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Pilcher J, Patel M, Smith A, Davies C, Pritchard A, Travers J, Black P, Weatherall M, Beasley R, Harwood M. Combination budesonide/formoterol inhaler as maintenance and reliever therapy in Māori with asthma. Respirology 2014; 19:842-51. [PMID: 24889937 DOI: 10.1111/resp.12319] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/28/2014] [Accepted: 03/30/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE There are significant health disparities between Māori and non-Māori with asthma, a pattern seen between other ethnic populations. This study investigates outcomes for Māori in a randomized controlled trial (RCT) of combination budesonide/formoterol inhaler therapy in asthma. METHODS This 24-week multicentre RCT recruited 303 adult asthma patients, 44 of whom were Māori. Participants were randomized to the single combination budesonide/formoterol inhaler as maintenance and reliever therapy ('SMART') regimen or 'standard' regimen (combination budesonide/formoterol inhaler for maintenance and salbutamol as reliever). Outcomes included patterns of beta-agonist inhaler use including 'high use' of reliever therapy (>8 actuations of budesonide/formoterol in excess of four maintenance doses per day for SMART and >16 actuations per day of salbutamol for standard). Differences in outcomes for Māori versus non-Māori were assessed using an interaction term between ethnicity and treatment. RESULTS With adjustment for ethnicity, the SMART group had fewer days of high use (relative rate (RR) 0.57 (95% confidence interval (CI): 0.38-0.85)), days of high use without medical review within 48 h (RR 0.49 (95% CI: 0.32-0.75)) and severe exacerbations (RR 0.54 (95% CI: 0.36-0.81)) compared with standard. The magnitude of the benefit from the SMART regimen was similar in Māori and non-Māori. Regardless of treatment regimen, Māori demonstrated more days of high use, high use without medical review and underuse of maintenance therapy. CONCLUSIONS The SMART regimen has a favourable risk/benefit profile in Māori. Days of high use, days of high use without medical review and underuse of maintenance treatment were greater in Māori, regardless of treatment regimen.
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Patel M, Pilcher J, Reddel HK, Pritchard A, Corin A, Helm C, Tofield C, Shaw D, Black P, Weatherall M, Beasley R. Metrics of salbutamol use as predictors of future adverse outcomes in asthma. Clin Exp Allergy 2014; 43:1144-51. [PMID: 24074332 DOI: 10.1111/cea.12166] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/18/2013] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Beta-agonist overuse is associated with adverse outcomes in asthma, however, the relationships between different metrics of salbutamol use and future risk are uncertain. OBJECTIVE To investigate the relationship between metrics of salbutamol use and adverse outcome. METHODS In a 24-week randomized controlled trial of 303 asthma patients at risk of severe exacerbations which compared the efficacy and safety of combination budesonide/formoterol inhaler according to a single inhaler regimen (SMART) with a fixed-dose regimen with salbutamol as reliever ('Standard'), actual medication use was measured by electronic monitoring (Australian New Zealand Clinical Trials Registry Number ACTRN12610000515099). A nested cohort study explored the relationship between metrics of baseline salbutamol use over 2 weeks and future severe asthma exacerbations, poor asthma control (ACQ-5 ≥ 1.5) or 'extreme' salbutamol overuse (> 32 salbutamol actuations/24-h period). RESULTS Higher mean daily salbutamol use (per two actuations/day) [Odds ratio (OR) (95% CI) 1.24 (1.06-1.46)], higher days of salbutamol use (per 2 days in 2 weeks) [OR 1.15 (1.00-1.31)] and higher maximal 24-h use (per two actuations/day) [OR 1.09 (1.02-1.16)] were associated with future severe exacerbations. Higher mean daily salbutamol use was associated with future poor asthma control [OR 1.13 (1.02-1.26)]. Higher mean daily salbutamol use [OR 2.73 (1.84-4.07)], number of days of use [OR 1.46 (1.24-1.71)], and maximal daily use [OR 1.57 (1.31-1.89)] were associated with an increased risk of future extreme salbutamol overuse. CONCLUSION AND CLINICAL RELEVANCE Electronically recorded frequency of current salbutamol use is a strong predictor of risk of future adverse outcomes in asthma, with average daily use performing the best. These findings provide new information for clinicians considering metrics of salbutamol as predictors of future adverse outcomes in asthma.
