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Alarfaj AA. Unraveling the Power of Topical Inhaled Steroids in Treating Laryngeal Granulomas: A Systematic Review. Life (Basel) 2023; 13:1984. [PMID: 37895366 PMCID: PMC10608710 DOI: 10.3390/life13101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
The efficacy of inhaled steroids in the treatment of airway laryngeal granuloma is an important topic of research, given the increasing prevalence of this condition. In this systematic review, we aimed to evaluate the existing evidence on the effectiveness of inhaled steroids in treating airway granuloma. The search was performed in several electronic databases including PubMed, Embase, and the Cochrane Library. We included all relevant studies that were published in the English language between 2005 and 2021. A total of nine studies were eligible for inclusion in our systematic review, including one randomized controlled trial, one case-control study, and seven retrospective studies. The results of our review suggest that inhaled steroids may be effective in treating airway granuloma, but more research is needed to confirm these findings. The limitations of the included studies, such as small sample sizes, inconsistent study designs, and a lack of long-term follow-up, suggest that additional research is needed to confirm the effectiveness of inhaled steroids in treating airway granuloma. Overall, this systematic review highlights the need for further studies to confirm the effectiveness of inhaled steroids in treating airway granuloma.
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Affiliation(s)
- Abdullah A Alarfaj
- Otolaryngology Unit, Department of Surgery, King Faisal University, Al Ahsa 31982, Saudi Arabia
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2
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Akangire G, Lachica C, Noel-MacDonnell J, Begley A, Sampath V, Truog W, Manimtim W. Outcomes of infants with severe bronchopulmonary dysplasia who received tracheostomy and home ventilation. Pediatr Pulmonol 2023; 58:753-762. [PMID: 36377273 DOI: 10.1002/ppul.26248] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/02/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the survival rate, timing of liberation from the ventilator, and factors favorable for decannulation among infants with severe bronchopulmonary dysplasia (sBPD) who received tracheostomy. METHODS Demographics and clinical outcomes were obtained through retrospective chart review of 98 infants with sBPD who were born between 2004 and 2017, received tracheostomy at <1 year of age, and were followed in the Infant Tracheostomy and Home Ventilator clinic up to 4 years of age. RESULTS The number of infants with sBPD who received tracheostomy increased significantly over the study period. The median age at tracheostomy was 4 months (IQR 3, 5) or 43 weeks corrected gestational age; the median age at NICU discharge was 7 months (IQR 6, 9). At 48 months of age, all subjects had been liberated from the ventilator, at a median age of 24 months (IQR 18, 29); 52% had been decannulated with a median age at decannulation of 32 months (IQR 26, 39). Only 1 (1%) infant died. Multivariate logistic regression showed infants who were White, liberated from the ventilator by 24 months of age and have public insurance had significantly greater odds of being decannulated by 48 months of age. Tracheobronchomalacia was associated with decreased odds of decannulation. CONCLUSION Infants with sBPD who received tracheostomy had an excellent survival rate. Liberation from home ventilation and decannulation are likely to occur by 4 years of age.
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Affiliation(s)
- Gangaram Akangire
- Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Charisse Lachica
- Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Janelle Noel-MacDonnell
- Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA.,Department of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Addie Begley
- Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Venkatesh Sampath
- Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - William Truog
- Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Winston Manimtim
- Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
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Rai DK, Sharma P, Karmakar S, Thakur S, Ameet H, Yadav R, Gupta VB. Approach to post COVID-19 persistent cough: A narrative review. Lung India 2023; 40:149-154. [PMID: 37006099 PMCID: PMC10174656 DOI: 10.4103/lungindia.lungindia_250_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 03/05/2023] Open
Abstract
A large proportion of patients who completely recovered from acute coronavirus disease 2019 (COVID-19) infection later continued to experience symptoms even after recovery, irrespective of the severity of the disease. Various terms with varying duration were used for those who had persistent symptoms, of which cough was the most common. We systematically searched the published literature concerning post-COVID-19 cough, its prevalence, and the potential ways to reduce it in clinical practice. The aim of this review was to provide an overview of existing literature concerning post-COVID-19 cough. Literature shows that augmented cough reflex sensitivity is responsible for persistent cough after acute viral upper respiratory infection (URI). Overall, the heightened cough reflex associated with SARSCoV2 induces neurotropism, neuroinflammation, and neuroimmunomodulation via the vagal sensory nerves. Therapies for post-COVID-19 cough aim at the suppression of cough reflex. For a patient who does not respond to early symptomatic treatment, Inhaled corticosteroids can be given a trial to suppress airway inflammation. More trials of novel cough therapies in patients with post-COVID-19 cough using various outcome measures need to be studied in future research. Several agents are currently available for symptomatic relief. However, non-response or refractory cough continues to preclude adequate symptom relief.
