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Fung LW, Yan VK, Kwan C, Kwok WC, Lam DC, McDonald CF, Bloom CI, Wong IC, Chan EW. SABINA + Hong Kong: a territory wide study of prescribing trends and outcomes associated with the use of short-acting β2 agonists in the Chinese population. BMC Pulm Med 2024; 24:232. [PMID: 38745268 PMCID: PMC11094848 DOI: 10.1186/s12890-024-03038-1] [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: 05/31/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Excessive use of short-acting β2 agonists (SABA) in patients with asthma continues to be a notable concern due to its link to higher mortality rates. Global relevance of SABA overuse in asthma management cannot be understated, it poses significant health risk to patients with asthma and imposes burden on healthcare systems. This study, as part of global SABINA progamme, aimed to describe the prescribing patterns and clinical outcomes associated with SABA use in the Chinese population. METHODS Retrospective cohort study was conducted using anonymized electronic healthcare records of Clinical Data Analysis and Reporting System (CDARS) from Hong Kong Hospital Authority (HA). Patients newly diagnosed with asthma between 2011 and 2018 and aged ≥12 years were included, stratified by SABA use (≤2, 3-6, 7-10, or ≥11 canisters/year) during one-year baseline period since asthma diagnosis date. Patients were followed up from one-year post-index until earliest censoring of events: outcome occurrence and end of study period (31 December 2020). Cox proportional regression and negative binomial regression were used to estimate the mortality risk and frequency of hospital admissions associated with SABA use respectively, after adjusting for age, sex, Charlson Comorbidity Index (CCI), and inhaled corticosteroid (ICS) dose. Outcomes include all-cause, asthma-related, and respiratory-related mortality, frequency of hospital admissions for any cause, and frequency of hospital admissions due to asthma. RESULTS 17,782 patients with asthma (mean age 46.7 years, 40.8% male) were included and 59.1% of patients were overusing SABA (≥ 3 canisters per year). Each patient was prescribed a median of 5.61 SABA canisters/year. SABA overuse during baseline period was associated with higher all-cause mortality risk compared to patients with ≤2 canisters/year. Association was dose-dependent, highest risk in those used ≥11 canisters/year (adjusted hazard ratio: 1.42, 95% CI: 1.13, 1.79) and 3-6 canisters/year (adjusted hazard ratio: 1.22, 95% CI: 1.00, 1.50). Higher SABA prescription volume associated with increased frequency of hospital admissions with greatest risk observed in 7-10 canisters/year subgroup (adjusted rate ratio: 4.81, 95% CI: 3.66, 6.37). CONCLUSIONS SABA overuse is prevalent and is associated with increased all-cause mortality risk and frequency of hospital admissions among the patients with asthma in Hong Kong.
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Affiliation(s)
- Lydia Wy Fung
- formerly, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- formerly, Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Vincent Kc Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Christine Kwan
- Sau Po Centre of Ageing, The University of Hong Kong, Hong Kong SAR, China
- formerly, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- formerly, Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - W C Kwok
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - David Cl Lam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Melbourne, Victoria, Australia
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ian Ck Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China
- Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK
- Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong SAR, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China.
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China.
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Ma J, Sun X, Wang X, Liu B, Shi K. Factors Affecting Patient Adherence to Inhalation Therapy: An Application of SEIPS Model 2.0. Patient Prefer Adherence 2023; 17:531-545. [PMID: 36896268 PMCID: PMC9990505 DOI: 10.2147/ppa.s395327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/18/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose This study aims to explore factors that affect patient adherence to inhalation therapy by applying a patient-centered approach. Patients and Methods We conducted a qualitative study to identify the factors that influence adherent behaviors among asthma/COPD patients. 35 semi-structured interviews with patients, and 15 semi-structured interviews with healthcare providers (HCPs) who manage asthma/COPD patients were conducted. The SEIPS 2.0 model was applied as a conceptual framework for guiding the interview content and analysis of the interview data. Results Based on the findings of this study, a conceptual framework of patient adherence in asthma/COPD during inhalation therapy was constructed including five themes: person, task, tool, physical environment, and culture and society. Person-related factors include patient ability and emotional experience. Task-related factors refer to task type and frequency and flexibility. Tool-related factors are the type of inhalers and usability of inhalers. Physical environment-related factors include home environment and COVID-19 situation. Culture and social related factors consist of two aspects: cultural beliefs and social stigma. Conclusion The findings of the study identified 10 influential factors that impact on patient adherence to inhalation therapy. A SEIPS-based conceptual model was constructed based on the responses of patients and HCPs to explore the experiences of patients engaging in inhalation therapy and interacting with inhalation devices. In particular, new insight about factors of emotional experience, physical environment and traditional cultural beliefs were found crucial for patients with Asthma/COPD to conduct patients' adherent behaviors.
