Chronic Respiratory Disease

The disease-specific-TACQOL-asthma questionnaire measures health-status and appraisal of health status. The TACQOL-asthma evaluates the personal feelings about problems in the domains, ‘complaints, situations, emotions, treatment and medication’. The TACQOL-asthma can be used alone or in combination with the generic TACQOL. Our objective was to study the psychometric properties of the TACQOL-asthma-questionnaire. Responses of 298 parents and children with asthma (age eight to 16 years) in four paediatric practices in the northern part of the Netherlands were studied. The factor-analysis and item-domain correlation analysis show a moderate to strong correlation between the different items and their hypothesised domains. For all items, the correlation of the separate item with the hypothesized domain is stronger than with any other domain. The internal consistency (Cronbach's alpha) of the domains is moderate to good. Concurrent correlation with the Paediatric-Asthma-Quality-of-Life-Questionnaire-(PAQLQ) was significant. Effect sizes of differences between asthma-severity classes in TACQOL-asthma and PAQLQ-scores were similar and of clinical importance. This study validates the TACQOL-asthma as a new disease-specific questionnaire. The TACQOL-asthma ensures a measurement of health status as well as appraisal ofhealth problems. The TACQOL-asthma has good reliability and validity properties to serve as an evaluative and discriminate disease-specifichealth-related-quality-of-life questionnaire.

The purpose of our research was to design, implement and evaluate a cognitive-behavioral asthma self-management program for adults. Seventeen adults with asthma completed an eight-week course (two hours, once a week) that consisted of interactive small group discussions and a behavior change procedure. The group discussions were led by a multi-disciplinary faculty (nurse, respiratory therapist, allergist, social worker, psychologist). Following each weekly discussion, participants would attempt to change a behavior related to the discussion. At the following meeting, participants would share their results and get feedback from the group; subsequently a new topic was introduced for discussion and a new behavioral change goal was added at the end of the meeting. Primary outcome measurements included asthma related quality of life, peak flow rate and frequency of key lifestyle behaviors. Outcome analyses indicated statistically significant improvements in frequency of: 1) peak flow monitoring; 2) practicing relaxation; 3) drinking 64 ounces of water a day (P < 0.05). Outcome analyses also indicated statistically significant improvements inquality-of-life (QOL) and asthma knowledge (P < 0.05). These results provide evidence that a cognitive-behavioral asthma education program that incorporates a behavior change procedure with interactive group discussions can lead to both knowledge acquisition and behavioral changes. Such outcomes are essential for reducing asthma morbidity and asthma mortality.

Chronic cough and sputum production are common featuresof chronic obstructive pulmonary disease (COPD) and havea significant impact on exacerbation frequency and qualityof life. Despite this, techniques to assist with removal of sputum from the airway do not have a well-defined role in COPD management. Clinical trials of airway clearance techniques (ACTs) in COPD have shown mixed results with little evidence of long-term benefit. However many studies havefailed to account for the heterogeneity of COPD lung disease, particularly with regard to the presence of bronchiectasis. Analysis of short-term studies suggests that there may be a cohort of patients who will benefit from prescription of a sputum clearance regimen. This review proposes a physiological rationale for the use of ACTs in COPD, taking into consideration the presence of bronchiectasis, the amount of sputum produced, the degree of airflow obstruction and the presence of decreased lung elastic recoil. The selection of an optimal ACT for individuals with COPD should take into account its effects on lung vloumes, expiratory flow and dynamic airway compression. Care should be taken to avoid airway collapse during forced expirations in patients with reduced lung recoil pressure; positive expiratory pressure therapy or autogenic drainage may prove effective in this patient group. The acceptability of ACTs to patients should also be considered, especially where long-term adherence is required. Future research should focus on more appropriate matching of the physiological effects of individual ACTs to the pathophysiology of lung disease in COPD.

Over 50 000 people die per year in England and Wales from lung cancer and chronic obstructive pulmonary disease (COPD). Current National Institute for Clinical Evidence guidelines for lung cancer and COPD recommend provision of palliative care for those that need it. Palliative care historically has accepted patients with cancer, but access to patients with non-malignant disease has been more sporadic. This paper aims to highlight the many ethical dilemmas faced when treating both these groups of patients. These include issues surrounding the form of treatment or treatment with drawal, the burden on the patient or on the health service; or conducting research in terminally ill patients.

Japan appears to be one of the healthiest nations. However, each step of healthcare services is not excellent while macroscopic outcomes are exceptional. Globalization is also key concept in Japanese respiratory healthcare services. As international communication between physicians become more common, the reality that various gaps in respiratory healthcare services still remain in place is becoming clearer. Now, clinicians are paying attention to global sources of information. Respiratory medicine will also change from experience-based medicine to evidence-based science.