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Yao TC, Huang JL, Wu CS, Horng-Shing Lu H, Chang YC, Chen WY, Kao HF, Wu AC, Tsai HJ. Comparative Risk of Neuropsychiatric Adverse Events Associated With Leukotriene-Receptor Antagonists Versus Inhaled Corticosteroids. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00955-3. [PMID: 39369853 DOI: 10.1016/j.jaip.2024.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 09/23/2024] [Accepted: 09/24/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Leukotriene-receptor antagonists (LTRA) and inhaled corticosteroids (ICS) are common controller medications for asthma, but limited studies examine their comparative risks on neuropsychiatric adverse events (NAEs) in patients with asthma. OBJECTIVE To investigate the comparative risks of LTRA versus ICS on 7 distinct categories of NAEs in patients with asthma at a nationwide level. METHODS We conducted a nationwide cohort study during 2010-2021. Incident NAEs and their clinical subgroups (eg, psychotic disorders, anxiety disorders, movement disorders, behavioral and emotional disorders, mood disorders, sleep-related disorders, and personality disorders) were assessed. Cox proportional hazards regressions were used to quantify the comparative risks. RESULTS There were 1,249,897 patients with asthma aged 6 to 64 years. Incidence rates for NAEs were 25.10 per 1000 person-years among patients treated with LTRA and 23.46 per 1000 person-years among those treated with ICS. The incidence rate difference was 1.64 (95% confidence interval [CI]: 0.30-2.98) per 1000 person-years. Positive associations of NAEs and 3 clinical subgroups were found in patients treated with LTRA compared with ICS (hazard ratios [HR]: 1.06 [95% CI: 1.00-1.12] for NAEs; HR: 1.88 [95% CI: 1.24-2.84] for psychotic disorders; HR: 1.10 [95% CI: 1.01-1.20] for anxiety disorders; and HR: 1.27 [95% CI: 1.02-1.58] for behavioral and emotional disorders), but not for movement disorders, mood disorders, sleep-related disorders, and personality disorders. CONCLUSIONS This nationwide cohort study identified heightened risks, ranging from 6% to 88%, of NAEs and 3 clinical subgroups in patients with asthma treated with LTRA compared with ICS. These findings underscore the necessity for clinicians to communicate with patients regarding potential neuropsychiatric harms when prescribing LTRA.
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Affiliation(s)
- Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Jing-Long Huang
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Pediatrics, New Taipei Municipal TuCheng Hospital, New Taipei, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Yunlin branch, Douliu, Taiwan
| | - Henry Horng-Shing Lu
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yen-Chen Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Wei-Yu Chen
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hui-Fang Kao
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Ann Chen Wu
- Department of Pediatrics, Children's Hospital, Boston, Mass
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan.
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Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group. J Clin Med 2022; 11:jcm11164763. [PMID: 36013002 PMCID: PMC9409690 DOI: 10.3390/jcm11164763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/20/2022] Open
Abstract
Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable phenotypes. Despite many efforts, there is a large gap in knowledge regarding management of preschool wheezing. In order to fill this lack of knowledge, the aim of these guidelines was to define management of wheezing disorders in preschool children (aged up to 5 years). A multidisciplinary panel of experts of the Emilia-Romagna Region, Italy, addressed twelve different key questions regarding the management of preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes) and systematic reviews have been conducted on PubMed to answer these specific questions, with the aim of formulating recommendations. The GRADE approach has been used for each selected paper, to assess the quality of the evidence and the degree of recommendations. These guidelines represent, in our opinion, the most complete and up-to-date collection of recommendations on preschool wheezing to guide pediatricians in the management of their patients, standardizing approaches. Undoubtedly, more research is needed to find objective biomarkers and understand underlying mechanisms to assess phenotype and endotype and to personalize targeted treatment.
