Browsing by Author "Cowie, Robert L"

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    Asthma Education and Management Programs in Canada
    (2001-01-01) Cowie, Robert L; Cicutto, Lisa; Boulet, Louis-Philippe; the Patient Education Program Committee, Canadian Network For Asthma Care,
    OBJECTIVE: To establish the number and type of asthma patient education programs throughout Canada.DESIGN: National survey.SETTING: Canada.METHODS: Over a three-year period, contact was made with individuals and groups offering educational services for patients with asthma. Education given as part of a physician's consultation or a pharmacist's dispensing of medications for asthma was not considered a patient education program for the purposes of the survey. Contact was initially established by asking staff from well known asthma programs to provide lists of other such programs in their provinces or regions. Asthma programs were also identified from notices presented at Canada's Third and Fourth National Conferences on Asthma and Education. Lung associations, lay organizations and industry representatives affiliated with the Canadian Network for Asthma Care helped to supplement the list. Once identified, each patient education program was contacted by telephone and by mail to complete a 26-item questionnaire about their program. The province of Quebec was not included in the survey because it already had a province-wide, structured asthma education program and register.RESULTS: Seventy-four asthma education and management programs were identified outside Quebec. Staff in these programs were registered nurses (n=46), respiratory therapists (n=48) and other health professionals (n=21). Forty-one programs stated that at least one member of their staff had been trained as an asthma educator. In 71 programs, the initial patient encounter was of at least one hour's duration. Physician referral was required by 41 programs. The province of Quebec has a joint asthma education program provided by 114 asthma education centres throughout the province under the umbrella of the Quebec Asthma Education Network (QAEN). This comprehensive program is provided in hospitals and community centres by specialized educators - nurses, pharmacists or respiratory therapists - to patients referred by their physicians.CONCLUSIONS: A three-year search for asthma education programs in Canada identified 74 patient education programs (outside Quebec) for an asthma population estimated to exceed 1.2 million. For the province of Quebec, an integrated asthma education program is provided through a network of 114 education centres - the QAEN. The present survey shows that there has been progress in establishing asthma education programs in Canada, although there are significant regional differences in the availability of such programs.
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    Asthma in Adolescents: A Randomized, Controlled Trial of an Asthma Program for Adolescents and Young Adults with Severe Asthma
    (2002-01-01) Cowie, Robert L; Underwood, Margot F; Little, Cinde B; Mitchell, Ian; Spier, Sheldon; Ford, Gordon T
    BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects.OBJECTIVE: To determine the impact of an age-specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma.METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional group attended an age-specific asthma program that included assessment, education and management by a team of asthma educators, respiratory therapists and respiratory physicians. In the control group, spirometry was performed, and the patients continued to receive usual care from their regular physicians. The outcomes were assessed by a questionnaire six months after entry into the study.RESULTS: Ninety-three subjects entered the study and were randomly assigned to the intervention or control group. Of these, only 62 patients were available for review after six months. Subjects in both the control and the intervention groups showed a marked improvement in their level of asthma control, reflected primarily by a 73% reduction in the rate of emergency department attendance for asthma. Other indexes of disease control, including disease-specific quality of life, as assessed by questionnaires, were improved. There was, however, no discernible difference between the subjects in the two groups, with the exception of an improvement in favour of the intervention group in the symptom (actual difference 0.7, P=0.048) and emotional (actual difference 0.8, P=0.028) domains of the asthma quality of life questionnaire. The overall quality of life score favoured the intervention group by a clinically relevant difference of 0.6, but this difference did not reach statistical significance (P=0.06).CONCLUSIONS: Although all subjects demonstrated a significant improvement in asthma control and quality of life, the improvement attributable to this intervention was limited to two domains in disease-specific quality of life.
