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Savran O, Suppli Ulrik C. Inhaled Corticosteroid Exposure and Risk of Cataract in Patients with Asthma and COPD: A Systematic Review and Meta-Analysis. J Ophthalmol 2023; 2023:8209978. [PMID: 37899845 PMCID: PMC10602708 DOI: 10.1155/2023/8209978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 08/28/2023] [Accepted: 10/14/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose Both systemic and inhaled corticosteroids may increase the risk of cataract in patients with both chronic obstructive pulmonary disease (COPD) and asthma. Our aim was to assess the degree of association between cataract and corticosteroid exposure in patients with asthma and COPD. Methods A systematic literature review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The odds ratio estimates were extracted from each article. A random effects model was applied for estimate pooling in separate meta-analyses according to study design. Meta-regression was performed to assess the dose-response relationship between corticosteroid exposure and the risk of cataract development. Results A total of 19 studies met the criteria for inclusion in this review, of which 12 studies provided effect estimates for pooled analyses. All but one of the included observational studies reported a significant association between use of corticosteroids and cataract development in cohorts of asthma and/or COPD patients. Pooled analyses revealed on average a doubled risk of cataract in corticosteroid-exposed asthma and COPD patients. Studies have shown that daily high-dose inhaled corticosteroid (ICS) ≥ 1000 μg is associated with a significant risk of developing cataract and by that predispose to subsequent cataract surgery, although one study showed that systemic corticosteroids increase cataract risk more than ICS. Conclusion ICS treatment in asthma and COPD patients is a risk factor for cataract development. Our results emphasize a previously underestimated potential long-term risk of treatment with ICS and underline the importance of targeting ICS treatment, and not least dosing, to improve the risk-benefit ratio of maintenance treatment in both asthma and COPD.
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Affiliation(s)
- Osman Savran
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Jordan A, Sivapalan P, Rømer V, Jensen JU. Time-Updated Phenotypic Guidance of Corticosteroids and Antibiotics in COPD: Rationale, Perspective and a Proposed Method. Biomedicines 2023; 11:biomedicines11051395. [PMID: 37239067 DOI: 10.3390/biomedicines11051395] [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: 04/01/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with distinct phenotypes, each having distinct treatment needs. Eosinophilic airway inflammation is present in a subset of COPD patients in whom it can act as a driver of exacerbations. Blood eosinophil counts are a reliable way to identify patients with an eosinophilic phenotype, and these measurements have proven to be successful in guiding the use of corticosteroids in moderate and severe COPD exacerbations. Antibiotic use in COPD patients induces a risk of Clostridium difficile infection, diarrhea, and antibiotic resistance. Procalcitonin could possibly guide antibiotic treatment in patients admitted with AECOPD. Current studies in COPD patients were successful in reducing exposure to antibiotics with no changes in mortality or length of stay. Daily monitoring of blood eosinophils is a safe and effective way to reduce oral corticosteroid exposure and side effects for acute exacerbations. No evidence on time-updated treatment guidance for stable COPD exists yet, but a current trial is testing an eosinophil-guided approach on inhaled corticosteroid use. Procalcitonin-guided antibiotic treatment in AECOPD shows promising results in safely and substantially reducing antibiotic exposure both in time-independent and time-updated algorithms.
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Affiliation(s)
- Alexander Jordan
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark
| | - Valdemar Rømer
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Deva FAL. Comparison of Conventional Nasal Douching with Corticosteroid Nasal Douching in Chronic Rhinosinusitis Patients Post Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:875-880. [PMID: 37206786 PMCID: PMC10188850 DOI: 10.1007/s12070-022-03389-3] [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: 03/21/2022] [Accepted: 12/07/2022] [Indexed: 01/17/2023] Open
Abstract
Objectives Chronic rhinosinusitis has a preponderance for recurrence even after functional endoscopic sinus surgery. Nasal Douching with saline has been used for decades as a treatment and as an adjunct following surgery. Steroid nasal wash has been introduced recently for the postoperative management of patients with chronic rhinosinusitis. The objective of this study was to evaluate the efficacy of postoperative steroid irrigation in patients with chronic rhinosinusitis with and without polyps. Methods This prospective study was done over a period of 2 years involving 70 chronic rhinosinusitis patients with and without nasal polyps who underwent functional endoscopic sinus surgery. The patients were divided into two groups, in group A, patients were given saline nasal douching and in group B, the budesonide nasal douching. The 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy scores were checked before and 1, 2, 4, and 6 months after the nasal irrigation. Results In group A, the mean SNOT-22 score improved from 52.5 ± 9.1 before irrigation to 22.1 ± 11.3 after 6 months of irrigation. The LK endoscopy score also improved from 7.2 ± 2.1 before irrigation to 2.1 ± 1.2 after 6 months. In group B, the mean SNOT-22 score improved from 48.9 ± 10.6 before irrigation to 19.8 ± 11.7 after 6 months of irrigation. The endoscopy score also improved from 6.9 ± 2.3 before irrigation to 1.5 ± 1.1 after 6 months. The mean SNOT-22 and Lund-Kennedy scores improved in both groups. Group B with budesonide irrigation was found to have improved significantly than the saline nasal irrigation group, however, the difference between the 2 groups was not significant. Conclusion Nasal douching with budesonide is an effective postoperative treatment for chronic rhinosinusitis with polyps. The addition of budesonide in douching improves the quality of life and reduces the chance of recurrence.
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Jordan A, Sivapalan P, Eklöf J, Vestergaard JB, Meteran H, Saeed MI, Biering-Sørensen T, Løkke A, Seersholm N, Jensen JUS. The Association between Use of ICS and Psychiatric Symptoms in Patients with COPD-A Nationwide Cohort Study of 49,500 Patients. Biomedicines 2021; 9:biomedicines9101492. [PMID: 34680609 PMCID: PMC8533368 DOI: 10.3390/biomedicines9101492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Psychiatric side effects are well known from treatment with systemic corticosteroids. It is, however, unclear whether inhaled corticosteroids (ICS) have psychiatric side effects in patients with COPD. We conducted a nationwide cohort study in all Danish COPD outpatients who had respiratory medicine specialist-verified COPD, age ≥40 years, and no previous cancer. Prescription fillings of antidepressants and risk of admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder were assessed by Cox proportional hazards models. We observed a dose-dependent increase in the risk of antidepressant-use with ICS cumulated dose (HR 1.05, 95% CI 1.03–1.07, p = 0.0472 with low ICS exposure, HR 1.10, 95% CI 1.08–1.12, p < 0.0001 with medium exposure, HR 1.15, 95% CI 1.11–1.15, p < 0.0001 with high exposure) as compared to no ICS exposure. We found a discrete increased risk of admission to psychiatric hospitals in the medium and high dose group (HR 1.00, 95% CI 0.98–1.03, p = 0.77 with low ICS exposure, HR 1.07, 95% CI 1.05–1.10, p < 0.0001 with medium exposure, HR 1.13, 95% CI 1.10–1.15, p < 0.0001 with high exposure). The association persisted when stratifying for prior antidepressant use. Thus, exposure to ICS was associated with a small to moderate increase in antidepressant-use and psychiatric admissions.
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Affiliation(s)
- Alexander Jordan
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
- Correspondence:
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Josefin Eklöf
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Jakob B. Vestergaard
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Howraman Meteran
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Mohamad Isam Saeed
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Tor Biering-Sørensen
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Anders Løkke
- Department of Medicine, Hospital Lillebælt, 7100 Vejle, Denmark;
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Niels Seersholm
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Jens Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Treatment Response Biomarkers in Asthma and COPD. Diagnostics (Basel) 2021; 11:diagnostics11091668. [PMID: 34574009 PMCID: PMC8464838 DOI: 10.3390/diagnostics11091668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and asthma are two of the most common chronic diseases worldwide. Both diseases are heterogenous and complex, and despite their similarities, they differ in terms of pathophysiological and immunological mechanisms. Mounting evidence supports the presence of several phenotypes with various responses to treatment. A systematic and thorough assessment concerning the diagnosis of both asthma and COPD is crucial to the clinical management of the disease. The identification of different biomarkers can facilitate targeted treatment and monitoring. Thanks to the presence of numerous immunological studies, our understanding of asthma phenotypes and mechanisms of disease has increased markedly in the last decade, and several treatments with monoclonal antibodies are available. There are compelling data that link eosinophilia with an increased risk of COPD exacerbations but a greater treatment response and lower all-cause mortality. Eosinophilia can be considered as a treatable trait, and the initiation of inhaled corticosteroid in COPD patients with eosinophilia is supported in many studies. In spite of advances in our understanding of both asthma and COPD in terms pathophysiology, disease mechanisms, biomarkers, and response to treatment, many uncertainties in the management of obstructive airways exist.
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Suissa S. Ten Commandments for Randomized Trials of Pharmacological Therapy for COPD and Other Lung Diseases. COPD 2021; 18:485-492. [PMID: 34468248 DOI: 10.1080/15412555.2021.1968816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The randomized controlled trial is the quintessential scientific tool to evaluate the effectiveness and safety of medications. While early trials of drugs used for the treatment of chronic obstructive pulmonary disease (COPD) and other respiratory diseases were generally unambiguous, more recent studies have been controversial. It has become evident that the conduct, design and analysis of these trials were highly variable and may have been responsible for incoherencies in results and interpretation. With the advent of new studies, the need for guiding principles for the conduct of future randomized trials has become manifest. We describe the concept of the counterfactual principle as it applies to the treatment of patients and to the randomized trial. We then present ten methodological tenets for the design and statistical aspects of randomized controlled trials evaluating the effectiveness of drugs used in the treatment of several respiratory diseases. They include eight study design and two statistical analysis principles: 1) Study question; 2) Intervention; 3) Study population; 4) Blinding; 5) Run-in period; 6) Follow-up; 7) Outcome; 8) Safety; 9) Intent-to-treat; 10) Covariate adjustment. These tenets are described using mainly examples from trials of pharmacological treatments for COPD, as well as some from asthma and idiopathic pulmonary fibrosis, conducted over the last 30 years. The careful application of these principles in the conduct of randomized trials will provide rigorous studies and improve the validity of results. The ensuing clearer interpretation of findings will permit their well-founded contribution to treatment guidelines and optimal clinical management.
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Affiliation(s)
- Samy Suissa
- Centre for Clinical Epidemiology, Jewish General Hospital, and the Departments of Epidemiology and Biostatistics and of Medicine, McGill University, Montreal, Canada
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Oustoglou E, Tzamalis A, Mamais I, Dermenoudi M, Tsaousis KT, Ziakas N, Tsinopoulos I. Reoperations After Cataract Surgery: Is the Incidence Predictable Through a Risk Factor Stratification System? Cureus 2020; 12:e10693. [PMID: 33133858 PMCID: PMC7593208 DOI: 10.7759/cureus.10693] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction The objective of the study was to quantify the number of procedures needed to achieve the best possible surgical outcome, depending on the number and type of risk factors identified. Methods Two independent observers reviewed the medical records of 1,502 patients who underwent phacoemulsification surgery, during a two-year period (January 1, 2014 to December 31, 2015). Preoperative risk factors were documented according to the stratification system used. Based on the total risk score, each case was allocated to one of four risk groups with 0, 1-2, 3-5, and >6 total risk factors, respectively. All qualitative and quantitative characteristics were gathered and included in a multivariate analysis. Results A total of 1,792 eyes were included. Αge over 88 years, low cooperation ability with the patient, and surgeries performed by residents tended to have more often complications, while white/intumescent cataract, iridodonesis/phacodonesis, α1 blockers intake, and male gender are risk factors positively associated with more than one surgery. Conclusions Risk factors tend to be prognostic for possible intraoperative complications. The number of procedures needed for the best possible surgical outcome seems to depend on these preoperative risk factors. A stratification method increases the level of awareness of the surgeon, and therefore may decrease the number of complications and even procedures while enhancing the "safe" practice and skills of residents.