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Zargar H, Aning J, Legiehn G, Black P. Renovascular Hypertension after Laparoscopic Partial Nephrectomy. J Urol 2014; 191:1418-20. [DOI: 10.1016/j.juro.2014.01.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2014] [Indexed: 11/25/2022]
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Liss M, Taylor SA, Batura D, Steensels D, Chayakulkeeree M, Soenens C, Rao GG, Dash A, Park S, Patel N, Woo J, McDonald M, Nseyo U, Banapour P, Unterberg S, Ahlering T, Van Poppel H, Fierer J, Black P. MP16-14 RECTAL CULTURE PRIOR TO PROSTATE BIOPSY IDENTIFIES MEN AT RISK FOR INFECTION: A MULTI-INSTITUTIONAL INTERNATIONAL COLLABORATIVE STUDY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bansal R, Kapoor A, Finelli A, Rendon R, Moore R, Breau R, Lacombe L, Kawakami J, Drachenberg D, Black P, Pautler S, Liu Z, Tanguay S. PD17-11 POSITIVE SURGICAL MARGINS AFTER PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA: PREDICTORS AND IMPACT ON ONCOLOGICAL OUTCOMES. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aning J, Peacock M, Zargar H, Harriman D, McKenzie M, Black P, So A, Goldenberg L, Gleave M. PD12-03 ACTIVE SURVEILLANCE IN 853 MEN WITH LOW AND INTERMEDIATE RISK PROSTATE CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nayak J, Patel P, Kaler K, Liu Z, Kapoor A, Rendon R, Tanguay S, Black P, Kawakami J, Breau R, Finelli A, Klotz L, Drachenberg D. PD10-12 CLINICAL OUTCOMES FOLLOWING LAPAROSCOPIC MANAGEMENT OF PT3 RENAL MASSES: A MULTI-INSTITUTIONAL ANALYSIS. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bansal R, Kapoor A, Finelli A, Rendon R, Moore R, Breau R, Lacombe L, Kawakami J, Drachenberg D, Black P, Pautler S, Liu Z, Tanguay S. MP59-16 RENAL ARTERY PSEUDOANEURYSMS AFTER NEPHRON SPARING SURGERY FOR RENAL CELL CARCINOMA: INCIDENCE, MANAGEMENT AND FUNCTIONAL OUTCOMES FROM CANADIAN KIDNEY CANCER INFORMATION SYSTEM DATABASE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jäger W, Thomas C, Janßen C, Schmidtmann I, Hainz M, Roos F, Thüroff J, Brenner W, Black P. MP40-01 HEDGEHOG PATHWAY BIOMARKERS PREDICT ONCOLOGIC OUTCOME IN CLEAR CELL RENAL CELL CARCINOMA. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bochner B, Sperling D, Feifer A, Mashni J, Bajorin D, Dalbagni G, Herr H, Donat SM, Milowsky M, Shah J, Kamat A, Grossman HB, Grubb R, Brandes S, Bullock A, Strope S, Roth B, Kibel A, Weigand L, Steinberg G, Stadler W, Rutiaga N, Schoenberg M, Bivalacqua T, Rogers C, Black P, So A, Gleave M, Kassouf W, Bachir B, Yafi F, Lerner S, Godoy G, Amiel G, Zlotta A, Fleshner N, Jewett M, Kulkarni G, Sridhar S, Tanock I, Joshua A, Bostrom P, Kuk C, Lotan Y. MP60-12 MULTI-INSTITUTIONAL QUALITY CARE INITIATIVE TO IMPROVE THE CARE OF PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Aning J, Zargar H, Black P, So A, Goldenberg L, Gleave M. MP62-09 COMPARISON OF PATHOLOGICAL AND ONCOLOGICAL OUTCOMES OF MEN ON ACTIVE SURVEILLANCE PROGRESSING TO RADICAL PROSTATECTOMY WITH A MATCHED COHORT OF MEN UNDERGOING IMMEDIATE RADICAL PROSTATECTOMY IN A SINGLE INSTITUTION. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bhatt JR, Tanguay S, Liu Z, Richard PO, Kapoor A, Rendon R, Lacombe L, Black P, Pautler S, Breau R, Moore R, Jewett M, Finelli A. MP40-02 INCREASED UPTAKE OF RENAL TUMOUR BIOPSIES FOR SMALL RENAL MASSES – RESULTS OF A MULTICENTRE CANADIAN EXPERIENCE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hayashi T, Jaeger W, Moskalev I, Awrey S, Li N, Fazli L, Yasui W, Matsubara A, Black P. MP28-14 TARGETING HER2 WITH TRASTUZUMAB-DM1 (T-DM1) IN HER2-OVEREXPRESSING BLADDER CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jäger W, Hayashi T, Ischia J, Janßen C, Awrey S, Fazli L, Gleave M, Black P. MP34-12 TARGETING IGF-BP2 AND 5 WITH THE BISPECIFIC ANTISENSE OLIGODEOXYNUCLEOTIDE OGX-225 IN CHEMORESISTANT BLADDER CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wickens K, Stanley T, Mitchell E, Barthow C, Fitzharris P, Purdie G, Siebers R, Black P, Crane J. O09 ‐ Early supplementation with Lactobacillus rhamnosus HN001 reduces eczema prevalence to 6 years: does it also reduce atopic sensitisation? Clin Transl Allergy 2014. [PMCID: PMC4094203 DOI: 10.1186/2045-7022-4-s1-o9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pataky R, Gulati R, Etzioni R, Black P, Chi KN, Coldman AJ, Pickles T, Tyldesley S, Peacock S. Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada. Int J Cancer 2014; 135:939-47. [PMID: 24443367 DOI: 10.1002/ijc.28732] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 12/30/2013] [Indexed: 11/06/2022]
