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Reynolds V, Demarco J, Steinberg K. Better Breathing, Tougher Speaking? A Scoping Review of the Effects of Inhaled Corticosteroids on the Voice Quality of Asthmatic Children. J Voice 2024:S0892-1997(24)00003-1. [PMID: 38331703 DOI: 10.1016/j.jvoice.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Inhaled corticosteroids (ICS) are a common treatment for certain lung diseases, including chronic obstructive pulmonary disorder in adults, and asthma across the lifespan. There is a link between the use of ICS and dysphonia in adults. This scoping review aims to investigate the incidence of dysphonia, in children aged under 12, who use ICS to treat asthma. METHODS A scoping review was conducted, in accordance with the guidelines prescribed by Arksey and O'Malley (2005). ASHAWire, Science Direct, PubMed, and ProQuest databases were searched. Out of the total yield of 1471 articles, four articles met the inclusion criteria, that is, were primary studies reporting on voice quality in children who use ICS, who present with asthma and/or allergy. RESULTS The majority of papers yielded from the initial search were retrieved because of the use of the term "dysphonia" in the basic definitions of asthma and descriptors of its side effects. Only four studies presented primary data about the presence of dysphonia in asthmatic children (with or without comorbid allergic conditions). None specifically investigated the relationship between ICS and dysphonia. Research questions focused on side effects associated with allergies and asthma, which included some information about medication. Only three of the four studies conducted a comprehensive review of the voice and utilized video laryngoscopy. DISCUSSION The evidence of a relationship, between ICS and dysphonia in children, is not conclusive, and is complicated by the connection between asthma, and breath support for phonation. There is a need for more thorough and focused investigation of the relationship between ICS, with or without bronchodilator use, and any resultant effects on children's vocal quality.
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Affiliation(s)
| | - Jenalee Demarco
- Lewis University, Romeoville, Illinois; Advanced Therapy and Wellness Clinic, Crest Hill, Illinois
| | - Katie Steinberg
- Lewis University, Romeoville, Illinois; Downers Grove Grade School District 58, Downers Grove, Illinois
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2
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He Y, Cui J, Xiao B, Hou L, Li Z, Zuo H, He Y, Yao D. Atomized inhalation of Icaritin reduces airway inflammation and remodeling in asthmatic mice. J Asthma 2024:1-10. [PMID: 38294683 DOI: 10.1080/02770903.2024.2313131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/29/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Asthma is a disease characterized by airway hyperresponsiveness and airway inflammation. Icaritin (ICT) is a plant hormone with various pharmacological activities such as anti-inflammatory, immune regulation, and anti-tumor. This study mainly explored the effects of nebulized inhalation of ICT on airway inflammation and airway remodeling in asthmatic mice. METHOD Different groups of ovalbumin (OVA)-induced asthma mice with acute and chronic airway inflammation received ICT. Asthmatic mice received budesonide (BDND) aerosol inhalation as a positive control, while normal control and asthma model mice received the same volume of saline. Following finishing of the study, analyses were conducted on behavioral tests, biochemical indices, and histological structures of lung tissues. RESULTS Aerosol inhalation of ICT can notably reduce inflammatory cells infiltration around the airways and pulmonary vessels, and suppressed goblet cell hyperplasia in asthmatic mice. Long-term inhalation of ICT can decrease airway collagen deposition and airway smooth muscle hyperplasia, and alleviate airway hyperresponsiveness, mirroring the effects observed with hormone employed in clinical practice. CONCLUSION Nebulized inhalation of ICT can effectively inhibit airway inflammation in asthmatic mice, improve airway remodeling, and reduce airway hyperresponsiveness, with effects similar to those of hormones. It may serve as a potential candidate used as a hormone replacement asthma treatment.
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Affiliation(s)
- Yintong He
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
- The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Jian Cui
- The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Bo Xiao
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Lixia Hou
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Zhimei Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Huiqin Zuo
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Yutong He
- Department of Anatomy, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, China
| | - Dong Yao
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
- Guangxi Clinical Research Center for Diabetes and Metabolic Diseases, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
- Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, The key laboratory of Respiratory Diseases, Education Department of Guangxi Zhuang Autonomous Region, Guilin Medical University, Guilin, China
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Kotoulas SC, Tsiouprou I, Domvri K, Ntontsi P, Pataka A, Porpodis K. Open and Closed Triple Inhaler Therapy in Patients with Uncontrolled Asthma. Adv Respir Med 2023; 91:288-300. [PMID: 37489386 PMCID: PMC10366885 DOI: 10.3390/arm91040023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/26/2023]
Abstract
Long-acting muscarinic antagonists (LAMAs) are a class of inhalers that has recently been included as add-on therapy in the GINA guidelines, either in a single inhaler device with inhaled corticosteroids plus long-acting β2-agonists (ICS + LABA) (closed triple inhaler therapy) or in a separate one (open triple inhaler therapy). This review summarizes the existing evidence on the addition of LAMAs in patients with persistently uncontrolled asthma despite ICS + LABA treatment based on clinical efficacy in the reduction of asthma symptoms and exacerbations, the improvement in lung function, and its safety profile.
