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Laitano R, Calzetta L, Matino M, Pistocchini E, Rogliani P. Asthma management with triple ICS/LABA/LAMA combination to reduce the risk of exacerbation: an umbrella review compliant with the PRIOR statement. Expert Opin Pharmacother 2024; 25:1071-1081. [PMID: 38864834 DOI: 10.1080/14656566.2024.2366991] [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: 04/16/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION According to Global Initiative for Asthma (GINA) guidelines, long-acting muscarinic antagonists (LAMAs) should be considered as add-on therapy in patients with asthma that remains uncontrolled, despite treatment with medium-dose (MD) or high-dose (HD) inhaled corticosteroids (ICS)/long-acting β2-agonist (LABA) combinations. In patients ≥ 18 years, LAMA may be added in triple combination with an ICS and a LABA. To date, the precise efficacy of triple ICS/LABA/LAMA combination remains uncertain concerning the impact on exacerbation risk in patients with uncontrolled asthma. Therefore, an umbrella review was performed to systematically summarize available data on the effect of triple ICS/LABA/LAMA combination on the risk of asthma exacerbation. METHODS An umbrella review has been performed according to the PRIOR statement. RESULTS The overall results obtained from 5 systematic reviews and meta-analyses suggest that triple ICS/LABA/LAMA combination reduces the risk of asthma exacerbation. HD-ICS showed a greater effect particularly in reducing severe asthma exacerbation, especially in patients with evidence of type 2 inflammation biomarkers. CONCLUSIONS The findings of this umbrella review suggest an optimization of ICS dose in triple ICS/LABA/LAMA combination, based on the severity of exacerbation and type 2 biomarkers expression.
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Affiliation(s)
- Rossella Laitano
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Matteo Matino
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Elena Pistocchini
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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Howell I, Howell A, Ramakrishnan S, Bafadhel M, Pavord I. How have we measured trial outcomes of asthma attack treatment? A systematic review. ERJ Open Res 2024; 10:00660-2023. [PMID: 38410715 PMCID: PMC10895432 DOI: 10.1183/23120541.00660-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/21/2023] [Indexed: 02/28/2024] Open
Abstract
Background Asthma attacks are a common problem for people with asthma and are responsible for significant healthcare costs. There is interest in a precision medicine approach to treatment. However, the choice of trial outcome measures for asthma attack treatment is hampered by the absence of a consensus on suitability. We carried out a systematic review to understand the characteristics of outcome measures used in randomised controlled trials of asthma attack treatment. Have randomised controlled trials of asthma attack treatment measured outcomes that are useful to patients and healthcare providers? Methods The protocol was registered on PROSPERO (CRD42022311479). We searched for randomised controlled trials comparing treatments for adults with asthma attacks, published in English between 1972 and 2022 on MEDLINE, Embase and Cochrane Library databases. We recorded the outcome measures and study characteristics. Results We identified 208 eligible randomised controlled trials from 35 countries. Trials ranged from 12 to 1109 participants, with a median of 60. The most common settings were the emergency department (n=165) and hospital admission (n=33). Only 128 studies had primary and secondary outcomes defined clearly. In those that did, 73% of primary outcomes measured change in lung function or other physiological parameters over a short period (usually <24 h). Patient-reported and healthcare utilisation outcomes were the primary outcome in 27%. Conclusions Outcomes in randomised controlled trials of asthma attack treatment focus on short-term changes in lung function and may not capture patient-centred and economically important longer-term measures. More work is needed to investigate patient and other stakeholder preferences on core outcome sets.
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Affiliation(s)
- Imran Howell
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Aleksandra Howell
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sanjay Ramakrishnan
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Mona Bafadhel
- King’s Centre of Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Ian Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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Xiong S, Chen W, Jia X, Jia Y, Liu C. Machine learning for prediction of asthma exacerbations among asthmatic patients: a systematic review and meta-analysis. BMC Pulm Med 2023; 23:278. [PMID: 37507662 PMCID: PMC10386701 DOI: 10.1186/s12890-023-02570-w] [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: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Asthma exacerbations reduce the patient's quality of life and are also responsible for significant disease burdens and economic costs. Machine learning (ML)-based prediction models have been increasingly developed to predict asthma exacerbations in recent years. This systematic review and meta-analysis aimed to identify the prediction performance of ML-based prediction models for asthma exacerbations and address the uncertainty of whether modern ML methods could become an alternative option to predict asthma exacerbations. METHODS PubMed, Cochrane Library, EMBASE, and Web of Science were searched for studies published up to December 15, 2022. Studies that applied ML methods to develop prediction models for asthma exacerbations among asthmatic patients older than five years and were published in English were eligible. The prediction model risk of bias assessment tool (PROBAST) was utilized to estimate the risk of bias and the applicability of included studies. Stata software (version 15.0) was used for the random effects meta-analysis of performance measures. Subgroup analyses stratified by ML methods, sample size, age groups, and outcome definitions were conducted. RESULTS Eleven studies, including 23 prediction models, were identified. Most of the studies were published in recent three years. Logistic regression, boosting, and random forest were the most used ML methods. The most common important predictors were systemic steroid use, short-acting beta2-agonists, emergency department visit, age, and exacerbation history. The overall pooled area under the curve of the receiver operating characteristics (AUROC) of 11 studies (23 prediction models) was 0.80 (95% CI 0.77-0.83). Subgroup analysis based on different ML models showed that boosting method achieved the best performance, with an overall pooled AUROC of 0.84 (95% CI 0.81-0.87). CONCLUSION This study identified that ML was the potential tool to achieve great performance in predicting asthma exacerbations. However, the methodology within these models was heterogeneous. Future studies should focus on improving the generalization ability and practicability, thus driving the application of these models in clinical practice.
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Affiliation(s)
- Shiqiu Xiong
- Department of Allergy, Center for Asthma Prevention and Lung Function Laboratory, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China.
- Graduate School, Peking Union Medical College, Beijing, 100730, China.
| | - Wei Chen
- Department of Allergy, Center for Asthma Prevention and Lung Function Laboratory, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | - Xinyu Jia
- Department of Allergy, Center for Asthma Prevention and Lung Function Laboratory, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China
| | - Yang Jia
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Chuanhe Liu
- Department of Allergy, Center for Asthma Prevention and Lung Function Laboratory, Children's Hospital of Capital Institute of Pediatrics, Beijing, 100020, China.
- Graduate School, Peking Union Medical College, Beijing, 100730, China.
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4
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Nascimento OA, Cançado JED, Gazzotti MR, dos Santos FM, Saturnino LTM, da Silva DO, Gomes ALBB, Viana KP, Alfonso-Cristancho R, Rodrigues CS. The economic impact of asthma on private healthcare system in Brazil: Economic impact of asthma in Brazil. Medicine (Baltimore) 2023; 102:e33077. [PMID: 36961140 PMCID: PMC10036068 DOI: 10.1097/md.0000000000033077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/02/2023] [Indexed: 03/25/2023] Open
Abstract
To assess healthcare resource utilization and costs of patients with asthma in Brazilian Supplementary Healthcare System, focusing on hospitalization data. Retrospective cohort study, using data from an administrative database of a private company (Orizon). Patients aged ≥ 12 years with at least one record of emergency visit/hospitalization in the database with the ICD-10 J45 between January/2010 and June/2015 were included and followed until June/2016, death or inactivation of health plan. Sociodemographic characteristics, emergency visit and hospital admission per patient per year (exacerbation rate), physician visit with a procedure, exams, length of hospitalization (with/without intensive care unit (ICU)), and in-hospital treatments were assessed. A total of 54,568 patients were included in this analysis. Regarding resource utilization, emergency visit and hospital admission rates of 0.34 and 0.04 per person-year were observed, respectively. Mean length of hospital stay were 8.82 (SD = 36.48), 5.24 (SD = 19.06) and 19.53 (63.89) days for hospitalizations in general, without and with ICU, respectively. An exacerbation rate of 0.36 per person year was observed with a mean cost per episode of 3178 Brazilian Real (BRL) (SD = 31,667). Mean cost related to emergency department visits was estimated at 293 BRL (SD = 328). Hospitalization costs were stratified by the need of ICU and values observed were of 9307 BRL (SD = 18,979) without ICU, and 75,252 BRL (SD = 174,248) with ICU need. Asthma exacerbations may cost ~75,000 BRL for an ICU-dependent event in the Supplementary Healthcare System. To improve disease control may reduce disease burden for both healthcare system and patients.
