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Nkoy FL, Stone BL, Deering-Rice CE, Zhu A, Lamb JG, Rower JE, Reilly CA. Impact of CYP3A5 Polymorphisms on Pediatric Asthma Outcomes. Int J Mol Sci 2024; 25:6548. [PMID: 38928254 PMCID: PMC11203737 DOI: 10.3390/ijms25126548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Genetic variation among inhaled corticosteroid (ICS)-metabolizing enzymes may affect asthma control, but evidence is limited. This study tested the hypothesis that single-nucleotide polymorphisms (SNPs) in Cytochrome P450 3A5 (CYP3A5) would affect asthma outcomes. Patients aged 2-18 years with persistent asthma were recruited to use the electronic AsthmaTracker (e-AT), a self-monitoring tool that records weekly asthma control, medication use, and asthma outcomes. A subset of patients provided saliva samples for SNP analysis and participated in a pharmacokinetic study. Multivariable regression analysis adjusted for age, sex, race, and ethnicity was used to evaluate the impact of CYP3A5 SNPs on asthma outcomes, including asthma control (measured using the asthma symptom tracker, a modified version of the asthma control test or ACT), exacerbations, and hospital admissions. Plasma corticosteroid and cortisol concentrations post-ICS dosing were also assayed using liquid chromatography-tandem mass spectrometry. Of the 751 patients using the e-AT, 166 (22.1%) provided saliva samples and 16 completed the PK study. The e-AT cohort was 65.1% male, and 89.6% White, 6.0% Native Hawaiian, 1.2% Black, 1.2% Native American, 1.8% of unknown race, and 15.7% Hispanic/Latino; the median age was 8.35 (IQR: 5.51-11.3) years. CYP3A5*3/*3 frequency was 75.8% in White subjects, 50% in Native Hawaiians and 76.9% in Hispanic/Latino subjects. Compared with CYP3A5*3/*3, the CYP3A5*1/*x genotype was associated with reduced weekly asthma control (OR: 0.98; 95% CI: 0.97-0.98; p < 0.001), increased exacerbations (OR: 6.43; 95% CI: 4.56-9.07; p < 0.001), and increased asthma hospitalizations (OR: 1.66; 95% CI: 1.43-1.93; p < 0.001); analysis of 3/*3, *1/*1 and *1/*3 separately showed an allelic copy effect. Finally, PK analysis post-ICS dosing suggested muted changes in cortisol concentrations for patients with the CYP3A5*3/*3 genotype, as opposed to an effect on ICS PK. Detection of CYP3A5*3/3, CYPA35*1/*3, and CYP3A5*1/*1 could impact inhaled steroid treatment strategies for asthma in the future.
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Affiliation(s)
- Flory L. Nkoy
- Department of Pediatrics, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA; (F.L.N.); (B.L.S.); (A.Z.)
| | - Bryan L. Stone
- Department of Pediatrics, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA; (F.L.N.); (B.L.S.); (A.Z.)
| | - Cassandra E. Deering-Rice
- Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, 30 S 2000 E, Room 201 Skaggs Hall, Salt Lake City, UT 84112, USA; (C.E.D.-R.); (J.G.L.); (J.E.R.)
| | - Angela Zhu
- Department of Pediatrics, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA; (F.L.N.); (B.L.S.); (A.Z.)
| | - John G. Lamb
- Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, 30 S 2000 E, Room 201 Skaggs Hall, Salt Lake City, UT 84112, USA; (C.E.D.-R.); (J.G.L.); (J.E.R.)
| | - Joseph E. Rower
- Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, 30 S 2000 E, Room 201 Skaggs Hall, Salt Lake City, UT 84112, USA; (C.E.D.-R.); (J.G.L.); (J.E.R.)
| | - Christopher A. Reilly
- Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, 30 S 2000 E, Room 201 Skaggs Hall, Salt Lake City, UT 84112, USA; (C.E.D.-R.); (J.G.L.); (J.E.R.)
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Nkoy FL, Stone BL, Zhang Y, Luo G. A Roadmap for Using Causal Inference and Machine Learning to Personalize Asthma Medication Selection. JMIR Med Inform 2024; 12:e56572. [PMID: 38630536 PMCID: PMC11063904 DOI: 10.2196/56572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
Inhaled corticosteroid (ICS) is a mainstay treatment for controlling asthma and preventing exacerbations in patients with persistent asthma. Many types of ICS drugs are used, either alone or in combination with other controller medications. Despite the widespread use of ICSs, asthma control remains suboptimal in many people with asthma. Suboptimal control leads to recurrent exacerbations, causes frequent ER visits and inpatient stays, and is due to multiple factors. One such factor is the inappropriate ICS choice for the patient. While many interventions targeting other factors exist, less attention is given to inappropriate ICS choice. Asthma is a heterogeneous disease with variable underlying inflammations and biomarkers. Up to 50% of people with asthma exhibit some degree of resistance or insensitivity to certain ICSs due to genetic variations in ICS metabolizing enzymes, leading to variable responses to ICSs. Yet, ICS choice, especially in the primary care setting, is often not tailored to the patient's characteristics. Instead, ICS choice is largely by trial and error and often dictated by insurance reimbursement, organizational prescribing policies, or cost, leading to a one-size-fits-all approach with many patients not achieving optimal control. There is a pressing need for a decision support tool that can predict an effective ICS at the point of care and guide providers to select the ICS that will most likely and quickly ease patient symptoms and improve asthma control. To date, no such tool exists. Predicting which patient will respond well to which ICS is the first step toward developing such a tool. However, no study has predicted ICS response, forming a gap. While the biologic heterogeneity of asthma is vast, few, if any, biomarkers and genotypes can be used to systematically profile all patients with asthma and predict ICS response. As endotyping or genotyping all patients is infeasible, readily available electronic health record data collected during clinical care offer a low-cost, reliable, and more holistic way to profile all patients. In this paper, we point out the need for developing a decision support tool to guide ICS selection and the gap in fulfilling the need. Then we outline an approach to close this gap via creating a machine learning model and applying causal inference to predict a patient's ICS response in the next year based on the patient's characteristics. The model uses electronic health record data to characterize all patients and extract patterns that could mirror endotype or genotype. This paper supplies a roadmap for future research, with the eventual goal of shifting asthma care from one-size-fits-all to personalized care, improve outcomes, and save health care resources.
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Affiliation(s)
- Flory L Nkoy
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Bryan L Stone
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Division of Biostatistics, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
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van den Berg LN, Hallensleben C, Vlug LA, Chavannes NH, Versluis A. The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study. JMIR Hum Factors 2024; 11:e54386. [PMID: 38574348 PMCID: PMC11027062 DOI: 10.2196/54386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/26/2024] [Accepted: 02/18/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication-specifically, short-acting beta2-agonist (SABA) overuse-is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. OBJECTIVE This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. METHODS A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. RESULTS The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; β=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. CONCLUSIONS The initial findings regarding the app's feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices.
