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Boylan PM, Abdalla M, Bissell B, Malesker MA, Santibañez M, Smith Z. Theophylline for the management of respiratory disorders in adults in the 21st century: A scoping review from the American College of Clinical Pharmacy Pulmonary Practice and Research Network. Pharmacotherapy 2023; 43:963-990. [PMID: 37423768 DOI: 10.1002/phar.2843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 07/11/2023]
Abstract
Theophylline is an oral methylxanthine bronchodilator recommended as alternate therapy for the treatment of asthma and chronic obstructive pulmonary disease (COPD). However, it is not generally recommended for the treatment of other respiratory disorders such as obstructive sleep apnea (OSA) or hypoxia. Most clinical practice guidelines rely on evidence published prior to the year 2000 to make these recommendations. This scoping review aimed to gather and characterize evidence describing theophylline for the management of respiratory disorders in adults between January 1, 2000 and December 31, 2020. Databases searched included Ovid MEDLINE, Embase, CINAHL Complete, Scopus, and International Pharmaceutical Abstracts. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Studies were included if they were published in English, theophylline was used for any respiratory disorder, and the study outcomes were disease- or patient-oriented. After removal of duplicates, 841 studies were screened and 55 studies were included. Results aligned with current clinical guideline recommendations relegating theophylline as an alternative therapy for the treatment of respiratory disorders, in favor of inhaled corticosteroids and inhaled bronchodilators. This scoping review identified the need for future research including: theophylline versus other medications deemed alternative therapies for asthma and COPD, meta-analyses of low-dose theophylline, and studies evaluating evidence-based patient-oriented outcomes for OSA, hypoxia, ventilator-induced diaphragmatic dysfunction, and spinal cord injury-related pulmonary function.
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Affiliation(s)
- Paul M Boylan
- Department of Pharmacy: Clinical and Administrative Sciences, The University of Oklahoma Health Sciences Center, College of Pharmacy, Oklahoma City, Oklahoma, USA
| | - Maha Abdalla
- Department of Pharmaceutical Sciences, South College, School of Pharmacy, Knoxville, Tennessee, USA
| | - Brittany Bissell
- Department of Pharmacy Practice and Science, The University of Kentucky, College of Pharmacy, Lexington, Kentucky, USA
| | - Mark A Malesker
- Department of Pharmacy Practice, Creighton University, School of Pharmacy and Health Professions, Omaha, Nebraska, USA
| | - Melissa Santibañez
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, USA
| | - Zachary Smith
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA
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Klimovic S, Scurek M, Pesl M, Beckerova D, Jelinkova S, Urban T, Kabanov D, Starek Z, Bebarova M, Pribyl J, Rotrekl V, Brat K. Aminophylline Induces Two Types of Arrhythmic Events in Human Pluripotent Stem Cell-Derived Cardiomyocytes. Front Pharmacol 2022; 12:789730. [PMID: 35111056 PMCID: PMC8802108 DOI: 10.3389/fphar.2021.789730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Cardiac side effects of some pulmonary drugs are observed in clinical practice. Aminophylline, a methylxanthine bronchodilator with documented proarrhythmic action, may serve as an example. Data on the action of aminophylline on cardiac cell electrophysiology and contractility are not available. Hence, this study was focused on the analysis of changes in the beat rate and contraction force of human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) and HL-1 cardiomyocytes in the presence of increasing concentrations of aminophylline (10 µM-10 mM in hPSC-CM and 8-512 µM in HL-1 cardiomyocytes). Basic biomedical parameters, namely, the beat rate (BR) and contraction force, were assessed in hPSC-CMs using an atomic force microscope (AFM). The beat rate changes under aminophylline were also examined on the HL-1 cardiac muscle cell line via a multielectrode array (MEA). Additionally, calcium imaging was used to evaluate the effect of aminophylline on intracellular Ca2+ dynamics in HL-1 cardiomyocytes. The BR was significantly increased after the application of aminophylline both in hPSC-CMs (with 10 mM aminophylline) and in HL-1 cardiomyocytes (with 256 and 512 µM aminophylline) in comparison with controls. A significant increase in the contraction force was also observed in hPSC-CMs with 10 µM aminophylline (a similar trend was visible at higher concentrations as well). We demonstrated that all aminophylline concentrations significantly increased the frequency of rhythm irregularities (extreme interbeat intervals) both in hPSC-CMs and HL-1 cells. The occurrence of the calcium sparks in HL-1 cardiomyocytes was significantly increased with the presence of 512 µM aminophylline. We conclude that the observed aberrant cardiomyocyte response to aminophylline suggests an arrhythmogenic potential of the drug. The acquired data represent a missing link between the arrhythmic events related to the aminophylline/theophylline treatment in clinical practice and describe cellular mechanisms of methylxanthine arrhythmogenesis. An AFM combined with hPSC-CMs may serve as a robust platform for direct drug effect screening.