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Affiliation(s)
- Eirini Oustoglou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis Mamais
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece, Athens, GRC.,Department of Health and Life Sciences/Epidemiology, Biostatistics and Methodology Research, European University of Cyprus, Nicosia, CYP
| | - Maria Dermenoudi
- Department of Ophthalmology, Health Center of Neapolis, Thessaloniki, GRC
| | - Konstantinos T Tsaousis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaliniki, GRC
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
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Saeed MI, Eklöf J, Achir I, Sivapalan P, Meteran H, Løkke A, Biering-Sørensen T, Knop FK, Jensen JUS. Use of inhaled corticosteroids and the risk of developing type 2 diabetes in patients with chronic obstructive pulmonary disease. Diabetes Obes Metab 2020; 22:1348-1356. [PMID: 32239604 DOI: 10.1111/dom.14040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
Abstract
AIM To determine the risk of type 2 diabetes onset associated with accumulated inhaled corticosteroids (ICS) dose during the previous year in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS We conducted a nationwide observational cohort study based on data from patients with COPD between 1 January 2010 and 31 December 2017 extracted from Danish health databases. Patients were followed for 7 years, until death or a type 2 diabetes event. A propensity-matched Cox model and an adjusted Cox proportional hazards model (stratified on body mass index [BMI]) were used to estimate the hazard ratio (HR) for new-onset type 2 diabetes. RESULTS A total of 50 148 patients with COPD were included, 3566 (7.1%) of whom had a type 2 diabetes event. During the previous year before study entry, 35 368 patients (70.5%) used ICS. The propensity-matched Cox model (N = 33 466) showed an increased risk of type 2 diabetes, which progressed with increasing accumulated ICS dose (low-ICS: HR 1.076, confidence interval [CI] 1.075-1.077, P < .0001; medium-ICS: HR 1.106, CI 1.105-1.108, P < .0001; high-ICS: HR 1.150, CI 1.148-1.151, P < .0001), compared with no ICS use. Results were confirmed in the adjusted Cox analysis on the entire study population, but only for patients with BMI <30 kg/m2 . CONCLUSIONS In patients with COPD, ICS use was associated with a moderate dose-dependent increase in the occurrence of type 2 diabetes.
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Affiliation(s)
- Mohamad Isam Saeed
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Imane Achir
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Internal Medicine, Zealand Hospital, University of Copenhagen, Roskilde, Denmark
| | - Howraman Meteran
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anders Løkke
- Department of Medicine, Hospital Little Belt, Vejle, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Filip Krag Knop
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Ulrik Staehr Jensen
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- PERSIMUNE & CHIP: Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Ardura-Garcia C, Arias E, Hurtado P, Bonnett LJ, Sandoval C, Maldonado A, Workman LJ, Platts-Mills TAE, Cooper PJ, Blakey JD. Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study. Eur Respir J 2019; 54:1802419. [PMID: 31515399 PMCID: PMC6860994 DOI: 10.1183/13993003.02419-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/11/2019] [Indexed: 01/23/2023]
Abstract
Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC.We followed a cohort of 5-15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months' follow-up.We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79-0.96 per year), previous asthma diagnosis (2.2, 1.2-3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1-1.5), food triggers (2.0, 1.1-3.6) and eczema diagnosis (4.2, 1.02-17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50-0.95). Laboratory and lung function tests did not predict recurrence.Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused.
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Affiliation(s)
- Cristina Ardura-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Erick Arias
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Paola Hurtado
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Laura J Bonnett
- Dept of Biostatistics, University of Liverpool, Liverpool, UK
| | - Carlos Sandoval
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Augusto Maldonado
- Colegio de Ciencias de la Salud, Universidad San Francsico de Quito, Quito, Ecuador
| | - Lisa J Workman
- Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, VA, USA
| | | | - Philip J Cooper
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
- Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St George's University of London, London, UK
- Both authors contributed equally
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, Curtin University, Perth, Australia
- Both authors contributed equally
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Kerwin EM, Ferguson GT, Mo M, DeAngelis K, Dorinsky P. Bone and ocular safety of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler in COPD: a 52-week randomized study. Respir Res 2019; 20:167. [PMID: 31358008 PMCID: PMC6664772 DOI: 10.1186/s12931-019-1126-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022] Open
Abstract
Background Long-term use of inhaled corticosteroids (ICSs) has been associated with increased risk of bone and ocular comorbidities. We evaluated the effects of the triple fixed-dose combination budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler (BGF MDI), formulated using co-suspension delivery technology, on bone mineral density (BMD) and ocular safety in patients with moderate-to-very severe chronic obstructive pulmonary disease (COPD). Methods In this extension study, a subset of patients from the 24-week, phase III, randomized, double-blind KRONOS study (NCT02497001) continued treatment (BGF MDI 320/18/9.6 μg, budesonide/formoterol fumarate [BFF] MDI 320/9.6 μg or glycopyrrolate/formoterol fumarate [GFF] MDI 18/9.6 μg, as a non-steroidal comparator) for an additional 28 weeks. Primary endpoints were percentage change from baseline in lumbar spine BMD and change from baseline in lens opacities classification system III posterior subcapsular cataract (P) score, both at Week 52. Adverse events were also assessed. Results In total, 456 patients were included in the safety population (53.1% male, mean age 62.8 years). Changes from baseline in lumbar spine BMD (least squares mean [LSM] range − 0.12 to 0.38%) and P score (LSM range 0.02–0.15) were small for all treatments. Both BGF MDI and BFF MDI were non-inferior to GFF MDI using margins of −2% (BMD) and 0.5 units (P score). The incidence of treatment-emergent adverse events (TEAEs) was generally similar among groups. Rates of confirmed pneumonia were low overall (2.4%) and highest in the GFF MDI group (3.4%), followed by BGF MDI (2.1%) and BFF MDI (1.1%). There were no cumulative adverse effects of treatment over time as the incidence and types of TEAEs, were generally similar in the first 24 weeks of the study and after Week 24. Conclusions In patients with COPD, both ICS-containing therapies were non-inferior to GFF MDI for the primary BMD and ophthalmological endpoints. Changes from baseline in all three treatment groups over 52 weeks were small and not clinically meaningful. All treatments were well tolerated with no new or unexpected safety findings. Trial registration ClinicalTrials.gov NCT02536508. Registered 27 August 2015. Electronic supplementary material The online version of this article (10.1186/s12931-019-1126-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward M Kerwin
- Clinical Research Institute of Southern Oregon, 3860 Crater Lake Avenue, Medford, OR, 97504, USA.
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
| | - Mindy Mo
- Formerly of AstraZeneca, Morristown, NJ, USA
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11
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Harrison A, Borg B, Thompson B, Hew M, Dabscheck E. Inappropriate inhaled corticosteroid prescribing in chronic obstructive pulmonary disease patients. Intern Med J 2018; 47:1310-1313. [PMID: 29105270 DOI: 10.1111/imj.13611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 12/31/2022]
Abstract
The Australian National Chronic Obstructive Pulmonary Disease (COPD) guidelines recommend that inhaled corticosteroids (ICS) be reserved for patients with a post-bronchodilator forced expiratory volume in 1 s (FEV1 ) less than 50% predicted and those who experience ≥2 exacerbations in 12 months. In total, 707 COPD patients were identified from the lung function test database at our tertiary hospital; 52.4% of patients with a post-bronchodilator FEV1 ≥50% were prescribed an ICS. Significant discordance exists between guideline recommendations and inhaler prescription.
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Affiliation(s)
- Amelia Harrison
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Brigitte Borg
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Bruce Thompson
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Hew
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eli Dabscheck
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
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12
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Design of a Clinical Decision Support System for Fracture Prediction Using Imbalanced Dataset. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:9621640. [PMID: 29765586 PMCID: PMC5885339 DOI: 10.1155/2018/9621640] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/11/2018] [Accepted: 01/23/2018] [Indexed: 11/18/2022]
Abstract
More than 1 billion people suffer from chronic respiratory diseases worldwide, accounting for more than 4 million deaths annually. Inhaled corticosteroid is a popular medication for treating chronic respiratory diseases. Its side effects include decreased bone mineral density and osteoporosis. The aims of this study are to investigate the association of inhaled corticosteroids and fracture and to design a clinical support system for fracture prediction. The data of patients aged 20 years and older, who had visited healthcare centers and been prescribed with inhaled corticosteroids within 2002-2010, were retrieved from the National Health Insurance Research Database (NHIRD). After excluding patients diagnosed with hip fracture or vertebrate fractures before using inhaled corticosteroid, a total of 11645 patients receiving inhaled corticosteroid therapy were included for this study. Among them, 1134 (9.7%) were diagnosed with hip fracture or vertebrate fracture. The statistical results showed that demographic information, chronic respiratory diseases and comorbidities, and corticosteroid-related variables (cumulative dose, mean exposed daily dose, follow-up duration, and exposed duration) were significantly different between fracture and nonfracture patients. The clinical decision support systems (CDSSs) were designed with integrated genetic algorithm (GA) and support vector machine (SVM) by training and validating the models with balanced training sets obtained by random and cluster-based undersampling methods and testing with the imbalanced NHIRD dataset. Two different objective functions were adopted for obtaining optimal models with best predictive performance. The predictive performance of the CDSSs exhibits a sensitivity of 69.84-77.00% and an AUC of 0.7495-0.7590. It was concluded that long-term use of inhaled corticosteroids may induce osteoporosis and exhibit higher incidence of hip or vertebrate fractures. The accumulated dose of ICS and OCS therapies should be continuously monitored, especially for patients with older age and women after menopause, to prevent from exceeding the maximum dosage.
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13
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Heffler E, Madeira LNG, Ferrando M, Puggioni F, Racca F, Malvezzi L, Passalacqua G, Canonica GW. Inhaled Corticosteroids Safety and Adverse Effects in Patients with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:776-781. [DOI: 10.1016/j.jaip.2018.01.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 01/06/2023]
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14
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Baptist AP, Busse PJ. Asthma Over the Age of 65: All's Well That Ends Well. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:764-773. [PMID: 29747982 PMCID: PMC5951417 DOI: 10.1016/j.jaip.2018.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/29/2018] [Accepted: 02/03/2018] [Indexed: 12/11/2022]
Abstract
Asthma in older adults (often classified as those 65 years or older) is relatively common, underdiagnosed, and suboptimally treated. It is an important health problem, as the population of the United States continues to age. Unfortunately, asthma morbidity and mortality rates are highest in this age group. Alterations in the innate and adaptive immune responses occur with aging, and contribute to pathophysiologic differences and subsequent treatment challenges. The symptoms of asthma may differ from those in younger populations, and often include fatigue. There are unique factors that can complicate asthma management among older adults, including comorbidities, menopause, caregiver roles, and depression. Pharmacologic therapies are often not as effective as in younger populations, and may have greater side effects. Spirometry, peak flow measurements, and asthma education are typically underused, and may contribute to delays in diagnosis as well as worse outcomes. There are specific strategies that health care providers can take to improve the care of older adults with asthma.