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Affiliation(s)
- Oliver A. Nascimento
- GlaxoSmithKline, Rio DE Janeiro, Brazil
- Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo – EPM/UNIFESP, São Paulo (SP), Brasil
- Faculdade de Medicina São Leopoldo Mandic, Campinas (SP), Brasil
| | | | - Mariana Rodrigues Gazzotti
- GlaxoSmithKline, Rio DE Janeiro, Brazil
- Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo – EPM/UNIFESP, São Paulo (SP), Brasil
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Jácome C, Almeida R, Pereira AM, Amaral R, Vieira-Marques P, Mendes S, Alves-Correia M, Ferreira JA, Lopes I, Gomes J, Araújo L, Couto M, Chaves Loureiro C, Santos LM, Arrobas A, Valério M, Todo Bom A, Azevedo J, Teixeira MF, Ferreira-Magalhães M, Pinto PL, Pinto N, Neves AC, Morête A, Bom FT, Costa A, Silva D, Vasconcelos MJ, Falcão H, Marques ML, Mendes A, Cardoso J, Cidrais Rodrigues JC, Oliveira G, Carvalho J, Lozoya C, Santos N, Menezes F, Gomes R, Câmara R, Alves RR, Moreira AS, Abreu C, Silva R, Bordalo D, Alves C, Lopes C, Taborda-Barata L, Fernandes RM, Ferreira R, Chaves-Loureiro C, Cálix MJ, Alves A, Fonseca JA. Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:649506. [PMID: 35047915 PMCID: PMC8757762 DOI: 10.3389/fmedt.2021.649506] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/10/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support. Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use. Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use. Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25–P75) 16–36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3–45] days, translated on a median use rate of 15 [3–38]%. Median inhaler adherence assessed through the app was 34 [4–73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6–83]% and 43 [3–73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen. Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.
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Affiliation(s)
- Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rute Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Rita Amaral
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal.,Department of Women's and Children's Health, Pediatric Research, Uppsala University, Uppsala, Sweden
| | - Pedro Vieira-Marques
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Mendes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - José Alberto Ferreira
- Serviço de Imunoalergologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Inês Lopes
- Serviço de Imunoalergologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Joana Gomes
- Serviço de Imunoalergologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Luís Araújo
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Mariana Couto
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | | | - Lilia Maia Santos
- Serviço de Pneumologia, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal
| | - Ana Arrobas
- Serviço Pneumologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Margarida Valério
- Serviço Pneumologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Ana Todo Bom
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Azevedo
- Imunoalergologia, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Maria Fernanda Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuel Ferreira-Magalhães
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paula Leiria Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Nicole Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Castro Neves
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Morête
- Serviço de Imunoalergologia, Hospital Infante D. Pedro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Filipa Todo Bom
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Alberto Costa
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Diana Silva
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Helena Falcão
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria Luís Marques
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - João Cardoso
- Serviço de Pneumologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | | | - Georgeta Oliveira
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Carlos Lozoya
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Fernando Menezes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - Ricardo Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - Rita Câmara
- Serviço de Imunoalergologia, Serviço de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | | | - Ana Sofia Moreira
- Serviço de Imunoalergologia, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Carmo Abreu
- Serviço de Imunoalergologia, Hospital São Pedro de Vila Real, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, Portugal
| | - Rui Silva
- Serviço de Imunoalergologia, Hospital São Pedro de Vila Real, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, Portugal
| | - Diana Bordalo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Carlos Alves
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Cristina Lopes
- Unidade de Imunoalergologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.,Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Luís Taborda-Barata
- Department of Allergy and Clinical Immunology, Cova da Beira University Hospital Center, Covilhã, Portugal.,CICS - Health Sciences Research Center, University of Beira Interior; NuESA -Environment and Health Study Group, Faculty of Health Sciences, Covilhã, Portugal
| | - Ricardo M Fernandes
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Rosário Ferreira
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Carla Chaves-Loureiro
- Serviço Pediatria Ambulatória, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria José Cálix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Adelaide Alves
- Serviço de Pneumologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.,MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
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Nair P, O’Byrne PM. Medical algorithms: Approach to adult asthma exacerbations. Allergy 2021; 76:3556-3559. [PMID: 34086360 DOI: 10.1111/all.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Parameswaran Nair
- Firestone Institute for Respiratory HealthSt Joseph’s Healthcare & Department of MedicineMcMaster University Hamilton ON Canada
| | - Paul M. O’Byrne
- Firestone Institute for Respiratory HealthSt Joseph’s Healthcare & Department of MedicineMcMaster University Hamilton ON Canada
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7
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Neves AL, Jácome C, Taveira-Gomes T, Pereira AM, Almeida R, Amaral R, Alves-Correia M, Mendes S, Chaves-Loureiro C, Valério M, Lopes C, Carvalho J, Mendes A, Ribeiro C, Prates S, Ferreira JA, Teixeira MF, Branco J, Santalha M, Vasconcelos MJ, Lozoya C, Santos N, Cardia F, Moreira AS, Taborda-Barata L, Pinto CS, Ferreira R, Morais Silva P, Monteiro Ferreira T, Câmara R, Lobo R, Bordalo D, Guimarães C, Espírito Santo M, Ferraz de Oliveira J, Cálix Augusto MJ, Gomes R, Vieira I, da Silva S, Marques M, Cardoso J, Morete A, Aroso M, Cruz AM, Nunes C, Câmara R, Rodrigues N, Abreu C, Albuquerque AL, Vieira C, Santos C, Páscoa R, Chaves-Loureiro C, Alves A, Neves Â, Varanda Marques J, Reis B, Ferreira-Magalhães M, Almeida Fonseca J. Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies. J Med Internet Res 2021; 23:e25472. [PMID: 34550077 PMCID: PMC8495570 DOI: 10.2196/25472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/01/2021] [Accepted: 06/14/2021] [Indexed: 12/23/2022] Open
Abstract
Background Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.