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Affiliation(s)
- Simon Klimovic
- CEITEC, Masaryk University, Brno, Czechia
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Biochemistry, Faculty of Science, Masaryk University, Brno, Czechia
| | - Martin Scurek
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Pesl
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
- First Department of Internal Medicine—Cardioangiology, Faculty of Medicine, St. Anne’s University Hospital, Masaryk University, Brno, Czechia
| | - Deborah Beckerova
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
| | - Sarka Jelinkova
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tomas Urban
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
- First Department of Internal Medicine—Cardioangiology, Faculty of Medicine, St. Anne’s University Hospital, Masaryk University, Brno, Czechia
| | - Daniil Kabanov
- CEITEC, Masaryk University, Brno, Czechia
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Biochemistry, Faculty of Science, Masaryk University, Brno, Czechia
| | - Zdenek Starek
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
- First Department of Internal Medicine—Cardioangiology, Faculty of Medicine, St. Anne’s University Hospital, Masaryk University, Brno, Czechia
| | - Marketa Bebarova
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Pribyl
- CEITEC, Masaryk University, Brno, Czechia
| | - Vladimir Rotrekl
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
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Shuai T, Zhang C, Zhang M, Wang Y, Xiong H, Huang Q, Liu J. Low-dose theophylline in addition to ICS therapy in COPD patients: A systematic review and meta-analysis. PLoS One 2021; 16:e0251348. [PMID: 34029327 PMCID: PMC8143407 DOI: 10.1371/journal.pone.0251348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A synergism has been reported between theophylline and corticosteroids, wherein theophylline increases and restores the anti-inflammatory effect of inhaled corticosteroids (ICS) by enhancing histone deacetylase-2 (HDAC) activity. Several studies have explored the efficacy of low-dose theophylline plus ICS therapy on chronic obstructive pulmonary disease (COPD) but the results are discrepant. METHOD We conducted searches in electronic database such as PubMed, Web Of Science, Cochrane Library, and Embase to find out original studies. Stata/SE 15.0 was used to perform all data analysis. RESULT A total of 47,556 participants from 7 studies were included in our analysis and the sample size of each study varied from 24 to 10,816. Theophylline as an add-on therapy to ICS was not associated with the reduction of COPD exacerbations (HR: 1.08, 95% CI: 0.97 to 1.19, I2 = 95.2%). Instead, the theophylline group demonstrated a higher hospitalization rate (HR: 1.12, 95% CI: 1.10 to 1.15, I2 = 20.4%) and mortality (HR: 1.19, 95% CI: 1.14 to 1.25, I2 = 0%). Further, the anti-inflammatory effect of low-dose theophylline as an adjunct to ICS on COPD was controversial. Besides, the theophylline group showed significant improvement in lung function compared with the non-theophylline group. CONCLUSION Based on current evidence, low-dose theophylline as add-on therapy to ICS did not reduce the exacerbation rate. Instead, the hospitalization rate and mortality increased with theophylline. Thus, we do not recommend adding low-dose theophylline to ICS therapy in COPD patients. TRIAL REGISTRATION PROSPERO Registration CRD42021224952.
