1
|
Giordano F, Guidotti S, Giordano T, Pruneti C. Clinical and psychological aspects in a group of allergic asthma patients and the impact on their health status perception. HEALTH PSYCHOLOGY REPORT 2023; 11:321-330. [PMID: 38178964 PMCID: PMC10762305 DOI: 10.5114/hpr/168790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/24/2023] [Accepted: 06/26/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The interplay between physical and psychological symptoms frequently affects the health-related quality of life of asthma patients. PARTICIPANTS AND PROCEDURE This research aimed at assessing the psychological status of 60 patients attending their first/second doctor visit at which they were diagnosed with allergic asthma. Information on psychological distress was collected through the Symptom Questionnaire (SQ), personality traits were described through Cattell's 16-Personality Factor Questionnaire (16-PF), stress-related behavior was detected through the P Stress Questionnaire (PSQ), and the perceived quality of life was described with the Rhinasthma questionnaire. RESULTS The SQ revealed anxiety levels above the clinical cut-off in 71.7% of patients, levels of depression in 46.7%, anger-hostility in 53.3%, and somatic symptoms in 65%. No significant differences were observed after three months. The 16-PF scores were also suggestive of specific personality traits associated with the predisposition towards psychosomatic disorders. However, no stress-related behaviors were observed with the PSQ. Rhinasthma highlighted a certain degree of the perceived quality of life. Additionally, the quality of life correlated with age, all psychological distress scales, a few personality traits, vigor, and stress disorders. CONCLUSIONS Allergic asthma patients present a higher-than-average level of psychological distress and impaired perceived quality of life at the time of diagnosis. Therefore, it is important to assess the psychological status in addition to the respiratory function.
Collapse
|
2
|
Huang HC, Li WC, Tadrous M, Schumock GT, Touchette D, Awadalla S, Lee TA. Evaluating the use of methods to mitigate bias from non-transient medications in the case-crossover design: A systematic review. Pharmacoepidemiol Drug Saf 2023; 32:939-950. [PMID: 37283212 DOI: 10.1002/pds.5649] [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: 12/09/2022] [Revised: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The case-crossover design is a self-controlled study design used to compare exposure immediately preceding an event occurrence with exposure in earlier control periods. The design is most suitable for transient exposures in order to avoid biases that can be problematic when using the case-crossover design for non-transient (i.e., chronic) exposures. Our goal was to conduct a systematic review of case-crossover studies and its variants (case-time-control and case-case-time-control) in order to compare design and analysis choices by medication type. METHODS We conducted a systematic search to identify recent case-crossover, case-time-control, and case-case-time-control studies focused on medication exposures. Articles indexed in MEDLINE and EMBASE using these study designs that were published between January 2015 and December 2021 in the English language were identified. Reviews, methodological studies, commentaries, articles without medications as the exposure of interest, and articles with no available full text were excluded. Study characteristics including study design, outcome, risk window, control window, reporting of discordant pairs, and inclusion of sensitivity analyses were summarized overall and by medication type. We further evaluated the implementation of recommended methods to account for biases introduced by non-transient exposures among articles that used the case-crossover design on a non-transient exposure. RESULTS Of the 2036 articles initially identified, 114 articles were included. The case-crossover was the most common study design (88%), followed by the case-time-control (17%), and case-case-time-control (3%). Fifty-three percent of the articles included only transient medications, 35% included only non-transient medications, and 12% included both. Across years, the proportion of case-crossover articles evaluating a non-transient medication ranged from 30% in 2018 to 69% in 2017. We found that 41% of the articles that evaluated a non-transient medication did not apply any of the recommended methods to account for biases and more than half of which were conducted by authors with no previous publication history of case-crossover studies. CONCLUSION Using the case-crossover design to evaluate a non-transient medication remains common in pharmacoepidemiology. Researchers should apply appropriate design and analysis choices when opting to use a case-crossover design with non-transient medication exposures.
