Establishing the safety and effectiveness of a diagnostic therapeutic trial for asthma in community elderly

确定社区老年人哮喘诊断治疗试验的安全性和有效性

• 批准号: nhmrc : 399124
• 负责人: Prof David.H. Wilson
• 金额: $ 26.48万
• 依托单位: The University of Adelaide
• 依托单位国家: 澳大利亚
• 项目类别: NHMRC Project Grants
• 财政年份: 2007
• 资助国家: 澳大利亚
• 起止时间: 2007-01-01 至 2007-12-31
• 项目状态: 已结题
• 来源: https://researchdata.edu.au/establishing-safety-effectiveness-community-elderly/95167
• 关键词: Establishing; safety; effectiveness; diagnostic; therapeutic

Asthma is a major Australian health priority affecting over 2 million people. It is under-diagnosed and a source of significant morbidity in older people. Previous work by the investigators for the Commonwealth of Australia has shown that in the over 55-year age group approximately 40% of asthma is undiagnosed. In this age group severity is comparable with those diagnosed and worse than those diagnosed under the age of 55 years. Most (80%) of asthma deaths occur in the people aged greater than 55 years. There are clear patient and system factors that contribute to under diagnosis. The patient factors are currently being addressed in a general practice patient pilot study. System issues make the diagnosis of asthma in general practice a difficult task. The study is important, as older people are more likely to access the general practitioner than a specialist for respiratory problems. Spirometry in general practice is not common and is of variable quality. The most common approach to diagnosis by the general practitioner is a diagnostic trial of medication to provide evidence of asthma. This can be broken down into four elements of: entry criteria to a therapeutic trial; choice of drug in a therapeutic trial; length of time for a therapeutic trial, and; assessment criteria in a therapeutic trial. No evidence-based guidelines are available to assist the general practitioner in each of these stages making the therapeutic trial a safety and effectiveness issue of major importance, especially in the older person. The purpose of the study proposed is to conduct a randomised controlled trial in a representative population sample of older people to determine the evidence-based components of a diagnostic therapeutic trial for the guidance of general practitioners. The study will also assess which diagnostic questions and medical tests provide greatest assistance to the general practitioner in diagnosing asthma in the older person.

哮喘是澳大利亚的一个主要健康问题，影响着超过 200 万人。它的诊断不足，并且是老年人发病的重要来源。澳大利亚联邦研究人员之前的研究表明，在 55 岁以上的年龄组中，大约 40% 的哮喘未被诊断出来。在这个年龄组中，严重程度与诊断的患者相当，但比 55 岁以下诊断的患者更严重。大多数 (80%) 哮喘死亡发生在 55 岁以上的人群中。有明显的患者和系统因素导致诊断不足。目前正在一项全科实践患者试点研究中解决患者因素。系统问题使得哮喘的诊断在一般实践中成为一项艰巨的任务。这项研究很重要，因为老年人更有可能去看全科医生，而不是呼吸系统疾病专家。一般实践中的肺活量测定并不常见，而且质量参差不齐。全科医生最常见的诊断方法是进行药物诊断试验，以提供哮喘的证据。这可以分为四个要素： 治疗试验的进入标准；治疗试验中药物的选择；治疗试验的时间长度；治疗试验中的评估标准。没有基于证据的指南可以在每个阶段为全科医生提供帮助，这使得治疗试验成为一个非常重要的安全性和有效性问题，特别是对于老年人。拟议研究的目的是在老年人的代表性人群样本中进行随机对照试验，以确定诊断治疗试验的循证组成部分，以指导全科医生。该研究还将评估哪些诊断问题和医学测试可以为全科医生诊断老年人哮喘提供最大帮助。