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Jardel H, Rappazzo KM, Luben TJ, Keeler C, Staley BS, Ward-Caviness CK, O'Lenick CR, Rebuli ME, Xi Y, Hernandez M, Chelminski A, Jaspers I, Rappold AG, Dhingra R. Gestational and postnatal exposure to wildfire smoke and prolonged use of respiratory medications in early life. ENVIRONMENTAL RESEARCH, HEALTH : ERH 2024; 2:045004. [PMID: 39268508 PMCID: PMC11389793 DOI: 10.1088/2752-5309/ad748c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/30/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024]
Abstract
As wildfire frequency and severity increases, smoke exposures will cause increasingly more adverse respiratory effects. While acute respiratory effects of smoke exposure have been documented in children, longer term sequelae are largely unstudied. Our objective here was to examine the association between gestational and postnatal exposure to wildfire smoke and prolonged use of prescription medication for respiratory conditions in early childhood. Using Merative MarketScan claims data, we created cohorts of term children born in western states between 1 January 2010-31 December 2014 followed for at least three years. Using NOAA Hazard Mapping System data, we determined the average number of days a week that >25% of the population in a metropolitan statistical area (MSA) was covered by smoke within each exposure period. The exposure periods were defined by trimester and two 12 week postnatal periods. Medication use was based on respiratory indication (upper respiratory, lower respiratory, or any respiratory condition) and categorized into outcomes of prolonged use (⩾30 d use) (PU) and multiple prolonged uses (at least two prolonged uses) (MPU). We used logistic regression models with random intercepts for MSAs adjusted for child sex, birth season, and birth year. Associations differed by exposure period and respiratory outcome, with elevated risk of MPU of lower respiratory medications following exposure in the third trimester and the first 12 postnatal weeks (RR 1.15, 95% CI 0.98, 1.35; RR 1.21, 95% CI 1.05, 1.40, respectively). Exposure in the third trimester was associated with an increase in MPU of any respiratory among males infants only (male RR 1.22, 95% CI 1.00, 1.50; female RR 0.93, 95% CI 0.66, 1.31). Through novel use of prescription claims data, this work identifies critical developmental windows in the 3rd trimester and first 12 postnatal weeks during which environmental inhalational disaster events may impact longer-term respiratory health.
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Affiliation(s)
- Hanna Jardel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
- Oak Ridge Institute for Science and Education (ORISE) Predoctoral Fellow at United States Environmental Protection Agency (US EPA), Research Triangle Park, NC, United States of America
| | - Kristen M Rappazzo
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Thomas J Luben
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Corinna Keeler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Brooke S Staley
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
| | - Cavin K Ward-Caviness
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Cassandra R O'Lenick
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Meghan E Rebuli
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Yuzhi Xi
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States of America
- Oak Ridge Institute for Science and Education (ORISE) Predoctoral Fellow at United States Environmental Protection Agency (US EPA), Research Triangle Park, NC, United States of America
| | - Michelle Hernandez
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ann Chelminski
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Ilona Jaspers
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ana G Rappold
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States of America
| | - Radhika Dhingra
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Brody School of Medicine, East Carolina University, Greenville, NC, United States of America
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Sposato B, Petrucci E, Lacerenza GL, Micheletto C, Montagnani A, Alessandri M, Cresti A, Serafini A, Lena F, Scala R, Rogliani P, Perrella A, Scalese M. Sex differences in excessive oral corticosteroid exposure in poor adherent adult asthmatics overusing short-acting β-2 agonists. Minerva Med 2023; 114:642-651. [PMID: 34269554 DOI: 10.23736/s0026-4806.21.07645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We know that excessive short-acting β2-agonists (SABA) use in asthma may be associated to high exacerbation risks. We studied whether such excessive SABA consumption is connected with different higher oral corticosteroid (OC) prescriptions in the two sexes. METHODS In our prescribing database, we searched subjects aged 18-40 years that were prescribed at least one SABA package/year and/or at least two ICS or two ICS/LABA boxes/year to identify asthmatics. Their OC prescriptions/year were also examined. Subjects were divided into 4 groups according to SABA packages/year prescribed (0, 1-2,3-6 and ≥7), considering sexes separately. RESULTS Individuals recruited were 9,102. Subjects with at least one OC prescription were higher in each group and were females (P<0.001). The OC packages/year number was also more elevated in women especially those with >7 SABA prescriptions/year (0.96 in males vs. 2.64 in females, P<0.001). 94.7%/93.6% males/females, who never used SABA, took at least one ICS/LABA (mean 5.84/5.48 packages/year), while the subject percentage adhering to ICS/LABA dropped to 28-47% (mean 0.94-3.82 packages/year) in those who used SABA (P<0.001). Higher SABA prescriptions were associated with an increasing OC dispensation (β=0.057, P<0.0001). We observed also a greater risk of using >3 OC packages/year in subjects with 3-6 (OR: 2.98 [95% CI: 2.19-4.06], P<0.001) and ≥7 (OR: 3.49 [95% CI: 2.39-5.10], P<0.001) SABA prescriptions compared to those that never used SABA. Besides, we found that using ICS (OR:0.51 [95% CI: 0.35-0.75], P<0.001) or ICS/LABA (OR:0.07 [95% CI: 0.05-0.09], P<0.001) may significantly reduce SABA prescriptions. CONCLUSIONS Poor adherence to maintenance treatment appears to associated with excessive SABA prescriptions that may lead to a higher OC consumption particularly noticeable in women.
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Affiliation(s)
- Bruno Sposato
- Department of Pneumology, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy -
- Experimental Medicine and Systems, Department of Systems Medicine, Tor Vergata University, Rome, Italy -
| | - Elisa Petrucci
- Unit of Local Health, Pharmaceutical Department, USL Toscana Sud Est, Grosseto, Italy
| | - Gianluca L Lacerenza
- Unit of Local Health, Pharmaceutical Department, USL Toscana Sud Est, Grosseto, Italy
| | - Claudio Micheletto
- Respiratory Unit, Cardio-Thoracic Department, Integrated University Hospital, Verona, Italy
| | - Andrea Montagnani
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Grosseto, Italy
| | - Massimo Alessandri
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Grosseto, Italy
| | - Alberto Cresti
- Department of Cardiology, Misericordia Hospital, USL Tuscany South-East, Grosseto, Italy
| | - Andrea Serafini
- Department Medical Management, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy
| | - Fabio Lena
- Unit of Local Health, Pharmaceutical Department, USL Toscana Sud Est, Grosseto, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Paola Rogliani
- Respiratory Unit, Department of Experimental Medicine, Tor Vergata University, Rome, Italy
| | - Antonio Perrella
- Department of Pneumology, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Carlsen HK, Valdimarsdóttir U, Briem H, Dominici F, Finnbjornsdottir RG, Jóhannsson T, Aspelund T, Gislason T, Gudnason T. Severe volcanic SO 2 exposure and respiratory morbidity in the Icelandic population - a register study. Environ Health 2021; 20:23. [PMID: 33639965 PMCID: PMC7916308 DOI: 10.1186/s12940-021-00698-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/01/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND The Holuhraun volcanic eruption September 2014 to February 2015 emitted large amounts of sulfur dioxide (SO2). The aim of this study was to determine the association between volcanic SO2 gases on general population respiratory health some 250 km from the eruption site, in the Icelandic capital area. METHODS Respiratory health outcomes were: asthma medication dispensing (AMD) from the Icelandic Medicines Register, medical doctor consultations in primary care (PCMD) and hospital emergency department visits (HED) in Reykjavík (population: 215000) for respiratory disease from 1 January 2010 to 31 December 2014. The associations between daily counts of health events and daily mean SO2 concentration and high SO2 levels (24-h mean SO2 > 125 μg/m3) were analysed using generalized additive models. RESULTS After the eruption began, AMD was higher than before (129.4 vs. 158.4 individuals per day, p < 0.05). For PCMD and HED, there were no significant differences between the number of daily events before and after the eruption (142.2 vs 144.8 and 18.3 vs 17.5, respectively). In regression analysis adjusted for other pollutants, SO2 was associated with estimated increases in AMD by 0.99% (95% CI 0.39-1.58%) per 10 μg/m3 at lag 0-2, in PCMD for respiratory causes 1.26% (95% CI 0.72-1.80%) per 10 μg/m3 SO2 at lag 0-2, and in HED by 1.02% (95% CI 0.02-2.03%) per 10 μg/m3 SO2 at lag 0-2. For days over the health limit, the estimated increases were 10.9% (95% CI 2.1-19.6%), 17.2% (95% CI 10.0-24.4%) for AMD and PCMD. Dispensing of short-acting medication increased significantly by 1.09% (95% CI 0.49-1.70%), and PCMD for respiratory infections and asthma and COPD diagnoses and increased significantly by 1.12% (95% CI 0.54-1.71%) and 2.08% (1.13-3.04%). CONCLUSION High levels of volcanic SO2 are associated with increases in dispensing of AMD, and health care utilization in primary and tertiary care. Individuals with prevalent respiratory disease may be particularly susceptible.