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Affiliation(s)
- Liselot N van den Berg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Lisa Ae Vlug
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
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Kupczyk M, Barg W, Bochenek G, Brożek G, D¹browiecki P, Brzostek D, D¹browski A, Dobek R, Gawlik R, Kucharczyk A, Kupryś-Lipińska I, Mastalerz-Migas A, Kowalski† ML. Predictors of excessive short-acting β 2-agonist use and asthma exacerbations: a retrospective analysis of a Polish prescription database. Postepy Dermatol Alergol 2023; 40:790-797. [PMID: 38282873 PMCID: PMC10809829 DOI: 10.5114/ada.2023.133454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/10/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Despite being linked to unfavourable outcomes, short-acting β2-agonists (SABAs) are still overused by a substantial proportion of patients with asthma. Aim To analyse the prevalence and predictors of SABA overuse and exacerbations in patients with asthma in a nationwide database of prescription purchase records. Material and methods The prevalence of excessive SABA use (≥ 12 canisters) and overuse (≥ 3 canisters) was analysed among patients aged 18-64 years who purchased asthma medications in 2018. Predictors of excessive SABA use and SABA overuse were examined by quasi-Poisson regression. Negative binomial regression was used to study the association of excessive SABA use or overuse to the risk of asthma exacerbation defined as a prescription for oral corticosteroids. Results Of 91,763 patients with asthma, 42,189 (46%) were SABA users (mean age, 47 years; 58% female). Among them, 34% purchased ≥ 3 SABA canisters, and 6% purchased ≥ 12 canisters. The risk (risk ratio, 95% CI) of excessive SABA use was lower in patients with concomitant prescriptions for inhaled corticosteroids (0.41, 0.34-0.48) or inhaled corticosteroids and long-acting β2-agonists (0.52, 0.47-0.56), women (0.63, 0.58-0.68), and those in secondary care (0.60, 0.44-0.66); older age was associated with a higher risk of excessive SABA use (1.06, 1.03-1.10). Excessive SABA use was the strongest predictor of asthma exacerbations among all patients (3.24, 2.84-3.70) and in those with ≥ 1 exacerbation (1.60, 1.50-1.71). Conclusions Excessive SABA use is highly prevalent in asthma management, is associated with lack of prescriptions for inhaled corticosteroids, and substantially increases the exacerbation risk.
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Affiliation(s)
- Maciej Kupczyk
- Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Wojciech Barg
- Department of Human Physiology, Medical College of Rzeszów University, Rzeszow, Poland
| | - Grażyna Bochenek
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Grzegorz Brożek
- Department of Epidemiology, School of Medicine Katowice, Medical University of Silesia, Katowice, Poland
| | - Piotr D¹browiecki
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, Warsaw, Poland
| | | | - Andrzej D¹browski
- Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland
| | - Rafał Dobek
- Department of Lung Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Radosław Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Aleksandra Kucharczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Military Institute of Medicine, Warsaw, Poland
| | - Izabela Kupryś-Lipińska
- Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Marek L. Kowalski†
- Department of Immunology, Rheumatology and Allergy, Chair of Clinical Immunology and Microbiology, Healthy Ageing Research Center, Medical University of Lodz, Lodz, Poland
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5
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Belhassen M, Nolin M, Jacoud F, Marant Micallef C, Van Ganse E. Trajectories of Controller Therapy Use Before and After Asthma-Related Hospitalization in Children and Adults: Population-Based Retrospective Cohort Study. JMIR Public Health Surveill 2023; 9:e50085. [PMID: 37751244 PMCID: PMC10565628 DOI: 10.2196/50085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/19/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Inappropriate use of inhaled corticosteroids (ICSs) for asthma impairs control and may cause exacerbation, including asthma-related hospitalization (ARH). In prospective studies, ICS use peaked around ARH, but information on routine care use is limited. Since ARH is a major outcome, controller therapy use in routine care before and after ARH should be documented. OBJECTIVE This study aimed to distinguish ICS use typologies (trajectories) before and after ARH, and assess their relationships with sociodemographic, disease, and health care characteristics. METHODS A retrospective cohort study was performed using a 1% random sample of the French claims database. All patients hospitalized for asthma between January 01, 2013, and December 31, 2015, were classified as either children (aged 1-10 years) or teens/adults (aged ≥11 years). Health care resource use was assessed between 24 and 12 months before ARH. ICS use was computed with the Continuous Measures of Medication Acquisition-7 (CMA7) for the 4 quarters before and after ARH. Initially, the overall impact of hospitalization on the CMA7 value was studied using a segmented regression analysis in both children and teens/adults. Then, group-based trajectory modeling differentiated the groups with similar ICS use. We tested different models having 2 to 5 distinct trajectory groups before selecting the most appropriate trajectory form. We finally selected the model with the lowest Bayesian Information Criterion, the highest proportion of patients in each group, and the maximum estimated probability of assignment to a specific group. RESULTS Overall, 863 patients were included in the final study cohort, of which 447 (51.8%) were children and 416 (48.2%) were teens/adults. In children, the average CMA7 value was 12.6% at the start of the observation period, and there was no significant quarter-to-quarter change in the value (P=.14) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 34.9% (P=.001), before a significant decrease (P=.01) of 7.0% per quarter. In teens/adults, the average CMA7 value was 31.0% at the start, and there was no significant quarter-to-quarter change in the value (P=.08) before hospitalization. Immediately after hospitalization, the average CMA7 value rose by 26.9% (P=.002), before a significant decrease (P=.01) of 7.0% per quarter. We identified 3 and 5 trajectories before ARH in children and adults, respectively, and 5 after ARH for both groups. Trajectories were related to sociodemographic characteristics (particularly, markers of social deprivation) and to potentially inappropriate health care, such as medical management and choice of therapy. CONCLUSIONS Although ARH had an overall positive impact on ICS use trajectories, the effect was often transient, and patient behaviors were heterogeneous. Along with overall trends, distinct trajectories were identified, which were related to specific patients and health care characteristics. Our data reinforce the evidence that inappropriate use of ICS paves the way for ARH.
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Affiliation(s)
| | | | | | | | - Eric Van Ganse
- PELyon, Lyon, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Respiratory Medicine, Croix Rousse University Hospital, Lyon, France
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Zhang X, Quint JK. Online Survey to Investigate Asthma Medication Prescription and Adherence from the Perspective of Patients and Healthcare Practitioners in England. J Asthma Allergy 2023; 16:987-996. [PMID: 37745901 PMCID: PMC10516124 DOI: 10.2147/jaa.s426227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023] Open
Abstract
Background High short-acting β2-agonist (SABA) use and/or inhaled corticosteroid (ICS) underuse are common and are associated with poor asthma outcomes. This study explored patients' and healthcare practitioners' (HCPs') perspectives to contextualize asthma treatment patterns observed in real-world studies. Methods Data were collected using online surveys from HCPs and people with asthma (≥18 years old with a confirmed asthma diagnosis of any severity) who had consented to research participation through the Clinical Practice Research Datalink. Data were analysed using descriptive statistics. Results In total, 76 HCPs and 63 patients were invited to take part. Of 48 valid HCP responders, 54.2% (n=26) reported scheduling an annual asthma treatment review with their patients and 83.3% of general practitioners (n=40) had prescribed repeated inhalers at the patient's request. Of 47 valid patient responders, 57.4% (n=27) reported using their reliever (SABA) inhaler daily and 55.3% of patients (n=26) reported being prescribed a preventer inhaler. Of the total patient responders, 31.9% (n=15) reported that they never used their preventer inhaler. Consistent annual adherence with preventer inhalers was reported by 44.7% of all valid responders (n=21), while other patients admitted to using preventers intermittently. Conclusion SABA and ICS prescription patterns are driven by a combination of HCP and patient factors. Opportunities exist to improve asthma control and behaviours around inhaler use.