Collapse
Affiliation(s)
- Hsiao-Ching Huang
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Wen-Chin Li
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Daniel Touchette
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Saria Awadalla
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| |
Collapse
|
3
|
Exhaled Metabolite Patterns to Identify Recent Asthma Exacerbations. Metabolites 2021; 11:metabo11120872. [PMID: 34940630 PMCID: PMC8708458 DOI: 10.3390/metabo11120872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
Asthma is a chronic respiratory disease that can lead to exacerbations, defined as acute episodes of worsening respiratory symptoms and lung function. Predicting the occurrence of these exacerbations is an important goal in asthma management. The measurement of exhaled breath by electronic nose (eNose) may allow for the monitoring of clinically unstable asthma and exacerbations. However, data on its ability to perform this is lacking. We aimed to evaluate whether eNose could identify patients that recently had asthma exacerbations. We performed a cross-sectional study, measuring exhaled breath using the SpiroNose in adults with a physician-reported diagnosis of asthma. Patients were randomly divided into a training (n = 252) and validation (n = 109) set. For the analysis of eNose signals, principal component (PC) and linear discriminant analysis (LDA) were performed. LDA, based on PC1-4, reliably discriminated between patients who had a recent exacerbation from those who had not (training receiver operating characteristic (ROC)–area under the curve (AUC) = 0.76,95% CI 0.69–0.82), (validation AUC = 0.76, 95% CI 0.64–0.87). Our study showed that, exhaled breath analysis using eNose could accurately identify asthma patients who recently had an exacerbation, and could indicate that asthma exacerbations have a specific exhaled breath pattern detectable by eNose.
Collapse
|
4
|
Almonacid C, Melero C, López Viña A, Cisneros C, Pérez de Llano L, Plaza V, García-Rivero JL, Romero Falcón A, Ramos J, Bazús González T, Andrés Prado M, Muriel A. Effectiveness of Text Message Reminders on Adherence to Inhaled Therapy in Patients With Asthma: Prospective Multicenter Randomized Clinical Trial. JMIR Form Res 2021; 5:e12218. [PMID: 33560235 PMCID: PMC7902182 DOI: 10.2196/12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 07/20/2019] [Accepted: 10/28/2020] [Indexed: 01/15/2023] Open
Abstract
Background Poor adherence to inhaled medication in asthma patients is of great concern. It is one of the main reasons for inadequate asthma control. Objective The goal of the research was to determine if motivational messages using short message service (SMS, or text) improved adherence to inhaled medication in patients with asthma. Methods A prospective multicenter randomized parallel-group clinical trial was conducted in 10 asthma clinics in Spain. Adherence was assessed with electronic monitors (Smartinhaler, Adherium Ltd) connected to inhalers. Patients in the SMS group received psychologist-developed motivational messages every 3 days for 6 months. Results There were 53 patients in the SMS group and 88 patients in the control group. After 6 months, mean electronic adherence was 70% (SD 17%) in the intervention group and 69% (SD 17%) in the control group (P=.82). Significant differences between the study groups in morning and evening adherence to inhaled therapy, asthma control, exhaled nitric oxide levels, or improvement of lung functions were not observed. Conclusions Motivational messages were not useful to improve adherence to inhaled asthma medication compared with usual care.