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Affiliation(s)
- Tiankui Shuai
- Department of Intensive Care Unit, Lanzhou University, The First Hospital of Lanzhou University, Lan Zhou, Gansu Province, China
- The Fist Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu Province, China
| | - Chuchu Zhang
- Department of Intensive Care Unit, Lanzhou University, The First Hospital of Lanzhou University, Lan Zhou, Gansu Province, China
- The Fist Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu Province, China
| | - Meng Zhang
- Department of Intensive Care Unit, Lanzhou University, The First Hospital of Lanzhou University, Lan Zhou, Gansu Province, China
- The Fist Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yalei Wang
- Department of Intensive Care Unit, Lanzhou University, The First Hospital of Lanzhou University, Lan Zhou, Gansu Province, China
- The Fist Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu Province, China
| | - Huaiyu Xiong
- Department of Intensive Care Unit, Lanzhou University, The First Hospital of Lanzhou University, Lan Zhou, Gansu Province, China
- The Fist Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu Province, China
| | - Qiangru Huang
- Department of Intensive Care Unit, Lanzhou University, The First Hospital of Lanzhou University, Lan Zhou, Gansu Province, China
- The Fist Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu Province, China
| | - Jian Liu
- Department of Intensive Care Unit, Lanzhou University, The First Hospital of Lanzhou University, Lan Zhou, Gansu Province, China
- * E-mail:
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Steroid sparing effects of doxofylline. Pulm Pharmacol Ther 2017; 48:1-4. [PMID: 29031617 DOI: 10.1016/j.pupt.2017.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 12/18/2022]
Abstract
Glucocorticosteroids are widely used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). However, there are growing concerns about the side effect profile of this class of drug, particularly an increased risk of pneumonia. Over the last two decades there have been many attempts to find drugs to allow a reduction of glucocorticosteroids, including xanthines such as theophylline. Use of xanthines has been shown to lead to a reduction in the requirement for glucocorticosteroids, although xanthines also have a narrow therapeutic window limiting their wider use. Doxofylline is another xanthine that has been shown to be of clinical benefit in patients with asthma or COPD, but to have a wider therapeutic window than theophylline. In the present study we have demonstrated that doxofylline produces a clear steroid sparing effect in both an allergic and a non-allergic model of lung inflammation. Thus, we have shown that concomitant treatment with a low dose of doxofylline and a low dose of the glucocorticosteroid dexamethasone (that alone had no effect) significantly reduced both allergen-induced eosinophil infiltration into the lungs of allergic mice, and lipopolysaccharide (LPS)-induced neutrophil infiltration into the lung, equivalent to a higher dose of each drug. Our results suggest that doxofylline demonstrates significant anti-inflammatory activity in the lung which can result in significant steroid sparing activity.