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Affiliation(s)
- Xiubin Zhang
- National Heart and Lung Institute, Imperial College London, London, W12 0BZ, United Kingdom
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, W12 0BZ, United Kingdom
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Modi M, Mody K, Jhawar P, Sharma L, Padukudru Anand M, Gowda G, Mendiratta M, Kumar S, Nayar S, Manchanda M, Kumari Badam A, Singh M, Siddiqui W, Beekman M. Short-acting β2-agonists over-prescription in patients with asthma: an Indian subset analysis of international SABINA III study. J Asthma 2022; 60:1347-1358. [PMID: 36519934 DOI: 10.1080/02770903.2022.2147079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The SABINA (SABA use IN Asthma) program was initiated to describe short-acting β2-agonists (SABA) prescription patterns and assess the impact of its over-prescription on exacerbation risk and asthma control. We evaluated SABA prescription patterns in patients with asthma in the Indian cohort of SABINA III. METHODS This multi-centre, observational, cross-sectional study included retrospective and real-time electronic data collection. Data were extracted from medical records of patients with asthma (aged >12 years) having >3 consultations with the same healthcare practitioners between March 2019 and January 2020. The data included prescriptions of SABA and other asthma treatments and over-the-counter (OTC) purchases of SABA. SABA prescriptions were categorized by the number of SABA canisters prescribed in the 12 months preceding the study visit. RESULTS A total of 510 patients with asthma were included from specialist care (mean age 49.1 years; 57.65 females), with 8.2% classified with mild asthma and 91.8% with moderate-to-severe asthma. SABA as monotherapy and add-on to maintenance therapy was prescribed to 4.5% (n = 23) and 44.9% (n = 229) of patients, respectively. While ICS monotherapy and ICS/LABA were prescribed to 5.1% (n = 26) and 93.3% (n = 476) of patients, respectively. SABA was found to be over-prescribed (≥3 SABA canisters/year) among 23.9% of patients (n = 122). Additionally, 8% of patients (n = 41) purchased SABA OTC without prescription. CONCLUSIONS Nearly one-fourth of patients with asthma in India were over-prescribed SABA. Educational programmes targeted at national and regional levels should be expanded to raise greater asthma awareness and encourage the adoption of guideline-directed asthma treatment plans among healthcare practitioners.
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Affiliation(s)
- Mahavir Modi
- Modi Clinic Chest & ENT, Pune, Maharashtra, India
| | - Kavita Mody
- Dr Kavita Mody's Clinic, Mumbai, Maharashtra, India
| | - Pramod Jhawar
- Jhawar Chest, Allergy, Asthma & Bronchoscopy, Sleep Study Centre, Indore, Madhya Pradesh, India
| | - Lata Sharma
- Department of Respiratory Medicine, KIMS Hospital, Hyderabad, Telangana, India
| | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore, Karnataka, India
| | | | - Manisha Mendiratta
- Department of Pulmonology, Sarvodaya Hospital & Research Center, Faridabad, Haryana, India
| | | | | | - Manav Manchanda
- Department of Respiratory Medicine, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - Aruna Kumari Badam
- Department of Pulmonology, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
| | - Manoj Singh
- Department of Pulmonology, Apollo Hospital, Gandhinagar, Gujarat, India
| | - Waseem Siddiqui
- Medical Affairs - Respiratory & Immunology, AstraZeneca Pharma India Pvt. Ltd, Bengaluru, Karnataka, India
| | - Maarten Beekman
- Respiratory & Immunology, AstraZeneca, The Hague, Netherlands
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8
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Belhassen M, Bérard M, Devouassoux G, Dalon F, Bousquet J, Van Ganse E. Treatment of Allergic Rhinitis and Asthma in Primary Care: Dispensations Do Not Align with Prescriptions. J Asthma Allergy 2022; 15:1721-1729. [DOI: 10.2147/jaa.s376786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022] Open
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9
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Whittaker H, Van Ganse E, Dalon F, Nolin M, Marrant-Micallef C, Pison C, Ryan DP, Deslee G, Quint JK, Belhassen M. Differences in severe exacerbations rates and healthcare utilisation in COPD populations in the UK and France. BMJ Open Respir Res 2022; 9:9/1/e001150. [PMID: 35944943 PMCID: PMC9367183 DOI: 10.1136/bmjresp-2021-001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/31/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might relate to disease outcomes, to identify ways of improving local disease management. We aimed to describe and compare the management of patients with COPD in the UK and France between 2008 and 2017. Methods We used data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics in the UK and the Echantillon Généraliste des Bénéficiaire in France to identify patients with COPD each year between 2008 and 2017. We compared patient characteristics, all-cause mortality and COPD exacerbations each year between 2008 and 2017 for patients in the UK and France separately. Health care utilisation and COPD exacerbations in 2017 were compared between France and the UK using t-tests and χ2 tests. Results Patients with COPD were similar in gender and comorbidities in both countries. Incidence of COPD exacerbations remained stable in the UK and France between 2007 and 2017. In 2017, the proportion of all-cause and COPD-related hospitalisations was greater in the UK than in France (43.9% vs 32.8% and 8.3% vs 4.9%, respectively; p<0.001) as was the proportion of patients visiting accident and emergency (A&E) (39.8% vs 16.2%, respectively; p<0.001). In addition, the mean length of stay in hospital for COPD-related causes was shorter in the UK than in France (6.2 days (SD 8.4) vs 10.5 days (SD 9.1), respectively; p<0.001). Discussion Overall, UK patients were more likely to go to A&E, be hospitalised for COPD-related causes and stay in hospital for fewer days after being admitted for COPD-related reasons compared with patients in France, illustrating a difference in health-seeking behaviours and access to healthcare.
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Affiliation(s)
- Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Eric Van Ganse
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France.,Respiratory Medicine, Hospital Croix-Rousse, Lyon, France
| | | | - Maeva Nolin
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France
| | | | - Christophe Pison
- Clinique de Pneumologie, Centre Hospitalier Universitaire de Grenoble, Service de Pneumologie, Grenoble, France
| | - Dermot P Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences: GP Section, University of Edinburgh, Edinburgh, UK
| | - Gaetan Deslee
- Department of Respiratory Medicine, INSERM UMRS 903, University Hospital of Reims, Reims, France
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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van den Berg LN, Hallensleben C, Chavannes NH, Versluis A. Developing a Smartphone Application That Promotes Responsible Short-Acting Beta2-Agonist Use in People with Asthma: A Participatory Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148496. [PMID: 35886348 PMCID: PMC9318130 DOI: 10.3390/ijerph19148496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 01/27/2023]
Abstract
Around 339 million people worldwide have asthma, and 50% have uncontrolled asthma. One trait of uncontrolled asthma, often seen in primary care, is short-acting β2-agonist (SABA) overuse, defined as using SABA more than twice a week. SABA overuse can cause adverse health effects. An application could help patients gain more insight into their SABA use. Engaging stakeholders during the development is important to maximize the usability of and adherence to an application. This study describes the development process of an application that promotes responsible SABA use in people with asthma, using a participatory design. Different stakeholder groups were involved in two iterative development cycles. In the first cycle, four end-users evaluated the app’s prototype. During the second cycle, five end-users were interviewed about the usability of the new version. Resulting in an app that allows patients to register SABA use, asthma symptoms, and symptom triggers. A graph shows how these factors are related, and end-users can show the graph to their physician to facilitate communication. Medication use is compared to the medical guidelines or, when applicable, to the advice given by the users’ healthcare professionals. End-users found the app helpful. Research into the usability and effectiveness of the app in a bigger sample will follow.
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Affiliation(s)
- Liselot N. van den Berg
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
- Correspondence: ; Tel.: +31-(0)71-526-57-61
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands; (C.H.); (N.H.C.); (A.V.)
