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Navarro Ros FM, Maya Viejo JD. Preclinical Evaluation of Electronic Health Records (EHRs) to Predict Poor Control of Chronic Respiratory Diseases in Primary Care: A Novel Approach to Focus Our Efforts. J Clin Med 2024; 13:5609. [PMID: 39337095 PMCID: PMC11433338 DOI: 10.3390/jcm13185609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 09/17/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: Managing chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) within the Spanish Sistema Nacional de Salud (SNS) presents significant challenges, particularly due to their high prevalence and poor disease control rates-approximately 45.1% for asthma and 63.2% for COPD. This study aims to develop a novel predictive model using electronic health records (EHRs) to estimate the likelihood of poor disease control in these patients, thereby enabling more efficient management in primary care settings. Methods: The Seleida project employed a bioinformatics approach to identify significant clinical variables from EHR data in primary care centers in Seville and Valencia. Statistically significant variables were incorporated into a logistic regression model to predict poor disease control in patients with asthma and COPD patients. Key variables included the number of short-acting β-agonist (SABA) and short-acting muscarinic antagonist (SAMA) canisters, prednisone courses, and antibiotic courses over the past year. Results: The developed model demonstrated high accuracy, sensitivity, and specificity in predicting poorly controlled disease in both asthma and COPD patients. These findings suggest that the model could serve as a valuable tool for the early identification of at-risk patients, allowing healthcare providers to prioritize and optimize resource allocation in primary care settings. Conclusions: Integrating this predictive model into primary care practice could enhance the proactive management of asthma and COPD, potentially improving patient outcomes and reducing the burden on healthcare systems. Further validation in diverse clinical settings is warranted to confirm the model's efficacy and generalizability.
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Packham S, Ödling M, Bossios A, Konradsen JR, Stridsman C. Adherence to inhaled corticosteroid therapy and treatment escalation in the Swedish adult asthma population. Respir Med 2024; 231:107714. [PMID: 38885815 DOI: 10.1016/j.rmed.2024.107714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Patients with uncontrolled asthma should be evaluated for medication adherence. This study aimed to identify characteristics associated with poor adherence to inhaled corticosteroids (ICS) and to explore adherence prior to treatment escalation. METHODS This nationwide longitudinal cohort study included adult asthma patients (n = 30880) with a healthcare visit including Asthma Control Test (ACT) and registered in the Swedish National Airway Register between 1 July 2017 and 28 February 2019 (index date). Patient data was crosslinked to other national registers. Treatment steps two years pre- and one year post-index, were identified by prescribed drugs. Poor adherence was defined as Medication Possession Ratio <80 %. RESULTS Poor adherence was identified in 73 % of patients in treatment steps 2-5, where of 35 % had uncontrolled asthma (ACT≤19). In adjusted models, poor adherence was associated with better disease control; ACT≤19 (OR 0.78, 95 % CI 0.71-0.84), short-acting β2-agonist (SABA) overuse (0.69, 0.61-0.79) and exacerbations (0.79, 0.70-0.89) in steps 2-3. Among patients with uncontrolled asthma, poor adherence was associated with SABA overuse (1.71, 1.50-1.95), exacerbations (1.29, 1.15-1.46), current smoking (1.38, 1.21-1.57) and inversely associated with asthma management education (0.85, 0.78-0.93. Similar results were observed in steps 4-5. When investigating post-index treatment, 53 % remained stationary, 30 % stepped down and 17 % escalated treatment. Prior to escalation, 49 % had poor adherence. CONCLUSIONS Poor ICS adherence was associated with better asthma control. Among uncontrolled patients, poor adherence was associated with SABA overuse and exacerbations. Our result highlights the importance of asthma management education to improve adherence in uncontrolled patients.