Abstract
Prostate-specific antigen (PSA) screening for prostate cancer may reduce mortality, but it incurs considerable risk of over diagnosis and potential harm to quality of life. Our objective was to evaluate the cost-effectiveness of PSA screening, with and without adjustment for quality of life, for the British Columbia (BC) population. We adapted an existing natural history model using BC incidence, treatment, cost and mortality patterns. The modeled mortality benefit of screening derives from a stage-shift mechanism, assuming mortality reduction consistent with the European Study of Randomized Screening for Prostate Cancer. The model projected outcomes for 40-year-old men under 14 combinations of screening ages and frequencies. Cost and utility estimates were explored with deterministic sensitivity analysis. The incremental cost-effectiveness of regular screening ranged from $36,300/LYG, for screening every four years from ages 55 to 69 years, to $588,300/LYG, for screening every two years from ages 40 to 74 years. The marginal benefits of increasing screening frequency to 2 years or starting screening at age 40 years were small and came at significant cost. After utility adjustment, all screening strategies resulted in a loss of quality-adjusted life years (QALYs); however, this result was very sensitive to utility estimates. Plausible outcomes under a range of screening strategies inform discussion of prostate cancer screening policy in BC and similar jurisdictions. Screening may be cost-effective, but the sensitivity of results to utility values suggests individual preferences for quality versus quantity of life should be a key consideration.
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Kapoor A, Allard CB, Black P, Kassouf W, Morash C, Rendon R. Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma. Can Urol Assoc J 2013; 7:306-11. [PMID: 24319507 DOI: 10.5489/cuaj.1578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Williams AK, Kassouf W, Chin J, Rendon R, Jacobsen N, Fairey A, Kapoor A, Black P, Lacombe L, Tanguay S, So A, Lattouf JB, Bell D, Fradet Y, Saad F, Matsumoto E, Drachenberg D, Cagiannos I, Izawa JI. Multifocality rather than tumor location is a prognostic factor in upper tract urothelial carcinoma. Urol Oncol 2013; 31:1161-5. [DOI: 10.1016/j.urolonc.2011.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/03/2011] [Accepted: 12/04/2011] [Indexed: 11/28/2022]
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North S, Basappa N, Bjarnason G, Blais N, Canil C, Heng D, Knox J, Reaume N, Ruether D, Soulières D, Zalewski P, Black P, Breau RH, Jewett M, Kapoor A, Lattouf JB, Moore R, Rendon R, Todd G, Pituskin E, Gedye C, Wood L. Management of advanced kidney cancer: Canadian Kidney Cancer Forum 2013 Consensus Update: Canadian Kidney Cancer Forum 2013. Can Urol Assoc J 2013; 7:238-43. [PMID: 24032057 DOI: 10.5489/cuaj.536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Fairey AS, Jacobsen NE, Estey E, Tanguay S, Rendon R, Bell D, Izawa J, Chin J, Kapoor A, Matsumoto E, Black P, So A, Lattouf JB, Saad F, Drachenberg D, Cagiannos I, Lacombe L, Fradet Y, Kassouf W. Comorbidity Status Does Not Independently Predict Survival Outcomes After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol 2013; 64:518-9. [DOI: 10.1016/j.eururo.2013.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
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Bay BN, Black P. Double jeopardy? Renal-sparing management of simultaneous ipsilateral renal cell carcinoma and urothelial carcinoma. Can Urol Assoc J 2013; 7:E508-10. [PMID: 23914271 DOI: 10.5489/cuaj.409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The occurrence of renal cell carcinoma (RCC) and urothelial carcinoma (UC) synchronously in the same kidney is exceedingly rare. All reported cases have been managed with either nephroureterectomy or nephrectomy. We report on a patient who required renal-sparing management of his double malignancy, including open partial nephrectomy of his pT1a RCC and endoscopic laser ablation of his low-grade Ta renal pelvis UC. After 4 years, the patient is in good health and disease-free under strict surveillance. It, therefore, would appear justified to combine partial nephrectomy for RCC and endoscopic management of UC in the same kidney of an appropriately selected patient.
