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Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra. Le ricordiamo che questo materiale è di proprietà dell’autore e fornito come supporto didattico per uso personale. Modena LIBRA, March 1st,2011. Unmet Needs in ASTHMA and COPD.

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Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra.Le ricordiamo che questo materiale è di proprietà dell’autore e fornito come supporto didattico per uso personale.


Modena LIBRA, March 1st,2011 questo materiale delle Guidelines 2011 libra.

Unmet Needs in

ASTHMA and COPD

Prof. Giorgio Walter Canonica

Allergy and Respiratory Diseases Department

University of Genoa

Past President

1°vice President


COPD questo materiale delle Guidelines 2011 libra.


Calverley b j p 2008
Calverley, B.J.P. 2008 questo materiale delle Guidelines 2011 libra.


Calverley b j p 20081
Calverley, B.J.P. 2008 questo materiale delle Guidelines 2011 libra.


Decramer et al resp med 2011
Decramer et al. Resp.Med.2011 questo materiale delle Guidelines 2011 libra.


Decramer et al. Resp.Med.2011 questo materiale delle Guidelines 2011 libra.


Decramer et al. Resp.Med.2011 questo materiale delle Guidelines 2011 libra.


CONCLUSIONS questo materiale delle Guidelines 2011 libra.

Decramer et al. Resp.Med.2011


Morales asenco et al bmc 2010
Morales Asenco et al. BMC 2010 questo materiale delle Guidelines 2011 libra.


Pros patient reported outcomes
PROs questo materiale delle Guidelines 2011 libra.Patient Reported Outcomes


Real life observational studies
Real-life observational studies questo materiale delle Guidelines 2011 libra.

Patientreported

outcomes

Disease

phenotype

Therapy

Diseasecontrol

measures

Aetiology

Severity

Comorbidities

Drugs

Schedule

Symptoms Score

Composite Score

Function

Biology

Clinical parameters

Resource utilisation

Preference

Awareness

Satisfaction

Behaviour

Coping

Adherence

Stress

Anxiety/depression

Quality of life

Alexithymia

Mood


Braido et al cmro 2011
Braido et al. questo materiale delle Guidelines 2011 libra.CMRO 2011


Braido et al. CMRO 2011 questo materiale delle Guidelines 2011 libra.


Braido et al. CMRO 2011 questo materiale delle Guidelines 2011 libra.


Asthma
ASTHMA questo materiale delle Guidelines 2011 libra.


Guidelines
GUIDELINES questo materiale delle Guidelines 2011 libra.


Asthma guidelines
Asthma guidelines questo materiale delle Guidelines 2011 libra.


Asthma control in real life
Asthma Control questo materiale delle Guidelines 2011 libra.inReal Life


Worldwide epidemiological evaluation of asthma control level
Worldwide epidemiological evaluation of asthma control level questo materiale delle Guidelines 2011 libra.

2509 patients with asthma2

7 European countries

2803 patients with asthma1

AIRLA

Asthma Insights and Reality in Latin America

8 Asian-Pacific countries

3206 patients with asthma3

11 Latin American countries

2184 patients with asthma

1. Rabe et al. Eur Respir J 2000; 16: 802-8072. www.asthmainamerica.com 3. Lai et al. Eur Respir J 2003; 111: 263-268


Achieving control in asthmatic patients still a critical issue
Achieving control in asthmatic patients: still a critical issue?

Braido et al. Allergy 2009; 64: 937-943

Total control

Well controlled

Uncontrolled

122 patients51.3% LABA + ICS16 PTZ high-dose L + I

patients treated with

high-dose ICS + LABA

the total sample

Levels of asthma control in the total sample (right), and in the subgroup of patients treated with high-dose ICS + LABA (left)


Patients opinions on their asthma
Patients’ opinions on issue? their asthma

Asthma

96 patients

Do you think your disease is under control?

Do you think you relied on qualified professionals?

How do you cope with your disease?

Have drugs improved your disease?