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Affiliation(s)
- Deependra K. Rai
- Department of Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India
| | - Priya Sharma
- Department of Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India
| | - Saurabh Karmakar
- Department of Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India
| | - Somesh Thakur
- Department of Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India
| | - H Ameet
- Department of Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India
| | - Rajesh Yadav
- Department of Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India
| | - Vatsal B. Gupta
- Department of Pulmonary Medicine, AIIMS Patna, Patna, Bihar, India
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4
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Guilleminault L, Mounié M, Sommet A, Camus C, Didier A, Reber LL, Costa N, Conte C. Healthcare resource consumption prior to asthma-related death: a nationwide descriptive study. Ther Adv Respir Dis 2022; 16:17534666221130217. [PMID: 36239261 PMCID: PMC9577087 DOI: 10.1177/17534666221130217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although asthma mortality declined sharply until the mid-2000s, a stagnation in mortality has been observed over the past decade in different countries. OBJECTIVE The objective of this study is to describe healthcare resource consumption for patients who died from asthma in France. METHOD This study was conducted using data from the French National Health Data System. Patients who died from asthma between 2013 and 2017 were identified by the ICD10 codes J45 and J46. Health care consumption data were collected. Patients were categorized into four categories according to age: ⩾75, (18-75), (12-18), (0-12). Daily doses of ICS were categorized according to GINA guidelines. RESULTS A total of 3829 patients were included. No ICS or an inadequate ICS dose was observed in 43.8%, 50.6%, 48.1%, and 54.0% of patients aged ⩾75, (18-74), (12-18), and (0-12) years, respectively. Dispensation of six or more SABA canisters was observed in 37.2%, 49.0%, and 70.3% of patients aged of ⩾75, (18-75), and (12-18) years, respectively. Omalizumab dispensation rate was very low [1.1% and 2.8% in patients aged ⩾75 and (18-75) years)]. The proportion of patients with a pulmonologist office visit was 13.8% and 14.6% in patients ⩾75 and (18-75) years, respectively. A lung function test was noted in only 18.6%, 28.3%, and 25.9% of patients ⩾75, (18-75) and (12-18) years, respectively. CONCLUSION Half of the patients who died from asthma received inadequate ICS doses and only a small proportion had access to biological therapies. Less than 15% were referred to a specialist.
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Affiliation(s)
| | - Michael Mounié
- Unité d’Evaluation Médico-Economique, Centre
Hospitalier Universitaire, Toulouse, France,INSERM-UMR 1295–Center for Epidemiology and
Research in POPulation health (CERPOP), Inserm, UPS, Université de Toulouse,
Toulouse, France
| | - Agnès Sommet
- Unité Méthodologie, Data Management, Analyses
Statistiques, Centre d’Investigation Clinique 1436, Service de pharmacologie
médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | | | - Alain Didier
- Pôle des Voies Respiratoires, Service de
Pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, Toulouse,
France,Toulouse Institute for Infectious and
Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, University of
Toulouse, Toulouse, France,CRISALIS F-CRIN, Toulouse, France
| | - Laurent L. Reber
- Toulouse Institute for Infectious and
Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, University of
Toulouse, Toulouse, France
| | - Nadège Costa
- Unité d’Evaluation Médico-Economique, Centre
Hospitalier Universitaire, Toulouse, France,INSERM-UMR 1295–Center for Epidemiology and
Research in POPulation health (CERPOP), Inserm, UPS, Université de Toulouse,
Toulouse, France
| | - Cécile Conte
- Unité Méthodologie, Data Management, Analyses
Statistiques, Centre d’Investigation Clinique 1436, Service de pharmacologie
médicale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