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    Asthma Symptoms Do not Predict Spirometry
    (2007-01-01) Cowie, Robert L; Underwood, Margot F; Field, Stephen K
    BACKGROUND: Asthma is a disease characterized by variable airflow obstruction, but the measurement of airflow is often omitted in the process of diagnosis and management of the disease.OBJECTIVES: Features of asthma severity and control were examined to determine the extent to which objective measurements, including forced expiratory volume in 1 s and forced expiratory volume in 1 s/forced vital capacity, correlated with other manifestations of the disease.METHODS: Subjects were a consecutive sample of patients with asthma attending a university-based asthma clinic. All subjects underwent routine assessment using a standard questionnaire and spirometry.RESULTS: A total of 500 subjects were included in the present study, and their assessment showed that neither symptoms nor history could predict or be predicted by their measurements of lung function.CONCLUSION: Routine measurement of lung function should be performed on subjects with asthma if normal or near-normal lung function is a desired component of asthma control.
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    Comparison of Intramuscular Betamethasone and Oral Pprednisone in the Prevention of Relapse of Acute Asthma
    (2001-01-01) Chan, John S; Cowie, Robert L; Lazarenka, Gerald C; Little, Cinde; Scott, Sandra; Ford, Gordon T
    OBJECTIVE: To compare the relapse rate after a single intramuscular injection of a long acting corticosteroid, betamethasone, with oral prednisone in patients discharged from the emergency department (ED) for acute exacerbations of asthma.PATIENTS AND METHODS: Patients with acute exacerbations of asthma who were suitable for discharge from the ED were enrolled in a double-blind, randomized, placebo controlled pilot study. At discharge, patients were randomly assigned to receive either intramuscular betamethasone 12 mg and placebo capsules, or a placebo intramuscular injection and prednisone 50 mg daily for seven days. At days 7 and 21, patients were contacted by telephone to determine relapse. Relapse was defined as an unscheduled visit to a physician for treatment of continuing or worsening symptoms of asthma.RESULTS: One hundred and seventy-one patients were enrolled, of whom 87 were randomly assigned to the betamethasone group and 84 to the prednisone group. Baseline char- acteristics were matched evenly between the groups, with the exception of asthma duration (15.5 versus 21.2 years, respectively) and use of inhaled corticosteroids (46% versus 64.3% respectively) (Pud_less_than0.05). Using intention-to-treat analysis, the relapse rates for betamethasone and prednisone at day 7 were 14.9% (13 of 87 patients) and 25% (21 of 84 patients), respectively (P=0.1), and at day 21, the rates were 36.8% (32 of 87 patients) and 31% (26 of 84 patients), respectively (P=0.4). There were no differences in symptom score, peak flows and adverse effects between the two groups at days 7 and 21.CONCLUSIONS: A single dose of intramuscular betamethasone 12 mg was safe and as efficacious as prednisone in preventing the relapse of acute asthma. There was a trend toward a reduced relapse rate at seven days. In select ED patients discharged for acute asthma, intramuscular betamethasone may be an effective alternative to prednisone.
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    Comparison of Once- with Twice-Daily Dosing of Fluticasone Propionate in Mild and Moderate Asthma
    (2000-01-01) Boulet, Louis-Philippe; Cowie, Robert L; Negro, Roberto Dal; Brett, Wade; Gold, Milton; Marques, Agostinho; Thorburn, William S; Stepner, Nate M; Bobson, Reid
    OBJECTIVES: Two 12-week, randomized, double-blind, parallel-group studies were performed to compare the efficacy and safety of once- and twice-daily dosing of fluticasone propionate (FP) in the treatment of mild to moderate asthma, considered to require the equivalent of either 200 or 500 µg of FP daily.PATIENTS AND METHODS: In study A, 461 patients with asthma received FP either 200 µg once daily or 100 µg twice daily. In study B, 443 patients with asthma received FP, either 500 µg once daily or 250 µg twice daily.RESULTS: In both studies, regardless of the treatment regimen to which patients were randomly assigned, small improvements over baseline were observed in morning peak expiratory flows (PEF) and forced expiratory volume in 1 s (FEV1) following 12 weeks of treatment. In study A, the mean morning PEF improved by 2.4% and 4.3% (once daily versus twice daily, P=0.008).  In study B, the mean morning PEF improvement was 0.2% and 3.7% (once daily versus twice daily, PÃ0.001). For both studies, the increases observed in FEV1 were not significantly different between the two groups (P = not significant). The incidence of exacerbations of asthma and related events was 13% and 5%, respectively, in the patients with mild asthma for the once-daily group versus the twice-daily group; these exacerbations were 12% and 10%, respectively, in patients with moderate asthma. Otherwise, the incidence and types of adverse events were comparable for the two treatment regimens. Although twice-daily dosing demonstrated small but statistically significant improvements over once-daily dosing, patients of both groups generally maintained a good level of asthma control on both regimens according to current treatment guidelines. CONCLUSIONS: Twice-daily dosing of FP is more effective than once-daily dosing, although the latter can maintain asthma control in most patients.