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Use of cardioselective β-blockers and overall death and cardiovascular outcomes in patients with COPD: a population-based cohort study. Eur J Clin Pharmacol 2016; 72:1265-1273. [DOI: 10.1007/s00228-016-2097-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
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Horita N, Miyazawa N, Kojima R, Inoue M, Ishigatsubo Y, Kaneko T. Uso crónico de teofilina y mortalidad en la enfermedad pulmonar obstructiva crónica: un metaanálisis. Arch Bronconeumol 2016; 52:233-8. [DOI: 10.1016/j.arbres.2015.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/07/2015] [Accepted: 02/11/2015] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Bronchodilators are commonly used as maintenance and rescue therapy in patients with COPD. We aimed to examine the prescribing patterns of bronchodilators in clinical practice. METHODS We identified patients with COPD who initiated oral or inhaled bronchodilators between 2001 and 2010 from the Taiwan National Health Insurance Research Database. We followed the patients for 1 year. For bronchodilator prescriptions, we classified the treatments based on medication classes and regimens (oral bronchodilators alone, oral and inhaled bronchodilators in combination, or inhaled bronchodilators alone). For inhaled bronchodilator prescriptions, we further classified the treatments as short-acting bronchodilators alone, short-acting and long-acting bronchodilators in combination, and long-acting bronchodilators alone. We evaluated the prescribing patterns and the change with time, in different physician specialists, and in different hospital accreditation levels. RESULTS Among a cohort of 4,387 study-eligible patients, we identified 21,235 bronchodilator prescriptions for the analysis. The majority of prescriptions were oral xanthines or beta-2 agonists (62.63% and 47.54%, respectively) rather than prescriptions for inhaled bronchodilators (less than 10%). Nearly 80% of prescriptions were oral bronchodilator alone regimens. Use of oral bronchodilators declined with time and varied with health care providers, which were most commonly prescribed by non-chest specialists and in primary care clinics. Despite limited use of inhaled bronchodilators, it was noted that short-acting bronchodilators alone regimens accounted for 60% of the inhaled bronchodilator prescriptions. CONCLUSION Excessive use of oral and short-acting bronchodilators is noted in general practice. Further research and education programs are warranted to decrease inadequate oral bronchodilators and optimize inhaled treatments in the management of patients with COPD.
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Affiliation(s)
- Yaa-Hui Dong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Lin Hsu
- Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Ying Li
- Department of Pharmacy, Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Chia-Hsuin Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lai
- Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Cheng Y, Borrego ME, Frost FJ, Petersen H, Raisch DW. Predictors for mortality in hospitalized patients with chronic obstructive pulmonary disease. SPRINGERPLUS 2014; 3:359. [PMID: 25061552 PMCID: PMC4108717 DOI: 10.1186/2193-1801-3-359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has been the only leading cause of death associated with a continuously increasing trend in the US over the past 30 years. OBJECTIVES The aim of this research was to identify predictors for all-cause in-hospital mortality for COPD patients. METHODS We conducted a cross-sectional study of patients with the discharge diagnosis of COPD, utilizing the 2007 Premier Perspective database. Inpatients aged 40 years and above were selected if they had a discharge with a primary diagnosis of COPD between January 1, 2007 and December 31, 2007. All data analyses were based on individual level. If a patient had multiple discharges, only the last discharge was included for mortality analysis. Predictors for mortality were identified by multiple logistic regressions. Bonferroni correction for multiple logistic regression models was adapted to control for family-wise errors. RESULTS The total of 57,224 patients was selected for data analysis in the study. All-cause in-hospital mortality for patients with COPD was 2.4%. Older age, insurance coverage, elective admission, intensive care unit admission, prolonged length of stay, increased Deyo-adapted Charlson Index (DCI) score and Elixhauser comorbidities of renal failure, metastatic cancer, solid tumor without metastasis, and weight loss were identified as independent predictors for all-cause in-hospital mortality. Antibiotics and β-blockers were predictors of lower all-cause in-hospital mortality risk after adjusting for other factors. CONCLUSIONS The nationwide discharge database provides useful information to identify predictors for all-cause in-hospital mortality of patients with COPD.
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Affiliation(s)
- Yan Cheng
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah USA
| | - Matthew E Borrego
- Pharmacoeconomics, Epidemiology, Public Policy and Outcome Research, College of Pharmacy, University of New Mexico, Albuquerque, NM USA
| | - Floyd J Frost
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Hans Petersen
- Lovelace Respiratory Research Institute, Albuquerque, NM USA
| | - Dennis W Raisch
- Pharmacoeconomics, Epidemiology, Public Policy and Outcome Research, College of Pharmacy, University of New Mexico, Albuquerque, NM USA
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Abstract
The elderly patient (65 years and older) with chronic obstructive pulmonary disease (COPD) can be a challenge to the clinician. This begins with the correct and early diagnosis, the assessment of disease severity, recognizing complicating comorbidities, determining the burden of symptoms, and monitoring the frequency of acute exacerbations. Comprehensive management of COPD in the elderly patient should improve health-related quality of life, lung function, reduce exacerbations, and promote patient compliance with treatment plans. Only smoking cessation and oxygen therapy in COPD patients with hypoxemia reduce mortality. Bronchodilators, corticosteroids, methylxanthines, phosphodiesterase-4 inhibitors, macrolide antibiotics, mucolytics, and pulmonary rehabilitation improve some outcome measures such as spirometry measures and the frequency of COPD exacerbations without improving mortality. International treatment guidelines to reduce symptoms and reduce the risk of acute exacerbations exist. Relief of dyspnea and control of anxiety are important. The approach to each patient is best individualized. Earlier use of palliative care should be considered when traditional pharmacotherapy fails to achieve outcome measures and before consideration of end-of-life issues.
