Factors influencing dispensing of psychotropic medications to patients with asthma: a community pharmacy-based survey

Biofeedback Training to Increase P co2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions?

OBJECTIVE

Anxiety is highly prevalent in individuals with asthma. Asthma symptoms and medication can exacerbate anxiety, and vice versa. Unfortunately, treatments of comorbid anxiety and asthma are largely lacking. A problematic feature common to both conditions is hyperventilation. It adversely affects lung function and symptoms in asthma and anxiety. We examined whether a treatment to reduce hyperventilation, shown to improve asthma symptoms, also improves anxiety in asthma patients with high anxiety.

METHOD

One hundred twenty English- or Spanish-speaking adult patients with asthma were randomly assigned to either Capnometry-Assisted Respiratory Training (CART) to raise P co2 or feedback to slow respiratory rate (SLOW). Although anxiety was not an inclusion criterion, 21.7% met clinically relevant anxiety levels on the Hospital Anxiety and Depression Scale (HADS). Anxiety (HADS-A) and depression (HADS-D) scales, anxiety sensitivity (Anxiety Sensitivity Index [ASI]), and negative affect (Negative Affect Scale of the Positive Affect Negative Affect Schedule) were assessed at baseline, posttreatment, 1-month follow-up, and 6-month follow-up.

RESULTS

In this secondary analysis, asthma patients with high baseline anxiety showed greater reductions in ASI and PANAS-N in CART than in SLOW ( p values ≤ .005, Cohen d values ≥ 0.58). Furthermore, at 6-month follow-up, these patients also had lower ASI, PANAS-N, and HADS-D in CART than in SLOW ( p values ≤ .012, Cohen d values ≥ 0.54). Patients with low baseline anxiety did not have differential outcomes in CART than in SLOW.

CONCLUSIONS

For asthma patients with high anxiety, our brief training designed to raise P co2 resulted in significant and sustained reductions in anxiety sensitivity and negative affect compared with slow-breathing training. The findings lend support for P co2 as a potential physiological target for anxiety reduction in asthma.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT00975273 .

Prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients in general practice: a cross-sectional study based on French and Italian prescribing data

Background

Asthma is often poorly controlled and guidelines are often inadequately followed in medical practice. In particular, the prescription of non-asthma-specific drugs can affect the quality of care. The goal of this study was to measure the frequency of the prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients and to look for associations between sex or age and the prescription of these drugs.

Methods

A cross-sectional study was conducted using computerised medical records from French and Italian general practitioners’ networks. Patients were selected according to criteria adapted from the HEDIS (Healthcare Effectiveness Data and Information Set) criteria. The outcome measure was the number of antibiotics or anxiolytics/hypnotics prescriptions per patient in 1 year. Parallel multivariate models were developed.

Results

The final sample included 3,093 French patients (mean age 27.6 years, 49.7% women) and 3,872 Italian patients (mean age 29.1 years, 48.7% women). In the univariate analysis, the French patients were prescribed fewer antibiotics than the Italian patients (37.1% vs. 42.2%, p < 0.00001) but more anxiolytics/hypnotics (17.8% vs. 6.9%, p < 0.0001). In the multivariate models, the female patients were more likely to receive antibiotics (odds ratio: 1.5 [1.3–1.7]) and anxiolytics/hypnotics (odds ratio: 1.8 [1.5–2.1]).

Conclusions

The prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients is frequent, especially in women. Asthma guidelines should address this issue by referring to other guidelines covering the prescription of non-asthma-specific drugs, and alternative non-pharmacological interventions should be considered.

Predictors of asthma control: what can we modify?

PURPOSE OF REVIEW

One strategy to improve asthma control is to identify risk factors for uncontrolled asthma in epidemiologic studies and then consider those risk factors as potential targets for intervention. This article reviews predictors of impairment based on validated tools and predictors of severe asthma exacerbations.

RECENT FINDINGS

Indirectly modifiable risk factors for poor asthma control include older age in adults, lower socioeconomic status, and poor perception of dyspnea. Modifiable risk factors for poor asthma control include allergy triggers, low adherence, comorbidities, absence of specialty care, and various aspects of asthma self-management education.

SUMMARY

Intervention strategies are suggested for predictors that are directly or indirectly modifiable. It is hoped that attention to these factors will improve asthma control and reduce the burden of disease.

A prospective study of asthma and subsequent use of hypnotics in young adults

PURPOSE

To examine whether young adults with asthma are at higher risk of initiating hypnotic use.

METHODS

The study population was participants from the Norwegian youth health surveys, where all 10th grade students (15-17 years old) in five counties were invited. 10,164 participants with no prior use of hypnotics were linked to the Norwegian Prescription Database. Four groups were defined based on survey data about ever having had asthma and prescription data on asthma drugs received in the year prior to start of follow-up: (1) no asthma; (2) not active asthma; (3) active recently developed asthma; and (4) still active asthma. Incidence proportions were estimated as share of participants filling hypnotic prescriptions during 2005-July 2010. Incidence rate ratios (IRR), adjusted for potential confounders (illnesses, lifestyle and sociodemographic factors), were estimated with the number of hypnotic prescriptions filled during 2005-July 2010 as outcome.

RESULTS

The incidence proportion of filling hypnotic prescriptions was 6.1%, ranging from 5.7% in no asthma group to 9.5% in active recently developed asthma group. Crude IRR was 1.35 (95%CI 0.93-1.95) for not active asthma, 4.18 (1.83-9.55) for active recently developed asthma, and 1.63 (0.85-3.14) for still active asthma, with no asthma as reference. Adjusted IRR for active recently developed asthma group changed to 4.72 (2.07-10.75) while the other groups remained statistically not significant.

CONCLUSIONS

In this prospective study of young adults without prior use of hypnotics, an increased risk of initiating hypnotic use was present in asthmatics, especially among those who recently had received asthma drugs.

Validation of the Asthma Control Test questionnaire in a North African population

BACKGROUND

Patient-reported outcome measures are required to measure asthma control. The Asthma Control Test (ACT) is one such measure which was used in the AIRMAG study, a general population study of asthma in the Maghreb. Three dialectal Arabic versions of the ACT (Algerian, Moroccan and Tunisian) were developed.

OBJECTIVE

To perform a psychometric evaluation of the properties of dialectal Arabic versions of the ACT used in the AIRMAG study.

METHODS

The test data came from 624 adult subjects in a random general population sample in Algeria, Morocco and Tunisia. The internal consistency of the ACT was analysed using Cronbach's a coefficient. The factorial structure was explored by primary component analysis with varimax rotation. Test-retest reproducibility was assessed in a subgroup of 61 subjects. Face and discriminant validity were assessed.

RESULTS

Cronbach's a coefficient ranged from 0.58 for the Algerian version to 0.67 for the Moroccan version. The 'use-of-rescue-treatment' item was identified as discordant, since its removal resulted in an increase in Cronbach's a coefficient. The discordance of this item was confirmed by primary component analysis, where the four remaining items were aligned along a single dimension, and the 'use-of-rescue-treatment' item offset along a second dimension. Test and retest scores were well correlated (r =0.704). The ACT showed good face and discriminant validity.

CONCLUSIONS

The ACT is a valid measure of asthma control in a North African context, although its internal consistency is compromised by the 'use-of-rescue-treatment' item, probably due to limited access to care and use of short-acting beta-agonists.