["Real-life"-data on asthma control using budesonide/formoterol for both maintenance and relief: the Swiss experience]. / "Real-life"-Daten zur Asthmakontrolle mit Budesonid/Formoterol als Erhaltungs- und Bedarfstherapie: die Erfahrung in der Schweiz.

BACKGROUND: Asthma is not adequately controlled in many patients. A new approach in asthma treatment, known as Budesonide/Formoterol Maintenance and Reliever Therapy has shown improvement in asthma control compared to conventional therapy regimens. As Switzerland was the first European country to formally approve budesonide/formoterol maintenance and reliever therapy, a patient follow-up programme was commenced in January 2006 to investigate its efficacy and safety in a "real-life" environment. METHODS: A non randomized uncontrolled post-marketing survey involving 420 physicians in all language regions in Switzerland was carried out. 2035 patients with asthma were enrolled. Data on current asthma treatment, asthma control and unscheduled visits due to worsening asthma were recorded. Asthma control was assessed subjectively by both the patients and the physicians as well as by means of the validated 5-item Asthma Control Questionnaire (ACQ5). An ACQ score of 0.75 or less indicates well-controlled asthma. RESULTS: Data from 2006 out of 2035 patients were analysed (mean age 44.9 +/- 19.6 years, 50.5% female). With budesonide/formoterol maintenance and reliever therapy the mean ACQ5 score improved by more than 3-fold the defined minimal important difference (MID). The percentage of patients with an ACQ score < or =0.75 increased from 4.8% at baseline to 58.0% at the end of the follow-up programme. Patient satisfaction with budesonide/formoterol for both maintenance and relief was high. CONCLUSIONS: Budesonide/formoterol maintenance and reliever therapy improves asthma control in a non randomised real-life setting.

[Home-based nocturnal oxymetry by the primary care practitioner]. / Oxymétrie nocturne au cabinet du médecin de premier recours.

Sleep-related disordered breathing is frequent and associated with high morbidity and mortality, thus representing a public health problem. Sleep apnea-hypopnea syndrome (SAHS) is sorely under-diagnosed. Our questioning was about the usefulness of a home-based overnight oxymetry organised by the primary care physician (PCP) for SAHS detection. It appears from our review that patients with snoring and excessive daytime sleepiness can benefit from this tool. Oxygen desaturation index less than 5/h does not rule out SAHS but makes it very unlikely. In accordance with the symptoms, one should refer the patient for complementary investigation. Besides detection, PCP has an important role to play in partnership with the pneumologist in helping the patient to cope with his respiratory device and contributing to treatment com-

Predictors of participation and attendance in a new asthma patient self-management education program.

BACKGROUND: Low participation limits the effectiveness of patient education interventions. In this study, the characteristics of patients who agreed to participate in a clinical trial of disease self-management education for asthma were compared to the characteristics of those who declined, and among the former group patients who actually attended were compared to those who did not. METHODS: The education program, implemented at the Geneva University Hospitals between 1996 and 1998, consisted of three interactive sessions spread over 3 weeks. Only 131 of 253 eligible patients (52%) agreed to participate in the trial, and only 83 patients (63%) attended two to three educational sessions. All eligible patients filled out baseline questionnaires and were interviewed by a trained physiotherapist. RESULTS: Lower confidence in the patient's own current treatment regimen and a more severe baseline asthma attack were independently associated with participation in the trial. Among those who agreed to participate in the study, a university education, longer asthma duration, older age, and a higher level of asthma management knowledge were associated with higher attendance. Quality-of-life scores were not associated with higher course attendance. Among all eligible participants, persons with lower knowledge of asthma management (which was assessed by what to do during an asthma attack and knowledge of the correct use of a peak expiratory flowmeter and inhalers) were less likely to enroll in the trial and to attend the educational training sessions. CONCLUSIONS: Strategies need to be developed to motivate patients with lower disease self-management knowledge to participate in asthma education programs.

[How to prescribe treatment for an asthmatic patient]. / Comment prescrire un traitement chez un patient asthmatique?

The quality of life of an asthmatic patient is dependent of a regular use of appropriate drugs and preventive measures, both applied for a short as well as a long term course. The efficacy of the treatment will be dependent not only on the choice of the drugs, but also on the therapeutic observance or compliance, itself relying upon the patient's motivation for an improvement in his health and also to the way of teaching during the prescription of the treatment.

[Educating the asthmatic patient]. / Enseignement de l'asthmatique.

Education of the asthmatic patient by an appropriate program is an important tool in achieving optimal management. The program should include not only lectures on the physiopathology and treatment of asthma, but also self-management skills through a behavioural approach to the disease. The education program aims to assist the patient in preventing symptoms and coping with asthma attacks.

Ventilatory response to bronchospasm induced by methylcholine and histamine in man.

In 9 normal subjects, we compared mouth occlusion pressure (P0.1) and breathing pattern in bronchospasm of the same magnitude induced by inhalation of acetyl-beta-methylcholine (M) and histamine phosphate (H). The measurements were performed on two different days, in a single blind randomized crossover design, under basal conditions first, then after control inhalation of isotonic buffered saline and finally after inhalation of M or H. For a same mean decrease in FEV1 (+/- SD) by 22.2% (+/- 7.2) after M and 22.3% (+/- 9.4) after H (P less than 0.001), the increases in P0.1 were similar (P less than 0.01 for both drugs) and were correlated to the magnitude of the bronchospasm (r = 0.775, P less than 0.01 for M; r = 0.692, P less than 0.05 for H). However, the minute ventilation and breathing pattern parameters did not differ from each other and from basal or control conditions. Thus, although we can assume that both drugs have different effects on vagal airway receptors, they induce the same respiratory response. We conclude that only receptors indirectly stimulated via airway smooth muscle contraction contribute to the mediation of drive and breathing pattern in drug induced bronchospasm in humans.