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Deschildre A, Abou-Taam R, Drummond D, Giovannini-Chami L, Labouret G, Lejeune S, Lezmi G, Lecam MT, Marguet C, Petat H, Taillé C, Wanin S, Corvol H, Epaud R. [Update of the 2021 Recommendations for the management of and follow-up of adolescent asthmatic patients (over 12 years) under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version]. Rev Mal Respir 2022; 39:e1-e31. [PMID: 35148929 DOI: 10.1016/j.rmr.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- A Deschildre
- Université Lille, CHU Lille, service de pneumologie et allergologie pédiatriques, hôpital Jeanne de Flandre, 59000 Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019, CNRS UMR9017, équipe OpinFIELD: Infections opportunistes, Immunité, Environnement et Maladies Pulmonaires, Institut Pasteur de Lille, 59019 Lille cedex, France.
| | - R Abou-Taam
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - D Drummond
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - L Giovannini-Chami
- Service de Pneumo-Allergologie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - G Labouret
- Service de Pneumo-allergologie pédiatrique, Hôpital des Enfants, CHU Toulouse, 31000 Toulouse, France
| | - S Lejeune
- Université Lille, CHU Lille, service de pneumologie et allergologie pédiatriques, hôpital Jeanne de Flandre, 59000 Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019, CNRS UMR9017, équipe OpinFIELD: Infections opportunistes, Immunité, Environnement et Maladies Pulmonaires, Institut Pasteur de Lille, 59019 Lille cedex, France
| | - G Lezmi
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - M T Lecam
- Service de pathologies professionnelles et de l'environnement. Centre Hospitalier Inter Communal de Créteil, 94000 Créteil, France
| | - C Marguet
- Université de Normandie, UNIROUEN, EA 2456, CHU Rouen, maladies respiratoires et allergiques, CRCM, département de Pédiatrie, et de Médecine de l'adolescent, 76000 Rouen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN,UNIROUEN, EA2656, 14033 Caen, France
| | - H Petat
- Université de Normandie, UNIROUEN, EA 2456, CHU Rouen, maladies respiratoires et allergiques, CRCM, département de Pédiatrie, et de Médecine de l'adolescent, 76000 Rouen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN,UNIROUEN, EA2656, 14033 Caen, France
| | - C Taillé
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des maladies pulmonaires rares ; Inserm UMR1152, Paris, France
| | - S Wanin
- Service d'allergologie pédiatrique, hôpital universitaire Armand Trousseau, 75012 Paris, France; Unité Transversale d'éducation thérapeutique Sorbonne Université, Paris, France
| | - H Corvol
- Service de pneumologie pédiatrique, Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm UMRS938, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Trousseau, Paris, France
| | - R Epaud
- Centre hospitalier intercommunal de Créteil, service de pédiatrie générale, 94000 Créteil, France; Université Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France; FHU SENEC, Créteil, France
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McGeachie MJ, Wang AL, Lutz SM, Sordillo JE, Weiss ST, Tantisira KG, Iribarren C, Lu MX, Wu AC. Real-Life Patterns of Exacerbations While on Inhaled Corticosteroids and Long-Acting Beta Agonists for Asthma over 15 Years. J Clin Med 2020; 9:jcm9030819. [PMID: 32197337 PMCID: PMC7141292 DOI: 10.3390/jcm9030819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 12/14/2022] Open
Abstract
Asthma affects more than 300 million people in the world, costs over $80 billion annually in the United States, and is efficaciously treated with inhaled corticosteroids (ICS). To our knowledge, no studies have examined the real-world effectiveness of ICS, including the combination therapy consisting of ICS and long-acting beta agonists (LABAs), and patterns of use over a 15-year time period. We used data from the Kaiser Permanente Northern California multi-ethnic Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort which comprises longitudinal electronic health record data of over 100,000 people. Data included longitudinal asthma-related events, such as ambulatory office visits, hospitalizations, emergency department (ED) visits, and fills of ICS and ICS-LABA combination. Asthma exacerbations were defined as an asthma-related ED visit, hospitalization, or oral corticosteroid (OCS) burst. We used an expected-value approach to determine ICS and ICS-LABA coverage over exacerbation events. We compared rates of exacerbation of subjects on ICS or ICS-LABAs to their own rates of exacerbation when off controller medications. We found ICS-LABA therapy had significant effects, reducing all types of exacerbations per day by a factor of 1.76 (95% CI (1.06, 2.93), p = 0.03) and, specifically, bursts per day by a factor of 1.91 (95% CI (1.04, 3.53), p = 0.037). In conclusion, ICS-LABA therapy was significantly associated with fewer asthma-related exacerbations in a large population of individuals with asthma who were followed for 15 years.
