Browsing by Author "Underwood, Margot F"

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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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    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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    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.