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Affiliation(s)
- Ana Luísa Neves
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Imperial NIHR Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Cristina Jácome
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago Taveira-Gomes
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, Gandra, Portugal.,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - Ana Margarida Pereira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Rute Almeida
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rita Amaral
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal.,Department of Women's and Children's Health, Paediatric Research, Uppsala University, Uppsala, Sweden
| | | | - Sandra Mendes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Margarida Valério
- Serviço Pneumologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Cristina Lopes
- Unidade de Imunoalergologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.,Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Ana Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Carmelita Ribeiro
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sara Prates
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - José Alberto Ferreira
- Serviço de Imunoalergologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Maria Fernanda Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Branco
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Marta Santalha
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carlos Lozoya
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Francisca Cardia
- Unidade de Saúde Familiar Terras de Azurara, Agrupamento de Centros de Saúde Dão Lafões, Mangualde, Portugal
| | - Ana Sofia Moreira
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | - Luís Taborda-Barata
- Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal.,Centro de Investigação em Ciências da Saúde - Health Sciences Research Centre & NuESA -Environment & Health Study Group, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Cláudia Sofia Pinto
- Serviço de Pneumologia, Hospital São Pedro de Vila Real, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Rosário Ferreira
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | | | - Tania Monteiro Ferreira
- Unidade de Saúde Familiar Progresso e Saúde, Agrupamento de Centros de Saúde Baixo Mondego, Tocha, Portugal
| | - Raquel Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Rui Lobo
- Unidade de Saúde Familiar João Semana, Agrupamento de Centros de Saúde Baixo Vouga, Ovar, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Cristina Guimarães
- Unidade de Saúde Familiar Caminhos do Cértoma, Agrupamento de Centros de Saúde Baixo Mondego, Pampilhosa, Portugal
| | - Maria Espírito Santo
- Unidade de Saúde Familiar Arte Nova, Agrupamento de Centros de Saúde Baixo Vouga, Oliveirinha, Portugal
| | | | - Maria José Cálix Augusto
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Ricardo Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - Inês Vieira
- Unidade de Cuidados Saúde Personalizados Arnaldo Sampaio, Agrupamento de Centros de Saúde Pinhal Litoral, Leiria, Portugal
| | - Sofia da Silva
- Unidade de Saúde Familiar Cuidarte, Unidade Local de Saúde do Alto Minho, Portuzelo, Portugal
| | - Maria Marques
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Cardoso
- Serviço de Pneumologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Morete
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.,Serviço de Imunoalergologia, Hospital Infante D Pedro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Margarida Aroso
- Unidade de Saúde Familiar Pedras Rubras, Agrupamento de Centros de Saúde do Grande Porto III - Maia/Valongo, Maia, Portugal
| | - Ana Margarida Cruz
- Unidade de Saúde Familiar Bom Porto, Agrupamento de Centros de Saúde do Grande Porto V - Porto Ocidental, Porto, Portugal
| | - Carlos Nunes
- Imunoalergologia, Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - Rita Câmara
- Serviço de Imunoalergologia, Serviço de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | - Natalina Rodrigues
- Unidade de Saúde Familiar Mondego, Agrupamento de Centros de Saúde Baixo Mondego, Coimbra, Portugal
| | - Carmo Abreu
- Serviço de Imunoalergologia, Hospital São Pedro de Vila Real, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, Portugal
| | - Ana Luísa Albuquerque
- Unidade de Saúde Familiar Coimbra Centro, Agrupamento de Centros de Saúde Baixo Mondego, Coimbra, Portugal
| | - Claúdia Vieira
- Unidade de Saúde Familiar Corgo, Agrupamentos de Centros de Saúde Douro I - Marão e Douro Norte, Vila Real, Portugal
| | - Carlos Santos
- Unidade de Saúde Familiar Santo António, Agrupamento de Centros de Saúde do Cávado III - Barcelos/Esposende, Barcelos, Portugal
| | - Rosália Páscoa
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Unidade de Saúde Familiar Abel Salazar, Agrupamento de Centros de Saúde do Gaia, Vila Nova de Gaia, Portugal
| | - Carla Chaves-Loureiro
- Serviço Pediatria Ambulatória, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adelaide Alves
- Serviço de Pneumologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ângela Neves
- Unidade de Saúde Familiar Araceti, Agrupamento de Centros de Saúde Baixo Mondego, Arazede, Portugal
| | - José Varanda Marques
- Unidade de Saúde Familiar Viseu-Cidade, Agrupamento de Centros de Saúde do Dão Lafões, Viseu, Portugal
| | - Bruno Reis
- Unidade de Cuidados Saúde Personalizados Sicó, Agrupamento de Centros de Saúde Pinhal Litoral, Leiria, Portugal
| | - Manuel Ferreira-Magalhães
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Almeida Fonseca
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
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8
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Jácome C, Almeida R, Pereira AM, Amaral R, Mendes S, Alves-Correia M, Vidal C, López Freire S, Méndez Brea P, Araújo L, Couto M, Antolín-Amérigo D, de la Hoz Caballer B, Barra Castro A, Gonzalez-De-Olano D, Todo Bom A, Azevedo J, Leiria Pinto P, Pinto N, Castro Neves A, Palhinha A, Todo Bom F, Costa A, Chaves Loureiro C, Maia Santos L, Arrobas A, Valério M, Cardoso J, Emiliano M, Gerardo R, Cidrais Rodrigues JC, Oliveira G, Carvalho J, Mendes A, Lozoya C, Santos N, Menezes F, Gomes R, Câmara R, Rodrigues Alves R, Moreira AS, Bordalo D, Alves C, Ferreira JA, Lopes C, Silva D, Vasconcelos MJ, Teixeira MF, Ferreira-Magalhães M, Taborda-Barata L, Cálix MJ, Alves A, Almeida Fonseca J. Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study. JMIR Mhealth Uhealth 2021; 9:e26442. [PMID: 34032576 PMCID: PMC8188323 DOI: 10.2196/26442] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/26/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. OBJECTIVE This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). METHODS A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. RESULTS A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). CONCLUSIONS The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.
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Affiliation(s)
- Cristina Jácome
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Faculty of Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Rute Almeida
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Faculty of Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Faculty of Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Rita Amaral
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Faculty of Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
- Department of Cardiovascular and Respiratory Sciences, Porto Health School, Porto, Portugal
- Department of Women's and Children's Health, Paediatric Research, Uppsala University, Uppsala, Sweden
| | - Sandra Mendes
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Carmen Vidal
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Sara López Freire
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Paula Méndez Brea
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Luís Araújo
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Mariana Couto
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Darío Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Belén de la Hoz Caballer
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Alicia Barra Castro
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - David Gonzalez-De-Olano
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Ana Todo Bom
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Azevedo
- Imunoalergologia, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Paula Leiria Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Nicole Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Castro Neves
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Palhinha
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Filipa Todo Bom
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Alberto Costa
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Lilia Maia Santos
- Serviço de Pneumologia, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal
| | - Ana Arrobas
- Serviço Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Valério
- Serviço Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Cardoso
- Serviço de Pneumologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Madalena Emiliano
- Serviço de Pneumologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rita Gerardo
- Serviço de Pneumologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | | | - Georgeta Oliveira
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Ana Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Carlos Lozoya
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Fernando Menezes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - Ricardo Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - Rita Câmara
- Serviço de Imunoalergologia, Serviço de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | | | - Ana Sofia Moreira
- Serviço de Imunoalergologia, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Diana Bordalo
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Carlos Alves
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - José Alberto Ferreira
- Serviço de Imunoalergologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Cristina Lopes
- Unidade de Imunoalergologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Diana Silva
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria Fernanda Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuel Ferreira-Magalhães
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Faculty of Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Taborda-Barata
- Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
- Environment & Health Study Group, Faculty of Health Sciences, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Maria José Cálix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Adelaide Alves
- Serviço de Pneumologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Almeida Fonseca
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Faculty of Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
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9
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Rogliani P, Ritondo BL, Calzetta L. Triple therapy in uncontrolled asthma: a network meta-analysis of Phase III studies. Eur Respir J 2021; 58:13993003.04233-2020. [PMID: 33509960 DOI: 10.1183/13993003.04233-2020] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/13/2021] [Indexed: 11/05/2022]
Abstract
Conflicting evidence is currently available concerning the impact on asthma exacerbation of triple inhaled corticosteroid (ICS), long-acting β2-adrenoceptor agonist (LABA), and long-acting muscarinic receptor antagonist (LAMA) fixed-dose combination (FDC). Since meta-analyses allow settling controversies of apparently inconsistent results, we performed a network meta-analysis of Phase III randomised controlled trials including 9535 patients to assess the effect of ICS/LABA/LAMA combinations in uncontrolled asthma. Triple combination therapies with an ICS administered at high dose (HD) were more effective (p<0.05) than medium dose (MD) ICS/LABA/LAMA FDC and both MD and HD ICS/LABA FDCs against moderate to severe exacerbation (relative risk [RR] from 0.61 to 0.80) and increasing trough forced expiratory volume in the 1st second (mL from +33 to +114). Triple combination therapies including HD ICS were superior (p<0.05) than MD ICS/LABA/LAMA FDC in preventing severe exacerbation (RR from 0.46 to 0.65), but not with respect to moderate exacerbation (p>0.05). Triple combination therapies were equally effective on asthma control, with no safety concerns. This quantitative synthesis suggests that ICS/LABA/LAMA FDCs are effective and safe in uncontrolled asthma, and that the dose of ICS in the combination represents the discriminating factor to treat patients with a history of moderate or severe exacerbation.