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    Inhaled Corticosteroid Therapy Does Not Control Asthma
    (2004-01-01) Cowie, Robert L; Underwood, Margot F; Field, Stephen K
    BACKGROUND: Randomized clinical trials demonstrate efficacy and show that inhaled corticosteroid therapy can control asthma, but details concerning their effectiveness in achieving this goal in the community are lacking.OBJECTIVES: To determine whether inhaled corticosteroid therapy is effective in controlling asthma and to examine the rates of asthma control in relation to inhaled corticosteroid use outside the realm of randomized controlled trials.METHODS: Different populations were examined cross-sectionally to determine whether self-reported use of inhaled corticosteroids was associated with control of asthma. Subjects with asthma in the community and those attending a university-based asthma program were studied. The definition of asthma control was based on the recommendations of the Canadian Consensus Report. The elements of asthma control were examined in the context of the subject's stated use and dose of the inhaled corticosteroid.RESULTS: Asthma was controlled in 20% (95% CI 18.7% to 21.3%) of the 3427 subjects included in the present study. Only 15% (95% CI 13.5% to 16.5%) of the 2437 subjects using inhaled corticosteroids exhibited asthma control compared with 33% (95% CI 31.1% to 35.9%) of the 990 subjects not using inhaled corticosteroids (Pud_less_than0.000001).CONCLUSIONS: Although it is known that inhaled corticosteroid therapy can result in asthma control in most individuals with asthma, the present study has shown that this result may not be attained outside the realm of randomized clinical trials. Inhaled corticosteroid use for asthma in a 'real world' setting appears to reflect disease severity.
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    More than Just Great Quotes: An Introduction to the Canadian Tri-Council’s Qualitative Requirements
    (2013-01-01) Boffa, Jody; Moules, Nancy; Mayan, Maria; Cowie, Robert L
    Although at times misunderstood by the general research community, qualitative research has developed out of diverse, rich and complex philosophical traditions and theoretical paradigms. In the most recent Canadian Tri-Council policy statement on the ethical conduct of research involving humans, a chapter was devoted to a summary of methods and methodological requirements that characterize robust qualitative research, despite the diversity of approaches. To dispel common misperceptions about qualitative research and introduce the unfamiliar reader to these requirements, the work of a qualitative study on isoniazid preventive therapy for prophylaxis of tuberculosis published in AIDS is critiqued alongside each of the Tri-Council’s nine requirements.