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Affiliation(s)
- Hanne Krage Carlsen
- Centre of Public Health Sciences, University of Iceland, Sturlugata 8, Reykjavík, 102 Iceland
- Environment and Natural resources, University of Iceland, Sturlugata 7, University of Iceland, 102 Reykjavík, Iceland
- Section of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Medicinaregatan 16A, 40530 Gothenburg, Sweden
| | - Unnur Valdimarsdóttir
- Centre of Public Health Sciences, University of Iceland, Sturlugata 8, Reykjavík, 102 Iceland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 6, SE-171 77 Stockholm, Sweden
| | - Haraldur Briem
- Chief Epidemiologist, Directorate of Health, Centre for Health Threats and Communicable Diseases, Barónsstigur 57, 101 Reykjavík, Iceland
| | - Francesca Dominici
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | | | | | - Thor Aspelund
- School of Health Sciences, University of Iceland, Sæmundargata 2, 101 Reykjavík, Iceland
| | - Thorarinn Gislason
- Landspitali – the National University Hospital, Fossvogur, 108 Reykjavík, Iceland
- Faculty of medicine, University of Iceland, Vatnsmýrarvegi 16, 101 Reykjavík, Iceland
| | - Thorolfur Gudnason
- Chief Epidemiologist, Directorate of Health, Centre for Health Threats and Communicable Diseases, Barónsstigur 57, 101 Reykjavík, Iceland
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Bustaffa E, Cori L, Manzella A, Nuvolone D, Minichilli F, Bianchi F, Gorini F. The health of communities living in proximity of geothermal plants generating heat and electricity: A review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 706:135998. [PMID: 31862594 DOI: 10.1016/j.scitotenv.2019.135998] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
Since the 1990s, in areas with natural geothermal manifestations studies on the association between exposure to pollutants and health effect have become increasingly relevant. These emissions consist of water vapor mixed with carbon dioxide, hydrogen sulfide (H2S), methane and, to a lesser extent, rare gases and trace elements in volatile forms. Considering the indications of the World Health Organization and the growth in the use of geothermal energy for energy production, this review aims to report studies exploring the health status of the populations living in areas where geothermal energy is used to produce heat and electricity. Studies on the health effects of the general population exposed to emissions from both natural geothermal events and plants using geothermal energy at domestic or commercial level have been considered between 1999 and 2019. Studies were classified into those based on health indicators and those based on proxy-individual level exposure metrics. Both statistically significant results (p<0.05) and interesting signals were commented. The 19 studies selected (New Zealand, Iceland and Italy) provide heterogeneous results, with an increased risk for several tumor sites. Exposure to H2S low concentrations is positively associated with an increment of respiratory symptoms, anti-asthma drugs use, mortality for respiratory diseases and lung cancer. Exposure to H2S high levels is inversely related to cancer mortality but associated with an increase in hospitalization for respiratory diseases, central nervous system disorders and cardiovascular diseases. The results indicate that the health of populations residing in areas rich in geothermal emissions presents some critical elements to be explored. The two major limitations of the studies are the ecological design and the inadequate exposure assessment. The authors suggested the prosecution and the systematization of health surveillance and human biomonitoring activities associated with permanent control of atmospheric emissions from both industrial and natural plants.
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Affiliation(s)
- Elisa Bustaffa
- Unit of Environmental Epidemiology and Diseases Registries, Institute of Clinical Physiology, National Research Council, IFC-CNR, via Moruzzi 1, Pisa 56124, Italy.
| | - Liliana Cori
- Unit of Environmental Epidemiology and Diseases Registries, Institute of Clinical Physiology, National Research Council, IFC-CNR, via Moruzzi 1, Pisa 56124, Italy
| | - Adele Manzella
- Institute of Geosciences and Earth Resources, National Research Council, IGG-CNR, via Moruzzi 1, Pisa 56124, Italy
| | - Daniela Nuvolone
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, Florence 50100, Italy
| | - Fabrizio Minichilli
- Unit of Environmental Epidemiology and Diseases Registries, Institute of Clinical Physiology, National Research Council, IFC-CNR, via Moruzzi 1, Pisa 56124, Italy
| | - Fabrizio Bianchi
- Unit of Environmental Epidemiology and Diseases Registries, Institute of Clinical Physiology, National Research Council, IFC-CNR, via Moruzzi 1, Pisa 56124, Italy
| | - Francesca Gorini
- Unit of Environmental Epidemiology and Diseases Registries, Institute of Clinical Physiology, National Research Council, IFC-CNR, via Moruzzi 1, Pisa 56124, Italy
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Guo CL, Sun XM, Wang XW, Guo Q. Serum Eosinophil Cationic Protein Is a Useful Marker for Assessing the Efficacy of Inhaled Corticosteroid Therapy in Children with Bronchial Asthma. TOHOKU J EXP MED 2018; 242:263-271. [PMID: 28781336 DOI: 10.1620/tjem.242.263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bronchial asthma (BA) is a chronic inflammatory disorder of airways for which the effective therapies include inhaled corticosteroids (ICS) and short-acting β2-adrenoreceptor agonist (SABA). Serum eosinophil cationic protein (ECP) has been reported to reflect the degree of airway inflammation. We, therefore, explored the implication of serum ECP in assessing the efficacy of ICS therapy in BA children. Our prospective randomized control study enrolled 126 BA children and 78 healthy children (the control group). The BA patients were randomly assigned as two groups; 59 children were treated with ICS, twice a day, for three months and 67 patients received SABA inhalation only if necessary. After the 3-month therapy, the serum levels of ECP, endothelin-1, and nitric oxide and the eosinophil percentage (EOS%) in induced sputum were significantly lower in the ICS group, compared with the SABA group, but were still higher than the control group (all P < 0.05). The forced expiratory volume (FEV1%pred) and forced vital capacity (FEV1/FVC) were improved to the levels of the control group after therapy. Pearson correlation analysis presented that higher serum ECP levels were associated with higher EOS% in serum and with lower pulmonary function indices (FEVl%pred and FEV1/FVC). Importantly, the ICS group exhibited higher quality of life scores and lower symptom scores compared with the SABA group (all P < 0.05). ROC results revealed the diagnostic efficiency of serum ECP levels on the efficacy of ICS. In conclusion, measuring serum ECP levels is helpful for assessing the efficacy of ICS therapy in BA children.
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Affiliation(s)
- Cai-Li Guo
- The Respiratory Department, Children's Hospital of Zhengzhou
| | - Xiao-Min Sun
- The Respiratory Department, Children's Hospital of Zhengzhou
| | - Xiao-Wen Wang
- The Respiratory Department, Children's Hospital of Zhengzhou
| | - Qing Guo
- The Respiratory Department, Children's Hospital of Zhengzhou
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Pharmacist-managed short-acting beta agonist refill service in a general pediatric clinic. J Am Pharm Assoc (2003) 2018; 58:296-302. [PMID: 29402662 DOI: 10.1016/j.japh.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/21/2017] [Accepted: 01/01/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To use a pharmacist-managed short-acting beta agonist (SABA) service (1) to determine the patient's rationale for SABA refill requests, (2) to assess adherence to current controller therapy and current level of disease control, and (3) to characterize the pharmacist's recommendations made in response to a patient's SABA refill request. SETTING An academic-based general pediatric clinic. PRACTICE DESCRIPTION SABA overuse is a marker of increased morbidity and mortality in children with asthma. This article describes a pharmacist-managed SABA refill telephone service. PRACTICE INNOVATION The pediatric ambulatory care pharmacy team assessed and authorized (or denied) all SABA refill requests, provided education, and facilitated appropriate follow-up using a telephone service. INTERVENTIONS Upon receiving a patient-requested SABA refill, the pharmacist identified the reason for the SABA request, assessed asthma control, and determined adherence to daily controllers or spacer use, if applicable. Education was also provided. Data obtained were used to determine SABA refill approval. EVALUATION Primary reasons for SABA refill request were for (1) current symptom management and (2) no refills remaining in the absence of symptoms. Forty-two (50%) SABA refill requests were eligible for refill per the clinic algorithm, yet 70% actually received a refill after assessment by the pharmacist. Asthma control was assessed as 26% well controlled, 38% not well controlled, and 36% very poorly controlled. Forty-eight percent of patients prescribed daily controller medications were deemed adherent. Spacers were used in 43 of 76 (56%) patients using metered dose inhalers. Education was provided to 82% of caregivers. Pharmacists facilitated asthma follow-up visits in 41 of 84 (49%) patients contacted, and 61% of those appointments were kept. CONCLUSIONS Pharmacist management of a SABA refill telephone service provides an additional means for delivery of asthma education, facilitates follow-up asthma care, helps to identify patients at risk for increased morbidity and mortality due to the overuse of SABAs, and provides another mechanism for medication refills.