Collapse
Affiliation(s)
- Carlos Almonacid
- Department of Respiratory Medicine, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcala de Henares, Madrid, Spain
| | - Carlos Melero
- Department of Respiratory Medicine, Hospital Universitario 12 de Octubre, Institute for Health Research (i+12), Complutense University of Madrid, Madrid, Spain
| | - Antolín López Viña
- Department of Respiratory Medicine, Hospital Universitario Puerta de Hierro, Autonoma University of Madrid, Majadahonda, Spain
| | - Carolina Cisneros
- Department of Respiratory Medicine, Hospital Universitario La Princesa, Autónoma University of Madrid, Madrid, Spain
| | - Luis Pérez de Llano
- Department of Respiratory Medicine, Hospital Universitario Lucus Augusti, University of Lugo, Lugo, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Autònoma University of Barcelona, Barcelona, Spain
| | | | - Auxiliadora Romero Falcón
- Department of Respiratory Medicine, Hospital Universitario Reina Sofia, University of Cordoba, Córdoba, Spain
| | - Jacinto Ramos
- Department of Respiratory Medicine, Hospital Universitario de Salamanca, University of Salamanca, Salamanca, Spain
| | - Teresa Bazús González
- Department of Respiratory Medicine, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - María Andrés Prado
- Department of Health Information Management, Fundación Jimenez Diaz, Madrid, Spain
| | - Alfonso Muriel
- Unit of Clinical Biostatistics, Instituto Ramón y Cajal de Investigación Sanitaria, Consorcio Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, University of Alcala de Henares, Madrid, Spain
| |
Collapse
|
5
|
Comparison of Conventional Statistical Methods with Machine Learning in Medicine: Diagnosis, Drug Development, and Treatment. ACTA ACUST UNITED AC 2020; 56:medicina56090455. [PMID: 32911665 PMCID: PMC7560135 DOI: 10.3390/medicina56090455] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 01/22/2023]
Abstract
Futurists have anticipated that novel autonomous technologies, embedded with machine learning (ML), will substantially influence healthcare. ML is focused on making predictions as accurate as possible, while traditional statistical models are aimed at inferring relationships between variables. The benefits of ML comprise flexibility and scalability compared with conventional statistical approaches, which makes it deployable for several tasks, such as diagnosis and classification, and survival predictions. However, much of ML-based analysis remains scattered, lacking a cohesive structure. There is a need to evaluate and compare the performance of well-developed conventional statistical methods and ML on patient outcomes, such as survival, response to treatment, and patient-reported outcomes (PROs). In this article, we compare the usefulness and limitations of traditional statistical methods and ML, when applied to the medical field. Traditional statistical methods seem to be more useful when the number of cases largely exceeds the number of variables under study and a priori knowledge on the topic under study is substantial such as in public health. ML could be more suited in highly innovative fields with a huge bulk of data, such as omics, radiodiagnostics, drug development, and personalized treatment. Integration of the two approaches should be preferred over a unidirectional choice of either approach.
Collapse
|
6
|
Faverio P, Compagnoni MM, Della Zoppa M, Pesci A, Cantarutti A, Merlino L, Luppi F, Corrao G. Rehospitalization for pneumonia after first pneumonia admission: Incidence and predictors in a population-based cohort study. PLoS One 2020; 15:e0235468. [PMID: 32603334 PMCID: PMC7326167 DOI: 10.1371/journal.pone.0235468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background and objectives Hospital readmissions are a frequent complication of pneumonia. Most data regarding readmissions are obtained from the United States, whereas few data are available from the European healthcare utilization (HCU) systems. In a large cohort of Italian patients with a previous hospitalization for pneumonia, our aim was to evaluate the incidence and predictors of early readmissions due to pneumonia. Methods This is a observational retrospective, population based, cohort study. Data were retrieved from the HCU databases of the Italian Lombardy region. 203,768 patients were hospitalized for pneumonia between 2003 and 2012. The outcome was the first rehospitalization for pneumonia. The patients were followed up after the index hospital admission to estimate the hazard ratio, and relative 95% confidence interval, of the outcome associated with the risk factors that we had identified. Results 7,275 patients (3.6%) had an early pneumonia readmission. Male gender, age ≥70 years, length of stay of the first admission and a higher burden of comorbidities were significantly associated with the outcome. Chronic use of antidepressants, antiarrhythmics, glucocorticoids and drugs for obstructive airway diseases were also more frequently prescribed in patients requiring rehospitalization. Previous use of inhaled broncodilators, including both beta2-agonists and anticholinergics, but not inhaled steroids, were associated with an increased risk of hospital readmission. Conclusions Frail elderly patients with multiple comorbidities and complex drug regimens were at higher risk of early rehospitalization and, thus, may require closer follow-up and prevention strategies.