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Affiliation(s)
- Sylvia Packham
- Former employee at Teva Sweden AB, Helsingborg, Sweden; Dept of Public Health and Clinical Medicine, Division of Medicine/The OLIN-unit, Umeå University, Umeå, Sweden.
| | - Maria Ödling
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Apostolos Bossios
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Karolinska Severe Asthma Center, Department of Respiratory Medicine and Allergy, Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Stridsman
- Dept of Public Health and Clinical Medicine, Division of Medicine/The OLIN-unit, Umeå University, Umeå, Sweden
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Bendien SA, de Kruif MD, Feitsma H, van Hoolwerff-Blikkendaal C, Huurne KKT, Kuiterman A, Baranova EV, Wittkamp A, Brons A, Poulissen M, van der Meer AN. Summary of the Dutch Multidisciplinary Practice Guideline on Asthma and Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1751-1762. [PMID: 38513758 DOI: 10.1016/j.jaip.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
Asthma is the most common chronic respiratory disease in women of childbearing age and during pregnancy. This paper presents a summary of the Dutch multidisciplinary guideline on asthma and pregnancy. The aim of this guideline is to provide structured, where possible, evidence-based recommendations to optimize the management of asthma during pregnancy. The main topics covered in this guideline are preconception counseling, the safety of asthma medications during pregnancy and breastfeeding and risk assessment and monitoring of asthma during pregnancy. Because many caregivers are involved and a uniform approach is desirable, this guideline has been developed in collaboration with all relevant health care providers and patient representatives.
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Affiliation(s)
- Sarah A Bendien
- Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands.
| | | | - Hanneke Feitsma
- Department of Gynaecology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Cathelijn van Hoolwerff-Blikkendaal
- Nederlands huisartsen genootschap (NHG), Utrecht, The Netherlands; Dutch Association of General Practitioners and COPD & Astma Huisartsen Advies Groep (CAHAG), Utrecht, The Netherlands; Dutch COPD & Asthma Advisory Board for Practitioners, Utrecht, The Netherlands
| | | | | | - Ekaterina V Baranova
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Arjan Wittkamp
- Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Annette Brons
- Lung Foundation Netherlands, Amersfoort, The Netherlands
| | - Marjo Poulissen
- Lung Foundation Netherlands, Amersfoort, The Netherlands, and Patient Organization astma Vereniging Nederland en Davos (VND), Reeuwijk, The Netherlands
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van den Berg LN, Hallensleben C, Vlug LA, Chavannes NH, Versluis A. The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study. JMIR Hum Factors 2024; 11:e54386. [PMID: 38574348 PMCID: PMC11027062 DOI: 10.2196/54386] [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: 11/08/2023] [Revised: 01/26/2024] [Accepted: 02/18/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication-specifically, short-acting beta2-agonist (SABA) overuse-is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. OBJECTIVE This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. METHODS A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. RESULTS The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; β=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. CONCLUSIONS The initial findings regarding the app's feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices.
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Affiliation(s)
- Liselot N van den Berg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Lisa Ae Vlug
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
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Fukuda Y, Horita N, Aga M, Kashizaki F, Hara Y, Obase Y, Niimi A, Kaneko T, Mukae H, Sagara H. Efficacy and safety of macrolide therapy for adult asthma: A systematic review and meta-analysis. Respir Investig 2024; 62:206-215. [PMID: 38211545 DOI: 10.1016/j.resinv.2023.12.015] [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: 10/06/2023] [Revised: 11/29/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The evidence for macrolide therapy in adult asthma is not properly established and remains controversial. We conducted a systematic review and meta-analysis to examine the efficacy and safety of macrolide therapy for adult asthma. METHODS We searched randomized controlled trials from MEDLINE via the PubMed, CENTRAL, and Ichushi Web databases. The primary outcome was asthma exacerbation. The secondary outcomes were serious adverse events (including mortality), asthma-related quality of life (symptom scales, Asthma Control Questionnaire, and Asthma Quality of Life Questionnaire), rescue medication (puffs/day), respiratory function (morning peak expiratory flow, evening peak flow, and forced expiratory volume in 1 s), bronchial hyperresponsiveness, and minimum oral corticosteroid dose. Of the 805 studies, we selected seven studies for the meta-analysis, which was conducted using a random-effects model. SYSTEMATIC REVIEW REGISTRATION University Hospital Medical Information Network Clinical Trials Registry (UMIN000050824). RESULTS No significant difference between macrolide and placebo for asthma exacerbations was observed (risk ratio 0.71, 95 % confidence interval [CI] 0.46-1.09; p = 0.12). Macrolide therapy for adult asthma showed a significant improvement in rescue medication with short-acting beta-agonists (mean difference -0.41, 95 % CI -0.78 to -0.04; p = 0.03). Macrolide therapy did not show more serious adverse events (odd ratio 0.61, 95 % CI 0.34-1.10; p = 0.10) than those with placebo. The other secondary outcomes were not significantly different between the macrolide and placebo groups. CONCLUSIONS Macrolide therapy for adult asthma may be more effective than placebo and could be a treatment option.