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Abstract
The goals of management of COPD include reducing exposure to risk factors; improving lung function, exercise tolerance, and quality of life; and decreasing exacerbations and mortality. Pharmacologic treatments, such as inhaled β2-agonists, anticholinergics, and inhaled corticosteroids, are widely used to help achieve these goals. In addition to efficacy, medication safety is an important consideration in selecting COPD treatments. Clinical trials conducted in support of the regulatory review and approval process establish the general efficacy and tolerability of pharmacologic treatments for COPD, and these data are reflected in product labeling. Following approval, further research continues to provide more data with longer follow-up and in broader settings than feasible in clinical trials. These data add to our knowledge of the efficacy of medications. Understanding medication safety requires assessment of the quality and appropriateness of study design, as well as knowledge of study findings, and is of paramount importance in making sound clinical judgments in the treatment of patients with COPD. In recent years, a wealth of data on COPD medications has been published from different sources, including randomized clinical trials, meta-analyses, systematic reviews, and observational studies. This review discusses important considerations in interpreting data from different types of studies, summarizes the tolerability profile of COPD medications established in preapproval studies, and discusses new findings from more recent postapproval data.
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Affiliation(s)
- Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX.
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Pillay V, Seedat A, Choonara YE, du Toit LC, Kumar P, Ndesendo VMK. A review of polymeric refabrication techniques to modify polymer properties for biomedical and drug delivery applications. AAPS PharmSciTech 2013; 14:692-711. [PMID: 23543606 PMCID: PMC3665995 DOI: 10.1208/s12249-013-9955-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/05/2013] [Indexed: 01/14/2023] Open
Abstract
Polymers are extensively used in the pharmaceutical and medical field because of their unique and phenomenal properties that they display. They are capable of demonstrating drug delivery properties that are smart and novel, such properties that are not achievable by employing the conventional excipients. Appropriately, polymeric refabrication remains at the forefront of process technology development in an endeavor to produce more useful pharmaceutical and medical products because of the multitudes of smart properties that can be attained through the alteration of polymers. Small alterations to a polymer by either addition, subtraction, self-reaction, or cross reaction with other entities have the capability of generating polymers with properties that are at the level to enable the creation of novel pharmaceutical and medical products. Properties such as stimuli-responsiveness, site targeting, and chronotherapeutics are no longer figures of imaginations but have become a reality through utilizing processes of polymer refabrication. This article has sought to review the different techniques that have been employed in polymeric refabrication to produce superior products in the pharmaceutical and medical disciplines. Techniques such as grafting, blending, interpenetrating polymers networks, and synthesis of polymer complexes will be viewed from a pharmaceutical and medical perspective along with their synthetic process required to attain these products. In addition to this, each process will be evaluated according to its salient features, impeding features, and the role they play in improving current medical devices and procedures.
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Affiliation(s)
- Viness Pillay
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, Johannesburg, South Africa.