Collapse
Affiliation(s)
- Paola Faverio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
- * E-mail:
| | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Matteo Della Zoppa
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Alberto Pesci
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Anna Cantarutti
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Fabrizio Luppi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
7
|
Bleecker ER, Menzies-Gow AN, Price DB, Bourdin A, Sweet S, Martin AL, Alacqua M, Tran TN. Systematic Literature Review of Systemic Corticosteroid Use for Asthma Management. Am J Respir Crit Care Med 2020; 201:276-293. [PMID: 31525297 PMCID: PMC6999108 DOI: 10.1164/rccm.201904-0903so] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Systemic corticosteroid use to manage uncontrolled asthma and its associated healthcare burden may account for important health-related adverse effects. We conducted a systematic literature review to investigate the real-world extent and burden of systemic corticosteroid use in asthma. We searched MEDLINE and Embase databases to identify English-language articles published in 2010–2017, using search terms for asthma with keywords for oral corticosteroids and systemic corticosteroids. Observational studies, prescription database analyses, economic analyses, and surveys on oral/systemic corticosteroid use in children (>5 yr old), adolescents (12–17 yr old), and adults with asthma were included. We identified and reviewed 387 full-text articles, and our review included data from 139 studies. The included studies were conducted in Europe, North America, and Asia. Overall, oral/systemic corticosteroids were commonly used for asthma management and were more frequently used in patients with severe asthma than in those with milder disease. Long-term oral/systemic corticosteroid use was, in general, less frequent than short-term use. Compared with no use, long-term and repeated short-term oral/systemic corticosteroid use were associated with an increased risk of acute and chronic adverse events, even when doses were comparatively low. Greater oral/systemic corticosteroid exposure was also associated with increased costs and healthcare resource use. This review provides a comprehensive overview of oral/systemic corticosteroid use and associated adverse events for patients with all degrees of asthma severity and exposure duration. We report that oral/systemic corticosteroid use is prevalent in asthma management, and the risks of acute and chronic complications increase with the cumulative oral corticosteroid dosage.
Collapse
Affiliation(s)
- Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, Arizona
| | | | - David B Price
- Department of Primary Care Respiratory Medicine, University of Aberdeen, Aberdeen, United Kingdom.,Observational and Pragmatic Research Institute, Singapore
| | - Arnaud Bourdin
- Department of Respiratory Diseases, University of Montpellier, Montpellier, France
| | - Stephen Sweet
- Research Evaluation Unit, Oxford PharmaGenesis Ltd., Oxford, United Kingdom
| | | | | | | |
Collapse
|
8
|
Chongmelaxme B, Chaiyakunapruk N, Dilokthornsakul P. Association between adherence and severe asthma exacerbation: A systematic review and meta-analysis. J Am Pharm Assoc (2003) 2020; 60:669-685.e2. [PMID: 32192946 DOI: 10.1016/j.japh.2020.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/17/2019] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the association between adherence levels and severe asthma exacerbation. DESIGN A systematic search was performed from inception to November 2018 on the following databases: PubMed, CENTRAL, EMBASE, and ClinicalTrials.gov. SETTING AND PARTICIPANTS Randomized-controlled trials (RCTs) and cohort and case-control studies that investigated the impact of adherence to controller medications on severe asthma exacerbation were included in the analysis. Data extraction was undertaken by 2 reviewers, and all studies were assessed for their qualities using the Cochrane risk of bias tool for RCT and the Newcastle-Ottawa scale for cohort and case-control studies. Random-effects model meta-analyses were performed. OUTCOME MEASURES Severe asthma exacerbation. RESULTS From 8061 articles, 8 studies were included in quantitative synthesis. The meta-analyses revealed that the odds of exacerbation among the patients with 80% or more adherence were lowered by 47% (odds ratio 0.53 [95% CI 0.42-0.66], P < 0.001) compared with less than 80%. When compared with less than 20% adherence, a 33% reduction in the odds (0.67 [0.53-0.86], P = 0.001) was associated with the patients achieving 50% or more, whereas a decrease in exacerbation was not associated with 20% to 49% adherence (0.94 [0.85-1.04], P = 0.22). In addition, a 2.4-fold increase in the odds (2.4 [2.1-2.7], P < 0.001) was associated with discontinuation of therapy. CONCLUSION The highest reduction in the odds of exacerbation was associated with patients achieving 80% or more adherence, and the odds also reduced among those with 50% or more adherence, whereas a substantial increase in exacerbation was associated with discontinuation of therapy.