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Affiliation(s)
- Yosuke Fukuda
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan; Department of Medicine, Division of Respiratory Medicine, Yamanashi Red Cross Hospital, Yamanashi, Japan.
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Kanagawa, Japan
| | - Masaharu Aga
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
| | - Fumihiro Kashizaki
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akio Niimi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
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Jackson DJ, Heaney LG, Humbert M, Kent BD, Shavit A, Hiljemark L, Olinger L, Cohen D, Menzies-Gow A, Korn S. Reduction of daily maintenance inhaled corticosteroids in patients with severe eosinophilic asthma treated with benralizumab (SHAMAL): a randomised, multicentre, open-label, phase 4 study. Lancet 2024; 403:271-281. [PMID: 38071986 DOI: 10.1016/s0140-6736(23)02284-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Stepwise intensification of inhaled corticosteroids (ICS) is routine for severe eosinophilic asthma, despite some poor responses to high-dose ICS. Dose reductions are recommended in patients responding to biologics, but little supporting safety evidence exists. METHODS SHAMAL was a phase 4, randomised, open-label, active-controlled study done at 22 study sites in four countries. Eligible participants were adults (aged ≥18 years) with severe eosinophilic asthma and a five-item Asthma Control Questionnaire score below 1·5 and who received at least three consecutive doses of benralizumab before screening. We randomly assigned patients (3:1) to taper their high-dose ICS to a medium-dose, low-dose, and as-needed dose (reduction group) or continue (reference group) their ICS-formoterol therapy for 32 weeks, followed by a 16-week maintenance period. The primary endpoint was the proportion of patients reducing their ICS-formoterol dose by week 32. The primary outcome was assessed in the reduction group, and safety analyses included all randomly assigned patients receiving study treatment. This study is registered at ClinicalTrials.gov, NCT04159519. FINDINGS Between Nov 12, 2019, and Feb 16, 2023, we screened and enrolled in the run-in period 208 patients. We randomly assigned 168 (81%) to the reduction (n=125 [74%]) and reference arms (n=43 [26%]). Overall, 110 (92%) patients reduced their ICS-formoterol dose: 18 (15%) to medium-dose, 20 (17%) to low-dose, and 72 (61%) to as-needed only. In 113 (96%) patients, reductions were maintained to week 48; 114 (91%) of patients in the reduction group had zero exacerbations during tapering. Rates of adverse events were similar between groups. 91 (73%) patients had adverse events in the reduction group and 35 (83%) in the reference group. 17 patients had serious adverse events in the study: 12 (10%) in the reduction group and five (12%) in the reference group. No deaths occurred during the study. INTERPRETATION These findings show that patients controlled on benralizumab can have meaningful reductions in ICS therapy while maintaining asthma control. FUNDING AstraZeneca.
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Affiliation(s)
- David J Jackson
- School of Immunology & Microbial Sciences, Guy's Hospital, King's College London, London, UK.