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Affiliation(s)
- Michael J. McGeachie
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (M.J.M.)
| | - Alberta L. Wang
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (M.J.M.)
| | - Sharon M. Lutz
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02115, USA
| | - Joanne E. Sordillo
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02115, USA
| | - Scott T. Weiss
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (M.J.M.)
| | - Kelan G. Tantisira
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (M.J.M.)
| | - Carlos Iribarren
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, CA 94612, USA
| | - Meng X. Lu
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, CA 94612, USA
| | - Ann Chen Wu
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-617-867-4823
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Christensen ML, Davis RL. Identifying the "Blip on the Radar Screen": Leveraging Big Data in Defining Drug Safety and Efficacy in Pediatric Practice. J Clin Pharmacol 2019; 58 Suppl 10:S86-S93. [PMID: 30248191 DOI: 10.1002/jcph.1141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/23/2018] [Indexed: 11/10/2022]
Abstract
The immense amount of electronic health data (pharmacy and administrative claims, electronic health records, and clinical registries) that is being generated every day in the care of patients has the potential to be leveraged for improving clinical decisions at the point of care, uncovering or validating drug efficacy and drug safety. The potential use of big data for improving safe and effective use of medications is especially important in children because of their low drug exposure relative to adults. Electronic health data is collected primarily for clinical or billing purposes and not for research purposes. The major steps involved in data acquisition, extraction, aggregation, analysis, modeling, and interpretation are discussed. It is important to understand the limitation of big data and utilize appropriate study design and statistical methods. Possible applications are presented along with specific examples of how big data has been used in drug research to find that blip on the radar screen that may give an efficacy or safety signal that can lead to further investigation.
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Affiliation(s)
- Michael L Christensen
- Department of Clinical Pharmacy and Translational Sciences and the Center for Pediatric Pharmacokinetics and Therapeutics, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert L Davis
- Department of Pediatric and UTHSC and Oakridge National Laboratory Center in Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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6
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Current state and future prospect of the therapeutic strategy targeting cysteinyl leukotriene metabolism in asthma. Respir Investig 2019; 57:534-543. [PMID: 31591069 DOI: 10.1016/j.resinv.2019.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/12/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
Asthma is an allergic disorder with dominant type 2 airway inflammation, and its prevalence is increasing worldwide. Inhalation of corticosteroids is the primary treatment for asthma along with add-on drugs, including long-acting β2 agonists and/or cysteinyl leukotriene (cys-LT) receptor antagonists, in patients with poorly controlled asthma. Cys-LTs are composed of leukotriene C4 (LTC4), LTD4, and LTE4, which are enzymatically metabolized from arachidonic acid. These molecules act as inflammatory mediators through different types of high-affinity receptors, namely, CysLT1, CysLT2, and CysLT3 (also named as GPR99). CysLT1 antagonists possessing anti-inflammatory and bronchodilatory effects can be orally administered to patients with asthma. Recently, molecular biology-based studies have revealed the mechanism of inflammatory responses via other receptors, such as CysLT2 and CysLT3, as well as the importance of upstream inflammatory regulators, including type 2 cytokines (e.g., interleukins 4 and 5), in controlling cys-LT metabolism. These findings indicate the therapeutic potential of pharmacological agents targeting cys-LT metabolism-related receptors and enzymes, and antibody drugs neutralizing or antagonizing type 2 cytokines. This review focuses on the current state and future prospect of the therapeutic strategy targeting cys-LT metabolism.
