May 5, 2000
MEDIA TIP SHEET FOR THE AMERICAN THORACIC SOCIETY CONFERENCE
The following news tips are based on research expected to be presented at the American Thoracic Society Conference held May 5-10 in Toronto, Canada.
COMMON LUNG EXAM OFTEN CAUSES UNNECESSARY PAIN: MORE PAIN CONTROL NEEDED
A common, invasive procedure used to test for lung disease may be causing patients unnecessary pain, according to a new study. While most physicians always use topical anesthetic before flexible bronchoscopy (FOB), many believe that other pain killers aren't needed. Now, Johns Hopkins researchers have shown that, even when sedatives and analgesics are routinely used, some patients suffer pain.
"This study clearly shows that the procedure causes pain," says Greg Diette, M.D., an assistant professor of pulmonary and critical care medicine at the Hopkins School of Medicine. "In an era when we have access to superior pain medications, there is no excuse not to use them for this exam."
The results emerged from a study of 481 patients who underwent FOB at Johns Hopkins. Patients filled out two questionnaires, one before the exam and another one 48 hours after, designed to assess memories of the procedure, pain, satisfaction with care, and information provided about FOB. Physicians also kept a record of bronchoscopy technique, patients' underlying medical conditions, and doses of sedatives, analgesics, and topical anesthetic used.
Although sedatives and analgesics were given almost 100 percent of the time, only 36 percent of patients reported pain control as excellent and 10 percent reported pain control as poor or fair. "The number of patients experiencing pain at some other centers is most likely much higher given that one survey of North American bronchoscopists found that only 51 percent used sedatives routinely," Diette said. The researchers also discovered that individuals were more likely to experience pain if they were sicker, less educated or had asthma. "This is the first study to systematically identify which patients are at high risk of experiencing pain," says Diette. "If people have lower levels of education, there may not be good communication with health care providers and they may not understand the procedure. They may not expect the pain and this makes the pain worse."
Diette believes that better administration of pain medication and increased education about the procedure should help lower the number of people who experience pain during FOB.
This research will be presented at the American Thoracic Society's conference on May 7. It is embargoed until May 7 at 8:00 a.m. EDT.
QUICKER ASTHMA DIAGNOSES MAY LOWER HOSPITAL ADMISSION RATES FOR ELDERLY
Doctors can lower hospital admission rates of older asthma patients if they diagnose asthma problems earlier and control other illnesses, according to a new study by Johns Hopkins researchers. The study was designed to find out why older adults are hospitalized for asthma at much higher rates than younger adults.
"Medical care is actually better for older individuals, 65 and over, than younger adults," says Greg Diette, M.D., an assistant professor of pulmonary and critical care medicine at the Hopkins School of Medicine. "Worse health can explain the different rates of hospitalizations."
Studies have shown that adults aged 65 and over are hospitalized at more than twice the rate of individuals 18 to 35. The question was whether older adults got worse care, had worse asthma, or more co-morbid conditions, or whether doctors were just more likely to hospitalize the elderly.
In their Managed Health Care Association Outcomes Management System Asthma Project, Diette and his colleagues gathered and analyzed information from 6,572 sicker-than-average asthmatic individuals. They looked at co-morbid conditions, gender, race, education, asthma symptom severity, medications, health care access and satisfaction, and physician specialty. All subjects were employees and dependents of some of the largest U.S. companies and had health insurance coverage through managed care.
The researchers found that medical care was actually better for older adults and that the higher rates of hospitalization were due to more severe asthma and more co-morbid illnesses. Diette believes that older individuals may have worse asthma because some doctors attribute asthmatic symptoms to other diseases first and thus miss early diagnosis of asthma. Failure to provide treatment at an early stage can lead to a higher risk of hospitalization.
"We may be able to decrease hospitalizations by having doctors recognize severe symptoms of asthma earlier and increasing scrutiny for other co-morbid factors," says Diette.
This research will be presented at the American Thoracic Society's conference on May 9. It is embargoed until May 9 at 8:00 a.m. EDT.
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Media Contact: Kate O'Rourke (410)955-8665 [email protected]
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