Collapse
|
9
|
Gilbert I, Wada K, Burudpakdee C, Ghai C, Tan L. The Impact of a Forced Non-Medical Switch of Inhaled Respiratory Medication Among Patients with Asthma or Chronic Obstructive Pulmonary Disease: A Patient Survey on Experience with Switch, Therapy Satisfaction, and Disease Control. Patient Prefer Adherence 2020; 14:1463-1475. [PMID: 32903885 PMCID: PMC7445512 DOI: 10.2147/ppa.s242215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/26/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Budesonide/formoterol pressurized metered-dose inhaler (pMDI) was removed from a Medicare Part D formulary, and patients switched to fluticasone-based dry powder inhaler (DPI) therapies. This study describes the experience, satisfaction, and disease control among patients with asthma or chronic obstructive pulmonary disease (COPD) who switched due to removal from the formulary. PATIENTS AND METHODS A patient survey was conducted among adults with asthma or COPD who used budesonide/formoterol pMDI for ≥3 months prior to the formulary block and the new medication for ≥3 weeks after switching, recruited by providers in a research panel. Survey comprised both validated instruments (PASAPQ, OEQ, ACQ-6, and CAT) and stand-alone questions. Patient characteristics, switch experience, device and treatment satisfaction, onset of effect, and disease control were compared between disease (asthma and COPD) and medication (once and twice daily) cohorts. Minimal significance for group differences: P≤0.05. RESULTS Among 100 patients, 93% received communication from their doctor or nurse about the switch and 73% received training on using the new inhaler. Patients used their new treatment for an average of 7 months prior to completing the survey. Patient satisfaction with the new therapy was high (PASAPQ; mean overall satisfaction: 6.2 for asthma; 6.0 for COPD; P=0.338). However, asthma was not well controlled (ACQ-6) in 62% of patients with asthma, and 56% of patients with COPD reported high/very high impact of their illness on their lives (CAT). Sixty-eight percent and 70% of patients with asthma and COPD, respectively, required reliever medication (≥3 puffs) most days during the week prior to the survey. There were no significant differences in disease control (ACQ-6, CAT) between once-daily and twice-daily treatments (P>0.05 for both asthma and COPD). CONCLUSION Even when reporting satisfaction with their new medication, objective measures showed substantial morbidity, regardless of DPI device or dosing regimen.
Collapse
Affiliation(s)
- Ileen Gilbert
- AstraZeneca, Wilmington, DE, USA
- Correspondence: Ileen Gilbert Email
| | | | | | | | - Laren Tan
- Loma Linda University Health, Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda, CA, USA
| |
Collapse
|
10
|
Yuan Y, Li B, Huang M, Peng X, Zhao W, Ye Y, Zhang P, Yu C, Dong H, Cai S, Zhao H. Fractional exhaled nitric oxide was not associated with the future risk of exacerbations in Chinese asthmatics: a non-interventional 1-year real-world study. J Thorac Dis 2019; 11:2438-2447. [PMID: 31372281 DOI: 10.21037/jtd.2019.05.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Exacerbations are recognized as the most relevant predictor of future risk in asthmatics. We aimed to evaluate the association between asthma exacerbations, fractional exhaled nitric oxide (FENO), spirometry indices, and other potential risk factors in a non-interventional, real-world study performed in Guangzhou, China. Methods We performed a prospective 12 months follow-up of Chinese asthmatics. Spirometry and FENO measurements were performed at baseline. Adherence to inhaled corticosteroids (ICS) use was divided into two categories (>80% and <80%). Patients were seen 4 times after the initial baseline visit. Results A total of 222 patients with asthma (49.1% males) completed the study, of which 51 (23.0%) experienced exacerbations during the study period. Of the patients, 117 (52.7%) had good compliance. We compared lung function indices between the patients with and without exacerbations. There was no difference of forced expiratory volume in 1 s (FEV1) predicted, forced vital capacity (FVC) predicted, and FEVI/FVC (all, P>0.05) between the groups. There was also no significant difference in FENO level between the two groups. Compared to those that had exacerbations, patients without exacerbations had better treatment compliance (P<0.001). Logistic regression analysis identified an association between asthma exacerbations, poor control of symptom [odds ratio (OR) =2.295; 95% confidence interval (CI): 1.130-4.663; P=0.022], and nonadherence to asthma medications (OR =4.718; 95% CI: 2.149-10.359; P<0.001). Conclusions Poor adherence rather than baseline FENO and FEV1% predicted was associated with the future risk of exacerbations in Chinese asthmatics in real world.