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7
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Levine H, Leventer-Roberts M, Hoshen M, Mei-Zahav M, Balicer R, Blau H. Healthcare utilization in infants and toddlers with asthma-like symptoms. Pediatr Pulmonol 2019; 54:1567-1577. [PMID: 31298808 DOI: 10.1002/ppul.24429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/07/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recurrent asthma-like symptoms are common in infants, but few population studies describe diagnostic and treatment practice. METHODS Using the electronic data repository of Clalit Health Services, the largest integrated health care provider in Israel, we evaluated children born 2005-2012, who before 3 years of age had >3 episodes of asthma-like symptoms and/or >2 bronchodilator purchases within a year. We described health care utilization and the odds ratio for subsequent utilization after 3 and 12 months' controller therapy. The primary outcome measure was respiratory-related doctor visits. Linear and categorical regression analysis measured overall effectiveness of therapy. RESULTS Among 689 171 infants, 262 900 (38.1%) had > 3 asthma-like episodes/year during at least 1 year. Of those, 26 108 (10%) purchased controller therapy: 20 316 (77.8%) inhaled corticosteroids (ICS) with or without leukotriene receptor antagonists (LTRA), and 5792 (22.2%) LTRA alone. For these 26 108 over 3 months there were 93 845 respiratory-related doctor visits, 3110 hospital admissions, 5568 diagnoses of pneumonia, 9960 chest X-rays, 37 127 purchases for oral steroids, and 45 142 for antibiotics courses. Healthcare utilization decreased following ICS ± LTRA and LTRA alone, respectively, as follows: doctor visits 7% and 3%, chest X-rays 16% and 17%, bronchodilators 20% and 11%, systemic steroids 17% and 12%, and antibiotics by 35% and 22%, (P < .001 for all). Twelve months' therapy remained effective. CONCLUSIONS Asthma-like symptoms are common in infants. Health care utilization is very high and physician practices should be reassessed. Following controller therapy, health care utilization decreased. Yet controllers were prescribed in only a minority of eligible children.
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Affiliation(s)
- Hagit Levine
- Schneider Children's Medical Center of Israel, Pulmonary Institute, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Moshe Hoshen
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Meir Mei-Zahav
- Schneider Children's Medical Center of Israel, Pulmonary Institute, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Balicer
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Hannah Blau
- Schneider Children's Medical Center of Israel, Pulmonary Institute, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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A Comparison of Leukotriene Receptor Antagonists to Low-Dose Inhaled Corticosteroids in the Elderly with Mild Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2642-2652.e3. [PMID: 31108218 DOI: 10.1016/j.jaip.2019.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although elderly patients with asthma have clinical characteristics different from those of young adults, few studies or guidelines have focused on specific treatments for this population. OBJECTIVE This study compared the effectiveness of leukotriene receptor antagonists (LTRAs) versus inhaled corticosteroids (ICSs) in elderly patients with asthma in real-world settings. METHODS We extracted records for elderly patients with asthma who were newly prescribed LTRAs or low-dose ICSs from January 2003 to December 2010 from National Sample Cohort data of Korea. We defined the first prescription date for each medication as the index date. We compared the risks of asthma exacerbation between the 2 groups using Cox proportional-hazard regression after propensity score-based inverse probability of treatment weighting to balance covariates between treatment groups. We also compared asthma-related health care resource utilization and medication compliance in both groups using chi-square test and t test. RESULTS The number of identified patients newly treated with LTRAs and low-dose ICSs was 1571 and 121, respectively. The risks of asthma exacerbation in the LTRA and low-dose ICS groups after weighting were not significantly different (hazard ratio, 0.98; 95% CI, 0.65-1.54). The proportion with high compliance (medication possession ratio ≥ 80%) in the LTRA group was higher than that in the low-dose ICS group. CONCLUSIONS The effectiveness of LTRAs was not different from that of low-dose ICSs regarding the risk of asthma exacerbation in elderly patients with asthma in real-world settings. Given the practical benefits gained from convenient administration, LTRAs can be considered a reasonable alternative first-line therapy for elderly patients with mild asthma.