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Affiliation(s)
- Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
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10
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Amaral R, Jácome C, Almeida R, Pereira AM, Alves-Correia M, Mendes S, Rodrigues JCC, Carvalho J, Araújo L, Costa A, Silva A, Teixeira MF, Ferreira-Magalhães M, Alves RR, Moreira AS, Fernandes RM, Ferreira R, Pinto PL, Neuparth N, Bordalo D, Bom AT, Cálix MJ, Ferreira T, Gomes J, Vidal C, Mendes A, Vasconcelos MJ, Silva PM, Ferraz J, Morête A, Pinto CS, Santos N, Loureiro CC, Arrobas A, Marques ML, Lozoya C, Lopes C, Cardia F, Loureiro CC, Câmara R, Vieira I, da Silva S, Silva E, Rodrigues N, Fonseca JA. Profiling Persistent Asthma Phenotypes in Adolescents: A Longitudinal Diagnostic Evaluation from the INSPIRERS Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031015. [PMID: 33498858 PMCID: PMC7908090 DOI: 10.3390/ijerph18031015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13–17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk.
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Affiliation(s)
- Rita Amaral
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Department of Women’s and Children’s Health, Paediatric Research, Uppsala University, SE-751 05 Uppsala, Sweden
- Correspondence: ; Tel.: +351-917-006-669
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Rute Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Allergy Unit, CUF Porto Hospital and Institute, 4100-180 Porto, Portugal; (M.A.-C.); (L.A.)
| | - Magna Alves-Correia
- Allergy Unit, CUF Porto Hospital and Institute, 4100-180 Porto, Portugal; (M.A.-C.); (L.A.)
| | - Sandra Mendes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
| | - José Carlos Cidrais Rodrigues
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, 4464-513 Matosinhos, Portugal; (J.C.C.R.); (J.C.); (C.L.)
| | - Joana Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, 4464-513 Matosinhos, Portugal; (J.C.C.R.); (J.C.); (C.L.)
| | - Luís Araújo
- Allergy Unit, CUF Porto Hospital and Institute, 4100-180 Porto, Portugal; (M.A.-C.); (L.A.)
| | - Alberto Costa
- Serviço de Pediatria, Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal; (A.C.); (A.S.)
| | - Armandina Silva
- Serviço de Pediatria, Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal; (A.C.); (A.S.)
| | - Maria Fernanda Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal;
| | - Manuel Ferreira-Magalhães
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal;
| | - Rodrigo Rodrigues Alves
- Serviço de Imunoalergologia, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal;
| | - Ana Sofia Moreira
- Unidade de Imunoalergologia, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal;
| | - Ricardo M. Fernandes
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, 1649-035 Lisboa, Portugal; (R.M.F.); (R.F.); (A.M.)
| | - Rosário Ferreira
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, 1649-035 Lisboa, Portugal; (R.M.F.); (R.F.); (A.M.)
| | - Paula Leiria Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1150-199 Lisboa, Portugal; (P.L.P.); (N.N.)
| | - Nuno Neuparth
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1150-199 Lisboa, Portugal; (P.L.P.); (N.N.)
- Pathophysiology, CHRC/CEDOC, High Burden and High Mortality Diseases Thematic Line Coordinator, Nova Medical School, 1150-190 Lisboa, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, 4780-371 Vila Nova de Famalicão, Portugal;
| | - Ana Todo Bom
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Maria José Cálix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela–Viseu, 3504-509 Viseu, Portugal;
| | - Tânia Ferreira
- Unidade de Saúde Familiar Progresso e Saúde, ACeS Baixo Mondego, 3060-716 Tocha, Portugal;
| | - Joana Gomes
- Serviço de Imunoalergologia, Unidade I, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal;
| | - Carmen Vidal
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, 15706 Santiago De Compostela, Spain;
| | - Ana Mendes
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, 1649-035 Lisboa, Portugal; (R.M.F.); (R.F.); (A.M.)
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, 4200–319 Porto, Portugal;
| | | | - José Ferraz
- Imunoalergologia, Hospital Privado de Alfena, Trofa Saúde, 4445-243 Alfena, Portugal;
| | - Ana Morête
- Serviço de Imunoalergologia, Hospital Infante D. Pedro, Centro Hospitalar Baixo Vouga, 3814-501 Aveiro, Portugal;
| | - Claúdia Sofia Pinto
- Serviço de Pneumologia, Hospital São Pedro de Vila Real, Centro Hospitalar De Trás-Os-Montes E Alto Douro, 5000-508 Vila Real, Portugal;
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, 8000-386 Portimão, Portugal;
| | | | - Ana Arrobas
- Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Maria Luís Marques
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal;
| | - Carlos Lozoya
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal;
| | - Cristina Lopes
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, 4464-513 Matosinhos, Portugal; (J.C.C.R.); (J.C.); (C.L.)
- Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Francisca Cardia
- Unidade de Saúde Familiar Terras de Azurara, ACES Dão Lafões, 3530-113 Mangualde, Portugal;
| | - Carla Chaves Loureiro
- Departamento de Pediatria, Serviço de Pediatria Ambulatória, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Raquel Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, 2834-003 Barreiro, Portugal;
| | - Inês Vieira
- UCSP Dr. Arnaldo Sampaio, ACES Pinhal Litoral, 2419-014 Leiria, Portugal;
| | - Sofia da Silva
- USF Cuidarte, Unidade Local de Saúde do Alto Minho, 4925-083 Portuzelo, Portugal;
| | - Eurico Silva
- Unidade de Saúde Familiar João Semana, ACeS Baixo Vouga, 3880-225 Ovar, Portugal;
| | - Natalina Rodrigues
- Unidade de Saúde Familiar Mondego, ACES Baixo Mondego, 3045-059 Coimbra, Portugal;
| | - João A. Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (C.J.); (R.A.); (A.M.P.); (S.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Allergy Unit, CUF Porto Hospital and Institute, 4100-180 Porto, Portugal; (M.A.-C.); (L.A.)