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    Spirometric Findings among School-Aged First Nations Children on a Reserve: A Pilot Study
    (2004-01-01) Sin, Don D; Sharpe, Heather M; Cowie, Robert L; Man, SF Paul; on behalf of the Alberta Strategy to Help Manage Asthma (ASTHMA) Executive Committee,
    BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are increasing concerns for First Nations peoples in Canada. Although hospital utilization for asthma and COPD among First Nations peoples has been increasing, the prevalence of asthma or wheezing is comparable to national averages.OBJECTIVES: A pilot study was conducted to determine the prevalence of impaired lung function in school-aged First Nations children.PATIENTS AND METHODS: A First Nations community in northern Alberta was selected to participate. Consent forms and a school health survey were completed by parents or guardians. Children with consent completed spirometry at school, and results were compared with predicted values.RESULTS: A total of 36 children participated (response rate 70.6%). Of these, 19.4% of parents reported that their child had received a physician diagnosis of asthma at some point in their life; only 28.6% had a parental report of still having asthma. Parents smoked in 73.1% of the children's homes. The mean (± SD) percentage of forced expiratory volume in 1 s (FEV1) over forced vital capacity (FVC) was 82.6%±6.9% (94.4%±0.08% of predicted). Evidence of airflow obstruction was found in 25% of the children. Parental report of the child ever having asthma was associated with impaired lung function (OR 3.20; P=0.033). Children in a home with reported mold exposure were less likely to have impaired lung function (OR 0.68; P=0.030).CONCLUSIONS: Many children in this study already have established airflow obstruction and may be at increased risk for asthma or COPD. Exposure to mold appeared to be protective. Further research is needed to evaluate the lung health concerns of this population.
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    The Costs of Implementing the 1999 Canadian Asthma Consensus Guidelines Recommendation of Asthma Education and Spirometry for the Family Physician
    (2004-01-01) Corrigan, Susan P; Cecillon, David L; Sin, Don D; Sharpe, Heather M; Andrews, Elaine M; Cowie, Robert L; Man, SF Paul
    BACKGROUND: National and international asthma guidelines recommend that patients with asthma be provided with asthma education and spirometry as a component of enhanced asthma care. The cost of implementing these interventions in family physician practices is not known.OBJECTIVE: The objective of the present study was to determine the cost of providing recommended asthma care to adult patients in the family practice setting.METHODS: The present study was conducted using three scenarios of care in family practice. Small, medium and large asthmatic patient populations were used. The incremental costs of implementing enhanced asthma care based on the Canadian Asthma Consensus Guidelines, including the provision of spirometry and asthma education in both group and individual sessions, and the resources required for these interventions were calculated for each scenario.RESULTS: For a physician with 50 asthmatic patients, the cost of providing enhanced asthma care with spirometry and group education sessions was approximately $78 per patient in the first year of implementation. For individual sessions, the cost increased to $100 per patient for the first year. If the physician had 100 asthmatic patients, the per patient cost would decrease; however, the overall cost of the program would be $7,000.CONCLUSIONS: The costs of providing enhanced asthma care are significant. In most cases, physicians are inadequately reimbursed (or not reimbursed) for these interventions. In light of the evidence of the effectiveness of these interventions, health insurance plans should consider adding these services to fee schedules.
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    The Impact of Asthma Management Guideline Dissemination on the Control of Asthma in the Community
    (2001-01-01) Cowie, Robert L; Underwood, Margot F; Mack, Sally
    OBJECTIVE: To measure the impact of asthma management education on the control of asthma in the community.DESIGN: A cross-sectional study comparing three communities.SETTING: Three rural communities in southern Alberta.PATIENTS AND METHODS: A population sample of patients with asthma attending a pharmacy to fill a prescription for asthma medication were selected from three communities. Patients were asked to complete a questionnaire relating to their asthma management and control.INTERVENTION: Three levels of asthma management education were provided in the three communities with populations of 6000 to 10,000. The levels of education ranged from standard continuing medical education programs relating to the national asthma guidelines and a visiting asthma nurse educator to the establishment of an asthma clinic and a multiple-target, intensive education program for health professionals, town leaders, local media, schools and the public. The survey of the population with asthma was conducted approximately one year after the education program had been completed.RESULTS: A total of 327 completed questionnaires were submitted. Analysis showed that there was no significant difference that could be attributed to the intervention in the management of asthma or in the level of asthma control among the patients from the three communities.RESULTS: A total of 327 completed questionnaires were submitted. Analysis showed that there was no significant difference that could be attributed to the intervention in the management of asthma or in the level of asthma control among the patients from the three communities.