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Black P. Commentary on: Everolimus for Angiomyolipoma Associated With Tuberous Sclerosis Complex or Sporadic Lymphangioleiomyomatosis (EXIST-2): A Multicentre, Randomised, Double-blind, Placebo-controlled Trial. Urology 2013; 82:278-9. [DOI: 10.1016/j.urology.2013.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 02/11/2013] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
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Sexton P, Black P, Wu L, Sommerville F, Hamed M, Milne D, Metcalf P, Kolbe J. Chronic obstructive pulmonary disease in non-smokers: a case-comparison study. COPD 2013; 11:2-9. [PMID: 23844977 DOI: 10.3109/15412555.2013.800853] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND COPD is often regarded as a smoker's disease. In fact, up to 50% of COPD could be attributable to other causes. Relatively little is known about COPD among nonsmokers, and this group is usually excluded from studies of COPD. METHODS In this cross-sectional case-comparison study, smokers and nonsmokers aged over 45 with COPD (post-bronchodilator FEV1 ≤ 70% predicted, FEV1/FVC ratio < 0.7) were recruited from specialist outpatient clinics and from primary care. Subjects completed a questionnaire and interview, and underwent spirometry, venesection, exhaled nitric oxide (ENO) measurement, allergen skinprick testing, formal lung function testing and high resolution CT. RESULTS 48 nonsmokers and 45 smokers participated. Asthma was nearly universal among nonsmokers and was the commonest identifiable cause of COPD in that group. Nonsmokers also exhibited a high prevalence of objective eosinophilic inflammation (raised ENO and eosinophil counts, positive skinprick tests). Smokers had more severe airflow obstruction, but respiratory symptom prevalences were similar between groups. Nonsmokers reported greater lifetime burdens of respiratory disease. Nonsmokers' HRCT results showed functional small airways disease, with no significant emphysema in any subject. Previously undiagnosed bronchiectasis was common in both groups (31% and 42%). CONCLUSIONS Asthma is a very common cause of COPD among nonsmokers. Radiological bronchiectasis is common in COPD; the clinical significance of this finding is unclear.
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Patel M, Pilcher J, Munro C, Hosking A, Pritchard A, Shaw D, Black P, Weatherall M, Beasley R. Short-acting β-agonist use as a marker of current asthma control. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:370-7. [PMID: 24565542 DOI: 10.1016/j.jaip.2013.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/18/2013] [Accepted: 04/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between current asthma symptoms and rescue bronchodilator (reliever) use is uncertain, leading to different recommendations about the preferred reliever metric to use when assessing asthma control. In a 6-month randomized controlled trial of combination budesonide/formoterol as maintenance and reliever therapy versus combination budesonide/formoterol as maintenance treatment with albuterol as reliever, we measured inhaler use by electronic monitoring. OBJECTIVE To determine the agreement between current asthma symptoms and different metrics of albuterol use for patients randomly assigned to maintenance budesonide/formoterol treatment. METHODS Data on albuterol use were extracted for the 7-day period before visit 2 (at week 3) from 150 adult patients with asthma. Current asthma symptoms were measured by Asthma Control Questionnaire-5 (ACQ-5) score at the clinic visit. RESULTS The number of days of albuterol use, the average number of albuterol actuations/day, and the highest number of albuterol actuations/day in the 1-week period were all positively associated with ACQ-5 score (r = 0.41-0.45, P < .001) and had moderate discrimination for well-controlled and not well-controlled asthma (ACQ-5 scores ≤0.75 and ≥1.5, respectively), with receiver operator characteristic area under the curve of 0.80 to 0.82 and 0.70 to 0.77, respectively. Cut points of ≥3 days of albuterol use, average albuterol use of ≥1 actuation/day, and highest albuterol use of ≥4 actuations/day in the 1-week period had 73% sensitivity and 62% specificity, 78% sensitivity and 67% specificity, and 78% sensitivity and 66% specificity, respectively, for predicting an ACQ-5 ≥1.5. CONCLUSION Our findings support the use of the number of days of albuterol use, the average number of albuterol actuations per day, and the highest number of albuterol actuations per day over a 1-week period of observation as comparable markers of current asthma control.
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