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Affiliation(s)
- Jing Ma
- Faculty of Science and Engineering, University of Nottingham, Ningbo, People’s Republic of China
| | - Xu Sun
- Faculty of Science and Engineering, University of Nottingham, Ningbo, People’s Republic of China
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, People’s Republic of China
| | - Xinwei Wang
- Faculty of Science and Engineering, University of Nottingham, Ningbo, People’s Republic of China
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, People’s Republic of China
| | - Bingjian Liu
- Faculty of Science and Engineering, University of Nottingham, Ningbo, People’s Republic of China
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, People’s Republic of China
| | - Kaiqi Shi
- Suzhou Inhal Pharma Co., Ltd., Suzhou, People’s Republic of China
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Lizano-Barrantes C, Garin O, Dima AL, van Ganse E, de Bruin M, Belhassen M, Mayoral K, Pont À, Ferrer M. The Inhaler Technique Questionnaire (InTeQ): Development and Validation of a Brief Patient-Reported Measure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052591. [PMID: 35270283 PMCID: PMC8909835 DOI: 10.3390/ijerph19052591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
There is a need for instruments designed for patients with asthma to self-report their performance of inhaling steps. We aimed to develop an accessible and easy-to-use patient-reported tool for inhaler technique assessment, which could also serve as a training and monitoring resource for any type of inhaler device, and to evaluate its feasibility, validity, and reliability in adults with asthma. The development was based on literature review and pilot testing with clinicians and patients. The Inhaler Technique Questionnaire (InTeQ) asks about the frequency of performing five steps when using inhalers (on a five-point Likert scale). We analyzed data from adults with persistent asthma (n = 361). We examined the measurement model using Mokken scaling analysis, construct validity by assessing hypotheses on expected discrimination among known groups, and reliability based on internal consistency and reproducibility. Means of the InTeQ items were in the range of 0.23–1.61, and coefficients of homogeneity were above the cutoff point, demonstrating the unidimensionality of the scale. Known groups’ global score differences were statistically significant between patients reporting having “Discussed in detail” or having “Not discussed/Only in general” the inhaler technique with their healthcare providers (p = 0.023). The Cronbach’s alpha coefficient was 0.716, and the intraclass correlation coefficient was 0.775. The InTeQ is a feasible, valid, and reliable instrument for self-reporting inhaler technique on any type of device.
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Affiliation(s)
- Catalina Lizano-Barrantes
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Department of Pharmaceutical Care and Clinical Pharmacy, Faculty of Pharmacy, Universidad de Costa Rica, San Jose 2060, Costa Rica
| | - Olatz Garin
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
| | - Alexandra L. Dima
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Spain
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69003 Lyon, France;
- Correspondence:
| | - Eric van Ganse
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69003 Lyon, France;
- Respiratory Medicine, Croix-Rousse University Hospital, 69004 Lyon, France
- PELyon, Pharmacoepidemiology, 69007 Lyon, France;
| | - Marijn de Bruin
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | | | - Karina Mayoral
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Àngels Pont
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (C.L.-B.); (O.G.); (K.M.); (À.P.); (M.F.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, 28029 Madrid, Spain
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Metting E, Dassen L, Aardoom J, Versluis A, Chavannes N. Effectiveness of Telemonitoring for Respiratory and Systemic Symptoms of Asthma and COPD: A Narrative Review. Life (Basel) 2021; 11:1215. [PMID: 34833091 PMCID: PMC8624095 DOI: 10.3390/life11111215] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022] Open
Abstract
Asthma and chronic obstructive pulmonary diseases (COPD) are highly prevalent chronic lung diseases that require ongoing self-management, which itself is often suboptimal. Therefore, telemonitoring has been used to help patients measure their symptoms, share data with healthcare providers and receive education and feedback to improve disease management. In this study, we conducted a narrative review of recent evidence on the effectiveness of telemonitoring for asthma and COPD in adults. Of the thirteen identified studies, eleven focused on COPD and two focused on asthma. All studies were reviewed, and effects were compared between intervention and care as usual groups. Of the study interventions, seven showed a positive outcome on at least one outcome measure, and six had no significant results on any of the outcome measures. All of the interventions with a positive outcome included an educational component, while only one of the six interventions without positive outcomes included an educational component. We conclude that telemonitoring interventions for asthma and COPD seem more effective if they included an educational component regarding different aspects of self-management.