- National eHealth Living Lab (NeLL), 2333 ZD Leiden, The Netherlands
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11
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Leal LF, Tavares NUL, Borges RB, Mengue SS, Fagondes SC, Masarwa R, Pizzol TDSD. Prevalence of chronic respiratory diseases and medication use among children and adolescents in Brazil - a population based cross-sectional study. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-93042022000100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to describe the prevalence of chronic respiratory diseases and their pharmacological management in children and adolescents in Brazil. Methods: data from the Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)(National Access Survey, Use and Promotion of Rational Use of Medicines in Brazil),a population-based cross-sectional study, were analyzed. Household surveys were conducted between September 2013 and February 2014. We included the population under 20 years of age with chronic respiratory diseases. Prevalence of disease, indication of pharmacological treatment, and their use were assessed. Results: the prevalence of chronic respiratory diseases in children aged less than 6 years old was 6.1% (CI95%= 5.0-7.4), 4.7% (CI95%= 3.4-6.4) in those 6-12 years, and 3.9% (CI95%= 2.8-5.4) in children 13 years and older. Children under 6 showed a higher prevalence of pharmacological treatment indication (74.6%; CI95%= 66.0-81.7), as well as medication use (72.6%; CI95%= 62.8-80.7). Of those using inhalers, 56.6% reported using it with a spacer. The most frequent pharmacologic classes reported were short-acting β2 agonists (19.0%), followed by antihistamines (17.2%). Conclusion: children and adolescents who report chronic respiratory diseases living in urban areas in Brazil seem to be undertreated for their chronic conditions. Pharmacological treatment, even if indicated, was not used, an important finding for decision-making in this population.
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Canonica GW, Paggiaro P, Blasi F, Musarra A, Richeldi L, Rossi A, Papi A. Manifesto on the overuse of SABA in the management of asthma: new approaches and new strategies. Ther Adv Respir Dis 2021; 15:17534666211042534. [PMID: 34587829 PMCID: PMC8488406 DOI: 10.1177/17534666211042534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The risks of overusing short-acting β2-agonists (SABA), including an
increase in asthma-related deaths, are many and well known. The Global
Initiative on Asthma (GINA) 2019 and 2020 updates recommend as-needed inhaled
corticosteroid (ICS)/formoterol as the preferred rescue medication in mild
asthma as monotherapy and also in moderate to severe asthma when the maintenance
and reliever therapy (MART) strategy is used. Using SABA for symptom relief,
however, was the standard of treatment for many years, and consequently this
practice persists, particularly in patients not taking ICS regularly. Here, we
examine the rationale for this shift from a long-standing recommendation for
as-needed SABA treatment to the use of as-needed ICS/formoterol and consider
clinical evidence on strategies for asthma treatment and patient management.
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Affiliation(s)
- Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Personalized Medicine, Asthma and Allergy, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Luca Richeldi
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Rossi
- Pulmonary Unit, Azienda Ospedaliera Universitaria Integrata and University of Verona, Verona, Italy
| | - Alberto Papi
- Research Center on Asthma and COPD, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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13
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Looijmans-van den Akker I, Werkhoven A, Verheij T. Over-prescription of short-acting beta agonists in the treatment of asthma. Fam Pract 2021; 38:612-616. [PMID: 33738476 DOI: 10.1093/fampra/cmab013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite a clear guideline for asthma medication, excessive use of short-acting β2-agonists (SABAs) is common in clinical practice. Previous research has shown that excessive use of SABAs is associated with poor asthma control. OBJECTIVE This study examines current use of asthma medication in primary care and whether excessive use of SABAs is associated with exacerbations. METHODS The study design was a retrospective analysis using information from electronical medical records from patients aged 18 and older of five Julius Health Centers located in Utrecht, the Netherlands, in the period of 1 July 2018 through 1 July 2019. Excessive SABA use was defined as ≥400 inhalations per year. An exacerbation was defined as an acute worsening of asthma symptoms with the need for systemic corticosteroids. RESULTS A total of 1161 patients were included in the study. Of the patients using SABAs (n = 766), 193 (25%) overused SABAs. Among the patients with inappropriate SABA use (n = 193), 19% had an exacerbation compared with 7% of the appropriate SABA users. For patients using asthma medication the odds of having an exacerbation were 2.9 times higher if they used an inappropriate number of SABAs than if SABAs were used appropriately (odds ratio, 2.897; 95% confidence interval, 1.87-4.48). CONCLUSIONS This study shows that overuse of SABAs is still common and that it is associated with asthma exacerbations. It highlights that clinicians need to be aware of inappropriate SABA use as it is a sign of and can even contribute to poor asthma control.
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Affiliation(s)
| | - Anouk Werkhoven
- Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
| | - Theo Verheij
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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14
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Tuppin P, Aguadé AS, Guillo S, Gastaldi C, Taillé C. Evaluation of drug deliveries and refunds for obstructive airway diseases in France between 2012 and 2017. Respir Med Res 2021; 80:100854. [PMID: 34385098 DOI: 10.1016/j.resmer.2021.100854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/15/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this survey was to investigate variations of drugs for obstructive airway diseases delivery rates and refunds at a national level which are rarely reported. METHODS The French national health data system (56 million, 87% of the population) was used to identify insurance beneficiaries with at least one drug delivery (Anatomical Therapeutic Classification R03) per year between 2012 and 2017. RESULTS At least one drug delivery in 2017 was identified for 7.5 million people (12.9%). High proportions of people with at least one, two or three drug deliveries were observed between the ages of 0 to 2 years (22%, 10%, 5.5%), then decreased between the ages of 18 and 40 years (9.3%, 3.8%, 2.3%) and increased again in people 75 years and older (17.8%, 11.9% 9.9%), with strong variations between years. In 2017, the proportions of people with at least one delivery, either alone or in combination with other drugs, were 68% for inhaled corticosteroids (ICS) (median 1; IQR 1-4), 59% for short-acting beta2-agonists (SABA) (1; 1-3), 42% for long-acting beta2-agonists (LABA) (2; 1-6), 11% for leukotriene receptor antagonists (3; 1-9), and 12% for inhaled anti-cholinergics (4; 1-10). Younger patients more often received SABAs (0-2 years: 84%) and leukotriene receptor antagonists (3-6 years: 14%) and people 75 years and older more often received LABAs (59%) and ICS, either alone or in combination with other drugs (28%).The mean annual refund reimbursed per person decreased from €136 in 2012 to €118 in 2017. CONCLUSION This study suggests a low level of use for drug classes associated with low delivery rates, suggesting inappropriate prescriptions and poor follow-up. These results highlight the difficulty of identifying these problems if delivery rates variations over several years are not taken into account.
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Affiliation(s)
| | | | - Sylvie Guillo
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, Paris, France
| | | | - Camille 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 UMR 1152; Paris, France
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15
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Tong X, Liu T, Li Z, Liu S, Fan H. Is It Really Feasible to Use Budesonide-Formoterol as Needed for Mild Persistent Asthma? A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:644629. [PMID: 34149408 PMCID: PMC8213339 DOI: 10.3389/fphar.2021.644629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/19/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Previous studies suggest that inhaled budesonide-formoterol used as needed could effectively reduce the severe exacerbation of mild persistent asthma. However, there are some differences between these studies, so we conducted a meta-analysis. Methods: We searched PubMed, Ovid MEDLINE, Cochrane Library and several web search engines to screen the literature until March 25, 2020 and used risk ratios (RR), odds ratios, hazard ratios (HR) and weighted mean differences with 95% confidence intervals (CI) to evaluate the pooled effects. Adolescent/adult patients with mild persistent asthma who used budesonide-formoterol as needed were included in this study. The primary outcome was to investigate the superiority of budesonide-formoterol as needed in reducing severe exacerbations in patients with mild persistent asthma. STATA 12.0 software was used for statistical analysis. Results: Across all 4 articles, 4,023 patients used budesonide-formoterol as needed (budesonide-formoterol group), 4,042 patients used budesonide maintenance plus short-acting β2-agonist (SABA) as needed (budesonide group), and 1,500 patients used SABA as needed (SABA group). The results showed that the incidence of severe exacerbations and the time to first severe exacerbation in the budesonide-formoterol group were significantly different from those for the SABA group (RR = 0.46, 95% CI = 0.36-0.59, p < 0.001; HR = 0.43, 95% CI = 0.33-0.56, p < 0.001; respectively), but there was no difference between the budesonide-formoterol group and budesonide group (RR = 0.86, 95% CI = 0.62-1.04, p = 0.093; HR = 0.77, 95% CI = 0.57-1.03, p = 0.079; respectively). There were statistically significant differences in the forced expiratory volume in 1 second and in the responses to the Asthma Control Questionnaire-5 between the budesonide-formoterol group and the SABA group, but the differences were not clinically significant. In addition, the daily dose of budesonide in the budesonide-formoterol group was significantly lower than that in the budesonide group, and there was no difference in the incidence of adverse events among the three groups. Conclusion: In summary, budesonide-formoterol used as needed may reduce severe exacerbation in adolescent/adult patients with mild persistent asthma.