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Affiliation(s)
- Alan P Baptist
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
| | - Paula J Busse
- Icahn School of Medicine at Mount Sinai, New York, NY
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15
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Xiong J, Liu S, Pan Y, Zhang B, Chen X, Fan L. Combination of fish oil and ethanol extracts from Spirulina platensis inhibits the airway inflammation induced by ovalbumin in mice. J Funct Foods 2018. [DOI: 10.1016/j.jff.2017.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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16
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A Randomized Controlled Trial to Determine the Effect of Inhaled Corticosteroid on Intraocular Pressure in Open-Angle Glaucoma and Ocular Hypertension: The ICOUGH Study. J Glaucoma 2017; 26:182-186. [PMID: 27096722 DOI: 10.1097/ijg.0000000000000429] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to determine the risk of a steroid pressure response from inhaled corticosteroids. PATIENTS AND METHODS This randomized, double-masked, placebo-controlled trial included 22 adults with well-controlled open-angle glaucoma or ocular hypertension. Consenting participants were randomized to a 6-week course of twice-daily fluticasone propionate 250-μg metered-dose inhaler or saline placebo metered-dose inhaler. Biweekly clinic visits included masked Goldmann applanation tonometry and assessment to identify adverse effects. Primary outcome was mean intraocular pressure (IOP) at week 6. Secondary outcomes included IOP elevation of >20% at 2 consecutive visits, adherence, side effects, and logMAR visual acuity. RESULTS A total of 10 patients in each arm completed the study. There were no statistically significant differences in IOP between groups at baseline (14.3±3.0 and 15.6±3.6 mm Hg in steroid and placebo groups, respectively, P=0.39) or at week 6 (14.7±2.4 and 14.8±3.8 mm Hg in steroid and placebo groups, respectively, P=0.92). Adherence was >80% for all participants. There were no statistically significant differences between groups in any secondary measures. One patient in the steroid group met the secondary end point of >20% elevation in IOP (IOP increased from baseline of 9 to 11 mm Hg at weeks 2 and 4). CONCLUSIONS We found no clinically significant increase in mean IOP in patients with well-controlled open-angle glaucoma and ocular hypertension after 6 weeks of twice-daily inhaled fluticasone propionate compared with inhaled placebo. No participants exceeded their individualized target IOP. There were no differences in secondary outcomes.
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17
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Antidepressants and risk of cataract development: A population-based, nested case-control study. J Affect Disord 2017; 215:237-244. [PMID: 28342338 DOI: 10.1016/j.jad.2017.03.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies demonstrated increased risk of cataract development among users of selective serotonin reuptake inhibitors (SSRIs). However, it remains unknown whether this risk also prevails with the use of other types of antidepressants. The aim of this study was to investigate whether use of antidepressants is associated with an increased risk of cataract development. Moreover, the relationship between binding affinities of serotonin transporter (SERT) of antidepressant and the risk of cataracts is examined. METHODS We conducted a nested case-control study using National Health Insurance Research Database in Taiwan. A total of 14,288 patients were included; 7651 in the cataract group and 6637 in the control group. Antidepressant exposure was categorized by type, duration of use, and binding affinities of SERT. The association between antidepressant exposure and cataract development was assessed using conditional logistic regression analysis. RESULTS The adjusted odds ratios (AORs) for developing cataracts among continuous users of SSRIs, serotonin norepinephrine reuptake inhibitors (SNRIs), and other antidepressants were 1.26 (95% confidence interval (CI): 1.12-1.41, p<0.001), 1.21 (95% CI: 1.02-1.43, p=0.027), and 1.18 (95% CI: 1.04-1.34, p=0.009) respectively. Specifically, continuous uses of fluoxetine (AOR: 1.21; 95% CI: 1.01-1.46, p=0.042), fluvoxamine (AOR: 1.47; 95% CI: 1.01-2.12, p=0.043), venlafaxine (AOR: 1.44; 95% CI: 1.19-1.74, p<0.001) significantly increased the risk of cataract development. Moreover, continuous users of antidepressants with intermediate SERT binding affinities (AOR: 1.68; 95% CI: 1.10-2.56, p=0.017) were significantly associated with increased risks of cataract development. LIMITATIONS Several confounding factors such as obesity, multiple drug users, family history of cataracts, substance use, and environmental factors (such as sunlight or radiation exposure) were acquired. CONCLUSIONS We found increased risk of cataract development in patients continuously using antidepressants. Regular ocular evaluations in these patients are warranted.
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18
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Wang DE, Lam DJ, Bellmunt AM, Rosenfeld RM, Ikeda AK, Shin JJ. Intranasal Steroid Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngol Head Neck Surg 2017; 157:289-296. [PMID: 28535109 DOI: 10.1177/0194599817703046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked. Study Design Cross-sectional analysis of an administrative database. Subjects and Methods National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005 to 2012; univariate, multivariate, and stratified analyses of intranasal steroid usage were performed. The primary outcome was intranasal steroid administration, and the primary predictor was a diagnosis of OME. The impact of location of service was also analyzed. Results Data representing 1,943,177,903 visits demonstrated that intranasal steroids were administered in 10.0% of visits in which OME was diagnosed, in comparison to 3.5% of visits in which OME was not diagnosed (univariate odds ratio, 3.07; 95% confidence interval [CI], 1.85-5.08; P < .001). After adjusting for age, sex, race/ethnicity, and other confounding conditions, multivariate analysis demonstrated that OME remained associated with an increase in intranasal steroid usage (odds ratio, 3.58; 95% CI, 1.60-8.01; P = .002). This practice pattern was more prevalent in the ambulatory office setting (risk difference 6.6%, P < .001) and less seen in a hospital-based office or emergency department. Conclusion Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist.
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Affiliation(s)
- David E Wang
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Derek J Lam
- 2 Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA
| | - Angela M Bellmunt
- 3 Department of Otolaryngology, Hospital Universitari de la Vall d'Hebron, Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Richard M Rosenfeld
- 4 Department of Otolaryngology, SUNY Downstate Medical Center, New York, New York, USA
| | - Allison K Ikeda
- 5 School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jennifer J Shin
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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19
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Qian CJ, Coulombe J, Suissa S, Ernst P. Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi-cohort study. Br J Clin Pharmacol 2017; 83:2077-2086. [PMID: 28425216 DOI: 10.1111/bcp.13295] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/01/2017] [Accepted: 03/14/2017] [Indexed: 12/13/2022] Open
Abstract
AIM Studies have linked the use of inhaled corticosteroids (ICSs) to excess pneumonia risk in chronic obstructive pulmonary disease patients. The risk in asthma patients remains unclear. The objective of the present study was to examine the risk of pneumonia with ICSs in asthma patients aged 12-35 years. METHODS We formed a cohort of asthma patients treated from 1990 to 2007 using Quebec health insurance databases. Subjects were considered currently exposed if they had had an ICS dispensed within the 60 days prior to their pneumonia index event or matched person-moment. Secondary analyses investigated the risk of pneumonia according to ICS dose and type. Rate ratios (RRs) and rate differences (RDs) were both estimated through a quasi-cohort approach. RESULTS The cohort included 152 412 subjects, of whom 1928 had a pneumonia event during follow-up. There was an increased risk of pneumonia associated with current use of ICSs [RR 1.83; 95% confidence interval (CI) 1.57, 2.14] or an excess risk of 1.44 cases per 1000 person-years (RD 1.44; 95% CI 1.03, 1.85). There was an excess pneumonia risk with low doses (RR 1.60; 95% CI 1.06, 2.45), moderate doses (RR 1.53; 95% CI 1.12, 2.08) and high doses (RR 1.96; 95% CI 1.64, 2.34) of ICSs, and with budesonide (RR 2.67; 95% CI 2.05, 3.49) and fluticasone (RR 1.93; 95% CI 1.58, 2.36), specifically relative to no use. When accounting for potential protopathic bias, the risk with current use of ICSs was attenuated (RR 1.48; 95% CI 1.22, 1.78). CONCLUSION ICS use in asthma patients appears to be associated with an increased risk of pneumonia and is present for both budesonide and fluticasone.
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Affiliation(s)
- Christina J Qian
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Janie Coulombe
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Samy Suissa
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Pierre Ernst
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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20
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Everage NJ, Bai Y, Loop B, Volkova N, Liu N, Enger C. Diagnosed cataracts in patients with cystic fibrosis in a United States administrative database. Ophthalmic Genet 2017; 38:527-532. [PMID: 28394650 DOI: 10.1080/13816810.2017.1301964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We estimated the incidence and prevalence of diagnosed cataracts among patients with cystic fibrosis (CF) versus the general population (GP). METHODS Using a large US health insurance claims database, we identified a CF cohort and a GP cohort matched with respect to age, gender, and calendar year. The prevalence and incidence of diagnosed cataract (primary outcome) for both cohorts were calculated, as well as the incidence rate ratios (IRRs). RESULTS The prevalence of diagnosed cataracts among patients with CF alive and enrolled in the health plan on August 31, 2012 was 4.8% versus 2.8% in the GP. The incidence in the CF cohort was higher than in the GP and increased with age in both cohorts. The adjusted IRR comparing the CF and GP cohorts was 1.5 (95% CI: 1.2-1.8). CONCLUSIONS The study suggests that the risk of developing cataract was higher among patients with CF than among the GP.