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Greulich T, Koczulla AR, Vogelmeier C. [Chronic obstructive pulmonary disease : new pharmacotherapeutic options]. Internist (Berl) 2013; 53:1364-70, 1373-5. [PMID: 22955248 DOI: 10.1007/s00108-012-3119-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Data about the clinical presentation of chronic obstructive pulmonary disease (COPD) have resulted in a new classification of the disease. The degree of airflow limitation has been amended by symptoms and exacerbation rate. The standard pharmacotherapy of stable COPD is in transition, as fixed combinations of long acting beta agonists and long acting anticholinergics are in the late stages of clinical development. On this background inhaled corticosteroids will need to be re-evaluated. Roflumilast is a recently approved therapeutic option that primarily diminishes exacerbation frequency in patients with chronic bronchitis and severe airflow obstruction (FEV(1) < 50%). In COPD patients with acute exacerbations procalcitonin levels can be used to guide antibiotic therapy. Comparable clinical outcomes can be achieved while using significantly less amounts of antibiotics.
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Affiliation(s)
- T Greulich
- Klinik für Innere Medizin, Schwerpunkt Pneumologie, Universitätsklinikum Giessen und Marburg, Philipps-Universität Marburg, Deutschland.
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Zhang WH, Zhang Y, Cui YY, Rong WF, Cambier C, Devillier P, Bureau F, Advenier C, Gustin P. Can β2-adrenoceptor agonists, anticholinergic drugs, and theophylline contribute to the control of pulmonary inflammation and emphysema in COPD? Fundam Clin Pharmacol 2011; 26:118-34. [PMID: 22044554 DOI: 10.1111/j.1472-8206.2011.01007.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) has become a global epidemic disease with an increased morbidity and mortality in the world. Inflammatory process progresses and contributes to irreversible airflow limitation. However, there is no available therapy to better control the inflammatory progression and therefore to reduce the exacerbations and mortality. Thus, the development of efficient anti-inflammatory therapies is a priority for patients with COPD. β(2) -Adrenoceptor agonists and anticholinergic agents are widely used as first line drugs in management of COPD because of their efficient bronchodilator properties. At present, many studies in vitro and some data obtained in laboratory animals reveal the potential anti-inflammatory effects of these bronchodilators but their protective role against chronic inflammation and the development of emphysema in patients with COPD remains to be investigated. The anti-inflammatory effects of theophylline at low doses have also been identified. Beneficial interactions between glucocorticoids and bronchodilators have been reported, and signaling pathways explaining these synergistic effects begin to be understood, especially for theophylline. Recent data demonstrating interactions between anticholinergics with β(2) -adrenoceptor agonists aiming to better control the pulmonary inflammation and the development of emphysema in animal models of COPD justify the priority to investigate the interactive effects of a tritherapy associating corticoids with the two main categories of bronchodilators.
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Affiliation(s)
- Wen-Hui Zhang
- Department of Physiology, School of Medicine, Shanghai JiaoTong University, Shanghai, China.
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Pickard AS, Lee TA, Solem CT, Joo MJ, Schumock GT, Krishnan JA. Prioritizing comparative-effectiveness research topics via stakeholder involvement: an application in COPD. Clin Pharmacol Ther 2011; 90:888-92. [PMID: 22048220 DOI: 10.1038/clpt.2011.237] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A major priority for funding agencies and researchers involved in comparative-effectiveness research (CER) is to ensure that research questions will produce findings that are relevant and feasible to implement. In this article, we describe a process for involving experts and stakeholders in identifying and prioritizing CER studies, as illustrated by our experience in chronic obstructive pulmonary disease (COPD).
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Affiliation(s)
- A S Pickard
- Center for Pharmacoeconomic Research and Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.