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Khatri SB, Iaccarino JM, Barochia A, Soghier I, Akuthota P, Brady A, Covar RA, Debley JS, Diamant Z, Fitzpatrick AM, Kaminsky DA, Kenyon NJ, Khurana S, Lipworth BJ, McCarthy K, Peters M, Que LG, Ross KR, Schneider-Futschik EK, Sorkness CA, Hallstrand TS. Use of Fractional Exhaled Nitric Oxide to Guide the Treatment of Asthma: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2021; 204:e97-e109. [PMID: 34779751 PMCID: PMC8759314 DOI: 10.1164/rccm.202109-2093st] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The fractional exhaled nitric oxide (FENO) test is a point-of-care test that is used in the assessment of asthma. Objective: To provide evidence-based clinical guidance on whether FENO testing is indicated to optimize asthma treatment in patients with asthma in whom treatment is being considered. Methods: An international, multidisciplinary panel of experts was convened to form a consensus document regarding a single question relevant to the use of FENO. The question was selected from three potential questions based on the greatest perceived impact on clinical practice and the unmet need for evidence-based answers related to this question. The panel performed systematic reviews of published randomized controlled trials between 2004 and 2019 and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework to develop recommendations. All panel members evaluated and approved the recommendations. Main Results: After considering the overall low quality of the evidence, the panel made a conditional recommendation for FENO-based care. In patients with asthma in whom treatment is being considered, we suggest that FENO is beneficial and should be used in addition to usual care. This judgment is based on a balance of effects that probably favors the intervention; the moderate costs and availability of resources, which probably favors the intervention; and the perceived acceptability and feasibility of the intervention in daily practice. Conclusions: Clinicians should consider this recommendation to measure FENO in patients with asthma in whom treatment is being considered based on current best available evidence.
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Bucchieri S, Alfano P, Audino P, Cibella F, Fazio G, Marcantonio S, Cuttitta G. Lung Function Decline in Adult Asthmatics-A 10-Year Follow-Up Retrospective and Prospective Study. Diagnostics (Basel) 2021; 11:diagnostics11091637. [PMID: 34573977 PMCID: PMC8466239 DOI: 10.3390/diagnostics11091637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
Asthma may have an impact on lung function decline but conflicting results are reported in forced expiratory volume in one second (FEV1) decline. We aimed to describe the changes in FEV1 in lifelong non-smoking adult asthmatic outpatients during a 10-year follow-up comparing years 1–5 (1st period) with years 6–10 (2nd period) to assess factors affecting these changes. A total of 100 outpatients performed spirometry every 3 months during a 10-year survey. FEV1/Ht3 slope values of the 2nd period reduced significantly respect to the 1st period (p < 0.0001). FEV1 slopes of years 1–5 and 6–10 were inversely associated with FEV1 at enrolment (p = 0.02, p = 0.01, respectively). Reversibility and variability FEV1 showed a significant effect on the 1st period slopes (p = 0.01 and p < 0.04, respectively). Frequent exacerbators in the 1st year had steeper FEV1/Ht3 slopes in the 1st period (p = 0.01). The number of subjects using higher doses of ICS was significantly lower at the 10th years respect to the 5th and the 1st year (p < 0.001, p = 0.003, respectively). This study shows that FEV1 decline in treated adult asthmatics non-smokers, over 10-year follow-up, is not constant. In particular, it slows down over time, and is influenced by FEV1 at enrolment, reversibility, variability FEV1 and exacerbation score in the 1st year.
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Affiliation(s)
- Salvatore Bucchieri
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Via U.La Malfa, 153, 90146 Palermo, Italy; (S.B.); (P.A.); (P.A.); (F.C.); (G.C.)
| | - Pietro Alfano
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Via U.La Malfa, 153, 90146 Palermo, Italy; (S.B.); (P.A.); (P.A.); (F.C.); (G.C.)
| | - Palma Audino
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Via U.La Malfa, 153, 90146 Palermo, Italy; (S.B.); (P.A.); (P.A.); (F.C.); (G.C.)
| | - Fabio Cibella
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Via U.La Malfa, 153, 90146 Palermo, Italy; (S.B.); (P.A.); (P.A.); (F.C.); (G.C.)
| | - Giovanni Fazio
- Triolo Zanca Clinic, Piazza Fonderia, 23, 90133 Palermo, Italy
- Correspondence:
| | - Salvatore Marcantonio
- Quality, Planning and Strategic Support Area, University of Palermo, Piazza Marina, 61, 90133 Palermo, Italy;
| | - Giuseppina Cuttitta
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Via U.La Malfa, 153, 90146 Palermo, Italy; (S.B.); (P.A.); (P.A.); (F.C.); (G.C.)