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Affiliation(s)
| | - Yan Bai
- b Vertex Pharmaceuticals Incorporated , Boston , Massachusetts , USA
| | - Brett Loop
- b Vertex Pharmaceuticals Incorporated , Boston , Massachusetts , USA
| | - Nataliya Volkova
- b Vertex Pharmaceuticals Incorporated , Boston , Massachusetts , USA
| | - Nan Liu
- a Optum Epidemiology , Boston , Massachusetts , USA
| | - Cheryl Enger
- c Optum Epidemiology , Ann Arbor , Michigan , USA
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21
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Kubota M, Shui YB, Liu M, Bai F, Huang AJ, Ma N, Beebe DC, Siegfried CJ. Mitochondrial oxygen metabolism in primary human lens epithelial cells: Association with age, diabetes and glaucoma. Free Radic Biol Med 2016; 97:513-519. [PMID: 27445101 PMCID: PMC4996752 DOI: 10.1016/j.freeradbiomed.2016.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 06/14/2016] [Accepted: 07/18/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE The hypoxic environment around the lens is important for maintaining lens transparency. Lens epithelial cells (LECs) play a key role in lens metabolism. We measured oxygen consumption to assess the role of human LECs in maintaining hypoxia around the lens, as well as the impact of systemic and ocular diagnosis on these cells. METHODS Baseline cellular respiration was measured in rabbit LECs (NN1003A), canine kidney epithelial cells (MDCK), trabecular meshwork cells (TM-5), and bovine corneal endothelial cells (CCEE) using a XF96 Extracellular Flux Analyzer (Seahorse Bioscience, North Billerica, MA), which measures oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) in vitro. Following informed written consent, lens capsule epithelial cells were obtained from patients during cataract surgery and were divided into small explants in 96-well plates. Capsules were removed when LECs became confluent. OCR was normalized to the number of cells per well using rabbit LECs as a standard. The effect of patient age, sex, race, and presence of diabetes or glaucoma on oxygen consumption was assessed by using the Mann-Whitney U test and multivariate regression analysis. RESULTS Primary LECs were obtained from 69 patients. The OCR from donors aged 70 and over was lower than that of those under 70 years (2.21±1.037 vs. 2.86±1.383 fmol/min/cell; p<0.05). Diabetic patients had lower OCR than non-diabetic patients (2.02±0.911 vs. 2.79±1.332fmol/min/cell; p<0.05), and glaucoma patients had lower OCR than non-glaucoma patients (2.27±1.19 vs. 2.83±1.286 fmol/min/cell; p<0.05). Multivariate regression analysis confirmed that donors aged 70 and over (p<0.05), diabetic patients (p<0.01), and glaucoma patients (p<0.05) had significantly lower OCR, independent of other variables. Gender and race had no significant effect on OCR. CONCLUSIONS The lower oxygen consumption rate of human LECs in older donors and patients with diabetes or glaucoma could contribute to cataract development. Diabetes and glaucoma are particularly important factors associated with decreased OCR, independent of age. Ongoing studies are examining pO2 at the anterior surface of the lens in vivo and oxygen consumption in the patient's LECs.
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Affiliation(s)
- M Kubota
- Departments of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States; Departments of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Y B Shui
- Departments of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States.
| | - M Liu
- Departments of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States.
| | - F Bai
- Departments of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States.
| | - A J Huang
- Departments of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States.
| | - N Ma
- Departments of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States; Departments of Ophthalmology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
| | - D C Beebe
- Departments of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States; Departments of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, United States
| | - C J Siegfried
- Departments of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States.
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22
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Chou PH, Chu CS, Lin CH, Cheng C, Chen YH, Lan TH, Huang MW. Use of atypical antipsychotics and risks of cataract development in patients with schizophrenia: A population-based, nested case-control study. Schizophr Res 2016; 174:137-143. [PMID: 27061658 DOI: 10.1016/j.schres.2016.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Previous research has suggested a link between typical antipsychotic use and the development of cataracts, but the association between atypical antipsychotics and cataracts remains unclear in schizophrenia (SZ). METHODS A retrospective nested case-control study was conducted using data from the National Health Insurance Database of Taiwan between the year of 2000 and 2011. A total of 2144 SZ patients with cataracts and 2222 controls matched for age, sex, and index date were included. Antipsychotic exposure was categorized by type and duration, and the association between antipsychotic exposure and cataract development was assessed using a conditional logistic regression analysis. RESULTS We found that the severity of physical comorbidities, concurrent antidepressant use, and comorbidity with glaucoma or other retinal disorders were associated with an increased risk for cataract development. Alternatively, we did not find significant associations between continuous use of clozapine, risperidone, paliperidone, ziprasidone, olanzapine, quetiapine, amisulpride, zotepine or aripiprazole and risk of cataract development in SZ patients. CONCLUSIONS We did not detect any association between atypical antipsychotic use and risk of cataract development in SZ patients. Future studies with longitudinal ocular evaluations in patients using atypical antipsychotics are warranted to confirm our findings.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Psychiatry, School of Medicine, National Yang Ming University, Taipei, Taiwan.
| | - Che-Sheng Chu
- Department of Psychiatry, Puli Branch, Taichung Veterans General Hospital, Nantou County, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Chin Cheng
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Huey Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsuo-Hung Lan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Psychiatry, School of Medicine, National Yang Ming University, Taipei, Taiwan.
| | - Min-Wei Huang
- Chia-Yi branch, Taichung Veterans General Hospital, Chiayi City, Taiwan
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23
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Sy CB, Siracusa MC. The Therapeutic Potential of Targeting Cytokine Alarmins to Treat Allergic Airway Inflammation. Front Physiol 2016; 7:214. [PMID: 27378934 PMCID: PMC4906008 DOI: 10.3389/fphys.2016.00214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/23/2016] [Indexed: 01/12/2023] Open
Abstract
Asthma is a heterogeneous disorder that results in recurrent attacks of breathlessness, coughing, and wheezing that affects millions of people worldwide. Although the precise causes of asthma are unclear, studies suggest that a combination of genetic predisposition and environmental exposure to various allergens and pathogens contribute to its development. Currently, the most common treatment to control asthma is a dual combination of β2-adrenergic receptor agonists and corticosteroids. However, studies have shown that some patients do not respond well to these medications, while others experience significant side effects. It is reported that the majority of asthmas are associated with T helper type 2 (TH2) responses. In these patients, allergen challenge initiates the influx of TH2 cells in the airways leading to an increased production of TH2-associated cytokines and the promotion of allergy-induced asthma. Therefore, biologics that target this pathway may provide an alternative method to treat the allergic airway inflammation associated with asthma. As of now, only two biologics (omalizumab and mepolizumab), which target immunoglobulin E and interleukin-5, respectively, are FDA-approved and being prescribed to asthmatics. However, recent studies have reported that targeting other components of the TH2 response also show great promise. In this review, we will briefly describe the immunologic mechanisms underlying allergic asthma. Furthermore, we will discuss the current therapeutic strategies used to treat asthma including their limitations. Finally, we will highlight the benefits of using biologics to treat asthma-associated allergic airway inflammation with an emphasis on the potential of targeting cytokine alarmins, especially thymic stromal lymphopoietin.
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Affiliation(s)
- Chandler B Sy
- Department of Medicine, Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey Newark, NJ, USA
| | - Mark C Siracusa
- Department of Medicine, Center for Immunity and Inflammation, New Jersey Medical School, Rutgers-The State University of New Jersey Newark, NJ, USA
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24
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Rajavi Z, Javadi MA, Daftarian N, Safi S, Nejat F, Shirvani A, Ahmadieh H, Shahraz S, Ziaei H, Moein H, Motlagh BF, Feizi S, Foroutan A, Hashemi H, Hashemian SJ, Jabbarvand M, Jafarinasab MR, Karimian F, Mohammad-Rabei H, Mohammadpour M, Nassiri N, Panahi-Bazaz M, Rohani MR, Sedaghat MR, Sheibani K. Customized Clinical Practice Guidelines for Management of Adult Cataract in Iran. J Ophthalmic Vis Res 2016; 10:445-60. [PMID: 27051491 PMCID: PMC4795396 DOI: 10.4103/2008-322x.176913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population. Methods: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations. Results: The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population. Conclusion: Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients.
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Affiliation(s)
- Zhaleh Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narsis Daftarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Nejat
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Office for Healthcare Standards, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran; Department of Medical Education, Faculty of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Moein
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sepehr Feizi
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Foroutan
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Javad Hashemian
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabbarvand
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Jafarinasab
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Karimian
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Mohammad-Rabei
- Department of Ophthalmology, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Mohammadpour
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Nassiri
- Department of Ophthalmology, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Rohani
- Department of Ophthalmology, Al-Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Kourosh Sheibani
- Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran
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Suissa S, Coulombe J, Ernst P. Discontinuation of Inhaled Corticosteroids in COPD and the Risk Reduction of Pneumonia. Chest 2016; 148:1177-1183. [PMID: 26110239 DOI: 10.1378/chest.15-0627] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The widespread use of inhaled corticosteroids (ICSs) for COPD treatment has been questioned. Recent studies of weaning some patients with COPD off ICSs found little or no adverse consequences compared with long-acting bronchodilators. It is unclear, however, whether discontinuation of ICSs reduces the elevated risk of pneumonia associated with these drugs. METHODS Using the Quebec health insurance databases, we formed a new-user cohort of patients with COPD treated with ICSs during 1990 to 2005 and followed through 2007 or until a serious pneumonia event, defined as a first hospitalization for or death from pneumonia. A nested case-control analysis of the cohort was used to estimate the rate ratio of serious pneumonia associated with discontinuation of ICS use compared with continued use, adjusted for age, sex, respiratory disease severity, and comorbidity. RESULTS The cohort included 103,386 users of ICSs, of whom 14,020 had a serious pneumonia event during 4.9 years of follow-up (incidence rate, 2.8/100/y). Discontinuation of ICSs was associated with a 37% decrease in the rate of serious pneumonia (rate ratio [RR], 0.63; 95% CI, 0.60-0.66). The risk reduction was rapidly evident, going from 20% in the first month to 50% by the fourth month after discontinuation. The risk reduction was particularly marked with fluticasone (RR, 0.58; 95% CI, 0.54-0.61) but less so with budesonide (RR, 0.87; 95% CI, 0.78-0.97). CONCLUSIONS Discontinuation of ICS use in COPD is associated with a reduction in the elevated risk of serious pneumonia, particularly so with fluticasone.
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Affiliation(s)
- Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital; Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada.
| | - Janie Coulombe
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital
| | - Pierre Ernst
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital; Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
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26
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Vutcovici M, Bitton A, Ernst P, Kezouh A, Suissa S, Brassard P. Inflammatory bowel disease and risk of mortality in COPD. Eur Respir J 2016; 47:1357-64. [PMID: 26869671 DOI: 10.1183/13993003.01945-2015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/06/2016] [Indexed: 12/24/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) have higher incidence and prevalence of other chronic inflammatory diseases, including inflammatory bowel disease (IBD). We assessed whether IBD onset increases mortality risk in patients with COPD or asthma-associated COPD.Two population-based cohorts of COPD and asthma-COPD subjects were identified using the administrative health databases in Québec, Canada, 1990-2007. Death records were retrieved from the death certificate registry. Cox proportional hazards models were used to assess the impact of newly developed IBD on mortality risk.The COPD and asthma-COPD cohorts included 273 208 and 26 575 patients, respectively, of which 697 and 119 developed IBD. IBD increased the risk of all-cause mortality in both COPD (hazard ratio 1.23, 95% CI 1.09-1.4) and asthma-COPD (hazard ratio 1.65, 95% CI 1.23-2.22). In asthma-COPD patients, IBD increased the risk of mortality from respiratory conditions (hazard ratio 2.18, 95% CI 1.31-3.64); in COPD patients, IBD increased the risk of death from digestive conditions (hazard ratio 4.45, 95% CI 2.39-8.30).IBD is a risk factor for mortality in patients with pre-existing COPD or asthma-COPD. IBD increased mortality by respiratory and digestive conditions in patients with asthma-COPD and COPD, respectively.