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Turi KN, Gebretsadik T, Lee RL, Hartert TV, Evans AM, Stone C, Sicignano NM, Wu AC, Iribarren C, Butler MG, Mitchel E, Morrow J, Larkin EK, Wu P. Seasonal patterns of Asthma medication fills among diverse populations of the United States. J Asthma 2017; 55:764-770. [PMID: 28881155 DOI: 10.1080/02770903.2017.1362426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Nonadherence to controller and overuse of reliever asthma medications are associated with exacerbations. We aimed to determine patterns of seasonal asthma medication use and to identify time period(s) during which interventions to improve medication adherence could reduce asthma morbidity. METHODS We conducted a retrospective cohort study of asthmatics 4-50 years of age and enrolled in three diverse health insurance plans. Seasonal patterns of medications were reported by monthly prescription fill rates per 1000 individuals with asthma from 1998 to 2013, and stratified by healthcare plan, sex, and age. RESULTS There was a distinct and consistent seasonal fill pattern for all asthma medications. The lowest fill rate was observed in the month of July. Fills increased in the autumn and remained high throughout the winter and spring. Compared with the month of May with high medication fills, July represented a relative decrease of fills ranging from 13% (rate ratio, RR: 0.87, 95% confidence interval, 95%CI: 0.72-1.04) for the combination of inhaled corticosteroids (ICS) + long acting beta agonists (LABA) to 45% (RR: 0.55, 95%CI: 0.49-0.61) for oral corticosteroids. Such a seasonal pattern was observed each year across the 16-year study period, among healthcare plans, sexes, and ages. LABA containing control medication (ICS+LABA and LABA) fill rates were more prevalent in older asthmatics, while leukotriene receptor antagonists were more prevalent in the younger population. CONCLUSIONS A seasonal pattern of asthma medication fill rates likely represents a reactive response to a loss of disease control and increased symptoms. Adherence to and consistent use of asthma medications among individuals who use medications in reaction to seasonal exacerbations might be a key component in reducing the risk of asthma exacerbations.
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Affiliation(s)
- Kedir N Turi
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Tebeb Gebretsadik
- b Department of Biostatistics , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Rees L Lee
- c Naval Medical Research Unit Dayton , Wright Patterson AFB , OH , USA
| | - Tina V Hartert
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | | | - Cosby Stone
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | | | - Ann C Wu
- e Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care , Boston , MA , USA
| | - Carlos Iribarren
- f Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
| | - Melissa G Butler
- g Center for Clinical and Outcomes Research , Kaiser Permanente Georgia , Atlanta , GA , USA.,h Roivant Sciences Ltd. , Hamilton , Bermuda
| | - Edward Mitchel
- i Department of Health Policy , Vanderbilt University Medical Center , Nashville , TN , USA
| | - James Morrow
- i Department of Health Policy , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Emma K Larkin
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Pingsheng Wu
- a Department of Medicine , Vanderbilt University Medical Center , Nashville , TN , USA.,b Department of Biostatistics , Vanderbilt University Medical Center , Nashville , TN , USA
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10
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Al Sallakh MA, Vasileiou E, Rodgers SE, Lyons RA, Sheikh A, Davies GA. Defining asthma and assessing asthma outcomes using electronic health record data: a systematic scoping review. Eur Respir J 2017; 49:49/6/1700204. [DOI: 10.1183/13993003.00204-2017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/09/2017] [Indexed: 01/25/2023]
Abstract
There is currently no consensus on approaches to defining asthma or assessing asthma outcomes using electronic health record-derived data. We explored these approaches in the recent literature and examined the clarity of reporting.We systematically searched for asthma-related articles published between January 1, 2014 and December 31, 2015, extracted the algorithms used to identify asthma patients and assess severity, control and exacerbations, and examined how the validity of these outcomes was justified.From 113 eligible articles, we found significant heterogeneity in the algorithms used to define asthma (n=66 different algorithms), severity (n=18), control (n=9) and exacerbations (n=24). For the majority of algorithms (n=106), validity was not justified. In the remaining cases, approaches ranged from using algorithms validated in the same databases to using nonvalidated algorithms that were based on clinical judgement or clinical guidelines. The implementation of these algorithms was suboptimally described overall.Although electronic health record-derived data are now widely used to study asthma, the approaches being used are significantly varied and are often underdescribed, rendering it difficult to assess the validity of studies and compare their findings. Given the substantial growth in this body of literature, it is crucial that scientific consensus is reached on the underlying definitions and algorithms.