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Affiliation(s)
- Xiang Tong
- Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Tao Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhenzhen Li
- Health Management Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Sitong Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Hong Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
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16
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Azzi E, Kritikos V, Peters M, Price D, Cvetkovski B, Alphonse PS, Bosnic-Anticevich S. Perceptions, attitudes, and behaviors of short-acting beta 2 agonist users: an Australian cross-sectional community pharmacy-based study. J Asthma 2020; 59:178-188. [PMID: 33086885 DOI: 10.1080/02770903.2020.1841223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND High use of short-acting beta-2-agonist (SABA) medication is a significant problem. Attitudes and perceptions toward asthma of over-the-counter (OTC) reliever users are unknown. The study aimed to describe the asthma attitudes, perceptions, medication knowledge and information gathering behavior of people with asthma with recent high SABA use (i.e. SABA use > twice a week in the last 4 weeks) and compare them to people with asthma with no recent high SABA use. METHOD A real-world cross-sectional observational study in Australian community pharmacies was conducted; surveying patients ages ≥ 16 years requesting SABA medication OTC. Data collected included; demographics, medication usage, asthma control, asthma-related perceptions and behaviors. Data were summarized by using descriptive analyses. RESULTS 375 participants completed the survey, 73.9% were high SABA users. Of the 375, 90.4% reported that their asthma symptoms were controlled or somewhat controlled and 56.0% felt that their asthma was not serious. However, only 17.6%, had controlled asthma according to GINA-defined criteria. High SABA users tended to be more anxious about their asthma and worried about its impact in the future (50.5% vs. 28.6%, p < 0.001). High SABA users were more likely to agree with the statements suggesting that asthma impacted on activities of daily living (46.6% vs. 16.3%, p < 0.001); were socially conscious about their asthma and more likely to feel embarrassed carrying (21.3% vs 9.2%, p = 0.007) and using (29.2% vs 18.4%, p = 0.036) their asthma inhaler. CONCLUSION This study revealed the extent of uncontrolled asthma and uncovered an anxious and socially conscious group of OTC SABA users. There is a need to better understand patient perceptions and their relationships to high-SABA use, to ensure targeted educational interventions are developed and implemented.
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Affiliation(s)
- Elizabeth Azzi
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia.,School of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| | - Matthew Peters
- Respiratory Medicine, Concord Repatriation General Hospital, Concord, Australia.,Emphysema Centre, Woolcock Institute of Medical Research, Glebe, Australia
| | - David Price
- Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| | - Pamela Srour Alphonse
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
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17
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Voorham J, Baldi S, Santoro L, Kerkhof M, Contoli M, Fabbri LM, Kerstjens HAM, Luis López-Campos J, Roche N, Singh D, Vogelmeier CF, Price DB. Extrafine Beclometasone Dipropionate/Formoterol Fumarate vs Double Bronchodilation Therapy in Patients with COPD: A Historical Real-World Non-Inferiority Study. Int J Chron Obstruct Pulmon Dis 2020; 15:2739-2750. [PMID: 33149571 PMCID: PMC7605609 DOI: 10.2147/copd.s269287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to evaluate the non-inferiority of initiating extrafine beclometasone dipropionate/formoterol fumarate (BDP/FF) versus double bronchodilation (long-acting beta-agonists [LABA]/long-acting muscarinic antagonists [LAMA]) among patients with a history of chronic obstructive pulmonary disease (COPD) exacerbations. Patients and Methods A historical cohort study was conducted using data from the UK's Optimum Patient Care Research Database. Patients with COPD ≥40 years at diagnosis were included if they initiated extrafine BDP/FF or any LABA/LAMA double therapy as a step-up from no maintenance therapy or monotherapy with inhaled corticosteroids (ICS), LAMA, or LABA and a history of ≥2 moderate/severe exacerbations in the previous two years. The primary outcome was exacerbation rate from therapy initiation until a relevant therapy change or end of follow-up. Secondary outcomes included rate of acute respiratory events, acute oral corticosteroids (OCS) courses, and antibiotic prescriptions with lower respiratory indication, modified Medical Research Council score (mMRC) ≥2, and time to first pneumonia diagnosis. The non-inferiority boundary was set at a relative difference of 15% on the ratio scale. Five potential treatment effect modifiers were investigated. Results A total of 1735 patients initiated extrafine BDP/FF and 2450 patients initiated LABA/LAMA. The mean age was 70 years, 51% were male, 41% current smokers, and 85% had FEV1 <80% predicted. Extrafine BDP/FF showed non-inferiority to LABA/LAMA for rate of exacerbations (incidence rate ratio [IRR] = 1.01 [95% CI 0.94-1.09]), acute respiratory events (IRR = 0.98 [0.92-1.04]), acute OCS courses (IRR = 1.01 [0.91-1.11]), and antibiotic prescriptions (IRR = 0.99 [0.90-1.09]), but not for mMRC (OR = 0.93 [0.69-1.27]) or risk of pneumonia (HR = 0.50 [0.14-1.73]). None of the a priori defined effect modifier candidates affected the comparative effectiveness. Conclusion This study found that stepping up to extrafine BDP/FF from no maintenance or monotherapy was not inferior to stepping up to double bronchodilation therapy in patients with a history of exacerbations.
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Affiliation(s)
- Jaco Voorham
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Data to Insights Research Solutions, Lisbon, Portugal
| | - Simonetta Baldi
- Department of Global Clinical Development, Chiesi SAS, Bois Colombes Cedex, France
| | - Luigi Santoro
- Department of Global Clinical Development, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - Marjan Kerkhof
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Mescio Research, Blauwestad, The Netherlands
| | - Marco Contoli
- Section of Respiratory Medicine, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Leonardo M Fabbri
- Section of Respiratory Medicine, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Huib A M Kerstjens
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | | | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, APHP, Centre-Université de Paris, Paris, France
| | - Dave Singh
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Claus F Vogelmeier
- Department of Internal Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany
| | - David B Price
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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18
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Bloom CI, Cabrera C, Arnetorp S, Coulton K, Nan C, van der Valk RJP, Quint JK. Asthma-Related Health Outcomes Associated with Short-Acting β 2-Agonist Inhaler Use: An Observational UK Study as Part of the SABINA Global Program. Adv Ther 2020; 37:4190-4208. [PMID: 32720299 DOI: 10.1007/s12325-020-01444-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Patients with asthma typically increase short-acting β2-agonists (SABA) use with worsening symptoms. Excessive SABA use may lead to a higher risk of adverse outcomes. We evaluated, in a large population cohort, an association between SABA inhaler use and asthma exacerbations and healthcare utilization. METHODS As part of the SABINA (SABA use IN Asthma) global program, we conducted a retrospective longitudinal observational study (SABINA I) using UK primary care electronic healthcare records (Clinical Practice Research Datalink; 2007-2017) from asthma patients aged ≥ 12 years. SABA inhaler use was classified as 'high use', ≥ 3 canisters/year versus 'low use', 0-2 canisters/year. Taking into consideration all their asthma prescriptions, patients were categorized into a treatment step according to 2016 British Thoracic Society (BTS) asthma management guidelines. Multivariable regression assessed the association of SABA inhaler use by BTS treatment steps (grouped as BTS steps 1/2 and 3-5), separately, and with outcomes of exacerbations or asthma-related healthcare utilization (primary care and hospital outpatient consultations); only patients with linked hospital data were included in this analysis. RESULTS Of the 574,913 patients included, 218,365 (38%) had high SABA inhaler use. Overall, 336,412 patients had linked hospital data. High SABA inhaler use was significantly associated with an increased risk of exacerbations [adjusted hazard ratio, 95% confidence interval (CI): BTS steps 1/2 = 1.20, 1.16-1.24; BTS steps 3-5 = 1.24, 1.20-1.28], asthma-related primary care consultations [adjusted incidence rate ratio (IRR), 95% CI: BTS steps 1/2 = 1.24, 1.23-1.26; BTS steps 3-5 = 1.13, 1.11-1.15], and asthma-related hospital outpatient consultations (adjusted IRR, 95% CI: BTS steps 1/2 = 1.19, 1.12-1.27; BTS steps 3-5 = 1.19, 1.13-1.26). CONCLUSION High SABA inhaler use was frequent across BTS steps and was associated with a significant increase in exacerbations and asthma-related healthcare utilization.