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Asthma exacerbations and worsenings in patients aged 1-75 years with add-on tiotropium treatment. NPJ Prim Care Respir Med 2020; 30:38. [PMID: 32868782 PMCID: PMC7459309 DOI: 10.1038/s41533-020-00193-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/18/2020] [Indexed: 12/26/2022] Open
Abstract
This review explores the effect of tiotropium Respimat® add-on therapy on asthma exacerbations and worsenings, adverse events (AEs) related to exacerbations and symptoms and any effects on seasonality across the 10 UniTinA-asthma® clinical trials comprising over 6000 patients. When added on to inhaled corticosteroids ± additional therapies, tiotropium significantly reduced the risk of exacerbations and worsenings in adults with symptomatic severe asthma and provided a non-significant improvement in worsenings in adults with symptomatic moderate and mild asthma, which was significant for patients with moderate asthma receiving tiotropium 2.5 µg once daily vs. placebo. Trials in paediatric patients were not powered to assess exacerbations or worsenings, but when AEs related to asthma exacerbations and symptoms were grouped into a composite endpoint and pooled, tiotropium improved outcomes vs. placebo (rate ratio 0.76; 95% confidence interval 0.63, 0.93). The reduction in exacerbations with tiotropium is apparent across all patients during the observed seasonal peaks of these events.
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12
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Jácome C, Pereira AM, Almeida R, Ferreira-Magalhaes M, Couto M, Araujo L, Pereira M, Correia MA, Loureiro CC, Catarata MJ, Maia Santos L, Pereira J, Ramos B, Lopes C, Mendes A, Cidrais Rodrigues JC, Oliveira G, Aguiar AP, Afonso I, Carvalho J, Arrobas A, Coutinho Costa J, Dias J, Todo Bom A, Azevedo J, Ribeiro C, Alves M, Leiria Pinto P, Neuparth N, Palhinha A, Gaspar Marques J, Pinto N, Martins P, Todo Bom F, Alvarenga Santos M, Gomes Costa A, Silva Neto A, Santalha M, Lozoya C, Santos N, Silva D, Vasconcelos MJ, Taborda-Barata L, Carvalhal C, Teixeira MF, Alves RR, Moreira AS, Sofia Pinto C, Morais Silva P, Alves C, Câmara R, Coelho D, Bordalo D, Fernandes RM, Ferreira R, Menezes F, Gomes R, Calix MJ, Marques A, Cardoso J, Emiliano M, Gerardo R, Nunes C, Câmara R, Ferreira JA, Carvalho A, Freitas P, Correia R, Fonseca JA. Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts. BMJ Open 2019; 9:e031732. [PMID: 31699737 PMCID: PMC6858182 DOI: 10.1136/bmjopen-2019-031732] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. DESIGN Baseline data from two prospective multicentre observational studies. SETTING 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. PARTICIPANTS 395 patients (≥13 years old) with persistent asthma. MEASURES Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. RESULTS High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%). CONCLUSION Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
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Affiliation(s)
- Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
| | - Rute Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Manuel Ferreira-Magalhaes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mariana Couto
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
| | - Luís Araujo
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
| | - Mariana Pereira
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | | | - Cláudia Chaves Loureiro
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Maria Joana Catarata
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Lília Maia Santos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - João Pereira
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Bárbara Ramos
- Serviço de Pneumologia A, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Cristina Lopes
- Unidade de Imunoalergologia, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
- Imunologia Básica e Clínica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Mendes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal
| | | | - Georgeta Oliveira
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ana Paula Aguiar
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ivete Afonso
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ana Arrobas
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - José Coutinho Costa
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Joana Dias
- Serviço de Pneumologia B, Hospital Geral, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Ana Todo Bom
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - João Azevedo
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Carmelita Ribeiro
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Marta Alves
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Paula Leiria Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Nuno Neuparth
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
- Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - Ana Palhinha
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - João Gaspar Marques
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Nicole Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Pedro Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
- Pathophysiology, CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal
| | - Filipa Todo Bom
- Serviço de Pneumologia, Hospital Beatriz Ângelo, Loures, Portugal
| | | | | | | | - Marta Santalha
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimaraes, Portugal
| | - Carlos Lozoya
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar do Algarve EPE, Faro, Portugal
| | - Diana Silva
- Serviço de Imunoalergologia, Hospital São João, Porto, Portugal
| | | | - Luís Taborda-Barata
- University of Beira Interior, CICS - Health Sciences Research Centre; NuESA - Environment & Health Study Group, Faculty of Health Sciences, Covilha, Portugal
- Cova da Beira University Hospital Centre, Department of Allergy & Clinical Immunology, Covilhã, Portugal
| | - Célia Carvalhal
- Cova da Beira University Hospital Centre, Department of Allergy & Clinical Immunology, Covilhã, Portugal
| | - Maria Fernanda Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rodrigo Rodrigues Alves
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Ana Sofia Moreira
- Unidade de Imunoalergologia, Hospital do Divino Espirito Santo de Ponta Delgada EPE, Ponta Delgada, Portugal
| | - Cláudia Sofia Pinto
- Serviço de Pneumologia, Centro Hospitalar de Trás-os-montes e Alto Douro EPE, Vila Real, Portugal
| | | | - Carlos Alves
- Serviço de Pneumologia, Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | - Raquel Câmara
- Serviço de Pneumologia, Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | - Didina Coelho
- Serviço de Pneumologia, Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Centro Hospitalar do Médio Ave EPE, Santo Tirso, Portugal
| | - Ricardo M Fernandes
- Pediatrics, Hospital de Santa Maria, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon Medical Faculty, Lisboa, Portugal
| | | | - Fernando Menezes
- Serviço de Pneumologia, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Ricardo Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Maria José Calix
- Serviço de Pediatria, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | - Ana Marques
- Serviço de Pediatria, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | - João Cardoso
- Pneumology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | | | - Rita Gerardo
- Pneumology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carlos Nunes
- Imunoalergologia, Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - Rita Câmara
- Serviço de Imunoalergologia, Serviço de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | - José Alberto Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Aurora Carvalho
- Serviço de Imunoalergologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paulo Freitas
- Bloco operatório, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Correia
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal
| | - Joao A Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Immunoalergology, CUF-Porto Hospital and Institute, Porto, Portugal
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal
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Association of molds and metrological parameters to frequency of severe asthma exacerbation. Allergy Asthma Clin Immunol 2019; 15:29. [PMID: 31168304 PMCID: PMC6489181 DOI: 10.1186/s13223-019-0323-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/30/2019] [Indexed: 12/30/2022] Open
Abstract
Background Sensitization to airborne molds may be a risk factor for severe asthma and direct cause of asthma exacerbation (AE). Methods A prospective, 1-year (April 2016-March 2017) study, done in Kuwait Allergy Centre, investigated the link between AEs with exposure to outdoor molds and the role of meteorological parameters in mold sensitized patients and compared with non-allergic asthma patients who had asthma deterioration. The total of 676 adult asthmatics with moderate-severe AEs were included and divided into atopic (85.65%) and non-atopic group. Atopy was defined by positive skin prick test (SPT) to at least one inhalant allergen. Data regarding atopy and asthma severity were collected from patient's records. Patients with symptoms and signs of acute respiratory infection and patient sensitized to indoor allergens only were excluded. Daily count of local pollens (Salsola kali, Bermuda grass) and molds (Aspergillus, Alternaria and Cladosporium) were obtained from the Aerobiology department. Daily metrological parameters (atmospheric pressure-AP, temperature-T and relative humidity-RH) were provided by Kuwait Environment Public Authority. Count of spores/m3 and weather variable are shown on weekly basis. The year circle was divided into 4 Seasons (1, 2, 3, 4) accordingly to typical desert climate. Results Sensitization to molds was relatively high but significantly less (25.0%) if compared to the pollens sensitization. The highest number of AEs was in season 4 for both molds and pollens sensitized patients. Seasonal patterns for both allergens were significant and positively correlated with RH and AP. In season 1 only, mold sensitized patients showed higher rate of AEs. Non-atopic patients have been less sensitive to increased RH than atopic. Negative correlation with T was similar in both atopic and non-atopic patients. Conclusion Despite of high rate of sensitization to molds, their significant role in triggering AE was not found in desert environment. Typical desert climate and high allergencity of local weeds outweigh the influence of the molds.