Collapse
Affiliation(s)
- Yafei Yuan
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Bohou Li
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Minyu Huang
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Xianru Peng
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Wenqu Zhao
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Yanmei Ye
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Peifang Zhang
- Department of Respiratory Medicine, The First People's Hospital of Foshan, Foshan 528314, China
| | - Changhui Yu
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Hangming Dong
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Shaoxi Cai
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Haijin Zhao
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| |
Collapse
|
11
|
The Role of European Healthcare Databases for Post-Marketing Drug Effectiveness, Safety and Value Evaluation: Where Does Italy Stand? Drug Saf 2018; 42:347-363. [DOI: 10.1007/s40264-018-0732-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
12
|
Corrao G, Cantarutti A. Building reliable evidence from real-world data: Needs, methods, cautiousness and recommendations. Pulm Pharmacol Ther 2018; 53:61-67. [PMID: 30253238 DOI: 10.1016/j.pupt.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/10/2018] [Accepted: 09/22/2018] [Indexed: 10/28/2022]
Abstract
National healthcare systems of advanced countries, including Italy, widely agree on the approach whereby public healthcare decisions should be driven by available evidence on effectiveness and safety of therapeutics. It is equally accepted that randomized controlled clinical trials (RCTs), although universally recognised as the most robust "evidence generators", are insufficient for guiding the decision-making process since they are intrinsically unsuited to capture the impact of treatments in routine clinical practice. The complexity of treatments, as well as the demographic and clinical heterogeneity of patients receiving the treatments, and the long period of many treatments, explain the gap between the evidence generated in the controlled, but artificial, setting of RCTs and their current impact in the real world. The so-called pragmatic RCTs, despite guaranteeing greater flexibility compared to conventional trials, are not always able to reduce this gap. This explains the growing interest in the development of methods able to produce evidence on the real-world impact of care pathways (i.e., real-world evidence). Among them, those based on the Electronic Healthcare Records (EHRs), as the databases on the healthcare services of the National Health System provided to beneficiaries, known as Healthcare Utilization Databases (HCU), are becoming established and receiving increasing attention from the scientific community and healthcare decision-makers. We described the research areas in which HCU databases may be particularly useful, jointly with strength, weakness and potential of this approach. It is concluded that HCU data cannot substitute RCTs but they can usefully complement RCT data for adequately supporting healthcare decision-makers.
Collapse
Affiliation(s)
- Giovanni Corrao
- Center of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Italy
| | - Anna Cantarutti
- Center of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Italy.