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Affiliation(s)
- Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Claudia Cabrera
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Sofie Arnetorp
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Karen Coulton
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Cassandra Nan
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK.
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19
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Amin S, Soliman M, McIvor A, Cave A, Cabrera C. Usage Patterns of Short-Acting β 2-Agonists and Inhaled Corticosteroids in Asthma: A Targeted Literature Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2556-2564.e8. [PMID: 32244024 DOI: 10.1016/j.jaip.2020.03.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 01/14/2023]
Abstract
Despite the availability of effective asthma treatments, some patients are poorly controlled because of overreliance on short-acting β2-agonists (SABAs) and underuse of inhaled corticosteroids (ICSs). To identify patient characteristics and outcomes associated with SABA overreliance and ICS underuse, we conducted a targeted literature review of the quantitative evidence on asthma medication use. Articles evaluating SABA and/or ICS use in patients with asthma (aged ≥12 years), published between January 2012 and March 2018, were identified using MEDLINE and EMBASE. We observed that studies classified SABA usage as "overuse," "high use," "excess use," "extreme overuse," "suboptimal use," and "inappropriate use." Multiple thresholds were used to define overuse of SABA (≥3 to ≥12 canisters/y). SABA overreliance was prevalent, with approximately 20% of adults using 3 or more canisters per year (≥12 inhalations/wk). Similarly, inappropriate ICS use, classified as "suboptimal," "high use," "underuse," and "unlicensed use," was defined by varying thresholds. Specific patient populations, such as older adults, smokers, and patients with low income, were more susceptible to SABA overreliance and ICS underuse. Overreliance on SABAs was associated with increased risk of severe exacerbations, asthma-related hospitalizations, emergency department visits, and asthma-related costs. These findings emphasize the prevalence and related burden of SABA overreliance at the potential expense of appropriate ICS use.
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Affiliation(s)
| | - Mena Soliman
- BioPharmaceuticals Medical, AstraZeneca, Mississauga, ON, Canada
| | - Andrew McIvor
- Firestone Institute for Respiratory Health, St Joseph's Healthcare and McMaster University, Hamilton, ON, Canada
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Janson C, Menzies-Gow A, Nan C, Nuevo J, Papi A, Quint JK, Quirce S, Vogelmeier CF. SABINA: An Overview of Short-Acting β 2-Agonist Use in Asthma in European Countries. Adv Ther 2020; 37:1124-1135. [PMID: 31981105 PMCID: PMC7089727 DOI: 10.1007/s12325-020-01233-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Globally, individuals with asthma tend to overrely on short-acting β2-agonists (SABAs) and underuse inhaled corticosteroids, thereby undertreating the underlying inflammation. Such relief-seeking behavior has been reinforced by long-standing treatment guidelines, which until recently recommended SABA-only use for immediate symptom relief. We aimed to describe the current burden of SABA use among European individuals with asthma within the SABA use IN Asthma (SABINA) program. METHODS Prescription and/or dispensing data during 2006-2017 from electronic medical records and/or national patient registries in the United Kingdom (UK), Germany, Italy, Spain, and Sweden were analyzed. Individuals aged at least 12 years old with a current asthma diagnosis and no other chronic respiratory conditions were included. Asthma treatment step and severity were based on treatment guidelines in use in each individual country. The proportion of individuals prescribed SABA was measured during a 12-month period. SABA overuse was defined as at least three SABA canisters per year. RESULTS More than one million individuals with asthma were included across five European countries. Overall, the majority of individuals were over 45 years of age, except in Sweden (mean age 27.6 years) where individuals aged over 45 years were excluded to avoid a potential chronic obstructive pulmonary disease co-diagnosis. The study population was predominantly female (55-64%), except in the UK (46%). The prevalence of SABA overuse was 9% in Italy, 16% in Germany, 29% in Spain, 30% in Sweden, and 38% in the UK. In the UK, SABA overuse was greater in individuals with moderate-to-severe asthma versus individuals with mild asthma (58% versus 27%, respectively), while SABA overuse was similar in individuals with both mild (9-32%) and moderate-to-severe (8-31%) asthma in the other European countries. CONCLUSIONS The findings of this study from the SABINA program show that SABA overuse (at least three canisters per year) is common across Europe, despite the different healthcare and reimbursement policies of each country.
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Affiliation(s)
- Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Cassandra Nan
- Biopharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Javier Nuevo
- Biopharmaceuticals Medical, AstraZeneca, Serrano Galvache 56, 28033, Madrid, Spain.
| | - Alberto Papi
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, and CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
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21
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Van Ganse E, Texier N, Dima AL, Belhassen M, Laforest L, Herbage S, Schuck S, Hernandez G, Garin O, Ferrer M, de Bruin M. Effects of short- and long-acting beta-agonists on asthma exacerbations: a prospective cohort. Ann Allergy Asthma Immunol 2019; 124:254-260. [PMID: 31862434 DOI: 10.1016/j.anai.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/13/2019] [Accepted: 12/08/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND In asthma, short- and long-acting β-agonists (SABAs and LABAs) should be used together with inhaled corticosteroids (ICS), and regular use is inappropriate. OBJECTIVE To assess the relationship between patterns of use of therapy and asthma exacerbations (AEx). METHODS Patients with asthma (6-40 years) were enrolled in France and the United Kingdom. Prescribing data, computer-assisted telephone interviews (CATIs), and text messages assessed medication use and AEx over a maximum period of 24 months. Generalized linear mixed models provided AEx risks associated with therapy. RESULTS Among the 908 patients (median age: 20.0 years, 46.6% women, 24.5% children) answering a total of 4248 CATIs over 486 (±235) days, regular (ie, daily) use was more frequent for single LABAs and fixed dose combinations (FDCs) than for single ICS (75.6%, 70.1%, and 65.4% of investigated periods of use, respectively). Regular (ie, daily or almost daily) SABA use was observed for 21.1% of periods of use. Altogether, 265 patients (29.2%) experienced 1 or more AEx. The ORs for AEx risk related to regular vs no use of FDCs, single ICS, and single LABAs were 0.98 (95% CI = [0.73-1.33]), 0.90 (95% CI = [0.61-1.33]), and 1.29 (95% CI = [0.76-2.17]), respectively, after adjustment for cotherapy, sociodemographic, and disease characteristics. The OR was 2.09 (95% CI = [1.36-3.21]) in regular SABA users. CONCLUSION Inhaled corticosteroids and FDCs were often used intermittently, whereas SABAs and LABAs could be used regularly, and exacerbations were frequent. Compared with non-users, the risk of exacerbation increased moderately under regular use of single LABAs, whereas it doubled, significantly, in regular SABA users, likely in relationship with poor overall asthma control.
