Dispensing of antibiotics, antitussives and mucolytics to asthma patients: a pharmacy-based observational survey

Antitussive Use in Patients with Inadequately Controlled Moderate-to-Severe Asthma: A Post Hoc Analysis of the Omalizumab EXTRA Trial

Acute and chronic cough are common symptoms in patients with severe allergic asthma. Although asthma-related cough can be controlled by asthma-specific medications, both prescription and over-the-counter antitussives are often also necessary. The anti-immunoglobulin E monoclonal antibody omalizumab is an effective treatment for patients with moderate-to-severe asthma, but little is known about subsequent antitussive use patterns. This post hoc analysis examined data from the Phase 3 EXTRA study that included patients aged 12-75 years with inadequately controlled moderate-to-severe asthma. Baseline antitussive use was low overall (16/427, 3.7% for omalizumab and 18/421, 4.3% for placebo). Among patients with no baseline antitussive use (n = 411 omalizumab, n = 403 placebo), most patients (88.3% omalizumab, 83.4% placebo) reported not using antitussives during the 48-week treatment period. The percentage of patients using 1 antitussive was lower for patients treated with omalizumab than placebo (7.1% vs 13.2%), although the adjusted rate of antitussive use during the treatment period was similar for omalizumab and placebo (0.22 and 0.25). Non-narcotics were used more often than narcotics. In conclusion, this analysis found low use of antitussives in patients with severe asthma and suggests that omalizumab may have the potential to decrease antitussive use.

Mucus targeting as a plausible approach to improve lung function in COVID-19 patients

COVID-19 (SARS-CoV-2) has emerged as one of the worst pandemics that have tormented the globe due to its highly contagious nature. Even if the disease manifests fever-like symptoms mostly, the disease may progress to the pulmonary-hyper inflammatory phase, with severe pneumonia, hypoxia and subsequent multiple organ infection. This subsequently creates a huge burden to the health care systems across the globe for an immediate arrangement of ventilator facilities, oxygen supply and advanced health care. We evaluated the pathological similarity of COVID-19 with other airway obstructive disorders such as COPD and asthma and found typical mucus hypersecretion and mucus plugging in COVID-19 subjects. From several bronchoscopy and clinical autopsy carried out in COVID-19 patients, the overexpression of mucin gene was evident which play a significant role in mucus hypersecretion and accumulation, leading to airway obstruction and further to respiratory distress. In the present work, we highlight the need for intense research inputs to elucidate the exact role the mucus plays in worsening COVID-19 symptoms. This will further help to find a proper approach to quantify the airway mucus plugging in each patient and to develop an appropriate therapy either to inhibit mucus secretion or to improve mucus clearance through well-designed clinical trials.

Prescribed therapy for asthma: therapeutic ratios and outcomes

Background

Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy. The ICS-to-total-asthma-medication ratios, calculated from claims data, indicate potentially risky disease management in asthma. Our aim was to assess the utility of ICS-to-total-asthma-medication ratios from primary care electronic medical records (EMRs) in detecting patients at risk of asthma exacerbation, as approached by prescription of oral corticosteroids and/or antibiotics.

Methods

Retrospective cohort studies were identified, using the Health Improvement Network general practice database (THIN, United Kingdom) and the Cegedim Longitudinal Patient Data (France). We selected asthma patients aged 16–40 years, with ≥ 4 prescriptions for asthma medications in 2007 and ≥ 1 prescription in 2008. For each country, three groups were defined according to ratio value in 2008: 0% (non-ICS users), <50% (low-ICS-ratio group) and ≥50% (high-ICS-ratio group). Outcomes were marker of asthma exacerbations: systemic corticosteroids and antibiotics. They were compared between groups in each country.

Results

Among 38,637 British and 4,587 French patients, higher numbers of prescriptions per patient of systemic corticosteroids, antibiotics and total asthma medications were observed in the low-ICS-ratio groups compared to other groups (p < 0.0001 for each outcome in both countries). Likewise, low-ICS-ratio patients had more medical contacts (p < 0.0001 in both countries), suggesting poorly controlled asthma. ICS-treated patients had lower risks of receiving systemic corticosteroids in 2008 in the high-ICS-ratio group, compared to the low-ICS-ratio group: RR = 0.54, 95%CI = [0.50-0.57] and RR = 0.78, 95%CI = [0.67-0.91] in the UK and France, respectively.

Conclusions

Patients with high ICS-to-total-asthma-medication ratios presented fewer asthma-related outcomes. The low ICS-to-total-asthma-medication ratio calculated with EMRs data reflects insufficient prescribing of ICS relative to all asthma medications, which may lead to deteriorated asthma control.

[Student assessment of pharmacy practice experiences in France: a national survey]

Pharmacy practice experience (PPE) aims to help trainees to become independent professional practitioners and is a prerequisite for developing skills and competence. In France, it does not exist any study that describes student satisfaction related to preregistration trainings. The aim of this study was to assess student perceptions related to the four PPE types that are planned along the course of study. A questionnaire was sent to each student. Concerning the first and second year introductory PPE, among the 8491 responses, 73% of the students stated that the length was too long regarding their actual knowledge and the objectives were not always achieved. Four thousand and eleven responses regarding third and fourth year PPE were analyzed. Sixty-two percent of the students did not deliver drugs related to the practice's subject and 57% declared doing similar task assigned during the first year PPE especially storage one's. One thousand six hundred and seven questionnaires regarding hospital practices were received. Forty-one percent of the trainees were not asked to perform task that were related to their actual knowledge. Additional comments focused on overmuch shadowing. Among the 853 responses related to the 6th year PPE, 88% of the students considered that they were overall satisfied of the training. Although 30% felt they acquired insufficient skills and professionalism and declared they were not ready to integrate the work world. Those results should prompt decision makers to modify in depth PPE programs in France in order to improve trainees' professionalism and skills acquisition. Promoting and developing researches in the field of PPE is urgently needed.

Interrupting the cough reflex in asthma

PURPOSE OF REVIEW

Although cough is one of the defining symptoms of asthma, wheeze, chest tightness and breathlessness have generally received more attention. The impact of coughing for patients may be more important than currently appreciated and has been rated more troublesome than wheeze, chest tightness or disturbance of sleep.

RECENT FINDINGS

Studies objectively measuring cough in asthma reveal that cough frequencies vary from those similar to healthy volunteers to cough counts comparable to patients presenting with chronic cough, but the potential triggers for cough in asthma are poorly understood. This review discusses our current knowledge of cough in asthma, potential mechanisms that may provoke coughing, the effect of current treatments and possible future therapeutics.

SUMMARY

Cough in some asthma patients is a significant problem, deserving further attention in both clinical practice and clinical research.