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Lietzén R, Virtanen P, Kivimäki M, Korkeila J, Suominen S, Sillanmäki L, Koskenvuo M, Vahtera J. Change in β 2-agonist use after severe life events in adults with asthma: A population-based cohort study: Life events and bronchodilator usage among adults with asthma. J Psychosom Res 2017; 100:46-52. [PMID: 28789792 PMCID: PMC5556252 DOI: 10.1016/j.jpsychores.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/15/2017] [Accepted: 07/04/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This prospective, population-based cohort study of 1102 Finnish adults with asthma, examined whether exposure to stressful life events is associated with the intensity of usage of inhaled short-acting β2-agonists. METHODS Survey data was collected by two postal questionnaires. Baseline characteristics were obtained in 1998 and data on 19 specific stressful events (e.g. death of a child or spouse or divorce) within the six preceding months in 2003. Exposure to life events was indicated by a sum score weighted by mean severity of the events. Participants were linked to records of filled prescriptions for inhaled short-acting β2-agonists from national registers from 2000 through 2006. The rates of purchases of short-acting β2-agonists before (2000-2001), during (2002-2003) and after (2004-2006) the event exposure were estimated using repeated-measures Poisson regression analyses with the generalized estimating equation. RESULTS Of the 1102 participants, 162 (15%) were exposed to highly stressful events, 205 (19%) to less stressful events. During the 7-year observation period, 5955 purchases of filled prescription for inhaled short-acting β2-agonists were recorded. After exposure to highly stressful events, the rate of purchases of β2-agonists was 1.50 times higher (95% confidence interval (CI): 1.05, 2.13) than before the stressful event occurred. Among those with low or no exposure to life events, the corresponding rate ratios were not elevated (rate ratio 0.81, 95% CI: 0.66, 0.99 and 0.95, 95% CI: 0.83, 1.09 respectively). CONCLUSION An increase in β2-agonist usage after severe life events suggests that stressful experiences may worsen asthma symptoms.
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Affiliation(s)
- Raija Lietzén
- Department of Public Health, University of Turku, Turku, Finland.
| | - Pekka Virtanen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Mika Kivimäki
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland,Department of Epidemiology and Public Health, University College London Medical School, London, United Kingdom
| | - Jyrki Korkeila
- Department of Psychiatry, University of Turku and Harjavalta Hospital, Satakunta Hospital District, Harjavalta, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland,Department of Public Health, University of Skövde, Skövde, Sweden
| | - Lauri Sillanmäki
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markku Koskenvuo
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
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Boulieri A, Hansell A, Blangiardo M. Investigating trends in asthma and COPD through multiple data sources: A small area study. Spat Spatiotemporal Epidemiol 2016; 19:28-36. [PMID: 27839578 PMCID: PMC5118221 DOI: 10.1016/j.sste.2016.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 11/23/2022]
Abstract
This paper investigates trends in asthma and COPD by using multiple data sources to help understanding the relationships between disease prevalence, morbidity and mortality. GP drug prescriptions, hospital admissions, and deaths are analysed at clinical commissioning group (CCG) level in England from August 2010 to March 2011. A Bayesian hierarchical model is used for the analysis, which takes into account the complex space and time dependencies of asthma and COPD, while it is also able to detect unusual areas. Main findings show important discrepancies across the different data sources, reflecting the different groups of patients that are represented. In addition, the detection mechanism that is provided by the model, together with inference on the spatial, and temporal variation, provide a better picture of the respiratory health problem.
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Affiliation(s)
- Areti Boulieri
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.
| | - Anna Hansell
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Marta Blangiardo
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
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9
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Fattore E, Davoli E, Castiglioni S, Bosetti C, Re Depaolini A, Marzona I, Zuccato E, Fanelli R. Wastewater-based epidemiological evaluation of the effect of air pollution on short-acting beta-agonist consumption for acute asthma treatment. ENVIRONMENTAL RESEARCH 2016; 150:106-111. [PMID: 27281687 DOI: 10.1016/j.envres.2016.05.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/26/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
Asthma, one of the most common chronic diseases in the world and a leading cause of hospitalization among children, has been associated with outdoor air pollution. We applied the wastewater-based epidemiology (WBE) approach to study the association between the use of salbutamol, a short-acting beta-agonist used to treat acute bronchospasm, and air pollution in the population of Milan, Italy. Composite 24-h samples of untreated wastewater were collected daily and analyzed for human metabolic residues of salbutamol by liquid chromatography tandem mass spectrometry. Corresponding daily outdoor concentrations of particular matter up to 10µm (PM10) and 2.5µm (PM2.5) in aerodynamic diameter, nitrogen dioxide, ozone, sulfur dioxide, and benzene were collected from the public air monitoring network. Associations at different lag times (0-10 days) were assessed by a log-linear Poisson regression model. We found significant direct associations between defined daily doses (DDD) of salbutamol and mean daily concentrations of PM10 and PM2.5 up to nine days of lag time. The highest rate ratio, and 95% confidence interval (CI), of DDD of salbutamol was 1.06 (95% CI: 1.02-1.10) and 1.07 (95% CI: 1.02-1.12) at seven days of lag time and for an increase of 10 μg/m(3) of PM10 and PM2.5, respectively. Reducing the mean daily PM10 concentration in Milan from 50 to 30μg/m(3) means that 852 (95% CI: 483-1504) daily doses of salbutamol per day would not be used. These results confirm the association between asthma and outdoor PM10 and PM2.5 and prove the potential of the WBE approach to quantitatively estimate the relation between environmental exposures and diseases.
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Affiliation(s)
- Elena Fattore
- Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy.
| | - Enrico Davoli
- Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy.
| | - Sara Castiglioni
- Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy.
| | - Cristina Bosetti
- Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy.
| | - Andrea Re Depaolini
- Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy.
| | - Irene Marzona
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy.
| | - Ettore Zuccato
- Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy.
| | - Roberto Fanelli
- Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy.
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Taj T, Jakobsson K, Stroh E, Oudin A. Air pollution is associated with primary health care visits for asthma in Sweden: A case-crossover design with a distributed lag non-linear model. Spat Spatiotemporal Epidemiol 2016; 17:37-44. [PMID: 27246271 DOI: 10.1016/j.sste.2016.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/18/2016] [Accepted: 04/27/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Air pollution can increase the symptoms of asthma and has an acute effect on the number of emergency room visits and hospital admissions because of asthma, but little is known about the effect of air pollution on the number of primary health care (PHC) visits for asthma. OBJECTIVE To investigate the association between air pollution and the number of PHC visits for asthma in Scania, southern Sweden. METHODS Data on daily PHC visits for asthma were obtained from a regional healthcare database in Scania, which covers approximately half a million people. Air pollution data from 2005 to 2010 were obtained from six urban background stations. We used a case-crossover study design and a distributed lag non-linear model in the analysis. RESULTS The air pollution levels were generally within the EU air quality guidelines. The mean number of daily PHC visits for asthma was 34. The number of PHC visits increased by 5% (95% confidence interval (CI): 3.91-6.25%) with every 10µg m(-3) increase in daily mean NO2 lag (0-15), suggesting that daily air pollution levels are associated with PHC visits for asthma. CONCLUSION Even though the air quality in Scania between 2005 and 2010 was within EU's guidelines, the number of PHC visits for asthma increased with increasing levels of air pollution. This suggests that as well as increasing hospital and emergency room visits, air pollution increases the burden on PHC due to milder symptoms of asthma.
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Affiliation(s)
- Tahir Taj
- Laboratory Medicine, Occupational and Environmental Medicine, Lund University, Lund, Sweden. .
| | - Kristina Jakobsson
- Laboratory Medicine, Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Emilie Stroh
- Laboratory Medicine, Occupational and Environmental Medicine, Lund University, Lund, Sweden. ; Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden
| | - Anna Oudin
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden
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11
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Two-stage Bayesian model to evaluate the effect of air pollution on chronic respiratory diseases using drug prescriptions. Spat Spatiotemporal Epidemiol 2016; 18:1-12. [PMID: 27494955 DOI: 10.1016/j.sste.2016.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/22/2022]
Abstract
Exposure to high levels of air pollutant concentration is known to be associated with respiratory problems which can translate into higher morbidity and mortality rates. The link between air pollution and population health has mainly been assessed considering air quality and hospitalisation or mortality data. However, this approach limits the analysis to individuals characterised by severe conditions. In this paper we evaluate the link between air pollution and respiratory diseases using general practice drug prescriptions for chronic respiratory diseases, which allow to draw conclusions based on the general population. We propose a two-stage statistical approach: in the first stage we specify a space-time model to estimate the monthly NO2 concentration integrating several data sources characterised by different spatio-temporal resolution; in the second stage we link the concentration to the β2-agonists prescribed monthly by general practices in England and we model the prescription rates through a small area approach.
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Blakey JD, Zaidi S, Shaw DE. Defining and managing risk in asthma. Clin Exp Allergy 2015; 44:1023-32. [PMID: 24773229 DOI: 10.1111/cea.12334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Asthma attacks are a major global source of morbidity and cost. The incidence and impact of asthma attacks have not improved despite widespread adoption of effective universal treatment guidelines. Consequently, there is increasing interest in managing asthma based on specific assessments of both current symptoms and future risk. In this review, we consider 'risk' in asthma, and how it might be assessed from the patient's history and objective measurements. We also discuss the potential for encouraging shared decision-making and improving medical consensus through explicit communication of risk and highlight the potential opportunities and challenges in risk assessment to improve asthma management through individualised treatment strategies.