| |
Collapse
|
13
|
Choi JY, Yoon HK, Lee JH, Yoo KH, Kim BY, Bae HW, Kim YK, Rhee CK. Nationwide use of inhaled corticosteroids by South Korean asthma patients: an examination of the Health Insurance Review and Service database. J Thorac Dis 2018; 10:5405-5413. [PMID: 30416788 PMCID: PMC6196168 DOI: 10.21037/jtd.2018.08.110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/17/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous studies have found that the prescription rates of inhaled corticosteroid (ICS) were considerably low although it is recommended as the optimal asthma treatment. The aim of this study was to analyze the current status of ICS prescription for asthma patients in the South Korea. METHODS We evaluated quality assessment data based on nationwide Health Insurance Review and Service (HIRA) database from July 2013 to June 2014. ICS prescription rates in asthma patients were analyzed by types and specialty of medical institutions. Also, we graded medical institutions by their ICS prescription rate. In addition, ICS prescription rates were calculated by patient gender, age, and insurance type. RESULTS This study included 831,613 patients and 16,804 institutions in the analysis. The overall mean ICS prescription rate was 22.58%. Tertiary hospitals had the highest mean prescription rate (84.16%) whereas primary healthcare clinics had the lowest (20.71%). By specialty, internal medicine physicians prescribed ICS more frequently compared to other specialists. Of all, 47.17% of medical institutions prescribed ICS to <10% of asthma patients, while less than 6% of institutions prescribed ICS to >80% of asthma patients. Also, we found that female and patients with age >90 or <20 years exhibited lower ICS prescription rate. CONCLUSIONS The ICS prescription rate was found to be inadequate, given the importance of ICS as an asthma treatment. The prescription rates were especially low in primary healthcare clinics, and by specialists in fields other than internal medicine.
Collapse
Affiliation(s)
- Joon Young Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Ha Lee
- Division of Pulmonology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Bo Yeon Kim
- Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Hye Won Bae
- Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Young Kyoon Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
14
|
Kerwin E, Wachtel A, Sher L, Nyberg J, Darken P, Siddiqui S, Duncan EA, Reisner C, Dorinsky P. Efficacy, safety, and dose response of glycopyrronium administered by metered dose inhaler using co-suspension delivery technology in subjects with intermittent or mild-to-moderate persistent asthma: A randomized controlled trial. Respir Med 2018; 139:39-47. [PMID: 29858000 DOI: 10.1016/j.rmed.2018.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/18/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This randomized, double-blind, placebo-controlled, cross-over, Phase II dose-ranging study investigated the efficacy and safety of GP MDI (glycopyrronium administered by metered dose inhaler formulated using co-suspension delivery technology) compared with an open-label active comparator, salmeterol dry powder inhaler (SAL DPI), in subjects with intermittent or mild-to-moderate persistent asthma. METHODS Subjects were randomized to receive five of seven treatments (GP MDI 28.8, 14.4, 7.2, 3.6, and 1.9 μg, placebo MDI, and SAL DPI 50 μg), each for a 14-day period. The primary endpoint was peak change from baseline in forced expiratory volume in 1 s (FEV1) on Day 15. Secondary endpoints included additional lung function parameters and symptoms (Asthma Control Questionnaire-5). Safety was monitored throughout. RESULTS Of 248 subjects randomized, 211 completed the study. All doses of GP MDI resulted in significant improvements in the primary endpoint compared with placebo MDI in a dose-ordered fashion (range 85-155 mL, p < .0001), without appreciable differences between the two highest doses of GP MDI (28.8 and 14.4 μg) and SAL DPI 50 μg. Improvements in secondary lung function endpoints and symptoms were generally dose-ordered, with GP MDI 28.8 μg showing the greatest improvements. Similar results were observed when endpoints were analyzed based on subjects' background use of inhaled corticosteroids (yes/no). All GP MDI doses were well tolerated with no evidence of a dose-related effect on adverse events. CONCLUSIONS The results of this study suggest that GP MDI could offer an important treatment option for maintenance therapy of asthma, and warrants further investigation in Phase III clinical trials.
Collapse
Affiliation(s)
- Edward Kerwin
- Clinical Research Institute of Southern Oregon, Medford, OR, USA.