Are you following doctors’ prescriptions?

Do you think your disease will improve?

Do you feel helped by your family?

Do you feel helped by all the medical staff?

Not at all

3.1%

1.0%

19.8%

8.3%

A little

12.5%

7.3%

16.7%

14.6%

5.2%

33.3%

7.3%

10.4%

Fairly

58.3%

53.1%

51.0%

53.1%

50.0%

26.0%

36.5%

66.7%

A lot

22.9%

32.3%

24.0%

26.0%

39.6%

9.4%

33.3%

21.9%

Not indicated

6.3%

7.3%

5.2%

6.3%

4.2%

11.5%

14.6%

1.0%

Baiardini et al. J Investig Allergol Clin Immunol 2006; 16: 218-223


Real life asthma management
Real-life asthma management issue?

Braido et al. J Investig Allergol Clin Immunol 2010; 20: 9-12


Why do doctors and patients not follow guidelines? issue?

Baiardini et al.

Curr Opin Allergy Clin Immunol 2009; 9: 228-233


Why do doctors not follow guidelines
Why do issue? doctors not follow guidelines?

  • LACK of:

  • Consciousness

  • Familiarity

  • Agreement

  • Auto- effectiveness

  • Success expectation

  • Motivation and consolidation

  • External barriers

Baiardini et al. Curr Opin Allergy Clin Immunol 2009; 9: 228-233


Why do patients not follow guidelines
Why do issue? patients not follow guidelines?

Baiardini et al. Curr Opin Allergy Clin Immunol 2009; 9: 228-233


Adherence to treatment is a weak point in asthma management
Adherence to treatment issue? is a weak pointin asthma management


World health organisation 2003
World Health Organisation issue? 2003

World Health Organisation





COPD issue?


Overall persistence with single and fixed ics treatment in new users with asthma

Breekveldt-Postma et al. Pharmacoepidemiol Drug Saf 2008; 17: 411-422

Overall persistence with single and fixed ICS treatment in new users with asthma

Fixed

Single

Adults

Children and adolescents

1.0

1.0

0.8

0.8

0.6

0.6

Proportion of persistent ICS users by formulation in adults

Proportion of persistent ICS users by formulation in children and adolescents

0.4

0.4

0.2

0.2

0.0

0.0

0

50

100

150

200

250

300

350

400

0

50

100

150

200

250

300

350

400

Time since start of therapy (days)

Time since start of therapy (days)


Unmet needs in asthma: Global Asthma Physician and Patient (GAPP Survey): global adult findings

Canonica et al. Allergy 2007; 62: 668-674


Patients and physicians disagree on content of education provided and received
Patients and physicians disagree on (GAPP Survey): global adult findingscontent of education provided and received

Correct inhaler technique

Develop individual management plan

Patients perceive that only 25% of office visit time is devoted to asthma education

Monitor peak expiratory flow

Keep daily symptom/medication diaries

Contact patient support organisation

Respondents (%)

Does your doctor or other healthcare professional in his or her office discuss any of the following with you? Base: all respondents (patients)

Do you regularly discuss the following with your asthma patients? Base: all respondents (physicians)

Canonica et al. Allergy 2007; 62: 668-674


Treatment compliance increases with increased patient education
Treatment compliance increases with increased patient education

Patient treatment compliance

Amount of time spent on patient education

<51%

15%

51-80%

27%

81-99%

29%

100%

30%

Increase in compliance (%)

Canonica et al. Allergy 2007; 62: 668-674


Time with doctor in primary care
Time with doctor in primary care education

Malaysia 5-10 mins

Pakistan <3 mins

UK 8 mins

Australia 15 mins

South Africa 8-11 mins

Italy 8 mins

E Bateman



Can asthma control be improved by understanding the patient’s perspective?