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Affiliation(s)
- Maria Vutcovici
- Division of Gastroenterology, McGill University Health Centre, Montréal, QC, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montréal, QC, Canada Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Pierre Ernst
- Faculty of Medicine, McGill University, Montréal, QC, Canada Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Abbas Kezouh
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Samy Suissa
- Faculty of Medicine, McGill University, Montréal, QC, Canada Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Paul Brassard
- Faculty of Medicine, McGill University, Montréal, QC, Canada Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
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27
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Marra KV, Wagley S, Kuperwaser MC, Campo R, Arroyo JG. Care of Older Adults: Role of Primary Care Physicians in the Treatment of Cataracts and Macular Degeneration. J Am Geriatr Soc 2016; 64:369-77. [PMID: 26825587 DOI: 10.1111/jgs.13927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article aims to facilitate optimal management of cataracts and age-related macular degeneration (AMD) by providing information on indications, risk factors, referral guidelines, and treatments and to describe techniques to maximize quality of life (QOL) for people with irreversible vision loss. A review of PubMed and other online databases was performed for peer-reviewed English-language articles from 1980 through August 2012 on visual impairment in elderly adults. Search terms included vision loss, visual impairment, blind, low vision, QOL combined with age-related, elderly, and aging. Articles were selected that discussed vision loss in elderly adults, effects of vision impairment on QOL, and care strategies to manage vision loss in older adults. The ability of primary care physicians (PCPs) to identify early signs of cataracts and AMD in individuals at risk of vision loss is critical to early diagnosis and management of these common age-related eye diseases. PCPs can help preserve vision by issuing aptly timed referrals and encouraging behavioral modifications that reduce risk factors. With knowledge of referral guidelines for soliciting low-vision rehabilitation services, visual aids, and community support resources, PCPs can considerably increase the QOL of individuals with uncorrectable vision loss. By offering appropriately timed referrals, promoting behavioral modifications, and allocating low-vision care resources, PCPs may play a critical role in preserving visual health and enhancing the QOL for the elderly population.
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Affiliation(s)
- Kyle V Marra
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,School of Medicine, University of California at San Diego, La Jolla, California.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Sushant Wagley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Mark C Kuperwaser
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Rafael Campo
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jorge G Arroyo
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Erie JC, Pueringer MR, Brue SM, Chamberlain AM, Hodge DO. Statin Use and Incident Cataract Surgery: A Case-Control Study. Ophthalmic Epidemiol 2016; 23:40-5. [PMID: 26766069 DOI: 10.3109/09286586.2015.1077258] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine the association between statin use and incident cataract surgery. METHODS Using the resources of the Rochester Epidemiology Project, a retrospective population-based, case-control study was performed. Cases included 6024 county residents aged 50 years and older who had first-eye cataract surgery between 1 January 2004 and 31 December 2011. Controls included residents who had never had cataract surgery and were matched to cases by age, sex, and index date within 1 month of surgery. Statin medications continuously prescribed for at least 1 year before the surgery date (cases) or index date (controls) were examined. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression models. RESULTS There were 2557 (42%) statin users among cases having cataract surgery compared to 2038 (34%) statin users among controls never having had cataract surgery (p < 0.0001). Incident cataract surgery was significantly associated with increased odds of statin use (OR 1.29, 95% CI 1.19-1.55) after adjusting for age, sex, diabetes, cardiovascular disease, cerebrovascular disease, peripheral vascular disease, renal disease, oral and inhaled steroid use, and selective serotonin reuptake inhibitor use. The association was consistent in both subgroups of women (OR 1.34, 95%CI 1.22-1.49) and men (OR 1.17, 95% CI 1.05-1.30). CONCLUSIONS Incident cataract surgery was associated with increased odds of statin use, and underscores the possibility that increasing statin use could be contributing to rising rates of cataract surgery.
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Affiliation(s)
- Jay C Erie
- a Department of Ophthalmology, Mayo Clinic , Rochester , MN , USA
| | | | - Scott M Brue
- b Division of Biomedical Informatics Support System, Mayo Clinic , Rochester , MN , USA
| | | | - David O Hodge
- c Department of Health Sciences Research, Mayo Clinic , Rochester , MN , USA
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Kim HK, Kim TH. Current trends in treatment of allergic rhinitis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.4.300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ha Kyun Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea University College of Medicine, Seoul, Korea
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Ferrante G, Montalbano L, Cilluffo G, Malizia V, Marchese D, La Grutta S. Beclomethasone dipropionate hydrofluoroalkane for the treatment of allergic rhinitis. Expert Rev Clin Immunol 2015; 12:279-88. [PMID: 26558604 DOI: 10.1586/1744666x.2016.1118347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Allergic rhinitis (AR) is a common respiratory disease, and its prevalence is increasing all over the world, both in adults and in children. Patients experience symptoms that may negatively impact on physical, social and psychological well-being. Hence, if left untreated, allergic rhinitis may significantly affect quality of life. Under current guidelines, intranasal corticosteroids are considered the most effective drugs and they are recommended as first-line therapy. Among the several corticosteroid intranasal sprays available, beclomethasone dipropionate is one of the most prescribed. Recently, new intranasal hydrofluoroalkane-propelled formulations with little or no impact on the ozone layer have been developed for the treatment of AR. The use of these devices might improve patients' adherence to treatment, avoiding some of the most common side effects associated with aqueous formulations. This review provides the most recent evidence for the efficacy and safety of beclomethasone dipropionate hydrofluoroalkane nasal aerosol in the treatment of allergic rhinitis.
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Affiliation(s)
- Giuliana Ferrante
- a Department of Science for Health Promotion and Mother and Child Care , University of Palermo , Palermo , Italy
| | - Laura Montalbano
- b National Research Council CNR , Institute of Biomedicine and Molecular Immunology IBIM , Palermo , Italy.,c Department of Psychology , University of Palermo , Palermo , Italy
| | - Giovanna Cilluffo
- b National Research Council CNR , Institute of Biomedicine and Molecular Immunology IBIM , Palermo , Italy.,d Department of Economics, Business, and Statistics , University of Palermo , Palermo , Italy
| | - Velia Malizia
- b National Research Council CNR , Institute of Biomedicine and Molecular Immunology IBIM , Palermo , Italy
| | - Donatella Marchese
- e Istituto di Biomedicina e Immunologia Molecolare (IBIM) Consiglio Nazionale delle Ricerche (CNR) Palermo , Italy
| | - Stefania La Grutta
- b National Research Council CNR , Institute of Biomedicine and Molecular Immunology IBIM , Palermo , Italy
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31
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Kaplan AG. Applying the wisdom of stepping down inhaled corticosteroids in patients with COPD: a proposed algorithm for clinical practice. Int J Chron Obstruct Pulmon Dis 2015; 10:2535-48. [PMID: 26648711 PMCID: PMC4664433 DOI: 10.2147/copd.s93321] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Current guidelines for the management of chronic obstructive pulmonary disease (COPD) recommend limiting the use of inhaled corticosteroids (ICS) to patients with more severe disease and/or increased exacerbation risk. However, there are discrepancies between guidelines and real-life practice, as ICS are being overprescribed. In light of the increasing concerns about the clinical benefit and long-term risks associated with ICS use, therapy needs to be carefully weighed on a case-by-case basis, including in patients already on ICS. Several studies sought out to determine the effects of withdrawing ICS in patients with COPD. Early studies have deterred clinicians from reducing ICS in patients with COPD as they reported that an abrupt withdrawal of ICS precipitates exacerbations, and results in a deterioration in lung function and symptoms. However, these studies were fraught with numerous methodological limitations. Recently, two randomized controlled trials and a real-life prospective study revealed that ICS can be safely withdrawn in certain patients. Of these, the WISDOM (Withdrawal of Inhaled Steroids During Optimized Bronchodilator Management) trial was the largest and first to examine stepwise withdrawal of ICS in patients with COPD receiving maintenance therapy of long-acting bronchodilators (ie, tiotropium and salmeterol). Even with therapy being in line with the current guidelines, the findings of the WISDOM trial indicate that not all patients benefit from including ICS in their treatment regimen. Indeed, only certain COPD phenotypes seem to benefit from ICS therapy, and validated markers that predict ICS response are urgently warranted in clinical practice. Furthermore, we are now better equipped with a larger armamentarium of novel and more effective long-acting β2-agonist/long-acting muscarinic antagonist combinations that can be considered by clinicians to optimize bronchodilation and allow for safer ICS withdrawal. In addition to providing a review of the aforementioned, this perspective article proposes an algorithm for the stepwise withdrawal of ICS in real-life clinical practice.
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Affiliation(s)
- Alan G Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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32
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Ye YM, Kim SH, Hur GY, Kim JH, Park JW, Shim JJ, Jung KS, Lee HY, Park HS. Addition of Montelukast to Low-Dose Inhaled Corticosteroid Leads to Fewer Exacerbations in Older Patients Than Medium-Dose Inhaled Corticosteroid Monotherapy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 7:440-8. [PMID: 26122504 PMCID: PMC4509656 DOI: 10.4168/aair.2015.7.5.440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/28/2015] [Accepted: 02/11/2015] [Indexed: 11/20/2022]
Abstract
Purpose There have been few reports regarding the efficacy of antiasthmatics in older patients. To compare the efficacy of the addition of montelukast to low-dose inhaled budesonide (MON-400BUD) versus increasing the dose of inhaled steroid (800BUD) on asthma control in older asthmatics. Methods A randomized, open-label, parallel-designed trial was conducted for 12 weeks. The primary endpoint was the rate of patients who reached "well-controlled asthma status" after the 12-week treatment period. Additionally, asthma exacerbations, sputum inflammatory cells, asthma control test (ACT) and physical functioning scale (PFS), and adverse reactions were monitored. Results Twenty-four (36.9%) and 22 (34.9%) subjects in the MON-400BUD (n=65) and 800BUD (n=63) groups had well-controlled asthma at the end of the study, respectively. The numbers of asthma exacerbations requiring oral corticosteroid treatment (20 vs 9, respectively, P=0.036) and the development of sore throat (22 vs 11, respectively, P=0.045) were significantly higher in the 800BUD group than in the MON-400BUD group. Body mass index and changes in ACT, FEV1%, 6-min walk distance and PFS from baseline were all significant determinants for distinguishing subjects with well-controlled and partly controlled asthma from those with uncontrolled asthma (P<0.05) at the end of the study. Conclusions The efficacy of 12-week treatment with MON-400BUD in older asthmatics was comparable to that of 800BUD on asthma control but associated with reduced frequency of asthma exacerbations requiring oral steroids and sore throat events. Changes in ACT and PFS can be useful predictors of asthma control status in older patients.