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Affiliation(s)
| | - Ioanna Tsiouprou
- Pulmonary Clinic of Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Georgios Papanikolaou", Leoforos Papanikolaou, Exohi, 57010 Thessaloniki, Greece
| | - Kalliopi Domvri
- Laboratory of Histology-Embryology, Medical School, Aristotle University of Thessaloniki, Leoforos Agiou Dimitriou, 54124 Thessaloniki, Greece
| | - Polyxeni Ntontsi
- 2nd University Department of Respiratory Medicine, Attikon Hospital, 1st Rimini Street, Haidari,12462 Athens, Greece
| | - Athanasia Pataka
- Respiratory Failure Clinic of Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Georgios Papanikolaou", Leoforos Papanikolaou, Exohi, 57010 Thessaloniki, Greece
| | - Konstantinos Porpodis
- Pulmonary Clinic of Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Georgios Papanikolaou", Leoforos Papanikolaou, Exohi, 57010 Thessaloniki, Greece
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Protective Effects of Platycodin D3 on Airway Remodeling and Inflammation via Modulating MAPK/NF-κB Signaling Pathway in Asthma Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1612829. [PMID: 35990822 PMCID: PMC9385299 DOI: 10.1155/2022/1612829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/06/2022] [Accepted: 07/06/2022] [Indexed: 11/20/2022]
Abstract
Background Asthma is a disease with airway hyperresponsive and airway inflammation. Platycodin D is a triterpenoid saponin extracted from Platycodon grandiflorus root, which has various pharmacological activities. The study mainly explored the effects of platycodin D3 (PD3) in airway remodeling and inflammation of asthma. Methods The ovalbumin (OVA)-induced asthma mice were given PD3 (20 mg/kg, 40 mg/kg, and 80 mg/kg) in different groups. The asthma mice administrated with dexamethasone (DXM) were enrolled as the positive control group, and the normal control mice and asthma model mice separately received the same volume of saline. Mouse airway lung dynamic compliance (Cdyn) and total airway resistance (RL) were measured by the EMKA animal lung function analysis system. The inflammation factor levels were estimated by ELISA. Histopathological changes were tested by HE and PAS staining. The protein and phosphorylation levels of NF-κBp65, p38, ERK1/2, and JNK1/2 were detected by Western blot. Results In asthmatic mice, PD3 enhanced the airway Cdyn and decreased RL to improve the airway hyperreactivity and alleviated the pathological injury of lung tissues. In addition, PD3 could reduce the infiltration of inflammatory cells in BALF and suppress the levels of eotaxin, IL-4, IL-5, IL-13, IFN-γ, and IgE. Furthermore, PD3 treatment inhibited the phosphorylation of NF-κBp65, p38, ERK1/2, and JNK1/2 proteins in asthma mice. Conclusion PD3 treatment alleviated the airway remodeling and inflammation in asthmatic mice, which might be related to downregulating the phosphorylated proteins in the MAPK/NF-κB signaling pathway.
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Corvino A, Citi V, Fiorino F, Frecentese F, Magli E, Perissutti E, Santagada V, Calderone V, Martelli A, Gorica E, Brogi S, Colombo FF, Capello CN, Araujo Ferreira HH, Rimoli MG, Sodano F, Rolando B, Pavese F, Petti A, Muscará MN, Caliendo G, Severino B. H 2S donating corticosteroids: Design, synthesis and biological evaluation in a murine model of asthma. J Adv Res 2022; 35:267-277. [PMID: 35024201 PMCID: PMC8721254 DOI: 10.1016/j.jare.2021.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/27/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Hydrogen sulfide (H2S) is a fundamental biological endogenous gas-mediator in the respiratory system. It regulates pivotal patho-physiological processes such as oxidative stress, pulmonary circulation, airway tone and inflammation. Objectives We herein describe the design and synthesis of molecular hybrids obtained by the condensation of several corticosteroids with different hydrogen sulfide releasing moieties. Methods All the molecules are characterized for their ability to release H2S both via amperometric approach and using a fluorescent probe. The chemical stability of the newly synthesized hybrid molecules has been investigated at differing pH values and in human serum. Results Prednisone-TBZ hybrid (compound 7) was selected for further evaluations. The obtained results from the in vitro and in vivo studies clearly show evidence in favor of the anti-inflammatory properties of the released H2S. Conclusions The protective effect on airway remodeling makes the hybrid Prednisone-TBZ (compound 7) as a promising therapeutic option in reducing allergic asthma symptoms and exacerbations.