Patient

Horne et al. BMC Pulm Med 2007; 7: 8


Asthma physician s and patient s viewpoint two different perspectives
Asthma: physician’s and patient’s viewpoint – two different perspectives

Asthma

Inflammation

Comorbidity

IgE

Atopy

Histamine

Bronchoconstriction

FEV1

Asthma

Sleep

Eating

Physical functioning

Social life

Sport

Work Performance

Mental functioning

School Performance

Physician

Patient


A general process in guidelines evolution
A general process in guidelines evolution different perspectives

Evidence-based medicine


Factors that influence the strength of a recommendation
Factors that influence the strength of a recommendation different perspectives

  • Balance between desirable and undesirable effects

  • Quality of evidence

  • Patients’ values and preferences

  • Costs


PROs to support medical product different perspectiveslabelling claims:FDA perspective

PROs provide a unique perspective on medical therapy, because some effects of a health condition and its therapy are known only to patients

Patrick et al. Value Health 2007; 10 (Suppl 2): S125-S137

FDA, Food and Drug Administration


Braido et al. Allergy 2010: DOI: 10.1111/j.1398-9995.2010.02383.x.


Baiardini et al. J.ASTHMA 2011 10.1111/j.1398-9995.2010.02383.x.


Baiardini et al. J.ASTHMA 2011 10.1111/j.1398-9995.2010.02383.x.


Physician s and patient s viewpoint
Physician’s and patient’s viewpoint 10.1111/j.1398-9995.2010.02383.x.

Diagnosis

Drugs

Follow-up

Guidelines

Severity

Comorbidity

Costs

Clinical parameters

Functional parameters

Limits

Emotions

Knowledge

Satisfaction

Fear

Sleep

School

Relationships

Education

Consideration

Disease management

Physician

Patient


Characterisation of chronic diseases
Characterisation of chronic diseases 10.1111/j.1398-9995.2010.02383.x.

  • Persistance, more years of disability and handicap, shorter life expectancy and can totally or partly be abrogated by a continuous action by healthcare professionals

World Health Organisation

Chronic disease management

Physical functioning

Life expectancy


Take home messages 10.1111/j.1398-9995.2010.02383.x.

Disease Management is crucial

PROs should be priority outcomes

of treatments

Adherence to treatment

is our ultimate goal


Knowledge and health care resources allocation in asthma management: impact of one-year guidelines based CME/CPD course Braido F*, Comaschi M°, Valle I§, Delgado L+, Coccini A§, Guerrera P°°, Stagi E**, Canonica GW* on behalf of ARGA Study Groupand EAACI/CME Committee f.

Braido F* et al. submitted


Braido f et al submitted
Braido F* et al. submitted management: impact of one-year guidelines based CME/CPD course

  • Material and methods

  • Study design

  • The educational program was made up

    of 5 residential events with 4 short distance learning courses in-between.

  • The scientific contents of the courses were based on the economical analysis of Anatomical Therapeutic Chemical Classification System (ATC) Respiratory (R) drugs prescription and healthcare resource usage data related to the previous three-months, blindly obtained from the database of Local Health Unit ASL No 3 of Genoa.


Braido F* et al. submitted management: impact of one-year guidelines based CME/CPD course


Single drug prescriptions
Single Drug Prescriptions management: impact of one-year guidelines based CME/CPD course

Braido F* et al. submitted


Results
Results management: impact of one-year guidelines based CME/CPD course

  • Fourteen GPs (46.7%) completed the training course and 6 (20%) completed the distance-learning part.

  • Knowledge improved significantly after training (p <0.001, correct answers to key questions +13%).

  • Training resulted in pharmaceutical cost containment (trained GPs +0.5% vs controls +18.8%) and greater attention to diagnosis and monitoring (increase in spirometry +63.4% , p 0.01).

Braido F* et al. submitted


Final Take Home Message management: impact of one-year guidelines based CME/CPD course

GUIDELINES ARE INTERVENTIONALLY EFFECTIVEWHENEVER PROPERLY IMPLEMENTED


Thank you
Thank you management: impact of one-year guidelines based CME/CPD course

Fulvio BRAIDO

Ilaria BAIARDINI

[email protected]


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