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14
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Huang DT, Yealy DM, Filbin MR, Brown AM, Chang CCH, Doi Y, Donnino MW, Fine J, Fine MJ, Fischer MA, Holst JM, Hou PC, Kellum JA, Khan F, Kurz MC, Lotfipour S, LoVecchio F, Peck-Palmer OM, Pike F, Prunty H, Sherwin RL, Southerland L, Terndrup T, Weissfeld LA, Yabes J, Angus DC. Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. N Engl J Med 2018; 379:236-249. [PMID: 29781385 PMCID: PMC6197800 DOI: 10.1056/nejmoa1802670] [Citation(s) in RCA: 267] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effect of procalcitonin-guided use of antibiotics on treatment for suspected lower respiratory tract infection is unclear. METHODS In 14 U.S. hospitals with high adherence to quality measures for the treatment of pneumonia, we provided guidance for clinicians about national clinical practice recommendations for the treatment of lower respiratory tract infections and the interpretation of procalcitonin assays. We then randomly assigned patients who presented to the emergency department with a suspected lower respiratory tract infection and for whom the treating physician was uncertain whether antibiotic therapy was indicated to one of two groups: the procalcitonin group, in which the treating clinicians were provided with real-time initial (and serial, if the patient was hospitalized) procalcitonin assay results and an antibiotic use guideline with graded recommendations based on four tiers of procalcitonin levels, or the usual-care group. We hypothesized that within 30 days after enrollment the total antibiotic-days would be lower - and the percentage of patients with adverse outcomes would not be more than 4.5 percentage points higher - in the procalcitonin group than in the usual-care group. RESULTS A total of 1656 patients were included in the final analysis cohort (826 randomly assigned to the procalcitonin group and 830 to the usual-care group), of whom 782 (47.2%) were hospitalized and 984 (59.4%) received antibiotics within 30 days. The treating clinician received procalcitonin assay results for 792 of 826 patients (95.9%) in the procalcitonin group (median time from sample collection to assay result, 77 minutes) and for 18 of 830 patients (2.2%) in the usual-care group. In both groups, the procalcitonin-level tier was associated with the decision to prescribe antibiotics in the emergency department. There was no significant difference between the procalcitonin group and the usual-care group in antibiotic-days (mean, 4.2 and 4.3 days, respectively; difference, -0.05 day; 95% confidence interval [CI], -0.6 to 0.5; P=0.87) or the proportion of patients with adverse outcomes (11.7% [96 patients] and 13.1% [109 patients]; difference, -1.5 percentage points; 95% CI, -4.6 to 1.7; P<0.001 for noninferiority) within 30 days. CONCLUSIONS The provision of procalcitonin assay results, along with instructions on their interpretation, to emergency department and hospital-based clinicians did not result in less use of antibiotics than did usual care among patients with suspected lower respiratory tract infection. (Funded by the National Institute of General Medical Sciences; ProACT ClinicalTrials.gov number, NCT02130986 .).
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Affiliation(s)
- David T Huang
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Donald M Yealy
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Michael R Filbin
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Aaron M Brown
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Chung-Chou H Chang
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Yohei Doi
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Michael W Donnino
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Jonathan Fine
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Michael J Fine
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Michelle A Fischer
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - John M Holst
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Peter C Hou
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - John A Kellum
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Feras Khan
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Michael C Kurz
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Shahram Lotfipour
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Frank LoVecchio
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Octavia M Peck-Palmer
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Francis Pike
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Heather Prunty
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Robert L Sherwin
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Lauren Southerland
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Thomas Terndrup
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Lisa A Weissfeld
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Jonathan Yabes
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
| | - Derek C Angus
- From the CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center (D.T.H., C.-C.H.C., J.A.K., O.M.P.-P., D.C.A.), the Departments of Critical Care Medicine (D.T.H., J.A.K., O.M.P.-P., D.C.A.), Emergency Medicine (D.T.H., D.M.Y., A.M.B., H.P.), and Pathology (O.M.P.-P.), the MACRO (Multidisciplinary Acute Care Research Organization) Center (D.T.H., D.M.Y., D.C.A.), and the Divisions of General Internal Medicine (C.-C.H.C., M.J.F., J.Y.) and Infectious Diseases (Y.D.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (M.J.F.) - all in Pittsburgh; the Department of Emergency Medicine, Massachusetts General Hospital (M.R.F.), the Department of Emergency Medicine, Beth Israel Deaconess Medical Center (M.W.D.), and the Department of Emergency Medicine, Brigham and Women's Hospital (P.C.H.) - all in Boston; the Department of Emergency Medicine, Norwalk Hospital, Norwalk, CT (J.F.); the Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA (M.A.F., T.T.); the Department of Emergency Medicine, Essentia Health, Duluth, MN (J.M.H.); the Department of Emergency Medicine, University of Maryland Medical Center, Baltimore (F.K.); the Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Birmingham (M.C.K.); the Department of Emergency Medicine, University of California at Irvine Medical Center, Irvine (S.L.); the Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ (F.L.); Eli Lilly, Indianapolis (F.P.); the Department of Emergency Medicine, Detroit Receiving Hospital, Detroit (R.L.S.); the Department of Emergency Medicine, Ohio State University, Columbus (L.S., T.T.); and Statistics Collaborative, Washington, DC (L.A.W.)
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Emeryk A, Bartkowiak-Emeryk M, Raus Z, Braido F, Ferlazzo G, Melioli G. Mechanical bacterial lysate administration prevents exacerbation in allergic asthmatic children-The EOLIA study. Pediatr Allergy Immunol 2018; 29:394-401. [PMID: 29575037 DOI: 10.1111/pai.12894] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite progress in asthma management, prevention of asthma exacerbation remains challenging in school-aged children with allergic asthma. New therapeutic approaches are needed. Previously, a chemical bacterial lysate has been successfully used in preschool children to reduce wheezing attacks. We assessed the effect of Polyvalent Mechanical Bacterial Lysate (PMBL® ) Tablet on asthma clinical course and control in 6- to 16-year-old children with partly controlled or uncontrolled allergic asthma. METHODS A randomized, double-blind, placebo-controlled, parallel-group study was performed in 152 patients exhibiting allergic asthma assigned to receive Placebo or PMBL® . Eligible patients underwent four visits during the 9-month study. Asthma control level was assessed by ACT/C-ACT score. RESULTS The main criterion was not achieved as ACT/C-ACT changes were similar in both groups at the end of the 3-month treatment period. However, the mean number (±SD) of asthma exacerbations was significantly lower with PMBL® Tablet than with Placebo at Week 12 (0.3 ± 0.6 vs 0.8 ± 1.1, P = .009) and over the total study period (1.1 ± 1.3 vs 1.9 ± 2.0, P = .01). Consistently, the mean number of days with exacerbation per patient was significantly lower with PMBL® Tablet (13.3 ± 11.2 vs 19.8 ± 15.7 over the whole study, P = .009). Treatment with PMBL® Tablet prolonged the time to second exacerbation by 55% (Hazard Ratio [HR]=0.45; 95% Confidence Interval [CI] 0.27 to 0.77, P = .002) and to third exacerbation by 74% (HR=0.26; 95% CI 0.12 to 0.58, P < .001). No serious adverse event related to PMBL® Tablet administration was recorded. CONCLUSION Administration of PMBL® Tablet represents a safe and effective means for significantly reducing the rate of exacerbations in school-aged allergic asthmatic children. (EudraCT 2013-000737-12 and NCT02541331).