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Affiliation(s)
- Eric Van Ganse
- Lyon Pharmaco-Epidemiology Unit, Health Services and Performance Research (HESPER), Claude Bernard Lyon 1 University, Lyon, France; Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France; PELyon, Lyon, France.
| | | | - Alexandra L Dima
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, the Netherlands
| | - Manon Belhassen
- Lyon Pharmaco-Epidemiology Unit, Health Services and Performance Research (HESPER), Claude Bernard Lyon 1 University, Lyon, France; PELyon, Lyon, France
| | - Laurent Laforest
- Lyon Pharmaco-Epidemiology Unit, Health Services and Performance Research (HESPER), Claude Bernard Lyon 1 University, Lyon, France
| | - Sandrine Herbage
- Lyon Pharmaco-Epidemiology Unit, Health Services and Performance Research (HESPER), Claude Bernard Lyon 1 University, Lyon, France
| | | | - Gimena Hernandez
- IMIM-Hospital del Mar Medical, Research Institute, Barcelona, Spain
| | - Olatz Garin
- IMIM-Hospital del Mar Medical, Research Institute, Barcelona, Spain
| | - Montse Ferrer
- IMIM-Hospital del Mar Medical, Research Institute, Barcelona, Spain
| | - Marijn de Bruin
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, the Netherlands; University of Aberdeen, Scotland
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22
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Sá-Sousa A, Almeida R, Vicente R, Nascimento N, Martins H, Freitas A, Fonseca JA. High oral corticosteroid exposure and overuse of short-acting beta-2-agonists were associated with insufficient prescribing of controller medication: a nationwide electronic prescribing and dispensing database analysis. Clin Transl Allergy 2019; 9:47. [PMID: 31559008 PMCID: PMC6755705 DOI: 10.1186/s13601-019-0286-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022] Open
Abstract
Background Recurrent use of oral corticosteroids (OCS) and over-use of short-acting beta-2-agonists (SABA) are factors associated with adverse side effects and asthma-related death. We aim to quantify high OCS exposure, SABA over-use and its association with prescription and adherence to maintenance treatment for respiratory disease, among patients with prescriptions for respiratory disease, from the Portuguese electronic prescription and dispensing database (BDNP). Methods This was a 1-year (2016) retrospective population-based analysis of a random sample of adult patients from the BDNP, the nationwide compulsory medication prescription system. We assessed high OCS exposure (dispensing ≥ 4 packages containing 20 doses of 20 mg each of prednisolone-equivalent, ≥ 1600 mg/year) on patients on persistent respiratory treatment (PRT-prescription for > 2 packages of any respiratory maintenance medications). Excessive use of SABA was defined as having a ratio of SABA-to-maintenance treatment > 1 or having SABA over-use (dispensing of > 1 × 200 dose canister/month, of 100 μg of salbutamol-equivalent). Factors associated with high OCS exposure were assessed by multinomial logistic regression. Results The estimated number of patients on PRT was 4786/100,000 patients. OCS was prescribed to more than 1/5 of the patients on PRT and 101/100,000 were exposed to a high-dose (≥ 1600 mg/year). SABA excessive use was found in 144/100,000 patients and SABA over-use in 24/100,000. About 1/6 of SABA over-users were not prescribed any controller medication and 7% of them had a ratio maintenance-to-total ≥ 70% (high prescription of maintenance treatment). Primary adherence (median%) to controller medication was 66.7% for PRT patients, 59.6% for patients exposed to high OCS dose and 75.0% for SABA over-users. High OCS exposure or SABA over-use were not associated with primary adherence. High OCS exposure was associated with a maintenance-to-total medication ratio < 70% (insufficient prescription of maintenance treatment), age > 45 years old and male sex. Conclusions Exposure to high-dose of OCS (101 per 100,000 patients) and SABA over-use (24 per 100,000) were frequent, and were associated with a low maintenance-to-total prescription ratio but not with primary non-adherence. These results suggest there is a need for initiatives to reduce OCS and SABA inappropriate prescribing.
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Affiliation(s)
- Ana Sá-Sousa
- 1CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rute Almeida
- 1CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ricardo Vicente
- 2SPMS Shared Services of the Ministry of Health, Lisbon, Portugal
| | | | - Henrique Martins
- 2SPMS Shared Services of the Ministry of Health, Lisbon, Portugal
| | - Alberto Freitas
- 1CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,3MEDCIDS-Department of Community Medicine, Information, and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João Almeida Fonseca
- 1CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,3MEDCIDS-Department of Community Medicine, Information, and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,4Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
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23
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Voorham J, Corradi M, Papi A, Vogelmeier CF, Singh D, Fabbri LM, Kerkhof M, Kocks JH, Carter V, Price D. Comparative effectiveness of triple therapy versus dual bronchodilation in COPD. ERJ Open Res 2019; 5:00106-2019. [PMID: 31497610 PMCID: PMC6715826 DOI: 10.1183/23120541.00106-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/28/2019] [Indexed: 11/21/2022] Open
Abstract
This real-world study compared the effectiveness of triple therapy (TT; long-acting muscarinic antagonists (LAMAs)/long-acting inhaled β-agonists (LABAs)/inhaled corticosteroids (ICSs)) versus dual bronchodilation (DB; LAMAs/LABAs) among patients with frequently exacerbating COPD. A matched historical cohort study was conducted using United Kingdom primary care data. Patients with COPD aged ≥40 years with a history of smoking were included if they initiated TT or DB from no maintenance/LAMA therapy and had two or more exacerbations in the preceding year. The primary outcome was time to first COPD exacerbation. Secondary outcomes included time to treatment failure, first acute respiratory event, and first acute oral corticosteroid (OCS) course. Potential treatment effect modifiers were investigated. In 1647 matched patients, initiation of TT reduced exacerbation risk (adjusted hazard ratio (HR) 0.87, 95% CI 0.76–0.99), risk of acute respiratory event (HR 0.74, 95% CI 0.66–0.84) and treatment failure (HR 0.83, 95% CI 0.73–0.95) compared with DB. Risk reduction for acute respiratory events was greater for patients with higher rates of previous exacerbations. At baseline blood eosinophil counts (BECs) ≥ 0.35×109 cells·L−1, TT was associated with lower risk of OCS prescriptions than DB. This study provides real-life evidence of TT being more effective in reducing exacerbation risk than DB, which became more accentuated with increasing BEC and previous exacerbation rate. In a real-world population of COPD patients with history of exacerbations, initiation of triple therapy was associated with a larger reduction in future risk of exacerbation, acute respiratory event, and treatment failure compared with dual bronchodilationhttp://bit.ly/2xA1Xut
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Affiliation(s)
- Jaco Voorham
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Massimo Corradi
- Dept of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Alberto Papi
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Claus F Vogelmeier
- Dept of Internal Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany
| | - Dave Singh
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Leonardo M Fabbri
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Marjan Kerkhof
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Janwillem H Kocks
- Observational and Pragmatic Research Institute, Singapore, Singapore.,General Practitioners Research Institute, Groningen, The Netherlands
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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24
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Azzi EA, Kritikos V, Peters MJ, Price DB, Srour P, Cvetkovski B, Bosnic-Anticevich S. Understanding reliever overuse in patients purchasing over-the-counter short-acting beta 2 agonists: an Australian community pharmacy-based survey. BMJ Open 2019; 9:e028995. [PMID: 31412998 PMCID: PMC6701672 DOI: 10.1136/bmjopen-2019-028995] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Overuse of asthma relievers is associated with significant adverse consequences. This study aimed to better understand the population purchasing and using short-acting beta agonists (SABA) over the counter (OTC); and compare the demographic, clinical and behavioural characteristics of those who overuse SABA with those who do not. DESIGN AND SETTING Real-world cross-sectional observational study in community pharmacy. PARTICIPANTS Of 412 participants ≥16 years requesting SABA OTC, 289 were SABA overusers (used SABA more than twice per week in the past 4 weeks). MAIN OUTCOME MEASURE Reliever use, Global Initiative for Asthma-defined control, healthcare utilisation, patterns of preventer use. RESULTS 70.1% of participants were classified as SABA overusers, that is, reporting SABA use more than twice a week within the last 4 weeks, 73.6% reported not using a preventer daily and only 81.6% reported a doctor diagnosis of asthma. SABA overusers were more likely to have moderate-severe nasal symptoms (80.8% vs 63.0%, p<0.001) and a diagnosis of depression (11.1% vs 5.7%, p<0.001), when compared with SABA non-overusers. A higher proportion of SABA overusers had uncontrolled asthma (59.0% vs 15.4%, p<0.001), were more likely to use oral corticosteroids to manage worsening asthma symptoms (26.2% vs 13.5%, p<0.01) and visit the doctor for their asthma in the past 12 months (74.5% vs 62.5%, p<0.01), when compared to SABA non-overusers. CONCLUSIONS This study uncovers a hidden population of people who can only be identified in pharmacy with suboptimal asthma, coexisting rhinitis, poor preventer adherence and, in some cases, no asthma diagnosis.