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Affiliation(s)
- Esther Metting
- Data Science Center in Health, University of Groningen, University Medical Center Groningen, 9713 BZ Groningen, The Netherlands
- Department of Operations, Faculty of Economics and Business, University of Groningen, 9724 AV Groningen, The Netherlands;
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
| | - Lizayra Dassen
- Department of Operations, Faculty of Economics and Business, University of Groningen, 9724 AV Groningen, The Netherlands;
| | - Jiska Aardoom
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
- Public Health and Primary Care, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands
| | - Anke Versluis
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
- Public Health and Primary Care, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
- Public Health and Primary Care, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands
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Du J, Shi YH, Duan YX, Wang XR, Zhou M, Gu WC, Wen CJ, Gong Y, Du CL, Peng B, Sun L, Tang W. Asthma treatment adherence and related factors in Shanghai, China. Chin Med J (Engl) 2021; 134:2506-2508. [PMID: 34561319 PMCID: PMC8654441 DOI: 10.1097/cm9.0000000000001680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Juan Du
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Northern Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 201821, China
| | - Yu-Heng Shi
- Department of Respiratory Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
| | - Yu-Xiang Duan
- Department of Respiratory Medicine, TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200050, China
| | - Xiao-Ru Wang
- Department of Respiratory Medicine, Da Hua Hospital, Xuhui District, Shanghai 200237, China
| | - Min Zhou
- Department of Respiratory Medicine, Shanghai Sixth People's Hospital (Jinshan Branch), Shanghai 201500, China
| | - Wen-Chao Gu
- Department of Respiratory Medicine, People's Hospital of Shanghai Pudong District, Shanghai 201200, China
| | - Chi-Jun Wen
- Department of Xiao Gan, Shanghai Ninth People's Hospital (Huangpu Branch), Shanghai 200011, China
| | - Yi Gong
- Department of Respiratory and Critical Care Medicine, Huashan Hospital, Fudan University School of Medicine, Shanghai 200040, China
| | - Chun-Ling Du
- Department of Respiratory Medicine, People's Hospital of Shanghai Qingpu District, Shanghai 201700, China
| | - Bo Peng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Lin Sun
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wei Tang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Yıldız M, Aksu F, Yıldız N, Aksu K. Clinician's perspective regarding medication adherence in patients with obstructive lung diseases and the impact of COVID-19. ACTA ACUST UNITED AC 2021; 67Suppl 1:97-101. [PMID: 34406300 DOI: 10.1590/1806-9282.67.suppl1.20201095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Failure to achieve high levels of medication adherence in obstructive lung diseases is a major cause of uncontrolled disease. The purpose of this study is to reveal clinicians' opinions on the level of patient adherence and the change in adherence during the COVID-19 pandemic. METHODS A questionnaire containing multiple-choice questions about treatment adherence in patients with obstructive lung diseases was voluntarily applied to doctors working in a tertiary hospital for chest diseases. RESULTS Eighty-one doctors (mean age, 37.2 years [standard deviation, 9.7 years]; 57 (70.4%) women) answered the questionnaires. Almost all clinicians participating in the study reported that they always or frequently asked patients if they adhered to treatment. Most clinicians think that in 20-50% of patients with asthma and less than 20% of patients with chronic obstructive pulmonary disease, a decrease in medication adherence appears in the first year of treatment. Most clinicians think the main reason for patients with obstructive lung diseases not adhering is patients' reluctance to be treated regularly. Regarding the impact of the COVID-19 pandemic on patients' drug adherence, 43.2% of clinicians observed that adherence increased after the start of the pandemic. CONCLUSIONS Adherence to medication is not at the desired levels in patients with obstructive lung diseases. However, when faced with a serious health threat, such as the COVID-19 pandemic, patients realize the severity of their illness and begin using their treatments more regularly.
