1
|
Villa-Roel C, Borgundvaag B, Majumdar SR, Emond M, Campbell S, Sivilotti M, Abu-Laban RB, Stiell IG, Aaron SD, Senthilselvan A, Rowe BH. Reasons and outcomes for patients receiving ICS/LABA agents prior to, and one month after, emergency department presentations for acute asthma. J Asthma 2018; 56:985-994. [PMID: 30311821 DOI: 10.1080/02770903.2018.1508472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Asthma is a common emergency department (ED) presentation. This study examined factors associated with inhaled corticosteroids/long-acting beta-agonist (ICS/LABA) use; and management and outcomes before and after ED presentation. Methods: Secondary analysis of a prospective cohort study; adults treated for acute asthma in Canadian EDs underwent a structured interview before discharge and were followed-up four weeks later. Patients received oral corticosteroids (OCS) at discharge and, at physician discretion, most received ICS or ICS/LABA inhaled agents. Analyses focused on ICS/LABA vs "other" treatment groups at ED presentation. Results: Of 807 enrolled patients, 33% reported receiving ICS/LABA at ED presentation; 62% were female, median age was 31 years. Factors independently associated with ICS/LABA treatment prior to ED presentation were: having an asthma action plan; using an asthma diary/peak flow meter; influenza immunization; not using the ED as usual site for prescriptions; ever using OCS and currently using ICS. Patients were treated similarly in the ED and at discharge; however, relapse was higher in the ICS/LABA group, even after adjustment. Conclusion: One-third of patients presenting to the ED with acute asthma were already receiving ICS/LABA agents; this treatment was independently associated with preventive measures. While ICS/LABA management improves control of chronic asthma, patients using these agents who develop acute asthma reflect higher severity and increased risk of future relapse.
Collapse
Affiliation(s)
- Cristina Villa-Roel
- a Departments of Emergency Medicine, University of Alberta , Edmonton , AB , Canada
| | - Bjug Borgundvaag
- e Department of Emergency Medicine, Mt. Sinai Hospital , Toronto , ON , Canada
| | | | - Marcel Emond
- f Division of Emergency Medicine, Laval University , Quebec City , PQ , Canada
| | - Sam Campbell
- g Department of Emergency Medicine, Dalhousie University , Halifax , NS , Canada
| | - Marco Sivilotti
- h Departments of Emergency Medicine and of Biomedical & Molecular Sciences, Queen's University , Kingston , ON , Canada
| | - Riyad B Abu-Laban
- i Department of Emergency Medicine, University of British Columbia , Vancouver , BC , Canada
| | - Ian G Stiell
- j Department of Emergency Medicine and Medicine, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa , ON , Canada
| | - Shawn D Aaron
- j Department of Emergency Medicine and Medicine, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa , ON , Canada
| | | | - Brian H Rowe
- a Departments of Emergency Medicine, University of Alberta , Edmonton , AB , Canada.,c School of Public Health, University of Alberta , Edmonton , AB , Canada.,d Alberta Health Services (AHS) all in Edmonton , Edmonton , AB , Canada
| | | |
Collapse
|
2
|
Arrotta N, Hill J, Villa-Roel C, Dennett E, Harries M, Rowe BH. Factors associated with hospital admission in adult patients with asthma exacerbations: A systematic review. J Asthma 2018. [PMID: 29521552 DOI: 10.1080/02770903.2018.1424189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A variable proportion of patients presenting to the emergency department (ED) with acute asthma require admission to hospital. Previous studies have identified select factors associated with admission following ED presentation; however, no review has synthesized the evidence in this regard. This systematic review summarizes the evidence regarding factors associated with hospital admission following ED presentation. METHODS Searches were conducted in seven electronic databases and common sources of grey literature. Studies reporting disposition for adults after ED presentation were included. Admission proportions and factors associated with hospitalization that remained statistically significant in multivariable analyses (p < 0.05) were reported. RESULTS Out of an initial 5865 identified articles, 15 articles met full inclusion criteria and 11 were included in the analyses. Female sex (n = 2) and older age (n = 2) were individual factors associated with admission. Patient vital signs and severity followed by patient attributes were the two most frequent domains associated with admission. Admission proportions were analyzed in 10 studies at an median of ∼20% with no clear change between 1996 and 2012. CONCLUSIONS Factors such as patient demographics (e.g., female sex, older age), patient vital signs/severity, and history are associated with admission following ED presentation for acute asthma. These can be employed by ED clinicians to effectively discern patients at high risk for admission and lead to more evidence-based decision-making.