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Affiliation(s)
- J D Blakey
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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High Blood Eosinophil Count Is a Risk Factor for Future Asthma Exacerbations in Adult Persistent Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:741-50. [DOI: 10.1016/j.jaip.2014.06.005] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/03/2014] [Accepted: 06/12/2014] [Indexed: 02/03/2023]
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Yitshak-Sade M, Novack V, Katra I, Gorodischer R, Tal A, Novack L. Non-anthropogenic dust exposure and asthma medication purchase in children. Eur Respir J 2014; 45:652-60. [PMID: 25323244 DOI: 10.1183/09031936.00078614] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Air pollution has been shown to increase frequency of asthma attacks, as usually measured by hospitalisation rates. We hypothesise that purchase of asthma reliever medications will reflect a broader association between the environmental exposure and asthma exacerbations. In a time series analysis, we estimated the association of dust storms with mild asthma manifestations, as indicated by medication purchases, during 2005-2011. We compared our results with the estimation of the association of dust storms with hospitalisations due to asthma and asthma-like symptoms. We detected 289 dust storms characterised by high levels of particulate matter <10 μm in diameter. We identified 42,920 children with asthma, wheezing or asthma-like symptoms, of whom 2418 were hospitalised. We observed a higher risk of asthma medication purchase on the day of a mild dust storm (relative risk 1.05, 95% CI 1.00-1.10). The next peak in drug purchases was 3 days later and was more pronounced among Bedouin-Arab children. Stratified analyses showed higher risks for hospitalisation among Bedouin-Arab children; especially among children living in temporary houses (relative risk 1.33, 95% CI 1.04-1.71). We observed an increased risk of asthma medication purchase associated with mild dust storms. The risk observed for hospitalisation was more pronounced among the rural Bedouin-Arab population.
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Affiliation(s)
- Maayan Yitshak-Sade
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Itzhak Katra
- Dept of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rafael Gorodischer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Dept of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
| | - Asher Tal
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Dept of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lena Novack
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Sofianopoulou E, Rushton SP, Diggle PJ, Pless-Mulloli T. Association between respiratory prescribing, air pollution and deprivation, in primary health care. J Public Health (Oxf) 2014; 35:502-9. [PMID: 24293452 DOI: 10.1093/pubmed/fdt107] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We investigated the association between respiratory prescribing, air quality and deprivation in primary health care. Most previous studies have used data from secondary and tertiary care to quantify air pollution effects on exacerbations of asthma and chronic obstructive pulmonary disease (COPD). However, these outcomes capture patients who suffer from relatively severe symptoms. METHODS This is a population-based ecological study. We analysed respiratory medication (salbutamol) prescribed monthly by 63 primary care practices, UK. Firstly, we captured the area-wide seasonal variation in prescribing. Then, using the area-wide variation in prescribing as an offset, we built a mixed-effects model to assess the remaining variation in relation to air quality and demographic variables. RESULTS An increase of 10 μg/m(3) in ambient PM10 was associated with an increase of 1% (95% CI: 0.1-2%) in salbutamol prescribing. An increase of 1 SD in income and employment deprivation was associated with an increase of 20.5% (95% CI: 8.8-33.4%) and 14.7% (95% CI: 4.3-26.2%) in salbutamol prescribing rate, respectively. CONCLUSIONS The study provides evidence that monthly respiratory prescribing in primary care is a useful indicator of the extent to which air pollution exacerbates asthma and COPD symptoms. Respiratory prescribing was higher on deprived populations.
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Affiliation(s)
- Eleni Sofianopoulou
- Newcastle University, Institute of Health and Society, Baddiley-Clark Building, The Medical School, Newcastle upon Tyne NE2 4AX, UK
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Zeiger RS, Schatz M, Li Q, Solari PG, Zazzali JL, Chen W. Real-time asthma outreach reduces excessive short-acting β2-agonist use: a randomized study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:445-456, 456.e1-5. [PMID: 25017534 DOI: 10.1016/j.jaip.2014.01.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/28/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Excessive use of short-acting β2-agonists (SABA) indicates impaired asthma control. OBJECTIVE To determine whether real-time outreach to excessive SABA users reduces SABA canister dispensings. METHODS After real-time determination of a seventh SABA canister dispensing in the prior 12 months by using informational pharmacy technology, 12 to 56 year old patients with physician-coded asthma and inhaled corticosteroid dispensing were block randomized by prior asthma specialist care and medication step-care level into intervention (n = 1001) and control groups (n = 998). Intervention included real-time letter notification to patients and an electronic message to their physician with management suggestions, including facilitated allergy referral for patients without prior asthma specialist care. The control group received this organization's standard asthma care management without research contact. Frequency of the seventh SABA canister dispensing in the follow-up year was the primary outcome. RESULTS Compared with controls, intervention patients reached 7 SABA canister dispensings less frequently (50.7% vs 57.1%; risk ratio 0.89 [95% CI, 0.82-0.97]; P = .007) and later (hazard ratio 0.80 [95% CI, 0.71-0.91; P < .001). SABA canister dispensings (mean ± SD) were less in intervention (7.5 ± 4.9 canisters) than controls (8.6 ± 5.3 canisters) (rate ratio 0.87 [95% CI, 0.82-0.93]; P < .001). The intervention reduced the risk of ≥7 SABA canister dispensings in patients without specialist care compared with patients with specialist care in the prior 3 years (P < .001) (P = .04 for interaction by prior specialist care). Visits to allergists were more frequent for intervention patients (30.9%) than for control patients (16.8%) (risk ratio 1.83 [95% CI, 1.54-2.16]; P < .001). Asthma exacerbations were unaffected. CONCLUSIONS A novel administrative-based asthma outreach program improves markers of asthma impairment in patients without prior asthma specialist care and is adaptable to managed care organizations with electronic medical records.
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Affiliation(s)
- Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.
| | - Michael Schatz
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif
| | - Qiaowu Li
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif
| | | | | | - Wansu Chen
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif
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Bollinger ME, Mudd KE, Boldt A, Hsu VD, Tsoukleris MG, Butz AM. Prescription fill patterns in underserved children with asthma receiving subspecialty care. Ann Allergy Asthma Immunol 2013; 111:185-9. [PMID: 23987193 DOI: 10.1016/j.anai.2013.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 05/13/2013] [Accepted: 06/08/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children with asthma receiving specialty care have been found to have improved asthma outcomes. However, these outcomes can be adversely affected by poor adherence with controller medications. OBJECTIVE To analyze pharmacy fill patterns as a measure of primary adherence in a group of underserved minority children receiving allergy subspecialty care. METHODS As part of a larger 18-month nebulizer use study in underserved children (ages 2-8 years) with persistent asthma, 53 children were recruited from an urban allergy practice. Pharmacy records were compared with prescribing records for all asthma medications. RESULTS Allergist controller prescriptions were written in 30-day quantities with refills and short-acting β-agonists (SABAs) with no refills. Only 49.1% of inhaled corticosteroid (ICS), 49.5% of combination ICS and long-acting β-agonist, and 64.5% of leukotriene modifier (LTM) initial and refill prescriptions were ever filled during the 18-month period. A mean of 5.1 refills (range, 0-14) for SABAs were obtained during 18 months, although only 1.28 SABA prescriptions were prescribed by the allergist. Mean times between first asthma prescription and actual filling were 30 days (range, 0-177 days) for ICSs, 26.6 days (range, 0-156 days) for LTMs, and 16.8 days (range, 0-139 days) for SABAs. CONCLUSION Underserved children with asthma receiving allergy subspecialty care suboptimally filled controller prescriptions, yet filled abundant rescue medications from other prescribers. Limiting albuterol prescriptions to one canister without additional refills may provide an opportunity to monitor fill rates of both rescue and controller medications and provide education to patients about appropriate use of medications to improve adherence.
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Affiliation(s)
- Mary E Bollinger
- Division of Pediatric Pulmonology and Allergy, University of Maryland, Baltimore, Maryland, USA.
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18
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Elliott CT, Henderson SB, Wan V. Time series analysis of fine particulate matter and asthma reliever dispensations in populations affected by forest fires. Environ Health 2013; 12:11. [PMID: 23356966 PMCID: PMC3582455 DOI: 10.1186/1476-069x-12-11] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 01/10/2013] [Indexed: 05/15/2023]
Abstract
BACKGROUND Several studies have evaluated the association between forest fire smoke and acute exacerbations of respiratory diseases, but few have examined effects on pharmaceutical dispensations. We examine the associations between daily fine particulate matter (PM2.5) and pharmaceutical dispensations for salbutamol in forest fire-affected and non-fire-affected populations in British Columbia (BC), Canada. METHODS We estimated PM2.5 exposure for populations in administrative health areas using measurements from central monitors. Remote sensing data on fires were used to classify the populations as fire-affected or non-fire-affected, and to identify extreme fire days. Daily counts of salbutamol dispensations between 2003 and 2010 were extracted from the BC PharmaNet database. We estimated rate ratios (RR) and 95% confidence intervals (CIs) for each population during all fire seasons and on extreme fire days, adjusted for temperature, humidity, and temporal trends. Overall effects for fire-affected and non-fire-affected populations were estimated via meta-regression. RESULTS Fire season PM2.5 was positively associated with salbutamol dispensations in all fire-affected populations, with a meta-regression RR (95% CI) of 1.06 (1.04-1.07) for a 10 ug/m3 increase. Fire season PM2.5 was not significantly associated with salbutamol dispensations in non-fire-affected populations, with a meta-regression RR of 1.00 (0.98-1.01). On extreme fire days PM2.5 was positively associated with salbutamol dispensations in both population types, with a global meta-regression RR of 1.07 (1.04 - 1.09). CONCLUSIONS Salbutamol dispensations were clearly associated with fire-related PM2.5. Significant associations were observed in smaller populations (range: 8,000 to 170,000 persons, median: 26,000) than those reported previously, suggesting that salbutamol dispensations may be a valuable outcome for public health surveillance during fire events.