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7
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Zielen S, Reichert G, Donath H, Trischler J, Schulze J, Eickmeier O, Eckrich M, Blumchen K. Tiotropium as an Add-on Treatment Option for Severe Uncontrolled Asthma in Preschool Patients. J Asthma Allergy 2021; 14:23-30. [PMID: 33469318 PMCID: PMC7813466 DOI: 10.2147/jaa.s274544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Toddlers with asthma suffer disproportionally more than school-aged children from exacerbations with emergency visits and hospital admissions despite inhaled corticosteroid (ICS) treatment. A recent trial for children ≤5 years showed tolerability of tiotropium and potential to reduce asthma-related events. Methods We conducted a retrospective analysis of electronic outpatient records (2017‒2019) of children <6 years treated with ICS plus long-acting β2-agonists (LABAs) plus tiotropium as an add-on for uncontrolled severe asthma. The primary endpoint was a comparison of systemic corticosteroid (SCS) prescriptions 6 months before and after ICS/LABA/tiotropium start. Secondary endpoints included physician visits, hospitalisations and antibiotic prescriptions. We compared outcomes with children without asthma matched for age, sex, season and screening date. Results Compared with a mean 2.42 (95% CI: 1.75, 3.36) SCS courses per patient within 6 months prior to ICS/LABA/tiotropium, 0.74 (95% CI: 0.25, 1.08) SCS courses per patient were prescribed within 6 months after starting ICS/LABA/tiotropium (P<0.001). Physician visits dropped from 9.23 (95% CI: 7.15, 12.72) to 5.76 (95% CI: 3.10, 7.70) per patient (P<0.01). Nineteen hospitalisations were recorded 6 months before ICS/LABA/tiotropium compared with one hospitalisation after (P<0.01). A mean 1.79 antibiotic courses (95% CI: 1.22, 2.23) per patient were prescribed before ICS/LABA/tiotropium compared with 0.74 (95% CI: 0.22, 1.00) after ICS/LABA/tiotropium (P<0.001). Hospitalisation rates for patients at observation end were not statistically different from healthy controls before/after matching. Interpretation Our retrospective study showed that adding tiotropium to ICS/LABA is a new treatment option for patients with severe preschool asthma; however, larger confirmatory studies are needed.
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Affiliation(s)
- Stefan Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt, Germany
| | - Gianna Reichert
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt, Germany
| | - Helena Donath
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt, Germany
| | - Jordis Trischler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt, Germany
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt, Germany
| | - Olaf Eickmeier
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt, Germany
| | - Martin Eckrich
- Group Practice Dres. Med. Martin Eckrich and Matthias Gründler, Offenbach am Main, Germany
| | - Katharina Blumchen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt, Germany
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Yatam Ganesh S, Nachimuthu N. Treatment Experience With Inhaled Corticosteroids in Combination with Remdesivir and Dexamethasone Among COVID-19 Patients Admitted to a Rural Community Hospital: A Case Series. Cureus 2020; 12:e11787. [PMID: 33409034 PMCID: PMC7779146 DOI: 10.7759/cureus.11787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background Pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause severe inflammation of the lungs resulting in acute respiratory distress syndrome (ARDS). Current treatment guidelines support use of remdesivir as well as dexamethasone in hypoxic patients. There is very little information known about use of inhaled corticosteroids (ICS) in combination with the other two medications. Methods and outcomes We report our experience among six coronavirus disease 2019 (COVID-19) patients who received ICS, remdesivir and dexamethasone for treatment as well as their outcomes. Data were obtained from retrospective chart review during a two-week period from July 8, 2020 to July 22, 2020. Five patients were treated successfully and discharged home. One patient expired. Conclusions This case series highlights the possible benefits of inhaled steroids in treatment of COVID-19 patients with hypoxia. Further randomized controlled studies are needed to assess inhaled corticosteroids as possible treatment either alone or in combination with systemic steroids for treating COVID-19 patients. Dose and optimal duration need to be studied and evaluated.