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Affiliation(s)
- Murat Yıldız
- University of Health Sciences, Ankara Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Chest Diseases - Ankara, Turkey
| | - Funda Aksu
- University of Health Sciences, Ankara Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Chest Diseases - Ankara, Turkey
| | - Nurdan Yıldız
- University of Health Sciences, Ankara City Hospital, Department of Family Medicine - Ankara, Turkey
| | - Kurtuluş Aksu
- University of Health Sciences, Ankara Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Chest Diseases, Division of Immunology and Allergy - Ankara, Turkey
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Gon Y, Ishii T, Lawrence D, Nikolaev I, Wang D, Sumi K, Nakamura Y. Once-daily, single-inhaler indacaterol/mometasone versus twice-daily salmeterol/fluticasone in Asian patients with inadequately controlled asthma: Post hoc pooled analysis from PALLADIUM and IRIDIUM studies. J Asthma 2021; 59:1627-1637. [PMID: 34346266 DOI: 10.1080/02770903.2021.1962342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: PALLADIUM and IRIDIUM studies demonstrated efficacy and safety of indacaterol/mometasone (IND/MF) versus salmeterol/fluticasone (SAL/FLU). This post hoc analysis of pooled data from PALLADIUM and IRIDIUM studies evaluated efficacy and safety of IND/MF versus SAL/FLU in Asian patients with inadequately controlled asthma.Methods: Both studies were Phase III, 52-week, randomized, double-blind, active-controlled that included patients with predicted pre-bronchodilator FEV1 (PALLADIUM, ≥50%-<85%; IRIDIUM, <80%), ACQ-7 score ≥1.5. Patients treated with IND/MF high- (150/320μg) or medium-dose (150/160μg) or SAL/FLU high-dose (50/500μg) were included. Lung function, asthma control, and asthma exacerbations were evaluated.Results: In total, 323 patients (IND/MF high-dose, n = 107; IND/MF medium-dose, n = 106, SAL/FLU high-dose, n = 110) were included. IND/MF high-dose showed improvement in trough FEV1 versus SAL/FLU high-dose at Weeks 26 (Δ, 42 mL; 95% CI, -35 to 120 mL), and 52 (Δ, 41 mL; 95% CI, -37 to 120 mL). IND/MF high-dose exhibited numerically greater improvement in ACQ-7 score versus SAL/FLU high-dose at Weeks 26 (Δ, -0.215; 95% CI, -0.385 to -0.044) and 52 (Δ, -0.176; 95% CI, -0.348 to -0.005). Improvements in trough FEV1 and ACQ-7 score were comparable between IND/MF medium-dose and SAL/FLU high-dose. IND/MF high- and medium-dose showed reductions in moderate or severe (45%; 30%), severe (39%; 41%), and all (9%; 25%) exacerbations, respectively, versus SAL/FLU high-dose over 52 weeks. All treatments were well tolerated.Conclusions: Once-daily, single-inhaler IND/MF high-dose improved lung function with better asthma control, reduced asthma exacerbations with comparable safety versus twice-daily SAL/FLU high-dose. IND/MF medium-dose showed comparable outcomes to SAL/FLU high-dose at a reduced steroid dose.
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Affiliation(s)
- Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | - Yoichi Nakamura
- Department of Allergology, Medical Center for Allergy and Immune Diseases, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
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GINA 2020: Potential Impacts, Opportunities, and Challenges for Primary Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1516-1519. [PMID: 33373689 DOI: 10.1016/j.jaip.2020.12.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/23/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022]
Abstract
In 2019, it was reported that changes to asthma management reported in the Global Initiative for Asthma (GINA) "…might be considered the most fundamental changes in asthma management in 30 years." These changes refer to the recommendation that the treatment of asthma in adolescents and adults would no longer include short-acting ß2-agonist (SABA) only, but that people with asthma should receive either symptom-driven inhaled corticosteroids (ICS)-containing treatment (mild asthma) or daily ICS-containing treatment. The fundamental reason for this shift was driven by concerns about the risks and consequences associated with SABA-only treatment, the need to improve the day-to-day management of asthma symptoms to prevent exacerbations and emergent evidence. These recommendations have subsequently been reinforced and characterized in GINA 2020, and it is reasonable to say that they are significant, not only in terms of an asthma management framework but also as a management approach in practice. This opinion article specifically focuses on opportunities and challenges associated with the implementation of GINA 2020 in primary care practice that need to be recognized and addressed if the shift in asthma treatment paradigm is to be successfully implemented into day-to-day practice.