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Affiliation(s)
- Catherine T Elliott
- British Columbia Center for Disease Control, Environmental Health Services, BC Centre for Disease Control, Main Floor, 655 12th Ave W, Vancouver, BC, V5Z 4R4, Canada
- University of British Columbia School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sarah B Henderson
- British Columbia Center for Disease Control, Environmental Health Services, BC Centre for Disease Control, Main Floor, 655 12th Ave W, Vancouver, BC, V5Z 4R4, Canada
- University of British Columbia School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Victoria Wan
- British Columbia Center for Disease Control, Environmental Health Services, BC Centre for Disease Control, Main Floor, 655 12th Ave W, Vancouver, BC, V5Z 4R4, Canada
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Nilsson JLG, Haupt D, Krigsman K, Moen J. Asthma/COPD drugs reflecting disease prevalence, patient adherence and persistence. Expert Rev Respir Med 2012; 3:93-101. [PMID: 20477285 DOI: 10.1586/17476348.3.1.93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this review is to discuss the methodological issues involved in using pharmacy-record databases of drug sales in pharmacoepidemiology and to illustrate the usefulness of such data in estimating disease prevalence, patient adherence and persistence to therapy. Recent studies show that asthma/chronic obstructive pulmonary disease (COPD) prevalence increases with age. The volume of acquired asthma/COPD drugs per patient also increases with age and was approximately 2.5-times higher for patients aged 60-69 years compared with patients aged 20-29 years. Despite this, there is a comparatively low interest in asthma/COPD research involving elderly individuals. Published asthma/COPD-prevalence data and drug-treatment-prevalence data correspond reasonably well. Short- as well as long-term studies on drug acquisition indicate that approximately a third of patients have drugs available to cover at least 80% of the prescribed treatment time. Only approximately a tenth of the patients acquired steroids or steroid combinations, corresponding to one daily defined dose per day over a 5-year treatment period. It is probable that asthma/COPD is undertreated in all age groups.
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Stanford RH, Shah MB, D'Souza AO, Dhamane AD, Schatz M. Short-acting β-agonist use and its ability to predict future asthma-related outcomes. Ann Allergy Asthma Immunol 2012. [PMID: 23176877 DOI: 10.1016/j.anai.2012.08.014] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Short-acting β-agonist (SABA) use is well established in predicting asthma events in adults. However, this predictive ability has yet to be established in a pediatric population together with an assessment of amount of use. OBJECTIVE To identify the number of SABA canisters that best predicts future asthma-related exacerbations and the optimal length of time for measurement of SABA use in pediatric and adult asthma patients. METHODS Asthma patients were identified from a Medicaid and a commercially insured database (January 1, 2004, through December 31, 2005, and January 1, 2004, through June 30, 2006, respectively). Following the date of first asthma medication, an assessment period (3, 6, or 12 months) was used to measure SABA use. Asthma-related exacerbations were identified in the subsequent 12-month period. Receiver operating characteristic curve analyses and logistic regression were used to select the critical values of SABA use and optimal assessment periods and to conduct incremental analysis, respectively. RESULTS A total of 33,793 Medicaid and 101,437 commercial patients met the study criteria. Use of 3 or more SABA canisters during 12 months was identified in both pediatric Medicaid and commercial populations to best predict an increased risk of an asthma-related exacerbation. For adults, use of 2 or more SABA canisters was found as the critical value with shorter optimal assessment periods of 3 and 6 months. Each additional SABA canister resulted in an 8% to 14% and 14% to 18% increase in risk of an asthma-related exacerbation in children and adults, respectively. CONCLUSION The study identified critical values of SABA use that predict future asthma events. Each additional SABA canister predicted increases in exacerbation risk in children and adults.
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Bechtold P, Ranzi A, Gambini M, Capelli O, Magrini N, Cavallini R, Gallo L, Casale G, De Togni A, Cavagni G, Lauriola P. Assessing paediatric asthma occurrence through dispensed prescription data and questionnaires. Eur J Public Health 2012; 23:873-8. [PMID: 22689383 DOI: 10.1093/eurpub/cks066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of asthma, a common disorder in childhood, is often estimated by cross-sectional studies based on questionnaires, with the drawback that estimates are limited to certain age groups and areas. The use of electronic health data is increasingly allowing researchers to overcome these limitations. This study is aimed at assessing asthma occurrence of a school-aged population in Northeast Italy using two different data sources. METHODS In 2004, a population-based survey using a standardized questionnaire was conducted to estimate asthma occurrence among a resident population of children aged 6-7 years and adolescents aged 13 years. A selection of dispensed asthma medications was extracted from electronic databases for a 4-year period prior to questionnaire completion (2000-03). Asthma prevalence was estimated by commonly used questionnaire classifications and compared with use of inhaled bronchodilators (alone or in combination) in various time periods. Correlations between the two approaches were calculated. RESULTS A total of 10 252 subjects were eligible for analysis (85% of the resident population). A total of 4747 subjects (38% of the resident population) were registered in the drug database during 2000-03. Asthma prevalence was higher in males and in children. Congruence between the two enquiry methods varied according to criteria applied and improved with the protraction of the observation period. CONCLUSION A longer period for the capture of medication data yielded higher congruence. A degree of mismatch was observed between the two methods most likely related to factors of drug use and questionnaire reliability. Nonetheless, the benefits of using easily accessible population data prevail, and further studies are warranted.
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Affiliation(s)
- Petra Bechtold
- 1 Regional Reference Centre Environment and Health, ARPA Emilia-Romagna, Modena, Italy
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Carlsen HK, Zoëga H, Valdimarsdóttir U, Gíslason T, Hrafnkelsson B. Hydrogen sulfide and particle matter levels associated with increased dispensing of anti-asthma drugs in Iceland's capital. ENVIRONMENTAL RESEARCH 2012; 113:33-39. [PMID: 22264878 DOI: 10.1016/j.envres.2011.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 09/28/2011] [Accepted: 10/18/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Air pollutants in Iceland's capital area include hydrogen sulfide (H2S) emissions from geothermal power plants, particle pollution (PM10) and traffic-related pollutants. Respiratory health effects of exposure to PM and traffic pollutants are well documented, yet this is one of the first studies to investigate short-term health effects of ambient H2S exposure. OBJECTIVES The aim of this study was to investigate the associations between daily ambient levels of H2S, PM10, nitrogen dioxide (NO2) and ozone (O3), and the use of drugs for obstructive pulmonary diseases in adults in Iceland's capital area. METHODS The study period was 8 March 2006 to 31 December 2009. We used log-linear Poisson generalized additive regression models with cubic splines to estimate relative risks of individually dispensed drugs by air pollution levels. A three-day moving average of the exposure variables gave the best fit to the data. Final models included significant covariates adjusting for climate and influenza epidemics, as well as time-dependent variables. RESULTS The three-day moving average of H2S and PM10 levels were positively associated with the number of individuals who were dispensed drugs at lag 3-5, corresponding to a 2.0% (95% confidence interval [CI] 0.4, 3.6) and 0.9% (95% CI 0.1, 1.8) per 10 μg/m3 pollutant concentration increase, respectively. CONCLUSION Our findings indicated that intermittent increases in levels of particle matter from traffic and natural sources and ambient H2S levels were weakly associated with increased dispensing of drugs for obstructive pulmonary disease in Iceland's capital area. These weak associations could be confounded by unevaluated variables hence further studies are needed.
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Affiliation(s)
- Hanne Krage Carlsen
- Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Stapi v/Hringbraut, 101 Reykjavik, Iceland.
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Kawasumi Y, Abrahamowicz M, Ernst P, Tamblyn R. Development and validation of a predictive algorithm to identify adult asthmatics from medical services and pharmacy claims databases. Health Serv Res 2011; 46:939-63. [PMID: 21275988 PMCID: PMC3097410 DOI: 10.1111/j.1475-6773.2010.01235.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To develop and validate the accuracy of a predictive model to identify adult asthmatics from administrative health care databases. STUDY SETTING An existing electronic medical record project in Montreal, Quebec. STUDY DESIGN One thousand four hundred and thirty-one patients with confirmed asthma status were identified from primary care physician's electronic medical record. DATA COLLECTION/EXTRACTION METHODS Therapeutic indication of asthma in an electronic prescription and/or confirmed asthma from an automated problem list were used as the gold standard. Five groups of asthma-specific markers were identified from administrative health care databases to estimate the probability of the presence of asthma. Cross-validation evaluated the diagnostic ability of each predictive model using 50 percent of sample. PRINCIPAL FINDINGS The best performance in discriminating between the patients with asthma and those without it included indicators from medical service and prescription claims databases. The best-fitting algorithm had a sensitivity of 70 percent, a specificity of 94 percent, and positive predictive value of 65 percent. The prescriptions claims-specific algorithm demonstrated a nearly equal performance to the model with medical services and prescription claims combined. CONCLUSIONS Our algorithm using asthma-specific markers from administrative claims databases provided moderate sensitivity and high specificity.