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Affiliation(s)
- Elizabeth A Azzi
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Matthew J Peters
- Department of Respiratory Medicine, Concord Hospital, Concord, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David B Price
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Pamela Srour
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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25
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Belhassen M, Nolin M, Nibber A, Ginoux M, Devouassoux G, Van Ganse E. Changes in Persistent Asthma Care and Outcomes From 2006 to 2016 in France. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1858-1867. [PMID: 30836232 DOI: 10.1016/j.jaip.2019.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Changes in asthma care need to be documented at arrival of biotherapies. OBJECTIVES To characterize changes in asthma care and outcomes in patients with persistent asthma. METHODS Repeated transversal analyses were conducted on a historical cohort using the French national claims data over 10 years. Patients aged 18 to 40 years with either 1 or more (any-use population) or 4 or more (high-use population) yearly dispensings of controller therapy were selected. Clinical and demographic features were characterized, and comparisons were made between 2006 and 2016 to assess temporal changes in asthma therapy, health care resource utilization, and outcomes. RESULTS In 2016, prevalent use of controller therapy was 5.2% (any-use population) and 0.8% (high-use population) of the population aged 18 to 40 years. In the any-use population, the use of long-acting β2-agonists in monotherapy, and inhaled corticosteroids decreased (1.7% and 40.3% in 2016, respectively), whereas the use of fixed-dose combinations increased (56.4%). In both populations, visits to respiratory or hospital physicians and pulmonary function testing increased with time, in parallel to a decreasing number of general practitioner visits; in addition, oral corticosteroid use and incidence of emergency room visits increased. However, asthma hospitalizations and mortality remained low in both populations. CONCLUSIONS Changes in persistent asthma care included replacement of inhaled corticosteroids by fixed-dose combinations, decreased use of long-acting β2-agonists as a monotherapy, and increased involvement of secondary care physicians. In parallel, despite low figures for hospital admissions and mortality, overall use of oral corticosteroids and incidence of emergency room visits have increased over the last decade.
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Affiliation(s)
| | - Maëva Nolin
- PELyon, PharmacoEpidemiology Lyon, Lyon, France
| | - Anjan Nibber
- University of Oxford Medical School, Oxford, United Kingdom
| | | | - Gilles Devouassoux
- Respiratory Medicine, Croix Rousse University Hospital, and EA7426 University Claude Bernard Lyon-1, Lyon, France
| | - Eric Van Ganse
- PELyon, PharmacoEpidemiology Lyon, Lyon, France; Respiratory Medicine, Croix Rousse University Hospital, and EA7426 University Claude Bernard Lyon-1, Lyon, France; HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
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26
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Soriano JB. Challenges in interpreting trends in testing for α 1-antitrypsin deficiency in COPD patients from UK primary care. Eur Respir J 2018; 52:52/6/1802064. [PMID: 30573694 DOI: 10.1183/13993003.02064-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Joan B Soriano
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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27
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Molimard M, Girodet PO, Van Ganse E. Interest of pharmacoepidemiology for the study of inhaled drugs. Therapie 2018; 74:233-237. [PMID: 30392699 DOI: 10.1016/j.therap.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
Pharmacoepidemiology studies are of particular interest in the respiratory field and especially for inhaled drugs. In real-life, excessive use of rescue medications and under- or inappropriate-prescribing of preventer medications has been shown. In asthma and chronic obstructive pulmonary disease (COPD), the poor use of inhalation device is associated with uncontrolled diseases and occurrence of exacerbations. Inhalation treatments are directly delivered within the lung and are generally considered as safe. However, systemic adverse drug reactions that were not evidenced in clinical trials may be observed after a long-term treatment.
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Affiliation(s)
- Mathieu Molimard
- Service of medical pharmacology, university of Bordeaux, CHU de Bordeaux, 33076 Bordeaux, France; Inserm, UMR 1219, Bordeaux population health research center, team pharmacoepidemiology, 33000 Bordeaux, France.
| | - Pierre-Olivier Girodet
- Service of medical pharmacology, university of Bordeaux, CHU de Bordeaux, 33076 Bordeaux, France
| | - Eric Van Ganse
- EA 7425 HESPER health services and performance research, and PELyon, Claude-Bernard université, CIC 1401, 69424 Lyon, France; Respiratory medicine, Croix-Rousse hospital, 69317 Lyon, France
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28
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Affiliation(s)
- Viv Marsh
- Independent prescriber, Education Lead at Education for Health
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29
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Ryan D, Blakey J, Chisholm A, Price D, Thomas M, Ställberg B, Lisspers K, Kocks JWH. Use of electronic medical records and biomarkers to manage risk and resource efficiencies. Eur Clin Respir J 2017; 4:1293386. [PMID: 28469833 PMCID: PMC5404653 DOI: 10.1080/20018525.2017.1293386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/17/2017] [Indexed: 02/03/2023] Open
Abstract
The migration from paper to electronic medical records (EMRs) was motivated by the administrative need to record, retrieve and process increasing amounts of clinical data in the 1980s. In the intervening period, there has been growing recognition of the potential of such records for achieving care efficiencies, informing clinical decision making and real-life research. EMRs can be used to characterise patient groups, management approaches and differential outcomes. Characterisation can also help with identification of potential biomarkers for future risk determination and likely treatment response. The future heralds even greater opportunities through integration of clinical records and a range of technology-based solutions within a more complete electronic health record (EHR). Through application of algorithms based on identified risk predictors and disease determinants, clinical records could also be used to enable risk stratification of patients to optimise targeted interventions, conserving resources to achieve individual patient and system-wide benefit. In this review, we reflect on the evolution of the EMR and EHR and discuss current and emerging opportunities, particularly with respect to biomarkers and targeting of innovative biologic interventions. We also consider some of the critical issues associated with realising the potential of the EHR as a clinical aid and research tool in an age of emerging technologies..
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Affiliation(s)
- Dermot Ryan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Blakey
- Clinical Sciences, Liverpool School of Tropical Medicine, and Respiratory Medicine, Royal Liverpool Hospital, Liverpool, UK
| | | | - David Price
- Respiratory Effectiveness Group, Cambridge, UK
- Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Mike Thomas
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Björn Ställberg
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Janwillem W. H. Kocks
- Department of General Practice and Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - on behalf of the Respiratory Effectiveness Group
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Respiratory Effectiveness Group, Cambridge, UK
- Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore
- Clinical Sciences, Liverpool School of Tropical Medicine, and Respiratory Medicine, Royal Liverpool Hospital, Liverpool, UK
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
- Department of General Practice and Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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