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11
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Galbraith AA, Fung V, Li L, Butler MG, Nordin JD, Hsu J, Smith D, Vollmer WM, Lieu TA, Soumerai SB, Wu AC. Impact of Copayment Changes on Children's Albuterol Inhaler Use and Costs after the Clean Air Act Chlorofluorocarbon Ban. Health Serv Res 2016; 53:156-174. [PMID: 27868200 DOI: 10.1111/1475-6773.12615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine changes in children's albuterol use and out-of-pocket (OOP) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (CFC) propellants. SETTING Four health maintenance organizations (HMOs), two that increased copayments for albuterol inhalers that went from generic CFC-containing to branded CFC-free versions, and two that retained generic copayments for CFC-free inhalers (controls). We included children with asthma aged 4-17 years with commercial coverage from 2007 to 2010. DESIGN Interrupted time series with comparison series. DATA We obtained enrollee and plan characteristics from enrollment files, and utilization data from pharmacy and medical claims; OOP expenditures were extracted from pharmacy claims for two HMOs with cost data available. FINDINGS There were no significant differences in albuterol use between the group with increased cost-sharing and controls with respect to changes after the policy change. There was a postpolicy increase of $6.11 OOP per month per child using albuterol among those with increased cost-sharing versus $0.36 in controls; the difference between groups was significant (p < .01). CONCLUSIONS Increased copayments for brand-name CFC-free albuterol after the CFC ban did not lead to a decrease in children's albuterol use, but it led to a modest increase in OOP costs.
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Affiliation(s)
- Alison A Galbraith
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA
| | - Vicki Fung
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | | | - Melissa G Butler
- Roivant Sciences, Hamilton, Bermuda.,Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA
| | | | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Boston, MA.,Department of Health Care Policy, Harvard Medical School, Cambridge, MA
| | - David Smith
- Kaiser Permanente Center for Health Research Northwest, Portland, OR
| | - William M Vollmer
- Kaiser Permanente Center for Health Research Northwest, Portland, OR
| | - Tracy A Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA
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12
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Marcello C, Carlo L. Asthma phenotypes: the intriguing selective intervention with Montelukast. Asthma Res Pract 2016; 2:11. [PMID: 27965779 PMCID: PMC5142440 DOI: 10.1186/s40733-016-0026-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/25/2016] [Indexed: 01/19/2023] Open
Abstract
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation and a variable course associated with various underlying mechanisms that can differ between individuals. Patients with asthma can therefore exhibit different phenotypes, a term used to define the observable characteristics of an organism resulting from the interaction between its genetic makeup and the environment. The heterogeneity of asthma has received a large amount of attention in the last few years in order to better tailor treatment according to the different clinical and biological phenotypes of the disease. Specific asthma phenotypes may require an approach to treatment sometimes different from that recommended by current guidelines, so a personalized approach to asthma pharmacotherapy is recommended. Growing evidence suggests that leukotrienes play an important role in the pathogenesis of bronchial asthma. The mechanisms of action of leukotriene-receptor antagonists theoretically predict a good response in some asthma “phenotypes”.In this article we have performed an analysis of the recent literature (controlled clinical trials and real-life studies) about a possible selective intervention with Montelukast in specific asthma phenotypes.