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, UK
| | - Marc Humbert
- Service de Pneumologie, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Brian D Kent
- St James's Hospital, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Anat Shavit
- BioPharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | | | - Lynda Olinger
- Late-Stage Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK; Cytel, Waltham, MA, USA
| | - David Cohen
- BioPharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Andrew Menzies-Gow
- BioPharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Stephanie Korn
- Thoraxklinik Heidelberg, Germany, IKF Pneumologie, Mainz, Germany
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Smicherko G, Albright A, Nguyen K. Should all asthma patients be switched to single maintenance and reliever therapy? JAAPA 2023; 36:10-12. [PMID: 37668475 DOI: 10.1097/01.jaa.0000947068.06528.df] [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: 09/06/2023]
Abstract
ABSTRACT Recent data indicate that overuse of short-acting beta2-agonists (SABAs) results in an increased risk of asthma exacerbations and mortality. The use of inhaled corticosteroid-formoterol as both maintenance and reliever therapy has become a preferred regimen for asthma management. Clinicians should be aware of the pharmacology, dosing, and prescribing considerations regarding the use of budesonide-formoterol as the available combination in the United States.
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Affiliation(s)
- Gabriela Smicherko
- At the time this article was written, Gabriela Smicherko and Amanda Albright were doctor of pharmacy students at Wilkes University Nesbitt School of Pharmacy in Wilkes-Barre, Pa. Kimmy Nguyen is an assistant professor of pharmacy practice at Wilkes University and a clinical pharmacy specialist with Volunteers in Medicine of Wilkes-Barre. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Haughney J, Winders T, Holmes S, Chanez P, Menzies-Gow A, Kocks J, Mansur AH, McPherson C, Canonica GW. A Charter to Fundamentally Change the Role of Oral Corticosteroids in the Management of Asthma. Adv Ther 2023; 40:2577-2594. [PMID: 37027115 PMCID: PMC10080509 DOI: 10.1007/s12325-023-02479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/21/2023] [Indexed: 04/08/2023]
Abstract
Asthma affects 339 million people worldwide, with an estimated 5-10% experiencing severe asthma. In emergency settings, oral corticosteroids (OCS) can be lifesaving, but acute and long-term treatment can produce clinically important adverse outcomes and increase the risk of mortality. Therefore, global guidelines recommend limiting the use of OCS. Despite the risks, research indicates that 40-60% of people with severe asthma are receiving or have received long-term OCS treatment. Although often perceived as a low-cost option, long-term OCS use can result in significant health impairments and costs owing to adverse outcomes and increased utilization of healthcare resources. Alternative treatment methods, such as biologics, may produce cost-saving benefits with a better safety profile. A comprehensive and concerted effort is necessary to tackle the continued reliance on OCS. Accordingly, a threshold for OCS use should be established to help identify patients at risk of OCS-related adverse outcomes. Receiving a total dose of more than 500 mg per year should trigger a review and specialist referral. Changes to national and local policies, following examples from other chronic diseases, will be crucial to achieving this goal. Globally, multiple barriers to change still exist, but specific steps have been identified to help clinicians reduce reliance on OCS. Implementing these changes will result in positive health outcomes for patients and social and economic benefits for societies.