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Affiliation(s)
- Angela Corvino
- Department of Pharmacy, School of Medicine, University of Naples «Federico II», Via D. Montesano, 49, 80131 Napoli, Italy
| | - Valentina Citi
- Department of Pharmacy, University of Pisa, via Bonanno, 6, I-56126 Pisa, Italy
| | - Ferdinando Fiorino
- Department of Pharmacy, School of Medicine, University of Naples «Federico II», Via D. Montesano, 49, 80131 Napoli, Italy
| | - Francesco Frecentese
- Department of Pharmacy, School of Medicine, University of Naples «Federico II», Via D. Montesano, 49, 80131 Napoli, Italy
| | - Elisa Magli
- Department of Pharmacy, School of Medicine, University of Naples «Federico II», Via D. Montesano, 49, 80131 Napoli, Italy
| | - Elisa Perissutti
- Department of Pharmacy, School of Medicine, University of Naples «Federico II», Via D. Montesano, 49, 80131 Napoli, Italy
| | - Vincenzo Santagada
- Department of Pharmacy, School of Medicine, University of Naples «Federico II», Via D. Montesano, 49, 80131 Napoli, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, via Bonanno, 6, I-56126 Pisa, Italy
| | - Alma Martelli
- Department of Pharmacy, University of Pisa, via Bonanno, 6, I-56126 Pisa, Italy
| | - Era Gorica
- Department of Pharmacy, University of Pisa, via Bonanno, 6, I-56126 Pisa, Italy
| | - Simone Brogi
- Department of Pharmacy, University of Pisa, via Bonanno, 6, I-56126 Pisa, Italy
| | | | | | | | - Maria Grazia Rimoli
- Department of Pharmacy, School of Medicine, University of Naples «Federico II», Via D. Montesano, 49, 80131 Napoli, Italy
| | - Federica Sodano
- Department of Drug Science and Technology, University of Torino, Via Pietro Giuria, 9, 10125 Torino, Italy
| | - Barbara Rolando
- Department of Drug Science and Technology, University of Torino, Via Pietro Giuria, 9, 10125 Torino, Italy
| | - Francesca Pavese
- Genetic S.p.A., Via della Monica, 26 – 84083 Castel San Giorgio (SA), Italy
| | - Antonio Petti
- Genetic S.p.A., Via della Monica, 26 – 84083 Castel San Giorgio (SA), Italy
| | - Marcelo Nicolás Muscará
- Department of Pharmacology, Institute of Biomedical Sciences, University of Sao Paulo, São Paulo 05508-000, SP, Brazil
| | - Giuseppe Caliendo
- Department of Pharmacy, School of Medicine, University of Naples «Federico II», Via D. Montesano, 49, 80131 Napoli, Italy
| | - Beatrice Severino
- Department of Pharmacy, School of Medicine, University of Naples «Federico II», Via D. Montesano, 49, 80131 Napoli, Italy
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Abstract
PRACTICAL RELEVANCE Human allergy to cats affects a substantial and growing proportion of the global population, and cat allergy is regarded as the third most common cause of human respiratory allergies, and the second most common indoor cause. Veterinarians will frequently encounter owners who are cat-allergic, and having an understanding of this disease and the methods available to help control the allergy will assist them in giving appropriate advice, alongside human healthcare professionals. AIM The aim of this review is to summarise currently available data on the prevalence, causes, symptoms and control of human allergy to cats. In terms of managing cat allergy, the emphasis is on reviewing current and emerging modalities to reduce environmental exposure to cat allergens rather than on pharmacotherapy or immunotherapy, as it is in these areas in particular that the veterinarian may be able to offer help and advice to complement that of human healthcare professionals. EVIDENCE BASE The information in this review is drawn from the current and historical literature on human allergy to cats, and approaches to reduce exposure to cat allergens and manage symptoms of cat allergy.