Collapse
Affiliation(s)
- Nicholas Arrotta
- a Department of Emergency Medicine , University of Alberta , Edmonton, Alberta , Canada.,b School of Medicine, Trinity College Dublin , University of Dublin , Dublin , Ireland
| | - Jesse Hill
- a Department of Emergency Medicine , University of Alberta , Edmonton, Alberta , Canada.,c Faculty of Medicine and Dentistry , University of Alberta , Edmonton, Alberta , Canada
| | - Cristina Villa-Roel
- a Department of Emergency Medicine , University of Alberta , Edmonton, Alberta , Canada.,d School of Public Health , University of Alberta , Edmonton, Alberta , Canada
| | - Elizabeth Dennett
- e John W. Scott Health Sciences Library, University of Alberta , Edmonton, Alberta , Canada
| | - Molly Harries
- a Department of Emergency Medicine , University of Alberta , Edmonton, Alberta , Canada
| | - Brian H Rowe
- a Department of Emergency Medicine , University of Alberta , Edmonton, Alberta , Canada.,d School of Public Health , University of Alberta , Edmonton, Alberta , Canada.,f Alberta Health Services , Edmonton, Alberta , Canada
| |
Collapse
|
3
|
Refaat S, Aref H. Acute asthma in emergency department, prevalence of respiratory and non-respiratory symptoms. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
4
|
Su XM, Yu N, Kong LF, Kang J. Effectiveness of inhaled corticosteroids in the treatment of acute asthma in children in the emergency department: a meta-analysis. Ann Med 2014; 46:24-30. [PMID: 24328420 DOI: 10.3109/07853890.2013.859855] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This meta-analysis aimed to compare the treatment of an acute asthma attack in children in the emergency department (ED) with inhaled corticosteroids (ICS) versus placebo or oral systemic corticosteroids (SC) as assessed by the hospital admission rates. METHODS After searching Medline, Cochrane, EMBASE, and Google Scholar, we identified ten articles that described randomized controlled trials of ICS versus placebo or oral SC for treating children with asthma attacks in the ED. Primary outcome was the hospital admission rate as defined as inpatient admission or admission into intensive care unit. RESULTS Across the studies, a range of drugs and doses were used. For ICS, six studies administered budesonide (dose range: 0.4-2 mg), and three studies gave fluticasone/flunisolide (dose range: 0.5-2 mg). Six studies administered oral prednisone (dose range: 1-2 mg/kg/day), and four studies gave placebo. The rate of hospital admissions in patients treated with ICS was not significantly higher than those treated with oral SC. The rate of hospital admissions in patients treated with ICS was significantly lower than those treated with placebo. CONCLUSION ICS treatment of children with acute asthma exacerbations showed a similar rate of hospitalization as those treated by SC.
Collapse
Affiliation(s)
- Xin-Ming Su
- Department of Respiratory Disease, The First Hospital of China Medical University , Shenyang, 110001 , China
| | | | | | | |
Collapse
|
5
|
Abstract
Asthma is one of the most common conditions seen in clinical practice and carries both a significant disease burden in terms of patient morbidity and a high economic burden in both direct and indirect costs. Despite this, it remains a comparatively poorly understood disease, with only modest advances in treatment over the past decade. Corticosteroids remain the cornerstone of therapy. Both patient compliance with medications and physician adherence to evidence-based guidelines are often poor, and a high percentage of patients continue to have inadequately controlled disease even with optimal therapy. Following a contextual overview of the current treatment guidelines, this review focuses on novel asthma therapies, beginning with the introduction of the leukotriene receptor antagonist zafirlukast in the 1990s, continuing through advanced endoscopic therapy and into cytokine-directed biologic agents currently in development. Along with clinically relevant biochemistry and pharmacology, the evidence supporting the place of these therapies in current guidelines will be highlighted along with data comparing these agents with more conventional treatment. A brief discussion of other drugs, such as those developed for unrelated conditions and subsequently examined as potential asthma therapies, is included.
Collapse
|
6
|
Cazzola M, Page CP, Rogliani P, Matera MG. β2-agonist therapy in lung disease. Am J Respir Crit Care Med 2013; 187:690-6. [PMID: 23348973 DOI: 10.1164/rccm.201209-1739pp] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
β2-Agonists are effective bronchodilators due primarily to their ability to relax airway smooth muscle (ASM). They exert their effects via their binding to the active site of β2-adrenoceptors on ASM, which triggers a signaling cascade that results in a number of events, all of which contribute to relaxation of ASM. There are some differences between β2-agonists. Traditional inhaled short-acting β2-agonists albuterol, fenoterol, and terbutaline provide rapid as-needed symptom relief and short-term prophylactic protection against bronchoconstriction induced by exercise or other stimuli. The twice-daily β2-agonists formoterol and salmeterol represent important advances. Their effective bronchodilating properties and long-term improvement in lung function offer considerable clinical benefits to patients. More recently, a newer β2-agonist (indacaterol) with a longer pharmacodynamic half-life has been discovered, with the hopes of achieving once-daily dosing. In general, β2-agonists have an acceptable safety profile, although there is still controversy as to whether long-acting β2-agonists may increase the risk of asthma mortality. In any case, they can induce adverse effects, such as increased heart rate, palpitations, transient decrease in PaO2, and tremor. Desensitization of β2-adrenoceptors that occurs during the first few days of regular use of β2-agonist treatment may account for the commonly observed resolution of the majority of these adverse events after the first few doses. Nevertheless, it can also induce tolerance to bronchoprotective effects of β2-agonists and has the potential to reduce bronchodilator sensitivity to them. Some novel once-daily β2-agonists (olodaterol, vilanterol, abediterol) are under development, mainly in combination with an inhaled corticosteroid or a long-acting antimuscarinic agent.
Collapse
Affiliation(s)
- Mario Cazzola
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, Italy.
| | | | | | | |
Collapse
|
7
|
Greenberger PA. Terminology, close-calls, and bracketology for allergy, asthma, and immunology. Ann Allergy Asthma Immunol 2012; 110:141-5. [PMID: 23548520 DOI: 10.1016/j.anai.2012.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/24/2012] [Accepted: 11/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Paul A Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| |
Collapse
|