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Kritikos V, Price D, Papi A, Infantino A, Ställberg B, Ryan D, Lavorini F, Chrystyn H, Haughney J, Lisspers K, Gruffydd-Jones K, Román Rodríguez M, Høegh Henrichsen S, van der Molen T, Carter V, Bosnic-Anticevich S. A multinational observational study identifying primary care patients at risk of overestimation of asthma control. NPJ Prim Care Respir Med 2019; 29:43. [PMID: 31804501 PMCID: PMC6895161 DOI: 10.1038/s41533-019-0156-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/08/2019] [Indexed: 11/11/2022] Open
Abstract
Factors related to the discrepancy between patient-perceived and actual disease control remain unclear. Identifying patients at risk of overestimation of asthma control remains elusive. This study aimed to (i) investigate the relationship between patient-reported and actual level of asthma control (ii), compare the characteristics between patients who believe their asthma is well controlled that accurately report ‘well-controlled’ asthma with those that do not, and (iii) identify factors associated with inaccurately reported ‘well-controlled’ asthma. A historical, multinational, cross-sectional study using data from the iHARP (initiative Helping Asthma in Real-life Patients) review service for adults with asthma prescribed fixed-dose combination therapy. Data from 4274 patients were analysed. A major discrepancy between patient-reported and Global Initiative for Asthma defined asthma control was detected; 71.1% of patients who reported ‘well-controlled’ asthma were inaccurate in their perception despite receiving regular maintenance therapy. Significant differences were noted in age, gender, body mass index, education level, medication use, side effects, attitudes to preventer inhaler use, inhaler technique review and respiratory specialist review between patients who accurately reported ‘well-controlled’ asthma and those who did not. Independent risk factors associated with inaccurately reported ‘well-controlled’ asthma were: having taken a maximum of 5–12 puffs or more of reliever inhaler on at least one day within the previous 4 weeks; being female; having seen a respiratory specialist more than a year ago (rather than in the previous year); and having required oral corticosteroids for worsening asthma in the previous year. The study highlighted the significant hidden burden associated with under-recognition of poor asthma control, on the part of the patient and the need for targeted interventions designed to address the continuing discrepancy between perceived and actual disease control.
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Affiliation(s)
- Vicky Kritikos
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. .,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - David Price
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Southbank, Singapore.,Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Antonio Infantino
- Special Interest Respiratory Area, Italian Interdisciplinary Society for Primary Care, Bari, Italy
| | - Bjorn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Dermot Ryan
- Optimum Patient Care, Cambridge, UK.,Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Federico Lavorini
- Department Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | | | | | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | - Miguel Román Rodríguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Spain
| | - Svein Høegh Henrichsen
- Department of Primary Health Care Services, Norwegian Directorate of Health, Oslo, Norway
| | - Thys van der Molen
- Department of Primary Care, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Victoria Carter
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Southbank, Singapore
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Central Sydney Local Area Health District, Sydney, NSW, Australia
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Heru Setiawan C, Widayati A, Virginia DM, Armour C, Saini B. The role of pharmacists in the pharmaceutical care of asthma patients in Yogyakarta, Indonesia: the patients' views. J Asthma 2019; 57:1017-1028. [PMID: 31204546 DOI: 10.1080/02770903.2019.1622715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Community pharmacists are one of the most frequently accessed health professionals who can be involved in the provision of ongoing asthma management within the primary care setting. The aim of this study was to identify patients' views regarding current asthma care provided by their pharmacists and their perspectives on future pharmacy-based asthma services.Methods: This is a qualitative approach with an interview guide. Asthma patients were purposively selected. Interviews were conducted from April to June 2017. Patient's opinions about asthma and its management and their experiences regarding asthma care provided by pharmacists were collected. Data were analyzed using content analysis.Results: Thirty-three interviews were conducted. Asthma literacy was low. There was dis-engagement with the health care system, with only a few participants trusting conventional health care professionals. Alternative medicine systems and practitioners were better trusted and participants had strong preferences for family/peer involvement in their asthma care. Participants also had misunderstandings regarding their asthma disease and medications. Participants had experienced little pharmaceutical care provided by pharmacists but would welcome it in the future.Conclusion: Given the accessibility of community pharmacy venues and readiness of the profession for more involved care of chronic disease patients, it may be recommended that Indonesian community pharmacists should adopt the provision of pharmaceutical care models for asthma. Such pharmaceutical care models need to incorporate patients' unique sociocultural health beliefs, preferences for alternative medicines and family/social peer involvement as well as stronger collaboration between pharmacists and physicians.