| | - Andrew Wachtel
- Southern California Institute for Respiratory Diseases, Los Angeles, CA, USA
| | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, CA, USA
| | - Jack Nyberg
- Pearl - a member of the AstraZeneca Group, Morristown, NJ, USA
| | - Patrick Darken
- Pearl - a member of the AstraZeneca Group, Morristown, NJ, USA
| | | | | | - Colin Reisner
- Pearl - a member of the AstraZeneca Group, Morristown, NJ, USA; AstraZeneca, Gaithersburg, MD, USA
| | - Paul Dorinsky
- Pearl - a member of the AstraZeneca Group, Durham, NC, USA
| |
Collapse
|
15
|
McQuaid EL. Barriers to medication adherence in asthma: The importance of culture and context. Ann Allergy Asthma Immunol 2018; 121:37-42. [PMID: 29580846 DOI: 10.1016/j.anai.2018.03.024] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Significant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention. DATA SOURCES Data were gathered from numerous sources, including reports of pharmacy and medical records, observational studies, and trials. STUDY SELECTIONS Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity. RESULTS There is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of complementary and alternative medicine use, difficulties communicating with patients and caregivers with limited English proficiency, and implicit biases regarding cultural differences. Systems issues (eg, insurance status, cost) and social context factors (eg, exposure to violence) also present challenges. Culturally informed strategies that capitalize on patient strengths and training providers in culturally informed communication strategies hold promise as intervention approaches. CONCLUSION Disparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden.
Collapse
Affiliation(s)
- Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island; Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island.
| |
Collapse
|
16
|
Lim TK, Ko FWS, Benton MJ, Berge MVD, Mak J. Year in review 2016: Chronic obstructive pulmonary disease and asthma. Respirology 2017; 22:820-828. [PMID: 28371172 DOI: 10.1111/resp.13037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Tow Keang Lim
- Department of Medicine, National University Hospital, Singapore
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Melissa J Benton
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado, Colorado Springs, Colorado, USA
| | - Maarten Van den Berge
- Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith Mak
- Department of Medicine, Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong.,Department of Pharmacology and Pharmacy, Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong
| |
Collapse
|
17
|
Feng JX, Lin Y, Lin J, He SS, Chen MF, Wu XM, Xu YZ. Relationship between Fractional Exhaled Nitric Oxide Level and Efficacy of Inhaled Corticosteroid in Asthma-COPD Overlap Syndrome Patients with Different Disease Severity. J Korean Med Sci 2017; 32:439-447. [PMID: 28145647 PMCID: PMC5290103 DOI: 10.3346/jkms.2017.32.3.439] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/30/2016] [Indexed: 12/23/2022] Open
Abstract
This study explored the relationship between the fractional exhaled nitric oxide (FeNO) level and the efficacy of inhaled corticosteroid (ICS) in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) patients with different disease severity. A total of 127 ACOS patients with ACOS (case group) and 131 healthy people (control group) were enrolled in this study. Based on the severity of COPD, the ACOS patients were divided into: mild ACOS; moderate ACOS; severe ACOS; and extremely severe ACOS groups. We compared FeNO levels, pulmonary function parameters including percentage of forced expiratory volume in 1 second (FEV1) to predicted value (FEV1%pred), ratio of FEV1 to forced vital capacity (FEV1/FVC), inspiratory capacity to total lung capacity (IC/TLC) and residual volume to total lung capacity (RV/TLC), arterial blood gas parameters, including PH, arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂), total serum immunoglobulin E (IgE), induced sputum eosinophil (EOS), plasma surfactant protein A (SP-A), plasma soluble receptor for advanced glycation end products (sRAGE), sputum myeloperoxidase (MPO), sputum neutrophil gelatinase-associated lipocalin (NGAL) and Asthma Control Test (ACT) scores, and COPD Assessment Test (CAT) scores. Compared with pre-treatment parameters, the FeNO levels, RV/TLC, PaCO₂, total serum IgE, induced sputum EOS, plasma SP-A, sputum MPO, sputum NGAL, and CAT scores were significantly decreased after 6 months of ICS treatment, while FEV1%pred, FEV1/FVC, IC/TLC, PH, PaO2, plasma sRAGE, and ACT scores were significantly increased in ACOS patients with different disease severity after 6 months of ICS treatment. This finding suggests that the FeNO level may accurately predict the efficacy of ICS in the treatment of ACOS patients.
Collapse
Affiliation(s)
- Jia Xi Feng
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Yun Lin
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Jian Lin
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Su Su He
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Mei Fang Chen
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Xiao Mai Wu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - You Zu Xu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Linhai, China.
| |
Collapse
|