Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
ASTHMA GUIDELINE PICO QUESTIONS a. Control of Symptom: — Nighttime awakenings — Need for SABA for quick relief of symptoms — Work/school days missed — Ability to engage in normal daily activities or in desired activities b. Optimize (normal) lung function — (FEV1 pp; FEV1/FVC; peak flow) c. Reduce risk of exacerbation d. Minimize adverse effect e. Utilization of health care —Emergency room visits (exacerbations) —Hospital admissions f. Increase Working knowledge of asthma action plan g. Improve Patient satisfaction ------------------------------------------------------------------------------------------------------Diagnosis 1. In patients with asthma, does consultation or referral to a subspecialist (pulmonologist/allergist) at the time of diagnosis or early in treatment vs no consultation/referral improve symptom control, patient satisfaction and increase patient knowledge? (18) 2. In patients with asthma, does routine allergy testing (e.g., skin prick testing, aeroallergens, immunotherapy) vs. no testing or testing HIGH RISK (Severe uncontrolled Asthma, family Hx of allergies) improves outcomes in terms of QOL through allergen avoidance or immunotherapy, patient knowledge and adherence? (19) 3. In adults with exercise-related symptoms of asthma only and non-diagnostic spirometry, is formal exercise testing with pre- and post-PFTs compared to informal exercise testing (methacholine challenge test, broncho provocation test) better for establishing the diagnosis of EIB or exercise induced asthma? (29) 4. In adults with exercise-related symptoms asthma, is peak flow monitoring to assess variability of airway obstruction compared to Spirometry better for diagnosing of EIB or exercise induced asthma? (30) 5. In pregnant women who were not previously diagnosed with asthma, but who develop symptoms consistent with asthma, does assessing PFT compared to a presumptive diagnosis (no PFT) improve patient outcome with no harm? (33) Prognosis 6. In adults with asthma who present with an acute exacerbation, what clinical predictors are best at predicting successful outpatient management? (22) PICO Questions – page 1 7. In patients with difficult to control asthma, how frequently does the management of coexisting sinusitis or GERD compared to no management improve the control of asthma? (23) 8. In patients with asthma who are obese, does weight loss and exercise compared to no weight loss/exercise improve the control of asthma symptoms? (41) Medications 9. 10. In active duty personnel with asthma in operational environments, is one controller compared to other controllers better apt to control asthma symptoms? (31) In patients with mild persistent asthma and no evidence of allergies as triggers, does ICS compared to Montelukast or Tilade, Intal, or other pulmonary antiinflammatories lead to better outcome and minimimize harm? (9,15) 11. In patients with moderate or severe uncontrolled asthma, does increasing the dose of ICS compared to adjunctive therapy (LABA, Singulair, Leukotriene) lead to better control of symptoms with no harm? (17) 12. In adult patients with asthma, does tiotropium (Spiriva) compared to long acting inhaled bronchodilators lead to improved PFT and peak flow measures? 13. In patients with exercise-induced asthma (bronchospasm), does taking a preventive dose of LABA once before exercise compared to continuous qd LABA improve symptom control? (40) 14. In patients older than 65 years with asthma, does the use of long acting beta adrenergic drugs compared to not using the drug reduce adverse cardiovascular events (e.g., sudden death, acute MI, arrhythmias)? (36) 15. In patients older than 65 years who require long term systemic corticosteroids, does a reduced dose of corticosteroids compared to the regular dose reduce the risk for adverse complications (osteoporosis, DM, Vavascular necrosis of the femoral head, cataracts)? (37) 16. In patients with mild persistent asthma, does the use of Singulair compared to placebo result in better outcome and minimize harm? (39) Patient Education 17. Which strategy in the outpatient setting leads to better outcomes in terms of decreased frequency of exacerbations, ER visits or hospitalization in patients with Asthma? a) Implementation of a standardized asthma care plan compared to no standard care plan? (27) b) Implementation of comprehensive asthma care (pt. education, action plans and asthma educators) compared to usual care PICO Questions – page 2 c) Implementation of group visits compared to individual patients appointments. d) Written action plans compared to usual care (28) e) Providing patient education in modality other than written (e.g., media, computer based, internet) (26) PICO Questions – page 3