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Affiliation(s)
| | - Aris Widayati
- Faculty of Pharmacy, Universitas Sanata Dharma, Yogyakarta, Indonesia
| | | | - Carol Armour
- Sydney Local Health District, Sydney, Australia.,Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.,School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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11
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Wang DY, Cho SH, Lin HC, Ghoshal AG, Bin Abdul Muttalif AR, Thanaviratananich S, Tunceli K, Urdaneta E, Zhang D, Faruqi R. Practice Patterns for Chronic Respiratory Diseases in the Asia-Pacific Region: A Cross-Sectional Observational Study. Int Arch Allergy Immunol 2018; 177:69-79. [PMID: 29874659 DOI: 10.1159/000489015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR), asthma, chronic obstructive pulmonary disease (COPD), and rhinosinusitis are common and little studied in the Asia-Pacific region. OBJECTIVES We sought to investigate real-world practice patterns for these respiratory diseases in India, Korea, Malaysia, Singapore, Taiwan, and Thailand. METHODS This cross-sectional observational study enrolled adults (age ≥18 years) presenting to general practitioners (GP) or specialists for physician-diagnosed AR, asthma, COPD, or rhinosinusitis. Physicians and patients completed study-specific surveys at one visit, recording patient characteristics, health-related quality of life (QoL), work impairment, and healthcare resource use. Findings by country and physician category (GP or specialist) were summarized. RESULTS Of the 13,902 patients screened, 7,243 (52%) presented with AR (18%), asthma (18%), COPD (7%), or rhinosinusitis (9%); 5,250 of the 7,243 (72%) patients were eligible for this study. Most eligible patients (70-100%) in India, Korea, Malaysia, and Singapore attended GP, while most (83-85%) in Taiwan and Thailand attended specialists. From 42% (rhinosinusitis) to 67% (AR) of new diagnoses were made by GP. On average, patients with COPD reported the worst health-related QoL, particularly to GP. Median losses of work productivity for each condition and activity impairment, except for asthma, were numerically greater for patients presenting to GP vs. specialists. GP prescribed more antibiotics for AR and asthma, and fewer intranasal corticosteroids for AR, than specialists (p < 0.001 for all comparisons). CONCLUSIONS Our findings, albeit mostly descriptive and influenced by between-country differences, suggest that practice patterns differ between physician types, and the disease burden may be substantial for patients presenting in general practice.
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Affiliation(s)
- De Yun Wang
- Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Horng-Chyuan Lin
- Division of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | | | | | - Kaan Tunceli
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Eduardo Urdaneta
- Global Medical Affairs, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Dongmu Zhang
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Rab Faruqi
- Medical Affairs Asia-Pacific Region, Merck & Co., Inc., Kenliworth, New Jersey, USA
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12
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Bosnic-Anticevich SZ, Cvetkovski B, Azzi EA, Srour P, Tan R, Kritikos V. Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management. Pulm Ther 2018; 4:1-12. [PMID: 32026244 PMCID: PMC6966926 DOI: 10.1007/s41030-018-0051-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Indexed: 12/24/2022] Open
Abstract
Medication use has always played a highly significant role in the overall management of asthma, with appropriate use being linked to good asthma control. However, while patients with asthma enjoy the 'luxury' of having medications delivered directly to the lungs via inhaler devices, with that comes the additional challenge of ensuring that inhaler devices are used correctly. Research and practice provides evidence to the challenges associated with inhaler use and the particular steps that patients perform incorrectly. While this problem is well documented, acknowledged and reported, little has changed in 40 years, and the proportion of patients using inhaler devices remains unacceptably high. This review focuses on aspects specific to the errors that patient's make, the significance of these errors, and the important considerations for health care practitioners in supporting patients in correctly using their inhalers. This review highlights the complexities associated with patient's making inhaler technique errors and highlights the opportunities that lie in future technological developments of inhaler devices. Now more than ever, in the era of precision medicine, it is important that we address inhaler technique use once and for all.
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Affiliation(s)
- Sinthia Z Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia.
