with COPD.

We studied the validity of a recently introduced, handheld, electronic loading device in providing automatically processed information on external inspiratory work, power and breathing pattern during loaded breathing tasks in patients with COPD. Thirty-five patients with moderate to severe COPD performed an endurance breathing task against a fixed resistive inspiratory load that corresponded to 55 ± 13% of their maximal inspiratory pressure. Flow and pressure signals during this task were sampled and processed at 500 Hz by the handheld loading device and at 100 Hz with an external, laboratory system that provided the "gold standard" reference data. Intra Class Correlations between methods were 0.97 for average mean inspiratory power, 0.98 for average mean pressure, 0.98 for average duty cycle, and 0.99 for total work (all p < 0.0001). We conclude that the handheld device provides automatically processed and valid estimates of physical units of energy during loaded breathing tasks. This enables health care providers to quantify the load on inspiratory muscles during these tests in daily clinical practice.