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Affiliation(s)
- John Haughney
- Glasgow Clinical Research Facility, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Tonya Winders
- Allergy and Asthma Network, Vienna, VA, USA
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | | | - Pascal Chanez
- Department of Respiratory CIC Nord INSERM INRAE C2VN, Aix Marseille University, Marseille, France
| | | | - Janwillem Kocks
- General Practitioners Research Institute, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adel H Mansur
- Respiratory Medicine, Birmingham Heartlands Hospital and University of Birmingham, Birmingham, UK
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Personalized Medicine, Asthma and Allergy, Milan, Italy
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Uong SP, Hussain H, Thanik E, Lovinsky-Desir S, Stingone JA. Urinary metabolites of polycyclic aromatic hydrocarbons and short-acting beta agonist or systemic corticosteroid asthma medication use within NHANES. ENVIRONMENTAL RESEARCH 2023; 220:115150. [PMID: 36572332 PMCID: PMC9969867 DOI: 10.1016/j.envres.2022.115150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 11/14/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Within cross-sectional studies like the U.S. National Health and Nutritional Examination Survey (NHANES), researchers have observed positive associations between polycyclic aromatic hydrocarbon (PAH) exposure and asthma diagnosis. It is unclear whether similar relationships exist for measures of acute asthma outcomes, including short-term asthma medication use to alleviate symptoms. We examined the relationship between markers of recent PAH exposure and 30-day short-acting beta agonist (SABA) or systemic corticosteroid use, an indicator for recent asthma symptoms. MATERIALS AND METHODS For 16,550 children and adults across multiple waves of NHANES (2005-2016), we fit quasi-Poisson multivariable regression models to describe the association between urinary 1-hydroxypyrene (a metabolite of PAH) and SABA or systemic corticosteroid use. We assessed for effect modification by age group and asthma controller medication use. All models were adjusted for urinary creatinine, age, female/male designation, race/ethnicity, poverty, insurance coverage, and serum cotinine. RESULTS After controlling for confounding, an increase of one standard deviation of 1-hydroxypyrene was associated with greater prevalence of recent SABA or systemic corticosteroid use (PR: 1.06, 95% CI: 1.03-1.10). The results were similar among those with ever asthma diagnosis and across urine creatinine dilution methods. We did not observe effect modification by age group (p-interaction = 0.22) or asthma controller medication use (p-interaction = 0.73). CONCLUSION Markers of recent PAH exposure was positively associated with SABA or systemic corticosteroid use, across various urine dilution adjustment methods. It is important to ensure appropriate temporality between exposures and outcomes in cross-sectional studies.
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Affiliation(s)
- Stephen P Uong
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York City, NY, USA.
| | - Haider Hussain
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, New York City, NY, USA
| | - Erin Thanik
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, New York City, NY, USA
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, Division of Pulmonary Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York City, NY, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York City, NY, USA
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de Las Vecillas L, Quirce S. Landscape of short-acting beta-agonists (SABA) overuse in Europe. Clin Exp Allergy 2023; 53:132-144. [PMID: 36468654 DOI: 10.1111/cea.14250] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 12/11/2022]
Abstract
This review article provides an overview of short-acting beta-agonist (SABA) use and prescribing trends in Europe, summarizing updated data on the results from the industry-funded SABINA program (SABA use IN asthma) and other studies on this matter. SABA use continues to increase worldwide. Overuse has been defined as ≥3 canisters/year. Almost a third of European patients with asthma, at all severity levels, overuse SABA. Guidelines recommend close monitoring of patients who overuse SABA and avoiding over-reliance on SABA monotherapy. SABA overuse is associated with increased risk of asthma exacerbations and mortality, increased use of health services and negative physical and mental health outcomes. Reliance on SABA monotherapy can be unsafe and therefore it is necessary to change asthma treatment approaches and policies. Changes in physician and patient behaviours towards SABA use are required to ensure that patients with asthma are not over-reliant on SABA monotherapy. Notwithstanding, the limitations of the studies on the use of SABA should be considered, taking into account that the prescription/purchase of medication canisters does not always represent the actual use of the medication and that associations between SABA overuse and poor asthma outcomes may not be directly causal. National health systems and asthma guidelines must align asthma management with global recommendations and adjust them to local needs.
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Affiliation(s)
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
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11
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Guyton S, Jackson T. Asthma Control and Medication Reliance Among Asthmatics in a General Practice Setting - A Questionnaire Based Study. Cureus 2022; 14:e25465. [PMID: 35800840 PMCID: PMC9246449 DOI: 10.7759/cureus.25465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
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