- Woolcock Emphysema Centre, University of Sydney, Sydney, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Elizabeth A Azzi
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Pamela Srour
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rachel Tan
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
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13
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Chapman KR, Hinds D, Piazza P, Raherison C, Gibbs M, Greulich T, Gaalswyk K, Lin J, Adachi M, Davis KJ. Physician perspectives on the burden and management of asthma in six countries: The Global Asthma Physician Survey (GAPS). BMC Pulm Med 2017; 17:153. [PMID: 29169365 PMCID: PMC5701503 DOI: 10.1186/s12890-017-0492-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 11/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Despite recognition of asthma as a growing global issue and development of global guidelines, asthma treatment practices vary between countries. Several studies have reported patients’ perspectives on asthma control. This study presents physicians’ perspectives and strategies for asthma management. Methods Physicians seeing ≥4 adult patients with asthma per month in Australia, Canada, China, France, Germany, and Japan were surveyed (N=1809; ≈300 per country). A standardised questionnaire was developed for this study and administered by telephone, online or face-to-face. Statistics were weighted to account for the sampling scheme. Results Physicians estimated that 71% of their adult patients received maintenance medication, with adherence monitored by 76–97% of physicians. Perceived major barriers to patient adherence included: patients taking treatment as needed; acceptance of symptoms; and patients not perceiving treatment benefits. Written action plans (37%) and technology (15%) were seldom employed by physicians to aid patients’ asthma management. Physicians rarely (10%) used validated patient-reported questionnaires to monitor asthma control, instead monitoring selected symptoms, exacerbations, and/or lung function measurements. Awareness of single maintenance and reliever therapy (SMART/MART) varied among countries (56–100%); although most physicians (72%) had prescribed SMART/MART, the majority (91%) co-prescribed a short-acting bronchodilator at least some of the time. Conclusions These results show that physicians generally do not employ standardised tools to monitor asthma control or to manage its treatment and that despite high awareness of SMART/MART, the strategy appears to be commonly misapplied. Better education for patients and physicians is required to improve asthma management and resulting patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12890-017-0492-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - David Hinds
- Real World Evidence & Epidemiology, GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, PA, 19426, USA.
| | - Peter Piazza
- Five Dock Family Medical Practice, Five Dock, Australia
| | | | - Michael Gibbs
- Global Respiratory Franchise, GlaxoSmithKline, Brentford, UK
| | - Timm Greulich
- University Medical Centre Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | | | | | - Mitsuru Adachi
- International University of Health and Welfare, Tokyo, Japan
| | - Kourtney J Davis
- Real World Evidence & Epidemiology, GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, PA, 19426, USA
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14
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Ding B, Small M. Disease burden of mild asthma in China. Respirology 2017; 23:369-377. [PMID: 29052915 DOI: 10.1111/resp.13189] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/02/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The impact, treatment patterns and control of mild asthma are poorly understood for Chinese patients. This study describes the characteristics, therapeutic interventions and burden of mild asthma on patients residing in major cities of China. METHODS The Respiratory Disease Specific Program 2015, a cross-sectional survey, was conducted with Chinese physicians and their patients. The survey assessed clinical characteristics, asthma symptoms, exacerbations, rescue inhaler usage, treatment adherence, asthma control, work and activity impairments and healthcare utilization for patients prescribed Global Initiative for Asthma (GINA) Step 1 or 2 treatment defined mild asthma. RESULTS From a total sample of 988 patients, 229 patients met the criteria for mild asthma, with 25.3% classified as Step 1 and 74.7% as Step 2. Overall, 12.6% of patients were considered of high adherence to prescribed treatment. Physicians reported that 75% of patients overall were well controlled, although well-controlled asthma as defined by GINA was achieved in only 14.2% of patients. 26.5% of patients indicated daily use of as-needed rescue medication in the last 4 weeks. 17.8% of patients experienced ≥1 exacerbations in the last 12 months and impaired work productivity was 27.2% overall. CONCLUSION Less than 15% of patients were well controlled according to GINA criteria despite physicians reporting the majority of patients were well controlled. Over one-fourth of patients relied on daily rescue inhaler medication, while exacerbation frequency and work and activity impairment were higher than might reasonably be expected in a mild asthmatic population.
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Affiliation(s)
- Bo Ding
- Medical Evidence and Observational Research, AstraZeneca Gothenburg, Mölndal, Sweden
| | - Mark Small
- Respiratory Research, Adelphi Real World, Macclesfield, UK
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15
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Kim YH, Yoo KH, Yoo JH, Kim TE, Kim DK, Park YB, Rhee CK, Kim TH, Kim YS, Yoon HK, Um SJ, Park IN, Ryu YJ, Jung JW, Hwang YI, Lee HB, Lim SC, Jung SS, Kim EK, Kim WJ, Lee SS, Lee J, Kim KU, Kim HK, Kim SH, Park JH, Shin KC, Choe KH, Yum HK. The Need for a Well-Organized, Video-Assisted Asthma Education Program at Korean Primary Care Clinics. Tuberc Respir Dis (Seoul) 2017; 80:169-178. [PMID: 28416957 PMCID: PMC5392488 DOI: 10.4046/trd.2017.80.2.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/13/2017] [Accepted: 02/13/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control. METHODS Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT). RESULTS The study enrolled 144 patients (mean age, 56.7±16.7 years). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from 16.6±4.6 to 20.0±3.9 (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%). CONCLUSION This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.