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Affiliation(s)
- Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Sang Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Joo Hee Kim
- Department of Internal Medicine, Hallym University School of Medicine, Anyang, Korea
| | - Jung Won Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Jeong Shim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Ki Suck Jung
- Department of Internal Medicine, Hallym University School of Medicine, Anyang, Korea
| | - Hyun Young Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, Dawson DE, Dykewicz MS, Hackell JM, Han JK, Ishman SL, Krouse HJ, Malekzadeh S, Mims JWW, Omole FS, Reddy WD, Wallace DV, Walsh SA, Warren BE, Wilson MN, Nnacheta LC. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg 2015; 152:S1-43. [PMID: 25644617 DOI: 10.1177/0194599814561600] [Citation(s) in RCA: 372] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there is considerable variation in their use. This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options. PURPOSE The primary purpose of this guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to manage patients with AR as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with AR. Children under the age of 2 years were excluded from the clinical practice guideline because rhinitis in this population may be different than in older patients and is not informed by the same evidence base. The guideline is intended to focus on a limited number of quality improvement opportunities deemed most important by the working group and is not intended to be a comprehensive reference for diagnosing and managing AR. The recommendations outlined in the guideline are not intended to represent the standard of care for patient management, nor are the recommendations intended to limit treatment or care provided to individual patients. ACTION STATEMENTS The development group made a strong recommendation that clinicians recommend intranasal steroids for patients with a clinical diagnosis of AR whose symptoms affect their quality of life. The development group also made a strong recommendation that clinicians recommend oral second-generation/less sedating antihistamines for patients with AR and primary complaints of sneezing and itching. The panel made the following recommendations: (1) Clinicians should make the clinical diagnosis of AR when patients present with a history and physical examination consistent with an allergic cause and 1 or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing. Findings of AR consistent with an allergic cause include, but are not limited to, clear rhinorrhea, nasal congestion, pale discoloration of the nasal mucosa, and red and watery eyes. (2) Clinicians should perform and interpret, or refer to a clinician who can perform and interpret, specific IgE (skin or blood) allergy testing for patients with a clinical diagnosis of AR who do not respond to empiric treatment, or when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy. (3) Clinicians should assess patients with a clinical diagnosis of AR for, and document in the medical record, the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media. (4) Clinicians should offer, or refer to a clinician who can offer, immunotherapy (sublingual or subcutaneous) for patients with AR who have inadequate response to symptoms with pharmacologic therapy with or without environmental controls. The panel recommended against (1) clinicians routinely performing sinonasal imaging in patients presenting with symptoms consistent with a diagnosis of AR and (2) clinicians offering oral leukotriene receptor antagonists as primary therapy for patients with AR. The panel group made the following options: (1) Clinicians may advise avoidance of known allergens or may advise environmental controls (ie, removal of pets; the use of air filtration systems, bed covers, and acaricides [chemical agents formulated to kill dust mites]) in patients with AR who have identified allergens that correlate with clinical symptoms. (2) Clinicians may offer intranasal antihistamines for patients with seasonal, perennial, or episodic AR. (3) Clinicians may offer combination pharmacologic therapy in patients with AR who have inadequate response to pharmacologic monotherapy. (4) Clinicians may offer, or refer to a surgeon who can offer, inferior turbinate reduction in patients with AR with nasal airway obstruction and enlarged inferior turbinates who have failed medical management. (5) Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in nonpharmacologic therapy. The development group provided no recommendation regarding the use of herbal therapy for patients with AR.
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Affiliation(s)
- Michael D Seidman
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford West Bloomfield Hospital West Bloomfield, Michigan, USA
| | - Richard K Gurgel
- Department of Surgery Otolaryngology-Head and Neck Surgery University of Utah, Salt Lake City, Utah, USA
| | - Sandra Y Lin
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA
| | | | - Fuad M Baroody
- University of Chicago Medical Center, Department of Otolaryngology, Chicago, Illinois, USA
| | | | | | - Mark S Dykewicz
- Department of Internal Medicine, St Louis University School of Medicine, St Louis, Missouri, USA
| | | | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | | | - William D Reddy
- Acupuncture and Oriental Medicine (AAAOM), Annandale, Virginia, USA
| | - Dana V Wallace
- Florida Atlantic University, Boca Raton, Florida and Nova Southeastern University, Davie, Florida, USA
| | - Sandra A Walsh
- Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Barbara E Warren
- Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Meghan N Wilson
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Lorraine C Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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D'Urzo A, Donohue JF, Kardos P, Miravitlles M, Price D. A re-evaluation of the role of inhaled corticosteroids in the management of patients with chronic obstructive pulmonary disease. Expert Opin Pharmacother 2015; 16:1845-60. [PMID: 26194213 PMCID: PMC4673525 DOI: 10.1517/14656566.2015.1067682] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Inhaled corticosteroids (ICS) (in fixed combinations with long-acting β2-agonists [LABAs]) are frequently prescribed for patients with chronic obstructive pulmonary disease (COPD), outside their labeled indications and recommended treatment strategies and guidelines, despite having the potential to cause significant side effects. AREAS COVERED Although the existence of asthma in patients with asthma-COPD overlap syndrome (ACOS) clearly supports the use of anti-inflammatory treatment (typically an ICS/LABA combination, as ICS monotherapy is usually not indicated for COPD), the current level of ICS/LABA use is not consistent with the prevalence of ACOS in the COPD population. Data have recently become available showing the comparative efficacy of fixed bronchodilator combinations (long-acting muscarinic antagonist [LAMA]/LABA with ICS/LABA combinations). Additionally, new information has emerged on ICS withdrawal without increased risk of exacerbations, under cover of effective bronchodilation. EXPERT OPINION For patients with COPD who do not have ACOS, a LAMA/LABA combination may be an appropriate starting therapy, apart from those with mild disease who can be managed with a single long-acting bronchodilator. Patients who remain symptomatic or present with exacerbations despite effectively delivered LAMA/LABA treatment may require additional drug therapy, such as ICS or phosphodiesterase-4 inhibitors. When prescribing an ICS/LABA, the risk:benefit ratio should be considered in individual patients.
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Affiliation(s)
- Anthony D'Urzo
- University of Toronto, Department of Family and Community Medicine , 500 University Avenue, 5th Floor, Toronto, Ontario, M5G 1V7 , Canada +1 416 652 9336 ; +1 416 652 0218 ;
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Ernst P, Saad N, Suissa S. Inhaled corticosteroids in COPD: the clinical evidence. Eur Respir J 2014; 45:525-37. [PMID: 25537556 DOI: 10.1183/09031936.00128914] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this article, we focus on the scientific evidence from randomised trials supporting treatment with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), including treatment with combinations of long-acting β-agonist (LABA) bronchodilators and ICS. Our emphasis is on the methodological strengths and limitations that guide the conclusions that may be drawn. The evidence of benefit of ICS and, therefore, of the LABA/ICS combinations in COPD is limited by major methodological problems. From the data reviewed herein, we conclude that there is no survival benefit independent of the effect of long-acting bronchodilation and no effect on FEV1 decline, and that the possible benefit on reducing severe exacerbations is unclear. Our interpretation of the data is that there are substantial adverse effects from the use of ICS in patients with COPD, most notably severe pneumonia resulting in excess deaths. Currently, the most reliable predictor of response to ICS in COPD is the presence of eosinophilic inflammation in the sputum. There is an urgent need for better markers of benefit and risk that can be tested in randomised trials for use in routine specialist practice. Given the overall safety and effectiveness of long-acting bronchodilators in subjects without an asthma component to their COPD, we believe use of such agents without an associated ICS should be favoured.
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Affiliation(s)
- Pierre Ernst
- Dept of Medicine, Pulmonary Division, Jewish General Hospital, Montreal, Canada Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Canada
| | - Nathalie Saad
- Dept of Medicine, Pulmonary Division, Jewish General Hospital, Montreal, Canada
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Canada Dept of Epidemiology and Biostatistics, McGill University, Montréal, Canada
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Brassard P, Vutcovici M, Ernst P, Patenaude V, Sewitch M, Suissa S, Bitton A. Increased incidence of inflammatory bowel disease in Québec residents with airway diseases. Eur Respir J 2014; 45:962-8. [PMID: 25406447 DOI: 10.1183/09031936.00079414] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of the study was to assess whether the incidences of Crohn's disease and ulcerative colitis are increased in patients with asthma and chronic obstructive pulmonary disease (COPD) compared to the general population. A population-based retrospective cohort study was conducted using the administrative health databases of Québec, Canada. Incidences of Crohn's disease and ulcerative colitis among patients with asthma and COPD were assessed for the 2001-2006 period. In total, 136 178 subjects with asthma and 143 904 subjects with COPD were identified. The average incidence of Crohn's disease and ulcerative colitis was 23.1 and 8.8 per 100 000 person-years among asthmatic patients; in the COPD cohort there were 26.2 Crohn's disease cases and 17 ulcerative colitis cases per 100 000 person-years. The incidence of Crohn's disease in asthma and COPD patients was 27% and 55% higher than in the general population of Québec; the incidence of ulcerative colitis was 30% higher among COPD patients compared to the general population. Incidence of inflammatory bowel disease was significantly increased in asthma and COPD patients compared to the general population of Québec. Incidence rates were particularly high in patients with COPD. Awareness of an association between airway diseases and inflammatory bowel disease in older age groups may play an important role in earlier detection of bowel disease and in the therapeutic management of such patients.
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Affiliation(s)
- Paul Brassard
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada McGill University, Faculty of Medicine, Montreal, QC, Canada
| | - Maria Vutcovici
- McGill University Health Centre, Division of Gastroenterology, Montreal, QC, Canada
| | - Pierre Ernst
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada McGill University, Faculty of Medicine, Montreal, QC, Canada
| | - Valérie Patenaude
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Maida Sewitch
- McGill University, Faculty of Medicine, Montreal, QC, Canada McGill University Health Centre, Division of Clinical Epidemiology, Montreal, QC, Canada
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada McGill University, Faculty of Medicine, Montreal, QC, Canada
| | - Alain Bitton
- McGill University, Faculty of Medicine, Montreal, QC, Canada McGill University Health Centre, Division of Gastroenterology, Montreal, QC, Canada
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Ni S, Fu Z, Zhao J, Liu H. Inhaled corticosteroids (ICS) and risk of mycobacterium in patients with chronic respiratory diseases: a meta-analysis. J Thorac Dis 2014; 6:971-8. [PMID: 25093095 DOI: 10.3978/j.issn.2072-1439.2014.07.03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 06/10/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Studies have indicated that therapy with inhaled corticosteroids (ICS) can be associated with a higher risk of pneumonia. However, it is not known whether ICS increases the risk of mycobacterium. Most of these published studies were small, and the conclusions were inconsistent. METHODS A meta-analysis was conducted into whether ICS increases the risk of mycobacterium in patients with chronic respiratory diseases. PubMed, OVID, EMBASE and Cochrane Library databases were searched. RESULTS Five studies involving 4,851 cases and 28,477 controls were considered in the meta-analysis. From the pooled analyses, there was significant association between ICS and risk of mycobacterium in all patients with chronic respiratory diseases [risk ratio (RR) =1.81; 95% confidence interval (CI), 1.23-2.68; P=0.003]. Among patients with chronic respiratory diseases, the relationship between ICS and risk of tuberculosis (TB) was also significant (RR =1.34; 95% CI, 1.15-1.55; P=0.0001). And meta-analysis of four studies in patients with chronic obstructive pulmonary disease (COPD) (RR =1.42; 95% CI, 1.18-1.72; P=0.0003) or two studies in patients who have prior pulmonary TB (RR =1.61; 95% CI, 1.35-1.92; P<0.00001) or three studies in patients with high-dose ICS (RR =1.60; 95% CI, 1.28-1.99; P<0.0001) showed a relationship between ICS and risk of mycobacterium. CONCLUSIONS Significant relationship has been shown between ICS use and risk of mycobacterium in all patients with chronic respiratory diseases. ICS use also increases the risk of TB among the patients with chronic respiratory diseases. Use of ICS increases the risk of mycobacterium in patients with COPD or patients with prior pulmonary TB or patients inhaling high-dose corticosteroids. Further research is required to establish the potential adverse effect of ICS as a therapy for chronic respiratory diseases.