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Affiliation(s)
- Yuko Kawasumi
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, Canada.
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Bayliss EA, Blatchford PJ, Newcomer SR, Steiner JF, Fairclough DL. The effect of incident cancer, depression and pulmonary disease exacerbations on type 2 diabetes control. J Gen Intern Med 2011; 26:575-81. [PMID: 21203859 PMCID: PMC3101974 DOI: 10.1007/s11606-010-1600-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/13/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Little is known about how the development of a new chronic health condition affects management of existing chronic conditions over time. New conditions might worsen management of existing conditions because of competing demands or improve management of existing conditions because of increased engagement with heath care. We assessed the effect of incident stage 0, 1, 2 or 3 breast, colon or prostate cancer; incident depression; or an exacerbation of chronic pulmonary disease on control of type 2 diabetes (DM2). METHODS We conducted a longitudinal, historical cohort study within an integrated, not-for-profit HMO. Of a cohort of persons with diagnoses of DM2 between 1998 and 2008, 582, 2,959 and 2,332 developed incident cancer, depression or pulmonary disease exacerbation, respectively. We assessed change in hemoglobin A1c (A1c) as a function of the occurrence of the incident comorbidity in each subcohort for a period of 1 to 5 years after the occurrence of the incident comorbidity. Secondary outcomes were systolic blood pressure (SBP) and low density lipoprotein (LDL) levels. Multivariate linear regression was adjusted for demographics, morbidity level, BMI, numbers of primary and specialty visits, and continuity of primary care. Latent class analyses assessed post-comorbidity outcome trajectories. All time-varying covariates were calculated for a 24-month pre-diagnosis period and 0 to 24- and 24 to 60-month post-diagnosis periods. RESULTS For each condition, A1c did not change significantly from before to after the incident comorbidity. This was confirmed by latent class growth curve analyses that grouped patients by their A1c trajectories. SBP and LDL were also not significantly changed pre- and post-diagnosis of the incident comorbidities. DISCUSSION Although incident comorbidities inevitably will affect patients' and clinicians' care priorities, we did not observe changes in these particular outcomes. Additional investigation of interactions between diseases will inform changes in care that benefit complex patient populations.
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Affiliation(s)
- Elizabeth A Bayliss
- Kaiser Permanente Colorado, Institute for Health Research, 10065 E. Harvard Ave. Ste 300, Denver, CO 80231, USA.
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Abstract
Individuals with asthma living in the inner city experience increased asthma morbidity and mortality compared to the US average. The Controlling Asthma in America's Cities Project's Chicago site used a multifaceted approach to improve asthma care. The diverse scope of this project's interventions necessitated the use of novel methods to assess the effect of these interventions on the entire study area. Asthma-related medication-dispensing data were obtained from a large pharmacy chain for prescriptions filled in calendar years 2004-2006 for all individuals aged 5-17 years living in Chicago who filled at least four asthma-related medications within a 12-month period. Inhaled corticosteroid (ICS) use was considered inadequate if an individual had four or more dispensings of a short-acting beta-agonist without at least four dispensings of an ICS agent. Logistic regression was used to compare adequate ICS use in individuals within the intervention area with ICS use in the remainder of the city, after controlling for gender, insurance status, race, and poverty. A significant difference in adequate ICS use was found in years 2 (2005) and 3 (2006) of the project for individuals aged 5-9 in the intervention area (odds ratios for adequate ICS use-year 2, 1.26; CI, 1.04-1.53, p = 0.04; year 3, 1.30; CI, 1.08-1.55, p = 0.008) compared to individuals aged 5-9 in the remainder of the city. There was no similar significant difference in the 10-17 age group. These findings suggest an effect of a large multifaceted asthma intervention in improving medication use in the targeted age group. This methodology might also prove useful in the future for assessing the effect of similar interventions.
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Nwaru BI, Lumia M, Kaila M, Luukkainen P, Tapanainen H, Erkkola M, Ahonen S, Pekkanen J, Klaukka T, Veijola R, Simell O, Knip M, Virtanen SM. Validation of the Finnish ISAAC questionnaire on asthma against anti-asthmatic medication reimbursement database in 5-year-old children. CLINICAL RESPIRATORY JOURNAL 2010; 5:211-8. [PMID: 21801323 DOI: 10.1111/j.1752-699x.2010.00222.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Valid identification of childhood asthma at the population level for epidemiological purposes remains a challenge. We aimed at validating the Finnish version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire based on parental-reported childhood asthma. MATERIALS AND METHODS The ISAAC questionnaire has been validated against anti-asthmatic medication reimbursement data of the Finnish Social Insurance Institution, being the gold standard, among 2236 5-year-old consecutively born children (1996-2004) carrying human leukocyte antigen (HLA)-conferred susceptibility to type 1 diabetes. Two combined questionnaire questions (any wheezing symptom or use of asthma medication during the preceding 12 months plus ever asthma; any wheezing symptom or use of asthma medication during the preceding 12 months plus ever doctor-diagnosed asthma) were validated against valid reimbursement with purchase of at least one anti-asthmatic medication during a 12-month period. The validity of the questionnaire was estimated as the sensitivity, specificity, positive predictive value, negative predictive value, and Youden's index. RESULTS The sensitivity 0.98 [95% confidence interval (CI) = 0.92-0.99]; specificity 0.98 (95% CI = 0.97-0.98); negative predictive value 1.00 (95% CI = 1.00-1.00); and Youden's index 0.96 (95% CI = 0.96-0.96) were the same for each of the two sets of combined questions. The positive predictive value for the first combined question was 0.63 (95% CI = 0.55-0.71), while it was 0.64 (95% CI = 0.57-0.72) for the second combined question. CONCLUSION The Finnish ISAAC questionnaire was highly valid and is an acceptable instrument for the survey of the prevalence of parental-reported childhood asthma for epidemiological purposes.
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Dombkowski KJ, Harrison SR, Cohn LM, Lewis TC, Clark SJ. Continuity of prescribers of short-acting beta agonists among children with asthma. J Pediatr 2009; 155:788-94. [PMID: 19683253 DOI: 10.1016/j.jpeds.2009.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 05/14/2009] [Accepted: 06/15/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether short-acting beta-agonist (SABA) prescriber continuity was associated with emergency department visits among children with asthma. STUDY DESIGN An analysis of Michigan Medicaid administrative claims (2004-2005) for children ages 5 to 18 with asthma. Logistic regression models assessed the effect of SABA prescriber continuity (the number and site of prescribers) on emergency department visits, controlling for demographics, historical (2004) asthma use and SABA prescription frequency (2-5 low; > or = 6 high). RESULTS Most children had one SABA prescriber (62%); 13% had multiple prescribers in the same practice as the primary care provider and 25% had multiple prescribers in different practices. Children with multiple prescribers in different practices had increased odds of an emergency department visit compared with those with 1 prescriber, among those with high SABA prescription frequency (AOR: 2.7, 95% CI: 1.9, 3.9), as well as those with low prescription frequency (AOR: 1.7, 95% CI: 1.3, 2.2). CONCLUSIONS Children with discontinuity of SABA prescribers have an increased risk of asthma emergency department visits, irrespective of their SABA prescription frequency. Primary care providers may have difficulty identifying patients at high risk with asthma solely on the basis of SABAs prescribed within their own practices.
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Affiliation(s)
- Kevin J Dombkowski
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI 48109-0456, USA.
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Koné Péfoyo AJ, Rivard M, Laurier C. [Public health surveillance and role of administrative data]. Rev Epidemiol Sante Publique 2009; 57:99-111. [PMID: 19307073 DOI: 10.1016/j.respe.2008.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 06/09/2008] [Accepted: 11/26/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Public health surveillance constitutes an important activity since it helps in identifying health needs through data collection, and contributes to decision making and actions by analyzing and interpreting data and communicating key results. METHODS This paper presents a discussion on the concept of public health surveillance, its objectives and its historical evolution. It deals with the importance of surveillance systems while describing their components and challenges. In addition, the authors point out the importance of administrative data as a relevant source for the surveillance of public health problems, particularly chronic diseases and risk factors. RESULTS This theoretical discussion leads to the proposal of a conceptual model for surveillance systems, which integrates implementation and evaluation. CONCLUSION This article provides a summary of the concept of public health surveillance and underlines the general aspects to be considered by the managers of surveillance systems. It also discusses the use of administrative data for surveillance.
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Affiliation(s)
- A J Koné Péfoyo
- Département de médecine sociale et préventive, faculté de médecine, pavillon 1420 Mont-Royal, université de Montréal, Montréal, Canada.