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Stein BD, Bautista A, Schumock GT, Lee TA, Charbeneau JT, Lauderdale DS, Naureckas ET, Meltzer DO, Krishnan JA. The validity of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for identifying patients hospitalized for COPD exacerbations. Chest 2011; 141:87-93. [PMID: 21757568 DOI: 10.1378/chest.11-0024] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Acute exacerbations of COPD (AE-COPD) are a leading cause of hospitalizations in the United States. To estimate the burden of disease (eg, prevalence and cost), identify opportunities to improve care quality (eg, performance measures), and conduct observational comparative effectiveness research studies, various algorithms based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes have been used to identify patients with COPD. However, the validity of these algorithms remains unclear. METHODS We compared the test characteristics (sensitivity, specificity, positive predictive value, and negative predictive value) of four different coding algorithms for identifying patients hospitalized for an exacerbation of COPD with chart review (reference standard) using a stratified probability sample of 200 hospitalizations at two urban academic medical centers. Sampling weights were used when calculating prevalence and test characteristics. RESULTS The prevalence of COPD exacerbations (based on the reference standard) was 7.9% of all hospitalizations. The sensitivity of all ICD-9-CM algorithms was very low and varied by algorithm (12%-25%), but the negative predictive value was similarly high across algorithms (93%-94%). The specificity was > 99% for all algorithms, but the positive predictive value varied by algorithm (81%-97%). CONCLUSIONS Algorithms based on ICD-9-CM codes will undercount hospitalizations for AE-COPD, and as many as one in five patients identified by these algorithms may be misidentified as having a COPD exacerbation. These findings suggest that relying on ICD-9-CM codes alone to identify patients hospitalized for AE-COPD may be problematic.
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Affiliation(s)
- Brian D Stein
- Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL
| | - Adriana Bautista
- Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
| | - Glen T Schumock
- Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
| | - Todd A Lee
- Center for Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL; Center for Management of Complex Chronic Care, Hines VA Hospital, University of Chicago, Chicago, IL
| | - Jeffery T Charbeneau
- Department of Health Studies, Section of Pulmonary, University of Chicago, Chicago, IL
| | - Diane S Lauderdale
- Department of Health Studies, Section of Pulmonary, University of Chicago, Chicago, IL
| | | | - David O Meltzer
- Section of Hospital Medicine, University of Chicago, Chicago, IL
| | - Jerry A Krishnan
- Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL.
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Stein BD, Charbeneau JT, Lee TA, Schumock GT, Lindenauer PK, Bautista A, Lauderdale DS, Naureckas ET, Krishnan JA. Hospitalizations for acute exacerbations of chronic obstructive pulmonary disease: how you count matters. COPD 2010; 7:164-71. [PMID: 20486814 DOI: 10.3109/15412555.2010.481696] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
ICD-9-CM diagnosis codes are increasingly used to estimate the burden of disease, as well as to evaluate the quality of care and outcomes of various conditions. Acute exacerbations of COPD (AE-COPD) are common and associated with substantial health and financial burden in the U.S. Whether published algorithms that employ different combinations of ICD-9-CM codes to identify patients hospitalized for AE-COPD yield similar or different estimates of disease burden is unclear. In this study, the Nationwide Inpatient Sample from years 2000-2006 was used to identify and compare the number of hospitalizations, healthcare utilization, and outcomes for patients hospitalized for AE-COPD in the U.S. AE-COPD was identified using five different published ICD-9-CM algorithms. Estimates of the annual number of hospitalizations for AE-COPD in the U.S. varied more than 2-fold (e.g., 421,000 to 870,000 in 2006). Outcomes and healthcare utilization of patients hospitalized for AE-COPD varied substantially, depending on the algorithm used (e.g., in-hospital mortality 2.0% to 5.1%, total hospital days 2.0 to 5.1 million in 2006). Observed trends in the number of hospitalizations over the 7-year period varied depending on which algorithm was used. In conclusion, the estimated health burden and trends in hospitalizations for AE-COPD in the United States differ, depending on which ICD-9-CM algorithm is used. To improve our understanding of the burden of AE-COPD and to ensure that quality of care initiatives are not misdirected, a validated approach to identifying patients hospitalized for AE-COPD is needed.
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Affiliation(s)
- Brian D Stein
- Rush University Medical Center, Section of Pulmonary and Critical Care Medicine, Chicago, Illinois, USA.
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