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Affiliation(s)
- Songshi Ni
- Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Zhenxue Fu
- Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Jing Zhao
- Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Hua Liu
- Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China
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Erie JC, Brue SM, Chamberlain AM, Hodge DO. Selective serotonin reuptake inhibitor use and increased risk of cataract surgery: a population-based, case-control study. Am J Ophthalmol 2014; 158:192-197.e1. [PMID: 24631758 PMCID: PMC4356987 DOI: 10.1016/j.ajo.2014.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate whether selective serotonin reuptake inhibitor use is associated with an increased risk of cataract surgery. DESIGN Population-based case-control study. METHODS setting: Olmsted County, Minnesota. patient population: Eligible patients were county residents in the Rochester Epidemiology Project. Cases included 6024 county residents aged 50+ years who underwent first-eye cataract surgery between January 1, 2004 and December 31, 2011. Controls included 6024 residents who never had cataract surgery and were matched to cases by age, sex, and date of surgery. Logistic regression models were used to compute odds ratios for differences in selective serotonin reuptake inhibitor use between cases and controls, and to adjust for confounding variables. observation procedure: Rochester Epidemiology Project databases were used to assess cataract surgery and selective serotonin reuptake inhibitor treatment. main outcome measure: Selective serotonin reuptake inhibitor use. RESULTS In the cataract surgery cohort of 6024 residents, 1024 (17%) were selective serotonin reuptake inhibitor users compared to 788 (13%) in the matched cohort of 6024 residents never having cataract surgery (P < .001). Selective serotonin reuptake inhibitor use of 1 or more years was associated with an increased risk of cataract surgery (odds ratio [OR] = 1.36; 95% confidence interval [CI], 1.23-1.51; P < .001). The associations were similar in women (OR = 1.37; 95% CI, 1.22-1.55; P < .001) and men (OR = 1.34; 95% CI, 1.12-1.61; P = .002). The risk of cataract surgery was highest with citalopram use (OR = 1.53; 95% CI, 1.33-1.77; P < .001). CONCLUSION Selective serotonin reuptake inhibitor use of 1 or more years in people aged 50+ years is associated with an increased risk of cataract surgery.
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Affiliation(s)
- Jay C Erie
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
| | - Scott M Brue
- Division of Biomedical Informatics Support System, Mayo Clinic, Rochester, Minnesota
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Suissa S, Patenaude V, Lapi F, Ernst P. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax 2013; 68:1029-36. [PMID: 24130228 PMCID: PMC3812880 DOI: 10.1136/thoraxjnl-2012-202872] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use. Methods We formed a new-user cohort of patients with COPD treated during 1990–2005. Subjects were identified using the Quebec health insurance databases and followed through 2007 or until a serious pneumonia event, defined as a first hospitalisation for or death from pneumonia. A nested case–control analysis was used to estimate the rate ratio (RR) of serious pneumonia associated with current ICS use, adjusted for age, sex, respiratory disease severity and comorbidity. Results The cohort included 163 514 patients, of which 20 344 had a serious pneumonia event during the 5.4 years of follow-up (incidence rate 2.4/100/year). Current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63 to 1.75). The risk was sustained with long-term use and declined gradually after stopping ICS use, disappearing after 6 months (RR 1.08; 95% CI 0.99 to 1.17). The rate of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93 to 2.10), increasing with the daily dose, but was much lower with budesonide (RR 1.17; 95% CI 1.09 to 1.26). Conclusions ICS use by patients with COPD increases the risk of serious pneumonia. The risk is particularly elevated and dose related with fluticasone. While residual confounding cannot be ruled out, the results are consistent with those from recent randomised trials.
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Affiliation(s)
- Samy Suissa
- Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, , Montreal, Québec, Canada
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Pakzad-Vaezi KL, Etminan M, Mikelberg FS. The association between cataract surgery and atypical antipsychotic use: a nested case-control study. Am J Ophthalmol 2013; 156:1141-1146.e1. [PMID: 24075430 DOI: 10.1016/j.ajo.2013.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate cataract risk associated with the use of atypical antipsychotics. DESIGN Retrospective, nested case-control study. METHODS A large health claims database (The British Columbia Ministry of Health Databases) from British Columbia, Canada, was used from January 2000 through December 2007. Cases were defined as clinically significant cataracts requiring surgery and were identified using cataract surgery procedure codes. For each case, 4 to 10 controls were selected randomly using a density-based sampling approach and were matched to cases by age and calendar time. Rate ratios were calculated for users of atypical and typical antipsychotics adjusting for known cataractogenic factors. RESULTS One hundred sixty-two thousand five hundred one cases of cataract surgery and 650 004 controls were included. The adjusted rate ratio for current users of atypical antipsychotics was 0.84 (95% confidence interval, 0.80 to 0.89) compared with nonusers. A greater number of prescriptions filled in the year before cataract surgery compared with the median number of filled prescriptions was associated with a lower cataract surgery rate (adjusted rate ratio, 0.70; 95% confidence interval, 0.65 to 0.75) than those with fewer prescriptions filled (adjusted rate ratio, 0.85; 95% confidence interval, 0.79 to 0.91). CONCLUSIONS A protective association between the use of atypical antipsychotics and risk of clinically significant cataracts requiring surgery was established. Potential biochemical and neurochemical mechanisms for this protective effect are discussed.
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Abstract
BACKGROUND Obesity is more prevalent in asthmatics. Sleep duration is a novel risk factor for obesity in general populations. OBJECTIVE We tested the association of sleep duration and asthma characteristics with obesity. METHODS Adults at tertiary clinics were surveyed on asthma symptoms and habitual sleep duration. Medical records were used to assess asthma severity step (1-4), extract height and weight, current medications and diagnosed comorbid conditions. BMI ≥30 kg/m(2) defined obesity. Habitual sleep was categorized as <6 (very short), 6 to <7 h (short), 7-8 h (normal), >8 to ≤9 h (long) and >9 h (very long). Inhaled corticosteroid doses were categorized as low, moderate and high. RESULTS Among 611 participants (mean BMI 30 ± 8), 249 (41%) were obese. After adjustment for covariates, obesity was associated with short and very long sleep: as compared to normal sleepers, the odds of being obese were on an average 66% higher ([95% CI: 1.07-2.57], p = 0.02) among short and 124% higher ([1.08-1.65], p = 0.03) among very long sleepers, and the association with very short sleep approached significance (1.74 [0.96-3.14], p = 0.06). Obesity was also significantly related to highest asthma step (1.87 [1.09-3.21], p = 0.02) and psychopathology (1.64 [1.08-2.48], p = 0.02), and a trend was seen with high-dose inhaled corticosteroids (1.82 [0.93-3.56], p = 0.08). CONCLUSIONS Obesity in asthmatics is associated with shorter and very long sleep duration, worse asthma severity, psychopathology and high-dose inhaled corticosteroids. Although this cross-sectional study cannot prove causality, we speculate that further investigation of sleep may provide new opportunities to reduce the rising prevalence of obesity among asthmatics.
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Affiliation(s)
- Mihaela Teodorescu
- James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Center for Sleep Medicine and Sleep Research/Wisconsin Sleep, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David A. Polomis
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ronald E. Gangnon
- Departments of Biostatistics and Medical Informatics, and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Flavia B. Consens
- Department of Neurology and Sleep Disorders Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Ronald D. Chervin
- Department of Neurology and Sleep Disorders Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Mihai C. Teodorescu
- James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Center for Sleep Medicine and Sleep Research/Wisconsin Sleep, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Marcus MW, Müskens RPHM, Ramdas WD, Wolfs RCW, De Jong PTVM, Vingerling JR, Hofman A, Stricker BHC, Jansonius NM. Corticosteroids and open-angle glaucoma in the elderly: a population-based cohort study. Drugs Aging 2013; 29:963-70. [PMID: 23150239 DOI: 10.1007/s40266-012-0029-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND It is largely unknown if corticosteroid-induced open-angle glaucoma (OAG) is an entity that is limited to a few susceptible individuals or whether it contributes significantly to the overall population burden of OAG. OBJECTIVE The aim of this study was to determine whether there is an association between corticosteroid use and the incidence of OAG in the general elderly population. METHODS A prospective population-based cohort study was conducted in a general community setting. 3,939 participants of the Rotterdam Study aged 55 years and older for whom data from ophthalmic examinations at baseline and follow-up were available and who did not have glaucoma at baseline were included (baseline examination from 1991 to 1993; follow-up examinations from 1997 to 1999 and from 2002 to 2006). Ophthalmic examinations, including measurement of the intraocular pressure, assessment of the optic nerve head and perimetry, were performed at baseline and follow-up. The use of corticosteroids was monitored continuously during follow-up. Corticosteroids were stratified into five groups: ophthalmic steroids, inhaled steroids, nasal steroids, oral steroids and steroid ointments. Associations between the use of corticosteroids and incident OAG were assessed using logistic regression models. The study outcome measures were the odds ratios (ORs) of associations between the use of corticosteroids and incident OAG. RESULTS During a mean follow-up of 9.8 years, 108 participants (2.8%) developed OAG. The median number of steroid prescriptions during follow-up was 2 for ophthalmic, 7 for inhaled, 2 for nasal and 2 for oral steroids, and 3 for steroid ointments. The OR of the use of ophthalmic steroids was 1.04 [95% confidence interval (CI) 0.66, 1.65; p = 0.86], inhaled steroids 0.79 (95% CI 0.42, 1.48; p = 0.46), nasal steroids 1.26 (95% CI 0.74, 2.13; p = 0.40), oral steroids 1.03 (95% CI 0.65, 1.64; p = 0.89) and steroid ointments 0.70 (95% CI 0.47, 1.05; p = 0.086). These analyses were adjusted for age, sex, high myopia and family history of glaucoma. The small median numbers of prescriptions made it difficult to evaluate dose-response relationships. CONCLUSION None of the classes of steroids were associated with the incidence of OAG in this elderly population.
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Affiliation(s)
- Michael W Marcus
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Price D, Yawn B, Brusselle G, Rossi A. Risk-to-benefit ratio of inhaled corticosteroids in patients with COPD. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:92-100. [PMID: 23135217 PMCID: PMC6548052 DOI: 10.4104/pcrj.2012.00092] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/20/2012] [Accepted: 09/20/2012] [Indexed: 11/08/2022]
Abstract
While the pharmacological management of chronic obstructive pulmonary disease (COPD) has evolved from the drugs used to treat asthma, the treatment models are different and the two diseases require clear differential diagnosis in order to determine the correct therapeutic strategy. In contrast to the almost universal requirement for anti-inflammatory treatment of persistent asthma, the efficacy of inhaled corticosteroids (ICS) is less well established in COPD and their role in treatment is limited. There is some evidence of a preventive effect of ICS on exacerbations in patients with COPD, but there is little evidence for an effect on mortality or lung function decline. As a result, treatment guidelines recommend the use of ICS in patients with severe or very severe disease (forced expiratory volume in 1 second <50% predicted) and repeated exacerbations. Patients with frequent exacerbations - a phenotype that is stable over time - are likely to be less common among those with moderate COPD (many of whom are managed in primary care) than in those with more severe disease. The indiscriminate use of ICS in COPD may expose patients to an unnecessary increase in the risk of side-effects such as pneumonia, osteoporosis, diabetes and cataracts, while wasting healthcare spending and potentially diverting attention from other more appropriate forms of management such as pulmonary rehabilitation and maximal bronchodilator use. Physicians should carefully weigh the likely benefits of ICS use against the potential risk of side-effects and costs in individual patients with COPD.