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Affiliation(s)
| | - Lombardi Carlo
- Departmental Unit of Allergology, Immunology & Pulmonary Diseases, Fondazione Poliambulanza, Via Bissolati, 57, 25124 Brescia, Italy
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13
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Hossny E, Rosario N, Lee BW, Singh M, El-Ghoneimy D, SOH JY, Le Souef P. The use of inhaled corticosteroids in pediatric asthma: update. World Allergy Organ J 2016; 9:26. [PMID: 27551328 PMCID: PMC4982274 DOI: 10.1186/s40413-016-0117-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023] Open
Abstract
Despite the availability of several formulations of inhaled corticosteroids (ICS) and delivery devices for treatment of childhood asthma and despite the development of evidence-based guidelines, childhood asthma control remains suboptimal. Improving uptake of asthma management plans, both by families and practitioners, is needed. Adherence to daily ICS therapy is a key determinant of asthma control and this mandates that asthma education follow a repetitive pattern and involve literal explanation and physical demonstration of the optimal use of inhaler devices. The potential adverse effects of ICS need to be weighed against the benefit of these drugs to control persistent asthma especially that its safety profile is markedly better than oral glucocorticoids. This article reviews the key mechanisms of inhaled corticosteroid action; recommendations on dosage and therapeutic regimens; potential optimization of effectiveness by addressing inhaler technique and adherence to therapy; and updated knowledge on the real magnitude of adverse events.
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Affiliation(s)
- Elham Hossny
- Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, 11566 Egypt
| | | | - Bee Wah Lee
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Meenu Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dalia El-Ghoneimy
- Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, 11566 Egypt
| | - Jian Yi SOH
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter Le Souef
- Winthrop Professor of Paediatrics & Child Health, School of Paediatrics & Child Health, University of Western Australia, Crawley, Australia
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14
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Turner SW, Richardson K, Burden A, Thomas M, Murray C, Price D. Initial step-up treatment changes in asthmatic children already prescribed inhaled corticosteroids: a historical cohort study. NPJ Prim Care Respir Med 2015; 25:15041. [PMID: 26068328 PMCID: PMC4498242 DOI: 10.1038/npjpcrm.2015.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/03/2015] [Accepted: 04/07/2015] [Indexed: 01/14/2023] Open
Abstract
Background: When standard doses of inhaled corticosteroids (ICS) fail to control symptoms in children aged >4 years, guidelines recommend the addition of a long-acting β2-agonist (LABA), with other treatment options being available if symptoms persist. Aims: To determine the proportion of initial ‘step-up’ episodes where LABAs were prescribed and to describe characteristics of individuals not stepped up with LABA. Methods: Between 1999 and 2011, initial step-up episodes from ICS monotherapy were identified in children aged 5–12 years with asthma and in receipt of ICS. Data sources were the Clinical Practice Research Datalink and Optimum Patient Care Research Database. Results: Initial step-up episodes were identified in 10,793 children. ICS dose was increased in 6,252 children (58%), LABA was introduced in 3,436 (32%; including 1,107 where fixed dose combination inhaler (FDC) replaced the ICS inhaler), and leukotriene receptor antagonist (LTRA) was added in 1,105 (10%). Compared with children stepped up to any LABA, others were younger and prescribed lower doses of ICS and reliever medication. ICS dose increase was more likely in obese children and LTRA prescribing was more likely in children with rhinitis and in receipt of antibiotics. Compared with FDC, step-up to separate LABA inhaler was more likely in younger, obese children who were using less oral steroids. Conclusions: One-third of initial step-up episodes in children with asthma treated with ICS are to add LABA. Different characteristics of children prescribed therapies other than LABA suggest that prescribers tailor treatment in some clinical settings.
