What lies behind relief and worsening of asthma symptoms? A register-based study of adults with asthma and other chronic obstructive pulmonary diseases in Finland.

AIMS: To examine how subjects with relief or worsening of asthma symptoms differ in terms of gender, age, severity and duration of asthma, comorbidity, and difficulties with medication and daily life. METHODS: A postal inquiry among a sample of 6000 adults with clinically diagnosed asthma and/or other chronic obstructive pulmonary diseases. RESULTS: Relief of asthma symptoms over a 12-month period was associated with a recent asthma diagnosis, within five years, in both sexes. Lack of current smoking and lack of problems in using anti-asthmatic treatment were associated with a positive outcome in men, and mild asthma and living alone associated with a positive outcome in women. Severe and moderate asthma predicted worse symptoms in both sexes, as did other obstructive pulmonary diseases, living alone, and medication problems amongst men. CONCLUSIONS: Patients with asthma should be cared for comprehensively, requiring consideration of both clinical and psychosocial factors that can modify the course of the disease.

Comorbidity and medication load in adult asthmatics.

OBJECTIVE: To examine comorbidity and the medication load among asthmatics. Design A self-administered postal inquiry. SETTING: A national register-based random sample of 6000 subjects aged 16 years or older entitled to special reimbursement for anti-asthmatic medication in Finland. SUBJECTS: A total of 4690 subjects with clinically diagnosed asthma. MAIN OUTCOME MEASURES: Reporting of doctor-diagnosed chronic diseases and the number of prescription medicines used by asthmatics. RESULTS: Two-thirds of the subjects (n = 2952, 63%) reported other diseases in addition to other chronic pulmonary diseases and allergies. Musculoskeletal and cardiovascular disorders were the most common, increasing with age. Allergies were most frequent among the young asthmatics. Nearly all the subjects (n = 4444, 95%) took at least one anti-asthmatic medicine, and two out of every three (n = 3051, 65%) received other prescription medicines, most commonly cardiovascular drugs or analgesics. Some 41% (n=1938) of all the asthmatics and as many as 21% of the young adults (n = 269) were taking at least five prescription medicines concomitantly. The total medication load increased with age. CONCLUSION: The load of comorbidity and prescribed medication is heavy in adult asthmatics of all ages. Thus asthmatic patients should best be treated by GPs, while pulmonary specialists work as consultants and take care of the most severe cases.

Achievements and shortcomings of Finnish asthma care.

BACKGROUND: The Finnish National Asthma Programme was launched in 1994. AIM: A postal self-completion questionnaire study was undertaken to evaluate how the guideline is working in the Finnish healthcare system. METHODS: A postal inquiry was sent to a random sample of 6,000 subjects aged 16+ years who were entitled to special reimbursement for anti-asthmatic medication and 4,657 subjects with self-reported asthma were included. RESULTS: The subjects comprised 38% men (n=1,781) and 62% women (n=2,876). In all, 62% of all the subjects and 78% of those with severe asthma had visited a doctor on account of asthma in the past 12 months. Some 83% of the respondents had a given physician who was responsible for treating their asthma, and 75% of these were under observation by a primary healthcare physician. Visits to asthma nurses were relatively rare. Inhaled glucocorticoids were used by 83% of the subjects, but short-acting beta-2-agonists were still the most commonly used asthma drug in monotherapy regardless of the severity of asthma. Inhaled glucocorticoids and a short-acting beta-2-agonist was the most frequent combination. Every tenth subject used this combination supplemented by a long-acting beta-2-agonist. CONCLUSION: Asthma care in Finland seems to be compatible with the national guidelines in terms of continuity and the common use of inhaled glucocorticoids. The primary care sector has adopted the main responsibility for the treatment of asthma. The common use of short-acting beta-2-agonists is an exception to an otherwise positive trend.

Length of stay and interval to readmission in emergency hospital treatment of COPD.

BACKGROUND: increasing attention has recently been attached to the length of hospital stay and related factors in the treatment of COPD. OBJECTIVES: to assess the trend in the duration of inpatient episodes following emergency admissions for COPD by age and sex, and the frequency of readmissions, as well as the correlations between the frequency and duration of inpatient episodes. DESIGN: retrospective study. SETTING: the Finnish hospital discharge register. SUBJECTS: the 72,672 inpatient episodes following emergency admissions of patients aged over 44 years that ended in 1993-2001 and had COPD as the principal diagnosis. RESULTS: the mean duration of inpatient episodes was 8.5 days (SD 8.2) in 1993, but 6.8 days (SD 6.6) in 2001. The figure for 45- to 64-year-old men was 6.5 days (SD 6.6) and that for men aged >64 years, 7.8 days (SD 6.8). The corresponding figures for women were 7.1 days (SD 6.8) and 8.8 days (SD 8.4). The average interval between the end of one inpatient episode and the beginning of the next was 195.4 days (SD 327.7). This interval was longest when the inpatient episode lasted for 7 days (interval 215 days). CONCLUSIONS: the length of hospital stay for COPD exacerbation seems to be decreasing, and elderly women have the longest inpatient episodes. With the current treatment modalities, a 1-week stay in hospital results in the longest interval to readmission. The situation may change if supported home care at exacerbation can be increased.

Regional and seasonal variation in the length of hospital stay for chronic obstructive pulmonary disease in Finland.

Notable regional and seasonal variation has been reported in the rate of hospital admissions for chronic obstructive pulmonary disease (COPE). The aim of this study was to assess the variation in the length of hospital stay for COPD in Finland on the north south axis and by season. For this purpose, the patient records of subjects aged over 45 hospitalised altogether 153,401 times with COPD as their primary diagnosis during 1987 - 1998 were retrieved from the Finnish Hospital Discharge Register maintained by the National Research and Development Centre for Welfare and Health. During this period, the average length of hospital episodes was 9.8 (SD) 47.8) days in northern Finland and 11.9 (SD 54.5) days in southern Finland (p = 0.001). Throughout Finland, the mean duration of hospital stay was longest in the winter, 12.3 (SD) 62.3) days, and shortest in the summer, 11.0 (SD) 42.3) days (p = 0.001). The mean duration of hospital stay in northern Finland was also longest in the winter, 10.6 (SD 56.7) days, and shortest in the summer, 8.8. (SD) 26.7) days (p = 0.015). Hospital episodes for COPD vary in duration in Finland, probably mainly due to regional differences in health care resources and treatment routines. The light and warm northern summer may also speculatively serve to shorten hospital episodes.