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Abellard A, Pappalardo AA. Overview of severe asthma, with emphasis on pediatric patients: a review for practitioners. J Investig Med 2021; 69:1297-1309. [PMID: 34168068 DOI: 10.1136/jim-2020-001752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/03/2022]
Abstract
Asthma is the most common life-threatening chronic disease in children. Although guidelines exist for the diagnosis and treatment of asthma, treatment of severe, pediatric asthma remains difficult. Limited studies in the pediatric population on new asthma therapies, complex issues with adolescence and adherence, health disparities, and unequal access to guideline-based care complicate the care of children with severe, persistent asthma. The purpose of this review is to provide an overview of asthma, including asthma subtypes, comorbidities, and risk factors, to discuss diagnostic considerations and pitfalls and existing treatments, and then present existing and emerging therapeutic approaches to asthma management. An improved understanding of asthma heterogeneity, clinical characteristics, inflammatory patterns, and pathobiology can help further guide the management of severe asthma in children. More studies are needed in the pediatric population to understand emerging therapeutics application in children. Effective multimodal strategies tailored to individual characteristics and a commitment to address risk factors, modifiers, and health disparities may help reduce the burden of asthma in the USA.
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Affiliation(s)
- Arabelle Abellard
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea A Pappalardo
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA .,Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
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Debeljak J, Korošec P, Lopert A, Fležar M, Košnik M, Rijavec M. Asthma treatment response to inhaled corticosteroids is associated with variants in VEGFA gene. Gene 2021; 783:145573. [PMID: 33737125 DOI: 10.1016/j.gene.2021.145573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/26/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jerneja Debeljak
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Peter Korošec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Anton Lopert
- Outpatient Practice for Pulmonary Diseases and Allergy, Murska Sobota, Slovenia
| | - Matjaž Fležar
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Matija Rijavec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia; Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Galvão I, Kim RY, Shen S, Budden KF, Vieira AT, Hansbro PM. Emerging therapeutic targets and preclinical models for severe asthma. Expert Opin Ther Targets 2020; 24:845-857. [PMID: 32569487 DOI: 10.1080/14728222.2020.1786535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Asthma is a heterogeneous disease with complex multifactorial causes. It is possible to subclassify asthma into different phenotypes that have distinct immunological features. Eosinophilic asthma is a well-known phenotype of severe asthma; however, a large body of clinical and experimental evidence strongly associates persistent airway inflammation, including the accumulation of neutrophils in the bronchial mucosa, and resistance to corticosteroid therapy and non-Type-2 immune responses with severe asthma. Importantly, mainstay therapies are often ineffective in severe asthma and effective alternatives are urgently needed. AREAS COVERED Here, we discussed recently developed mouse models of severe asthma that recapitulates key features of the disease in humans. We also provide findings from clinically relevant experimental models that have identified potential therapeutic targets for severe asthma. The most relevant publications on the topic of interest were selected from PubMed. EXPERT COMMENTARY Increasing the understanding of disease-causing mechanisms in severe asthma may lead to the identification of novel therapeutic targets and the development of more effective therapies. Intense research interest into investigating the pathophysiological mechanisms of severe asthma has driven the development and interrogation of a myriad of mouse models that aim to replicate hallmark features of severe asthma in humans.
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Affiliation(s)
- Izabela Galvão
- Centre for Inflammation, Centenary Institute and University of Technology Sydney , Sydney, Australia
| | - Richard Y Kim
- Centre for Inflammation, Centenary Institute and University of Technology Sydney , Sydney, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and the University of Newcastle , Newcastle, Australia
| | - Sijie Shen
- Centre for Inflammation, Centenary Institute and University of Technology Sydney , Sydney, Australia
| | - Kurtis F Budden
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and the University of Newcastle , Newcastle, Australia
| | - Angélica T Vieira
- Laboratory of Microbiota and Immunomodulation, Department of Biochemistry and Immunology, Instituto De Ciências Biológicas, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute and University of Technology Sydney , Sydney, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and the University of Newcastle , Newcastle, Australia