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Affiliation(s)
| | | | | | - Mike Thomas
- Primary Care, University of Southampton, Southampton, UK
| | - Clare Murray
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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15
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Williams PV. What do "real life" studies tell us about asthma controllers? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 2:614-5. [PMID: 25213057 DOI: 10.1016/j.jaip.2014.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Paul V Williams
- Division of Allergy, University of Washington School of Medicine, Seattle, Wash.
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16
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Lu CY, Zhang F, Lakoma MD, Butler MG, Fung V, Larkin EK, Kharbanda EO, Vollmer WM, Lieu T, Soumerai SB, Chen Wu A. Asthma Treatments and Mental Health Visits After a Food and Drug Administration Label Change for Leukotriene Inhibitors. Clin Ther 2015; 37:1280-91. [PMID: 25920571 DOI: 10.1016/j.clinthera.2015.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/09/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE In 2009, the US Food and Drug Administration (FDA) mandated a label change for leukotriene inhibitors (LTIs) to include neuropsychiatric adverse events (eg, depression and suicidality) as a precaution. This study investigated how this label change affected the use of LTIs and other asthma controller medications, mental health visits, and suicide attempts. METHODS We analyzed data (2005-2010) from 5 large health plans in the US Population-Based Effectiveness in Asthma and Lung Diseases (PEAL) Network. The study cohort included children and adolescents (n = 30,000), young adults (n = 20,000), and adults (n = 90,000) with asthma. We used interrupted time series to examine changes in rates of LTI dispensings, non-LTI dispensings, mental health visits, and suicide attempts (using a validated algorithm based on a combination of diagnoses of injury or poisoning and psychiatric conditions). FINDINGS The label change was associated with abrupt reductions in LTI use among all age groups (relative reductions of 8.3%, 15.1%, and 6.0% among adolescents, young adults, and adults, respectively, compared with expected rates at 1 year after the warnings). Although we detected immediate offset increases in non-LTI asthma medication use, these increases were not sustained among adolescents and young adults. There were small increases in mental health visits among LTI users. IMPLICATIONS The FDA label change for LTIs communicated possible risk of neuropsychiatric events. Communication and enhanced awareness may have increased reporting of mental health symptoms among young adults and adults. It is important to assess intended and unintended consequences of FDA warnings and label changes.
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Affiliation(s)
- Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Matthew D Lakoma
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Vicki Fung
- Mongan Institute for Health Policy, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Emma K Larkin
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Elyse O Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - William M Vollmer
- Center for Health Research Northwest, Kaiser Permanente Northwest, Portland, Oregon
| | - Tracy Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Massachusetts
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17
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Wu AC, Gay C, Rett MD, Stout N, Weiss ST, Fuhlbrigge AL. Pharmacogenomic test that predicts response to inhaled corticosteroids in adults with asthma likely to be cost-saving. Pharmacogenomics 2015; 16:591-600. [PMID: 25880024 DOI: 10.2217/pgs.15.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIM To identify the clinical and economic circumstances under which a pharmacogenomic test that predicts response to inhaled corticosteroids might be a cost-effective option for individuals with asthma. MATERIALS & METHODS We synthesized published data on clinical and economic outcomes to project 10-year costs, quality-adjusted life-years and cost-effectiveness of pharmacogenomic testing for inhaled corticosteroid response. We assumed the pharmacogenomic test cost was $500 with a sensitivity and specificity of 84 and 98%, respectively. These were varied in sensitivity analyses. RESULTS Both strategies, pharmacogenomic testing for inhaled corticosteroid response and no testing conferred 7.1 quality-adjusted life-years. Compared with no testing, pharmacogenomic testing costs less. CONCLUSION Pharmacogenomic testing for asthma is cost-saving and noninferior in improving health. Original submitted 19 November 2014; Revision submitted 23 February 2015.
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Affiliation(s)
- Ann Chen Wu
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA 02215-5301, USA
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