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Thomas M, Price D, Chrystyn H, Lloyd A, Williams AE, von Ziegenweidt J. Inhaled corticosteroids for asthma: impact of practice level device switching on asthma control. BMC Pulm Med 2009; 9:1. [PMID: 19121204 PMCID: PMC2636760 DOI: 10.1186/1471-2466-9-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 01/02/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As more inhaled corticosteroid (ICS) devices become available, there may be pressure for health-care providers to switch patients with asthma to cheaper inhaler devices. Our objective was to evaluate impact on asthma control of inhaler device switching without an accompanying consultation in general practice. METHODS This 2-year retrospective matched cohort study used the UK General Practice Research Database to identify practices where ICS devices were changed without a consultation for > or =5 patients within 3 months. Patients 6-65 years of age from these practices whose ICS device was switched were individually matched with patients using the same ICS device who were not switched. Asthma control over 12 months after the switch was assessed using a composite measure including short-acting beta-agonist and oral corticosteroid use, hospitalizations, and subsequent changes to therapy. RESULTS A total of 824 patients from 55 practices had a device switch and could be matched. Over half (53%) of device switches were from dry powder to metered-dose inhalers. Fewer patients in switched than matched cohort experienced successful treatment based on the composite measure (20% vs. 34%) and more experienced unsuccessful treatment (51% vs. 38%). After adjusting for possible baseline confounding factors, the odds ratio for treatment success in the switched cohort compared with controls was 0.29 (95% confidence interval [CI], 0.19 to 0.44; p < 0.001) and for unsuccessful treatment was 1.92 (95% CI, 1.47 to 2.56; p < 0.001). CONCLUSION Switching ICS devices without a consultation was associated with worsened asthma control and is therefore inadvisable.
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Affiliation(s)
- Mike Thomas
- Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, UK.
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Laurent O, Pedrono G, Filleul L, Segala C, Lefranc A, Schillinger C, Rivière E, Bard D. Influence of socioeconomic deprivation on the relation between air pollution and beta-agonist sales for asthma. Chest 2008; 135:717-723. [PMID: 19017882 DOI: 10.1378/chest.08-1604] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Air pollution triggers asthma attacks hours to days after exposure. It remains unclear whether socioeconomic deprivation modulates these effects. Investigation of these interactions requires adequate statistical power, obtainable by using either a sufficient number of observations or very sensitive indicators of asthma attacks. Using a small-area temporal ecologic approach, we studied the short-term relations between ambient air pollution and sales of short-acting beta-agonist (SABA) drugs, a frequent and specific treatment for control of asthma attacks in children and young adults, and then tested the influence of deprivation on these relations. METHODS The study took place in Strasbourg, France in 2004. Health insurance funds provided data on 15,121 SABA sales for patients aged 0 to 39 years. Deprivation was estimated by small geographic areas using an index constructed from census data. Daily average ambient concentrations of particulate matter (particles with an aerodynamic diameter < 10 microm [PM(10)]), nitrogen dioxide (NO(2)), and ozone (O(3)) were modeled on a small-area level. Adjusted case-crossover models were used for statistical analysis. RESULTS Increased of 10 microg/m(3) in ambient PM(10), NO(2), and O(3) concentrations were associated, respectively, with increases of 7.5% (95% confidence interval [CI], 4 to 11.2%), 8.4% (95% CI, 5 to 11.9%), and 1% (95% CI, - 0.3 to 2.2%) in SABA sales. Deprivation had no influence on these relations. CONCLUSION The associations observed are consistent with those reported by studies focusing on SABA use. Similar studies in other settings should confirm whether the lack of interaction with deprivation is due to specific local conditions.
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Affiliation(s)
| | | | | | | | - Agnès Lefranc
- Département Santé Environnement, Institut de Veille Sanitaire, Saint Maurice
| | - Charles Schillinger
- Association pour la Surveillance et l'Etude de la Pollution Atmosphérique en Alsace, Schiltigheim
| | - Emmanuel Rivière
- Association pour la Surveillance et l'Etude de la Pollution Atmosphérique en Alsace, Schiltigheim
| | - Denis Bard
- LERES, Ecole des Hautes Etudes en Santé Publique, Rennes.
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Thomas M, von Ziegenweidt J, Lee AJ, Price D. High-dose inhaled corticosteroids versus add-on long-acting beta-agonists in asthma: an observational study. J Allergy Clin Immunol 2008; 123:116-121.e10. [PMID: 18986690 DOI: 10.1016/j.jaci.2008.09.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 09/15/2008] [Accepted: 09/16/2008] [Indexed: 12/23/2022]
Abstract
BACKGROUND Guidelines recommend that for patients uncontrolled on inhaled corticosteroids (ICSs), step-up options include an increase in ICS dosage or addition of a long-acting beta-agonist (LABA). Controversy persists about the best option in routine practice. OBJECTIVE To compare asthma outcomes in patients whose first step-up from ICS monotherapy was by addition of LABA (LABA cohort) or increase in ICS dosage or formulation (ICS cohort). METHODS Observational study using the General Practice Research Database, comparing outcomes in the following 12 months with regression modeling allowing for baseline cohort differences: age, sex, socioeconomic status, body mass index, comorbidity (rhinitis, heart disease), smoking status, short-acting beta-agonist (SABA) use, oral corticosteroid use, and use of asthma complicating medication. RESULTS We found 46,930 patients in the ICS and 17,418 in the LABA cohort. In adjusted analysis, the odds ratio (95% CI) of successful treatment (no hospitalization, no oral corticosteroid use, average daily SABA use <1 dose/d) was lower in the ICS cohort (0.75; 0.72-0.79). The adjusted odds ratio of needing rescue SABA prescriptions was higher in the ICS cohort (1.67; 1.59-1.76). However, the adjusted odds of using any oral corticosteroids were lower (0.75; 0.71-0.78), particularly of using 3 or more courses (0.50, 0.46-0.55), and the adjusted odds of respiratory hospitalization were lower (0.69; 0.59-0.81). CONCLUSION Although symptomatic control and rescue bronchodilator use may be improved by the addition of a LABA to ICS, there may be a lower risk of severe exacerbations and hospitalizations from ICS dose increase.
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Affiliation(s)
- Mike Thomas
- Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, United Kingdom.
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Butz AM, Thompson RE, Tsoukleris MG, Donithan M, Hsu VD, Mudd K, Zuckerman IH, Bollinger ME. Seasonal patterns of controller and rescue medication dispensed in underserved children with asthma. J Asthma 2008; 45:800-6. [PMID: 18972299 PMCID: PMC6410367 DOI: 10.1080/02770900802290697] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether temporal trends exist for short-acting beta agonist (SABA), oral corticosteroid (OCS), and anti-inflammatory prescription fills in children with persistent asthma. METHOD This was a longitudinal analysis of pharmacy record data and health information data obtained by parent report over 12 months for children with persistent asthma 2 to 9 years of age. Eligible children had to report current nebulizer use and one or more emergency department visits or hospitalizations within the past 12 months. RESULTS Children were primarily African-American (89%), male (64%), received Medicaid health insurance (82%), and were a mean age of 4.5 years (SD 2.1). Few families (11%) reported any problems paying for their child's asthma medications at baseline or at the 12-month follow-up. There was a high degree of association between filling a rescue (SABA or OCS) and controller (leukotriene modifier, inhaled corticosteroid, cromolyn) medication during the same month for all months with Pearson's correlation coefficients ranging from a low of 0.28 for October to a high of 0.53 in September. Short-acting beta agonist fills were significantly more likely to be filled concurrently with inhaled corticosteroid fills. However, significantly fewer prescription fills were obtained in the summer months with an acceleration of medication fills in September through December and an increase in early spring. CONCLUSIONS There was a summer decline in both inhaled corticosteroid and SABA fills. Timing of asthma monitoring visits to occur before peak prescription fill months, i.e., August and December for an asthma "tune-up," theoretically could improve asthma control. During these primary care visits children could benefit from more intensive monitoring of medication use including monitoring lung function, frequency of prescription refills, and assessment of medication device technique to ensure that an effective dose of medication is adequately delivered to the respiratory tract. Additionally, scheduling non-urgent asthma care visits at pre-peak prescription fill months can take advantage of "step down" during decreased symptom periods and when appropriate restart daily controller medications to "step up" prior to peak asthma periods.
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Affiliation(s)
- Arlene M Butz
- The Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD 21287, USA.
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Rai PR, Cool CD, King JAC, Stevens T, Burns N, Winn RA, Kasper M, Voelkel NF. The cancer paradigm of severe pulmonary arterial hypertension. Am J Respir Crit Care Med 2008; 178:558-64. [PMID: 18556624 DOI: 10.1164/rccm.200709-1369pp] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The plexiform lesions of severe pulmonary arterial hypertension (PAH) are similar in histologic appearance, whether the disease is idiopathic or secondary. Both forms of the disease show actively proliferating endothelial cells without evidence of apoptosis. Here, we discuss the pathobiology of the atypical, angioproliferative endothelial cells in severe PAH. The concept of the endothelial cell as a "quasi-malignant" cell provides a new framework for antiproliferative, antiangiogenic therapy in severe PAH.