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Albertson TE, Chenoweth JA, Pearson SJ, Murin S. The pharmacological management of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Expert Opin Pharmacother 2020; 21:213-231. [PMID: 31955671 DOI: 10.1080/14656566.2019.1701656] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a disease phenotype that shares T helper lymphocyte cell Th1/neutrophilic/non-Type-2 Inflammation pathways thought to be key in COPD and Th2/eosinophilic/Type-2 inflammatory pathways of asthma. The pharmacology of treating ACOS is challenging in severe circumstances.Areas covered: This review evaluates the stepwise treatment of ACOS using pharmacological treatments used in both COPD and asthma. The most common medications involve the same inhalers used to treat COPD and asthma patients. Advanced stepwise therapies for ACOS patients are based on patient characteristics and biomarkers. Very few clinical trials exist that focus specifically on ACOS patients.Expert opinion: After inhalers, advanced therapies including phosphodiesterase inhibitors, macrolides, N-acetylcysteine and statin therapy for those ACOS patients with a COPD appearance and exacerbations are available. In atopic ACOS patients with exacerbations, advanced asthma therapies (leukotriene receptor antagonists and synthesis blocking agents.) are used. ACOS patients with elevated blood eosinophil/IgE levels are considered for immunotherapy or therapeutic monoclonal antibodies blocking specific Th2/Type-2 interleukins or IgE. Symptom control, stabilization/improvement in pulmonary function and reduced exacerbations are the metrics of success. More pharmacological trials of ACOS patients are needed to better understand which patients benefit from specific treatments.Abbreviations: 5-LOi: 5-lipoxygenase inhibitor; ACOS: asthma - COPD overlap syndrome; B2AR: Beta2 adrenergic receptors; cAMP: cyclic adenosine monophosphate; cGMP: cyclic guanosine monophosphate; CI: confidence interval; COPD: chronic obstructive pulmonary disease; CRS : chronic rhinosinusitis; cys-LT: cysteinyl leukotrienes; DPI: dry powder inhaler; EMA: European Medicines Agency; FDA: US Food and Drug Administration; FDC: fixed-dose combination; FeNO: exhaled nitric oxide; FEV1: forced expiratory volume in one second; FVC: forced vital capacity; GM-CSF: granulocyte-macrophage colony-stimulating factor; ICS : inhaled corticosteroids; IL: interleukin; ILC2: Type 2 innate lymphoid cells; IP3: Inositol triphosphate; IRR: incidence rate ratio; KOLD: Korean Obstructive Lung Disease; LABA: long-acting B2 adrenergic receptor agonist; LAMA: long-acting muscarinic receptor antagonist; LRA: leukotriene receptor antagonist; LT: leukotrienes; MDI: metered-dose inhalers; MN: M-subtype muscarinic receptors; MRA: muscarinic receptor antagonist; NAC: N-acetylcysteine; NEB: nebulization; OR: odds ratio; PDE: phosphodiesterase; PEFR: peak expiratory flow rate; PGD2: prostaglandin D2; PRN: as needed; RR: risk ratio; SABA: short-acting B2 adrenergic receptor agonist; SAMA: short-acting muscarinic receptor antagonist; SDMI: spring-driven mist inhaler; Th1: T helper cell 1 lymphocyte; Th2: T helper cell 2 lymphocytes; TNF-α: tumor necrosis factor alpha; US : United States.
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Affiliation(s)
- Timothy E Albertson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.,Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA.,Veterans Administration Northern California Health Care System, Department of Medicine, Mather, CA, USA
| | - James A Chenoweth
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA.,Veterans Administration Northern California Health Care System, Department of Medicine, Mather, CA, USA
| | - Skyler J Pearson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.,Veterans Administration Northern California Health Care System, Department of Medicine, Mather, CA, USA
| | - Susan Murin
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.,Veterans Administration Northern California Health Care System, Department of Medicine, Mather, CA, USA
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Pharmacist Involvement in Population Health Management for a Pediatric Managed Medicaid Accountable Care Organization. CHILDREN-BASEL 2019; 6:children6070082. [PMID: 31277457 PMCID: PMC6678162 DOI: 10.3390/children6070082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 12/03/2022]
Abstract
Accountable care organizations (ACOs) have emerged as an effective healthcare delivery model for managing quality and cost at a population level. Within ACOs, pharmacists are critical for the delivery of high-value health care, offering patients and health care providers medication-related training, resources, and guidance that can improve quality of care at lower costs. Partners For Kids (PFK), one of the oldest and largest pediatric ACOs in the country, has successfully leveraged pharmacists to provide population health management and medication management to promote health outcomes for individual patients and the overall population it serves. This review explores how the inclusion of pharmacists in the development and execution of various quality improvement initiatives within PFK has positively impacted outcomes for patients while also lowering overall spend. A catalog of interventions is provided to offer various ways that pharmacists can intersect as providers in the triad of patient/family, payor, and provider. By providing enhanced training and education, on-site guidance, medication management, and population-level data analysis, pharmacists are able to identify and improve inefficiencies in care. Moving forward, ongoing engagement of pharmacists in health care operations will be a necessary feature to maximize health care value.
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