ABSTRACT
OBJECTIVE: We assessed retrospectively the feasibility of a home-based respiratory rehabilitation (RR) program for asthmatics under optimal pharmacological treatment, as this type of care can reduce costs and offer a more patient-friendly approach for subjects with persistent asthma. METHODS: Fifty-two patients with persistent asthma were recruited to the RR program (20 males, 32 females, 54 ± 11 (SD) years, forced expiratory volume in one second 71 ± 33% of predicted mean value, BMI 29.9 ± 7.9 kg/m(2)). This two-month protocol comprised education sessions, respiratory physiotherapy and an exercise training program at home and in groups supervised by an adapted physical activity instructor. RESULTS: Thirty-nine patients completed the whole RR program, i.e. 25% dropout. The dropout rate was significantly higher with respect to younger patients in employment. The number of exacerbations decreased significantly during the year following the program, regardless of whether the patients had dropped out (p < 0.02) or not (p < 0.001). The distance walked during a 6-min walking test increased by 33 m (p < 0.001). Several indices measured during a cycle ergometer test increased significantly after RR: peak oxygen uptake (10%), oxygen uptake at ventilatory threshold (12%) and maximum load (19%), all at a similar maximum heart rate. Concerning quality of life assessment, the Short-Form-36 Item Health Survey revealed a non-significant improvement in the "health change" item after RR (p < 0.07). CONCLUSIONS: This study demonstrates the potential of a home-based program in the treatment and rehabilitation of patients with asthma. Both functional and physiologic indices improved during the follow-up period.
Subject(s)
Asthma/rehabilitation , Home Care Services , Exercise Test , Feasibility Studies , Female , Humans , Male , Middle Aged , Pilot Projects , Retrospective Studies , Severity of Illness IndexABSTRACT
INTRODUCTION: Many asthmatics have few or no symptoms despite severe obstruction of the airways. Physicians confronted with this phenomenon may therefore underrate the severity of the asthma and treatment may be insufficient. We studied the capacity of a group of general practitioners to assess the bronchial obstruction of patients presenting with varying degrees of symptoms and obstruction. METHODS: Ten asthmatics were initially examined by a pneumologist. The patients were classified as: normal (N; no dyspnoea, no wheeze, normal spirometry; n = 2); abnormal (A; dyspnoea and whistling, bronchial obstruction; n = 4); falsely normal (FN; mild or no dyspnoea and no wheeze, bronchial obstruction; n = 4). Ten randomly selected general practitioners, ignoring the protocol and aim of the study, examined 6 patients, 2 from each category. They then had to choose from a list of antiasthma treatments, those that would be appropriate for each patient, and assess on a visual analog scale (VAS) the degree of respiratory tract obstruction at the time of examination. Finally, questions on their knowledge and approach to asthma were asked. RESULTS: The VAS assessments (mm) were of 15.6, 65.2 and 11.0 in the FN, A and N patients, corresponding to a maximum expiratory volume per second of 52, 51 and 98% of the predicted values. Dyspnoea and wheeze were mentioned by each physician as criteria for respiratory tract obstruction. Although they also mentioned the laboured breathing, none noted the signs of thoracic distension, present in the falsely normal patients. None used the paradoxical pulse (inspiratory drop in systolic pressure) and/or spirometric measurements; nobody had noted that dyspnoea and wheeze can be lacking despite substantial obstruction of the airways. Five had prescribed beta 2 agonists alone, without corticosteroid therapy in falsely normal patients. CONCLUSION: General practitioners may underrate the severity of asthma, despite substantial obstruction of the respiratory tract, if there are few symptoms and hence under-treat falsely normal patients.