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Affiliation(s)
- Pradeep R Rai
- Department of Pathology, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
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Haupt D, Wettermark B, Nilsson JLG. Dispensed volumes of anti-asthmatic drugs related to the prevalence of asthma and COPD in Sweden. Pharmacoepidemiol Drug Saf 2008; 17:461-7. [PMID: 18302301 DOI: 10.1002/pds.1564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE To explore the possibility of using dispensed volumes asthma/COPD drugs as a proxy for the combined prevalence of asthma plus COPD. METHODS The proportions of the Swedish population with inhalation drugs for asthma/COPD 2004 were obtained using three different databases. A pharmacy record database gave the volumes of dispensed drugs (defined daily doses, DDDs of R03A + R03B drugs) for each patient, 20 years and older. The X-plain database of Apoteket AB gave drug sales data for Sweden and Swedish population data were obtained from Swedish statistics. RESULTS The sales volumes of asthma/COPD drugs were much higher for older than for younger people. The volumes increased from 18 DDD/TID for the 20-29 year group up to 124 DDD/TID for patients 70-79 years, or about seven times. The average volumes per patient in the different age groups corresponded to one DDD/day in only three of the age groups (50-79 years). In the youngest group the average drug volume per patient corresponded to one DDD every second day, which may indicate undermedication. The percentages of the Swedish population with asthma/COPD drugs increased from 4.0% for 20-29 years old to 14.5% for 80+ years old, or 3.6 times. When head-to-head comparisons could be made between reported prevalence data of asthma and COPD and our data the two sets of data were in a reasonable agreement. CONCLUSION The prevalence of drug treatment, i.e. the proportion of the population with dispensed asthma/COPD drugs, could function as a proxy for the disease prevalence of asthma plus COPD.
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Affiliation(s)
- Dan Haupt
- Department of Health Sciences, Luleå Technical University, Luleå, Sweden
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Perry CD. Does treating maternal depression improve child health management? The case of pediatric asthma. JOURNAL OF HEALTH ECONOMICS 2008; 27:157-73. [PMID: 17498828 DOI: 10.1016/j.jhealeco.2007.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 02/06/2007] [Accepted: 03/15/2007] [Indexed: 05/15/2023]
Abstract
Past studies have demonstrated an association between maternal depression and poor management of pediatric asthma. Using an instrumental variables strategy to address the endogeneity of depression treatment, I build on this literature to answer the question of whether treating maternal depression leads to an improvement in pediatric asthma management. I show that treatment of mother's depression improves management of child's asthma, resulting in a reduction in asthma costs in the 6-month period following diagnosis of $798 per asthmatic child whose mother is treated for depression.
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Bollinger ME, Smith SW, LoCasale R, Blaisdell C. Transition to managed care impacts health care service utilization by children insured by Medicaid. J Asthma 2007; 44:717-22. [PMID: 17994400 DOI: 10.1080/02770900701595584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose. To evaluate the impact of transition to managed care from fee for service on asthma service utilization among Maryland Medicaid insured children. Methods. Healthcare claims from 1997-2000 for children with asthma insured by Maryland Medicaid were extracted and analyzed. Results. Between 1997-2000, inhaled corticosteroid use increased as a proportion of all asthma medications. Outpatient asthma visits increased from 4.2% to 5.9% of all outpatient claims as both asthma-related hospitalizations and emergency department visits decreased. Conclusions. Restructuring of Maryland Medicaid for children from fee for service to managed care was associated with improvement in asthma-related healthcare utilization claims.
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Affiliation(s)
- Mary Elizabeth Bollinger
- University of Maryland School of Medicine, Department of Pediatrics, Division of Pediatric Pulmonology/Allergy, Baltimore, Maryland 21201, USA.
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Furu K, Skurtveit S, Langhammer A, Nafstad P. Use of anti-asthmatic medications as a proxy for prevalence of asthma in children and adolescents in Norway: a nationwide prescription database analysis. Eur J Clin Pharmacol 2007; 63:693-8. [PMID: 17473919 DOI: 10.1007/s00228-007-0301-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 03/18/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The validity of using self-reported or parental reported asthma symptoms and/or doctor-diagnosed asthma in the estimation of asthma prevalence among children has been questioned. The aim of this study was to assess the prevalence of dispensed anti-asthmatic medications as a proxy of asthma among children and adolescents aged 0-19 years in Norway. METHODS Prescription data on subjects aged 0-19 years receiving at least one prescription for an anti-asthmatic during 2004 were retrieved from the nationwide Norwegian Prescription Database. RESULTS Overall, 108,719 (9.1% of the Norwegian population aged 0-19 years) individuals received at least one prescription for medication(s) for obstructive airway diseases. The application of criteria that restricted the study population to those receiving inhaled anti-asthmatic medications and those receiving medications reimbursed by the Norwegian health care system for asthma resulted in the identification of 64,458 (5.4%) individuals (4.6% of girls and 6.2% of boys). The prevalence varied by age, with a maximum in both genders at about 2 years of age (7.0% of girls and 10.1% of boys) and a minimum in girls at about 10 years of age (3.3%) and in boys at about 19 years of age (3.5%). Anti-asthmatic inhalants were more frequently prescribed among boys than among girls during the first 15 years of life. Of the children treated, 75% received inhaled glucocorticoids (ICS) in combination with beta2-agonists, of whom 38% received a fixed combination in one inhaler. CONCLUSIONS In 2004, about 1 in 20 Norwegians aged 0-19 years were in need of medical treatment for asthma for at least 3 months, reflecting ongoing and clinically important asthma. A rather high proportion of children received fixed combinations of ICS and long-acting beta2-agonists, which may indicate moderate to severe asthma.
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Affiliation(s)
- Kari Furu
- Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway.
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Borderias L, Mincewicz G, Paggiaro PL, Guilera M, Sazonov Kocevar V, Taylor SD, Badia X. Asthma control in patients with asthma and allergic rhinitis receiving add-on montelukast therapy for 12 months: a retrospective observational study. Curr Med Res Opin 2007; 23:721-30. [PMID: 17407628 DOI: 10.1185/030079906x167606] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Montelukast, a potent leukotriene receptor antagonist, is approved for treatment of both asthma and allergic rhinitis (AR). No studies to date have examined whether montelukast can improve asthma control over a long period of time in patients with seasonal AR and asthma. OBJECTIVE To evaluate asthma control and use of asthma-related medical resources by patients with inadequately controlled mild to moderate persistent asthma and seasonal AR who required addition of montelukast as part of routine care. METHODS This multicenter, 24-month, pre-post retrospective observational study included patients receiving current inhaled corticosteroid (ICS) therapy (alone or in combination with long-acting beta-agonist [LABA]), who received add-on treatment with montelukast for 12 consecutive months. The incidence of asthma attacks, defined as emergency department visit, hospitalization, or oral corticosteroid use for asthma, was compared for the year before and the year after addition of montelukast to therapy. RESULTS For the 696 patients from Italy, Poland, and Spain who were included in the analyses, the proportion of patients experiencing an asthma attack declined from 31.5% in the year before to 10.1% (p < 0.001) the year after addition of montelukast to therapy. Proportions of patients with an asthma-related emergency room visit, hospitalization, and oral corticosteroid use declined from 18.7% to 3.9%, from 5.2% to 1.4%, and from 17.5% to 5.9% (all p < 0.01), respectively. The incidence of these outcomes declined in all three countries, regardless of baseline asthma severity or asthma therapy (ICS alone or ICS + LABA). Important study limitations include the possibility of selection bias or missing medical chart data in this retrospective study design. Also noteworthy is the inclusion of only those patients who remained persistent with montelukast therapy. Therefore, the results of the study are relevant for patients who remain persistent with montelukast therapy. CONCLUSIONS Addition of montelukast to current ICS therapy improved long-term asthma control and resulted in substantial reductions in asthma-related resource use by patients with mild or moderate persistent asthma and concomitant seasonal AR who were persistent with montelukast therapy in this retrospective observational study.
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Affiliation(s)
- Luis Borderias
- Pneumology Department, San Jorge Hospital, Huesca, Spain
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Gandhi RK, Blaiss MS. What are the best estimates of pediatric asthma control? Curr Opin Allergy Clin Immunol 2006; 6:106-12. [PMID: 16520674 DOI: 10.1097/01.all.0000216853.18194.46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To evaluate asthma outcome measures in the face of the variable nature of asthma. The outcome measures are divided into objective and subjective clinical measures, humanistic measures such as quality of life, and costs of asthma control. RECENT FINDINGS Objective measures of asthma include those traditionally used such as spirometry, peak expiratory flow rate, and airway hyperresponsiveness. Recently, more attention has been geared towards markers of inflammation including exhaled nitric oxide and sputum eosinophils. Subjective measures of asthma control include patient-derived parameters such as number of wheezing episodes, nocturnal symptoms, exercise-induced symptoms, short-acting beta-agonist use, steroid bursts, emergency-department visits, and hospitalizations. Asthma-related quality of life is related to asthma morbidity, and patients with better baseline quality of life have improved outcomes. Asthma-related costs include direct costs mostly comprised of hospitalizations and emergency-room visits, and indirect costs including school absenteeism. SUMMARY There is no ideal outcome measure for evaluating pediatric asthma control, but each of these outcome measures must be used together to evaluate a patient at each outpatient visit. Patient-centered measures of asthma control must also be further incorporated into office visits for improved asthma management.
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Affiliation(s)
- Radha K Gandhi
- Department of Clinical Allergy and Immunology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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