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Affiliation(s)
- Andrzej Emeryk
- Department of Paediatric Pulmonology and Rheumatology, University Children Hospital of Lublin, Lublin, Poland
| | | | - Zbigniew Raus
- LaserMed Diagnosis and Treatment Centre, Chełm, Poland
| | - Fulvio Braido
- Allergy and Respiratory Diseases Department, University of Genoa, IRCCS A.O.U San Martino- IST, Genova, Italy
| | - Guido Ferlazzo
- Laboratory of Immunology and Biotherapy, Department of Human Pathology, University of Messina, Messina, Italy
| | - Giovanni Melioli
- Allergy and Respiratory Diseases Department, University of Genoa, IRCCS A.O.U San Martino- IST, Genova, Italy
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Loymans RJ, Sterk PJ. Exacerbation-Prone Asthma: A Separate Bioclinical Phenotype? Am J Respir Crit Care Med 2017; 195:275-277. [PMID: 28145763 DOI: 10.1164/rccm.201609-1819ed] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rik J Loymans
- 1 Academic Medical Centre University of Amsterdam Amsterdam, the Netherlands
| | - Peter J Sterk
- 1 Academic Medical Centre University of Amsterdam Amsterdam, the Netherlands
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Management of Acute Loss of Asthma Control: The Yellow Zone. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2016.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Barbarot S, Rogers NK, Abuabara K, Aubert H, Chalmers J, Flohr C, Hanifin J, Naldi L, Margolis DJ, Paul C, Ridd MJ, Schuttelaar MLA, Simpson E, Tauber M, Volke A, Weidinger S, Wilkes SR, Wollenberg A, Thomas KS. Strategies used for measuring long-term control in atopic dermatitis trials: A systematic review. J Am Acad Dermatol 2016; 75:1038-1044. [PMID: 27522613 DOI: 10.1016/j.jaad.2016.05.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/11/2016] [Accepted: 05/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease. There are no standardized methods for capturing long-term control of AD. OBJECTIVE We sought to identify how long-term control has been captured in published randomized controlled trials (RCTs). Results will initiate consensus discussions on how best to measure long-term control in the core outcome set for AD. METHODS We conducted a systematic review of RCTs of AD treatments published between 2000 and 2013, with a follow-up period of 3 months or longer, at least 1 outcome measure recorded at 3 or more time points, full article available, and published in English. RESULTS In all, 101 of 353 RCTs were eligible. Methods to capture long-term control included: repeated measurement of AD outcomes (92 RCTs; 91%), use of AD medication (29 RCTs; 28.7%), and AD flares/remissions (26 RCTs; 25.7%). Repeated measurements of AD outcomes were typically collected 3 to 5 times during a trial, but analysis methods often failed to make best use of the data. Time to first flare was most commonly used for trials including flare data (21/52). Medication use was recorded based on quantity, potency, and frequency of application. LIMITATIONS We included RCT data only. CONCLUSION This review illustrates the difficulties in measuring long-term control, and points to the need for improved harmonization of outcomes.
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Affiliation(s)
- Sebastien Barbarot
- Center of Evidence-based Dermatology, University of Nottingham, Nottingham, United Kingdom; Department of Dermatology, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | - Natasha K Rogers
- Center of Evidence-based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco, California
| | - Helene Aubert
- Department of Dermatology, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | - Joanne Chalmers
- Center of Evidence-based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Carsten Flohr
- Population-based Dermatology Research Unit, St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Jon Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Luigi Naldi
- Study Center Italian Group for Epidemiologic Research in Dermatology and Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - David J Margolis
- Departments of Dermatology and Biostatistics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Carle Paul
- Dermatology, Paul Sabatier University and Hôpital Larrey, Toulouse, France
| | - Matthew J Ridd
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | | | - Eric Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Marie Tauber
- Dermatology, Paul Sabatier University and Hôpital Larrey, Toulouse, France
| | - Annika Volke
- Department of Dermatology, University of Tartu, Tartu, Estonia
| | - Stephan Weidinger
- Department of Dermatology, Venereology, and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sally R Wilkes
- Center of Evidence-based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University Munich, Munich, Germany
| | - Kim S Thomas
- Center of Evidence-based Dermatology, University of Nottingham, Nottingham, United Kingdom.
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Virchow JC, Backer V, de Blay F, Kuna P, Ljørring C, Prieto JL, Villesen HH. Defining moderate asthma exacerbations in clinical trials based on ATS/ERS joint statement. Respir Med 2015; 109:547-56. [PMID: 25676887 DOI: 10.1016/j.rmed.2015.01.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Exacerbations are a key outcome in clinical research, providing patient-relevant information about symptomatic control, health state and disease progression. Generally considered as an episode of (sub)acute deterioration of respiratory symptoms, a precise, clinically useful definition is needed for use in clinical trials. AIM AND METHODS Focussing on moderate exacerbations, this opinion piece reviews landmark trials and current guidelines to provide a practical definition of a moderate exacerbation. Specifically, we adapt the ATS/ERS consensus statement of terminology Reddel et al. (2009) [1] which provides a conceptual (or 'theoretical') definition for moderate exacerbations, to an operational (or 'practical') criterion suitable for use in clinical research. RESULTS The proposed definition for a moderate exacerbation requires ≥1 of the following criteria combined with a change in treatment: a) nocturnal awakening(s) due to asthma requiring SABA for 2 consecutive nights or an increase of ≥0.75 from baseline in daily symptom scores on 2 consecutive days; b) increase from baseline in occasions of SABA use on 2 consecutive days (minimum increase: 4 puffs/day); c) ≥20% decrease in PEF from baseline on at least 2 consecutive mornings/evenings or ≥20% decrease in FEV1 from baseline and/or d) visit to the emergency room/trial site for asthma treatment not requiring systemic corticosteroids. CONCLUSION A clinically and patient-relevant, operational definition of moderate exacerbations is needed. The proposed definition has been endorsed by the EMA Scientific Advice Working Party in 2011and needs to be trialled in forthcoming clinical studies.