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Affiliation(s)
- David Price
- Primary Care Respiratory Society UK Professor of Primary Care Respiratory Medicine, University of Aberdeen, UK.
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Wilchesky M, Ernst P, Brophy JM, Platt RW, Suissa S. Bronchodilator use and the risk of arrhythmia in COPD: part 2: reassessment in the larger Quebec cohort. Chest 2012; 142:305-311. [PMID: 22871756 DOI: 10.1378/chest.11-1597] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A previous study suggested a potential increased risk of cardiac arrhythmia with new use of long-acting β-agonists and ipratropium bromide in patients with COPD, although conclusions were limited by the small cohort size. METHODS We reassessed this association in a larger cohort formed from the health-care databases of the province of Quebec, Canada. We identified a cohort of patients with COPD aged ≥ 67 years who began treatment between 1990 and 1999 and followed them until December 2003. A nested case-control approach matched each subject who developed severe arrhythmia during follow-up with 20 control subjects from the cohort on age, sex, and calendar time. The rate ratio (RR) of arrhythmia associated with new use of bronchodilators was estimated using conditional logistic regression, adjusting for COPD disease severity, cardiovascular disease, and other comorbidities. RESULTS The cohort included 76,661 patients with COPD, of whom 5,307 developed an arrhythmia (10.3 arrhythmias per 1,000 per year), 621 of which were fatal. The rate of cardiac arrhythmias was elevated with the new use of short-acting (RR, 1.27; 95% CI, 1.03-1.57) and long-acting (RR, 1.47; 95% CI, 1.01-2.15) β-agonists. The rate was slightly elevated, although not statistically significantly, with new use of ipratropium bromide (RR, 1.23; 95% CI, 0.95-1.57) and methylxanthines (RR, 1.28; 95% CI, 0.93-1.77). These effects waned with longer-term use. CONCLUSIONS New use of short- and long-acting β-agonists may slightly increase the risk of cardiac arrhythmia in patients with COPD. It remains unclear whether ipratropium bromide also increases this risk, despite the use of a larger study population.
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Affiliation(s)
- Machelle Wilchesky
- Donald Berman Maimonides Geriatric Centre, McGill University, QC, Canada; Centre for Clinical Epidemiology, Jewish General Hospital-Lady Davis Research Institute, Montreal, QC, Canada
| | - Pierre Ernst
- Department of Medicine, McGill University, QC, Canada; Centre for Clinical Epidemiology, Jewish General Hospital-Lady Davis Research Institute, Montreal, QC, Canada
| | - James M Brophy
- Department of Medicine, McGill University, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, QC, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, QC, Canada; Department of Pediatrics, McGill University, QC, Canada
| | - Samy Suissa
- Department of Medicine, McGill University, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, QC, Canada; Centre for Clinical Epidemiology, Jewish General Hospital-Lady Davis Research Institute, Montreal, QC, Canada.
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Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67:957-63. [PMID: 22684094 PMCID: PMC3505864 DOI: 10.1136/thoraxjnl-2011-201518] [Citation(s) in RCA: 479] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The long-term natural history of chronic obstructive pulmonary disease (COPD) in terms of successive severe exacerbations and mortality is unknown. Methods The authors formed an inception cohort of patients from their first ever hospitalisation for COPD during 1990–2005, using the healthcare databases from the province of Quebec, Canada. Patients were followed until death or 31 March 2007, and all COPD hospitalisations occurring during follow-up were identified. The hazard functions of successive hospitalised COPD exacerbations and all-cause mortality over time were estimated, and HRs adjusted for age, sex, calendar time and comorbidity. Results The cohort included 73 106 patients hospitalised for the first time for COPD, of whom 50 580 died during the 17-year follow-up, with 50% and 75% mortality at 3.6 and 7.7 years respectively. The median time from the first to the second hospitalised exacerbation was around 5 years and decreased to <4 months from the 9th to the 10th. The risk of the subsequent severe exacerbation was increased threefold after the second severe exacerbation and 24-fold after the 10th, relative to the first. Mortality after a severe exacerbation peaked to 40 deaths per 10 000 per day in the first week after admission, dropping gradually to 5 after 3 months. Conclusions The course of COPD involves a rapid decline in health status after the second severe exacerbation and high mortality in the weeks following every severe exacerbation. Two strategic targets for COPD management should include delaying the second severe exacerbation and improving treatment of severe exacerbations to reduce their excessive early mortality.
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Affiliation(s)
- Samy Suissa
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.
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The Excessive Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Izquierdo Alonso JL, Rodríguez Glez-Moro JM. The excessive use of inhaled corticosteroids in chronic obstructive pulmonary disease. Arch Bronconeumol 2012; 48:207-12. [PMID: 22385832 DOI: 10.1016/j.arbres.2012.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 01/08/2012] [Indexed: 01/04/2023]
Abstract
Despite the fact that the recommendations of the main clinical guidelines have restricted the indications for inhaled corticosteroids in chronic obstructive pulmonary disease (COPD), currently more than 80% of patients are receiving this treatment in Spain, mostly with high doses. A detailed review of the literature does not justify the use of these high doses, a position that agrees with the recommendations of the FDA. A re-evaluation of their safety, the consistency of the data on their efficacy showing similar results with moderate doses and a better patient selection require the use of this treatment in COPD patients to be reconsidered.
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Abstract
PURPOSE OF REVIEW Although inhaled corticosteroids (ICSs) are the mainstay of therapy in asthma, their use raises certain safety concerns. We review the articles appearing in the last year which have addressed the safety of ICSs when used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). RECENT FINDINGS Recent studies suggest that patients with asthma as opposed to COPD do not experience an excess risk of pneumonia with ICS use. Patients with respiratory diseases are at increased risk of developing active tuberculosis and this excess risk is exacerbated by the use of high doses of ICSs. ICSs have systemic effects and one result appears to be an increase in the risk of diabetes onset and progression, especially at high doses of ICSs. When examining cases of glaucoma requiring therapy, there was no increase in risk with ICSs even at high current and cumulative doses. Finally, use of even high doses of ICSs during pregnancy does not appear to affect foetal adrenal function. SUMMARY ICSs are a highly effective therapy in asthma and have an excellent safety profile at the low doses usually required in asthma. Adverse effects appear mostly at higher doses.
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Waudby CJ, Berg RL, Linneman JG, Rasmussen LV, Peissig PL, Chen L, McCarty CA. Cataract research using electronic health records. BMC Ophthalmol 2011; 11:32. [PMID: 22078460 PMCID: PMC3226674 DOI: 10.1186/1471-2415-11-32] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 11/11/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The eMERGE (electronic MEdical Records and Genomics) network, funded by the National Human Genome Research Institute, is a national consortium formed to develop, disseminate, and apply approaches to research that combine DNA biorepositories with electronic health record (EHR) systems for large-scale, high-throughput genetic research. Marshfield Clinic is one of five sites in the eMERGE network and primarily studied: 1) age-related cataract and 2) HDL-cholesterol levels. The purpose of this paper is to describe the approach to electronic evaluation of the epidemiology of cataract using the EHR for a large biobank and to assess previously identified epidemiologic risk factors in cases identified by electronic algorithms. METHODS Electronic algorithms were used to select individuals with cataracts in the Personalized Medicine Research Project database. These were analyzed for cataract prevalence, age at cataract, and previously identified risk factors. RESULTS Cataract diagnoses and surgeries, though not type of cataract, were successfully identified using electronic algorithms. Age specific prevalence of both cataract (22% compared to 17.2%) and cataract surgery (11% compared to 5.1%) were higher when compared to the Eye Diseases Prevalence Research Group. The risk factors of age, gender, diabetes, and steroid use were confirmed. CONCLUSIONS Using electronic health records can be a viable and efficient tool to identify cataracts for research. However, using retrospective data from this source can be confounded by historical limits on data availability, differences in the utilization of healthcare, and changes in exposures over time.
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Affiliation(s)
- Carol J Waudby
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Richard L Berg
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - James G Linneman
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Luke V Rasmussen
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Peggy L Peissig
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Lin Chen
- Department of Ophthalmology, Marshfield Clinic - Minocqua Center, Minocqua Wisconsin, USA
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Miller DP, Watkins SE, Sampson T, Davis KJ. Long-term use of fluticasone propionate/salmeterol fixed-dose combination and incidence of cataracts and glaucoma among chronic obstructive pulmonary disease patients in the UK General Practice Research Database. Int J Chron Obstruct Pulmon Dis 2011; 6:467-76. [PMID: 22003292 PMCID: PMC3186745 DOI: 10.2147/copd.s14247] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Some large population-based studies have reported a dose-related increased risk of cataracts and glaucoma associated with use of inhaled corticosteroids (ICS) in patients with asthma or chronic obstructive pulmonary disease (COPD). We evaluated the association between use of ICS-containing products, specifically fluticasone propionate/salmeterol fixed-dose combination (FSC), and incidence of cataracts and glaucoma among patients with COPD in a large electronic medical record database in the United Kingdom. Methods We identified a cohort of patients aged 45 years and over with COPD in the General Practice Research Database (GPRD) between 2003 and 2006. Cases of incident cataracts or glaucoma were defined based on diagnosis and procedure codes and matched to controls from the risk set to estimate odds ratios (OR) and 95% confidence intervals (CI). The association with FSC or ICS exposure was modeled using conditional logistic regression. Medication exposure was assessed with respect to recency, duration, and number of prescriptions prior to the index date. Average daily dose was defined as none, low (1–250 mcg), medium (251–500 mcg), high (501–1000 mcg), or very high (1001+ mcg) using fluticasone propionate (FP) equivalents. Results We identified 2941 incident cataract cases and 327 incident glaucoma cases in the COPD cohort (n = 53,191). FSC or ICS prescriptions were not associated with risk of incident cataracts or glaucoma for any exposure category, after adjusting for confounders. We observed a lack of a dose response in all analyses, where low dose was the reference group. The odds of cataracts associated with FSC dose were medium OR: 1.1 (95% CI: 0.9–1.4); high OR: 1.2 (95% CI: 0.9–1.5); and very high OR: 1.2 (95% CI: 0.9–1.7). The odds of glaucoma associated with FSC dose: medium OR: 1.0 (95% CI: 0.5–2.1); high OR: 1.0 (95% CI: 0.5–2.0); and very high OR: 1.0 (95% CI: 0.4–2.8). Conclusions FSC or other ICS exposure was not associated with an increased odds of cataracts or glaucoma, nor was a dose–response relationship observed in this population-based nested case-control study of COPD patients in the United Kingdom.
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Affiliation(s)
- David P Miller
- WorldWide Epidemiology, GlaxoSmithKline, Research Triangle Park, Durham, NC 27709-3398, USA
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