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Affiliation(s)
- Yee Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jee-Hong Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Tae-Eun Kim
- Department of Clinical Pharmacology, Konkuk University Medical Center, Seoul, Korea
| | - Deog Kyeom Kim
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yong Bum Park
- Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Chin Kook Rhee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung Kyu Yoon
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Jung Um
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - I-Nae Park
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Yon Ju Ryu
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae-Woo Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Heung Bum Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung-Chul Lim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Soo Jung
- Division of Pulmonology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Eun-Kyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jaechun Lee
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ki Uk Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyun Kuk Kim
- Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joo Hun Park
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Kyeong Cheol Shin
- Regional Center for Respiratory Disease, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Kang Hyeon Choe
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ho-Kee Yum
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
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Aalbers R, Park HS. Positioning of Long-Acting Muscarinic Antagonists in the Management of Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:386-393. [PMID: 28677351 PMCID: PMC5500692 DOI: 10.4168/aair.2017.9.5.386] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/09/2017] [Indexed: 01/13/2023]
Abstract
Despite a range of efficacious therapies for asthma, including inhaled corticosteroids (ICS) and long-acting β2-agonists (LABA), a significant proportion of patients have poor asthma control and retain a risk of future worsening of their symptoms. Long-acting muscarinic antagonist (LAMA) bronchodilators offer a well-tolerated, efficacious, and cost-effective add-on to a patient's treatment. Of the LAMAs currently under investigation or available for the treatment of asthma, evidence from a comprehensive clinical trial program in adults and children shows that once-daily treatment with tiotropium provides benefits for patients with uncontrolled asthma despite the use of ICS and LABAs. Tiotropium is included in the Global Initiative for Asthma (GINA) strategy document as an add-on therapy option for patients at Step 4 or 5 with a history of asthma exacerbations. Tiotropium Respimat® has demonstrated safety and efficacy in patients with a range of disease severities, ages, and phenotypes. This review describes the evidence for the use of LAMA as add-on therapy for patients with asthma who remain uncontrolled despite the use of ICS and LABA treatments.
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Affiliation(s)
- René Aalbers
- Department of Pulmonology, Martini Hospital, Groningen, The Netherlands
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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17
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David-Wang A, Price D, Cho SH, Ho JCM, Liam CK, Neira G, Teh PL. Development and Validation of an Attitudinal-Profiling Tool for Patients With Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:43-51. [PMID: 27826961 PMCID: PMC5102835 DOI: 10.4168/aair.2017.9.1.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/13/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
Abstract
Purpose To develop a profiling tool which accurately assigns a patient to the appropriate attitudinal cluster for the management of asthma. Methods Attitudinal data from an online survey of 2,467 patients with asthma from 8 Asian countries/region, aged 18-50 years, having had ≥2 prescriptions in the previous 2 years and access to social media was used in a discriminant function analysis to identify a minimal set of questions for the Profiling Tool. A split-sample procedure based on 100 sets of randomly selected estimation and validation sub-samples from the original sample was used to cross-validate the Tool and assess the robustness of its predictive accuracy. Results Our Profiling Tool contained 10 attitudinal questions for the patient and 1 GINA-based level of asthma control question for the physician. It achieved a predictive accuracy of 76.2%. The estimation and validation sub-sample accuracies of 76.7% and 75.3%, respectively, were consistent with the tool's predictive accuracy at 95% confidence level; and their 1.4 percentage-points difference set upper-bound estimate for the degree of over-fitting. Conclusions The Profiling Tool is highly predictive (>75%) of the attitudinal clusters that best describe patients with asthma in the Asian population. By identifying the attitudinal profile of the patient, the physician can make the appropriate asthma management decisions in practice. The challenge is to integrate its use into the consultation workflow and apply to areas where Internet resources are not available or patients who are not comfortable with the use of such technology.
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Affiliation(s)
- Aileen David-Wang
- Section of Pulmonary Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.,Observational & Pragmatic Research Institute Pte Ltd, Singapore
| | - Sang Heon Cho
- College of Medicine, Seoul National University, Seoul, Korea
| | - James Chung Man Ho
- Department of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chong Kin Liam
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Glenn Neira
- Medical Affairs Department, Mundipharma Pte Ltd, Singapore
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