Diana Kelly Levey

Study Finds This Test Might Help Keep Asthmatics out of the Hospital


August 24, 2018 | Categories: ,

You might want to ask your doctor about using an APGAR test during your next visit. Don’t worry; you won’t have to give blood.

A recent study published in the journal Annals of Family Medicine found that using the APGAR tools—which stands for “Activities, Persistent, triGGers, Asthma medications, Response to therapy/medications” resulted in reduced number of hospital visits among asthmatics over the course of a year.

Researchers conducted a cluster-randomized controlled design in 18 U.S. family medicine and pediatric practices to compare the outcomes of patients with persistent asthma between the ages of 5 to 45 after they were introduced to Asthma APGAR tools versus their standard care. The study looked at 1,063 patients’ outcomes which included asthma control, reported quality of life, as well as emergency department (ED), urgent care, and inpatient hospital visits based on a self-reported questionnaire at the beginning and end of the study.

Patients that used APGAR practices had a lower rate of an asthma-related emergency visit, urgent care, or hospital visit in the last six months of the study (10 percent) versus those patients that experienced their usual care practices (20 percent).

The researchers also found that patients who used APGAR reported improved rates of asthma control and were more likely to adhere to asthma management guidelines.

Intervention practices also significantly increased their adherence to three or more elements of the National Asthma Education and Prevention Program guidelines compared to usual care practices, according to the study results.

“It appeared that patients and their health care team working together to address issues made the difference,” said study author Barbara P. Yawn, MD, MSc, University of Minnesota.

The Asthma APGAR tools include a patient-completed asthma control assessment that covers domains: activity limitations (A/activity), daytime and nighttime symptom frequency (P/persistence of symptoms), asthma triggers (G/triGGers), adherence to asthma medications (A/adherence), and patient-perceived response to therapy (R/response to therapy). They answered the following questions:

A: In the past 2 weeks, how many times did any breathing problems (such as asthma) interfere with your ACTIVITIES or activities you wanted to do?

P: How many DAYS in the past 2 weeks did you have shortness of breath, wheezing, chest tightness, cough or felt you should use your rescue inhaler? How many NIGHTS in the past 2 weeks did you wake up or have trouble sleeping due to coughing, shortness of breath, wheezing, chest tightness or get up to use your rescue inhaler?

G: Do you know what makes your breathing problems or asthma worse? (Triggers)

A: List or describe medications you’ve taken for breathing problems or asthma in the past 2 weeks. Remember you may use nasal, oral, or inhaler medications. (Asthma Medications)

R: When I use my breathing or asthma medicines I feel: (Response to Medications) The first three questions were scored from 0 to 2 each and were tallied up. Any score of two or higher suggested that the asthma was out of control.

After these scores were tallied, the doctor or clinician reviewed the patient’s responses regarding triggers, how they were using their meds (assesses adherence) and how well the patient thinks their meds work, said Dr. Yawn. From there, the doctor goes to a care algorithm in supplemental materials and then would follow the path appropriate for each patient’s score.

“This how the Asthma APGAR is different from the ACT—it does not just give a control number—it gives information on most common reasons for being out of control—- triggers that are not addressed and lack of using medications as prescribed (adherence),” said Dr. Yawn. The patient information and the care algorithm then guide next steps of care. “APGAR provides tools to collect basic trigger and adherence information and uses that and the 0 to 6 control score to guide next steps of care with [the practitioner] having to go to asthma guidelines or remember everything.

Teaching the practices how to use the tools and helping them implement it in practice to use regularly for asthma patients resulted in the improvements,” she said.

Ask your doctor to go over the APGAR tools with you and address whether they could improve your asthma management plan.

Read the full article on usa.philips.com

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