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Affiliation(s)
- J Christian Virchow
- Department of Pneumology/Intensive Care Medicine, Zentrum für Innere Medizin, Klinik I, Universitätsklinikum Rostock, Germany.
| | - Vibeke Backer
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen University, Denmark
| | - Frédéric de Blay
- Chest Diseases Department, University Hospital of Strasbourg, Federation of Translational Medicine of Strasbourg, Strasbourg University, Strasbourg, France
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Lodz, Poland
| | - Christian Ljørring
- Global Clinical Development, ALK, Bøge Allé 1, DK 2970 Hørsholm, Denmark
| | - Jesus L Prieto
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Hanne H Villesen
- Global Clinical Development, ALK, Bøge Allé 1, DK 2970 Hørsholm, Denmark
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20
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Habre R, Moshier E, Castro W, Nath A, Grunin A, Rohr A, Godbold J, Schachter N, Kattan M, Coull B, Koutrakis P. The effects of PM2.5 and its components from indoor and outdoor sources on cough and wheeze symptoms in asthmatic children. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2014; 24:380-387. [PMID: 24714073 DOI: 10.1038/jes.2014.21] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/15/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
Particulate matter with aerodynamic diameter <2.5 μm (PM2.5) is associated with asthma exacerbation. In the Children's Air Pollution Asthma Study, we investigated the longitudinal association of PM2.5 and its components from indoor and outdoor sources with cough and wheeze symptoms in 36 asthmatic children. The sulfur tracer method was used to estimate infiltration factors. Mixed proportional odds models for an ordinal response were used to relate daily cough and wheeze scores to PM2.5 exposures. The odds ratio associated with being above a given symptom score for a SD increase in PM2.5 from indoor sources (PMIS) was 1.24 (95% confidence interval: 0.92-1.68) for cough and 1.63 (1.11-2.39) for wheeze. Ozone was associated with wheeze (1.82, 1.19-2.80), and cough was associated with indoor PM2.5 components from outdoor sources (denoted with subscript "OS") bromine (BrOS: 1.32, 1.05-1.67), chlorine (ClOS: 1.27, 1.02-1.59) and pyrolyzed organic carbon (OPOS: 1.49, 1.12-1.99). The highest effects were seen in the winter for cough with sulfur (SOS: 2.28, 1.01-5.16) and wheeze with organic carbon fraction 2 (OC2OS: 7.46, 1.19-46.60). Our results indicate that exposure to components originating from outdoor sources of photochemistry, diesel and fuel oil combustion is associated with symptom's exacerbation, especially in the winter. PM2.5 mass of indoor origin was more strongly associated with wheeze than with cough.
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Affiliation(s)
- Rima Habre
- 1] Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA [2] Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Erin Moshier
- Department of Community Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - William Castro
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Amit Nath
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Avi Grunin
- Department of Pediatrics, Mount Sinai School of Medicine, New York, New York, USA
| | - Annette Rohr
- Electric Power Research Institute, Palo Alto, California, USA
| | - James Godbold
- Department of Community Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Neil Schachter
- 1] Department of Community Medicine, Mount Sinai School of Medicine, New York, New York, USA [2] Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Meyer Kattan
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Brent Coull
- 1] Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA [2] Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
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21
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Custovic A, Johnston SL, Pavord I, Gaga M, Fabbri L, Bel EH, Le Souëf P, Lötvall J, Demoly P, Akdis CA, Ryan D, Mäkelä MJ, Martinez F, Holloway JW, Saglani S, O'Byrne P, Papi A, Sergejeva S, Magnan A, Del Giacco S, Kalayci O, Hamelmann E, Papadopoulos NG. EAACI position statement on asthma exacerbations and severe asthma. Allergy 2013; 68:1520-31. [PMID: 24410781 PMCID: PMC7159478 DOI: 10.1111/all.12275] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 02/02/2023]
Abstract
Asthma exacerbations and severe asthma are linked with high morbidity, significant mortality and high treatment costs. Recurrent asthma exacerbations cause a decline in lung function and, in childhood, are linked to development of persistent asthma. This position paper, from the European Academy of Allergy and Clinical Immunology, highlights the shortcomings of current treatment guidelines for patients suffering from frequent asthma exacerbations and those with difficult‐to‐treat asthma and severe treatment‐resistant asthma. It reviews current evidence that supports a call for increased awareness of (i) the seriousness of asthma exacerbations and (ii) the need for novel treatment strategies in specific forms of severe treatment‐resistant asthma. There is strong evidence linking asthma exacerbations with viral airway infection and underlying deficiencies in innate immunity and evidence of a synergism between viral infection and allergic mechanisms in increasing risk of exacerbations. Nonadherence to prescribed medication has been identified as a common clinical problem amongst adults and children with difficult‐to‐control asthma. Appropriate diagnosis, assessment of adherence and other potentially modifiable factors (such as passive or active smoking, ongoing allergen exposure, psychosocial factors) have to be a priority in clinical assessment of all patients with difficult‐to‐control asthma. Further studies with improved designs and new diagnostic tools are needed to properly characterize (i) the pathophysiology and risk of asthma exacerbations, and (ii) the clinical and pathophysiological heterogeneity of severe asthma.
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Affiliation(s)
- A. Custovic
- Centre Lead for Respiratory Medicine; Institute of Inflammation & Repair; University of Manchester; University Hospital of South Manchester; Manchester UK
| | - S. L. Johnston
- Airway Disease Infection Section; National Heart & Lung Institute; Imperial College London; Norfolk Place London UK
| | - I. Pavord
- Department of Respiratory Medicine; Thoracic Surgery and Allergy University Hospitals of Leicester NHS Trust; Glenfield Hospital; Leicester UK
| | - M. Gaga
- 7th Respiratory Medicine Department and Asthma Centre; Athens Chest Hospital; Athens Greece
| | - L. Fabbri
- Department of Oncology Haematology and Respiratory Diseases; University of Modena & Reggio Emilia; Modena Italy
| | - E. H. Bel
- Department of Respiratory Medicine; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - P. Le Souëf
- Department of Respiratory Medicine; University of Western Australia; Princess Margaret Hospital for Children; Perth WA Australia
| | - J. Lötvall
- Krefting Research Centre Sahlgrenska Academy; University of Gothenburg; Göteborg Sweden
| | - P. Demoly
- Allergology Unit; Département de Pneumologie-Addictologie; Hôpital de Villeneuve - Inserm U657; Montpellier France
| | - C. A. Akdis
- Swiss Institute of Allergy & Asthma Research (SIAF); University of Zurich; Davos
- Christine-Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - D. Ryan
- Woodbrook Medical Centre; Loughborough UK
| | - M. J. Mäkelä
- Skin and Allergy Hospital; Helsinki University Central Hospital; HUS Finland
| | - F. Martinez
- University of Arizona; Arizona Health Sciences Center; Pediatric Pulmonary Center; Tucson AZ USA
| | - J. W. Holloway
- University of Southampton; Faculty of Medicine Southampton General Hospital; Southampton UK
| | - S. Saglani
- National Heart & Lung Institute; Imperial College London; London UK
| | - P. O'Byrne
- Department of Medicine; Michael G DeGroote School of Medicine; McMaster University Faculty of Health Sciences; Hamilton ON Canada
| | - A. Papi
- Research Center on Asthma and COPD; University of Ferrara; Ferrara Italy
| | - S. Sergejeva
- Institute of Technology; University of Tartu; Tartu Estonia
| | - A. Magnan
- INSERM UMR915; l'institut du thorax; Faculté de Médecine; & Université de Nantes; Nantes France
| | - S. Del Giacco
- Department of Medical Science; University of Cagliari; Cagliari Italy
| | - O. Kalayci
- Pediatric Allergy and Asthma Unit; Ihsan Dogramaci Children's Hospital; Hacettepe University School of Medicine; Ankara Turkey
| | - E. Hamelmann
- Department of Pediatric Pneumology & Immunology; Charité Universitäts Berlin; Berlin Germany
- Department of Pediatrics; Ruhr-University Bochum; Bochum Germany
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22
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Ruffoni S, Passalacqua G, Ricciardolo F, Furgani A, Negrini AC, De Amici M, Ciprandi G. A 10-year survey on asthma exacerbations: Relationships among emergency medicine calls, pollens, weather, and air pollution. REVUE FRANCAISE D ALLERGOLOGIE 2013. [DOI: 10.1016/j.reval.2013.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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