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9
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Samiee-Zafarghandy S, van den Anker JN. Use of inhaled steroids to prevent bronchopulmonary dysplasia: a matter of great debate. Arch Dis Child 2019; 104:924-925. [PMID: 30498060 DOI: 10.1136/archdischild-2018-316132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2018] [Indexed: 11/03/2022]
Affiliation(s)
| | - John N van den Anker
- Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.,Division of Clinical Pharmacology, Children's National Health System, Washington, District of Columbia, USA
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Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease which develops as a result of neonatal/perinatal lung injury. It is the commonest cause of chronic lung disease in infancy and the most frequent morbidity associated with prematurity. The incidence of BPD has continued to rise despite many advances in neonatal care and this increase has been attributed to the increased survival of younger and more premature babies. There have been many advances in the care of patients with early and evolving BPD, yet there is a paucity of data regarding outpatient management of patients with established BPD. There are limited adequately-powered high-quality studies/randomized controlled trials which assess commonly used therapies such as supplemental oxygen, bronchodilators, steroids and diuretics in patients with BPD, beyond short-term effects. Further research is needed to improve our understanding of the role of currently used treatments on the long-term outcomes of patients with established BPD, post-discharge from the neonatal intensive care unit.
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Affiliation(s)
- Anita Bhandari
- Division of Pulmonary Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 11th floor Colket Building, 3501 Civic Center Boulevard, Philadelphia, PA 19446, United States.
| | - Howard Panitch
- Division of Pulmonary Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 11th floor Colket Building, 3501 Civic Center Boulevard, Philadelphia, PA 19446, United States
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11
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Cataldo D, Derom E, Liistro G, Marchand E, Ninane V, Peché R, Slabbynck H, Vincken W, Janssens W. Overuse of inhaled corticosteroids in COPD: five questions for withdrawal in daily practice. Int J Chron Obstruct Pulmon Dis 2018; 13:2089-2099. [PMID: 30013336 PMCID: PMC6039066 DOI: 10.2147/copd.s164259] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Evidence and guidelines are becoming increasingly clear about imbalance between the risks and benefits of inhaled corticosteroids (ICSs) in patients with COPD. While selected patients may benefit from ICS-containing regimens, ICSs are often inappropriately prescribed with - according to Belgian market research data - up to 70% of patients in current practice receiving ICSs, usually as a fixed combination with a long-acting β2-adrenoreceptor agonist. Studies and recommendations support withdrawal of ICSs in a large group of patients with COPD. However, historical habits appear difficult to change even in the light of recent scientific evidence. We have built a collaborative educational platform with chest physicians and primary care physicians to increase awareness and provide guidance and support in this matter.
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Affiliation(s)
- Didier Cataldo
- Department of Respiratory Medicine, Centre Hospitalier Universitaire de Liège (CHU) and University of Liège, Liège, Belgium,
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Gent, Belgium
| | - Giuseppe Liistro
- Department of Respiratory Medicine, University Hospitals Saint-Luc, Brussels, Belgium
| | - Eric Marchand
- Department of Respiratory Medicine, University Hospital UCL Namur, Yvoir, Belgium
- URPhyM, University of Namur, Namur, Belgium
| | - Vincent Ninane
- Department of Respiratory Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Rudi Peché
- Department of Respiratory Medicine, University Hospital Vésale, Montigny-le-Tilleul, Belgium
| | - Hans Slabbynck
- Department of Respiratory Medicine, ZNA Middelheim, Antwerpen, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
| | - Wim Janssens
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
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Athanazio R, da Costa JC, de la Rosa Carrillo D, Martínez-García MÁ. Current and future pharmacotherapy options for non-cystic fibrosis bronchiectasis. Expert Rev Respir Med 2018; 12:569-584. [PMID: 29806511 DOI: 10.1080/17476348.2018.1481392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION In recent years, there has been an increasing number of clinical trials investigating the effect of pharmacological treatments on patients with bronchiectasis. Areas covered: This review provides an overview of current drugs used in bronchiectasis patients as well as those that could make a future contribution to the management of this disease. Expert commentary: Bronchiectasis is a very heterogeneous disease, so it can be studied from a phenotypic standpoint and its pathophysiological mechanisms (endotypes) can be defined. This provides an interesting field of research as it enables the identification of patients suitable for inclusion in specific clinical trials on new drugs.
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Affiliation(s)
- Rodrigo Athanazio
- a Pulmonary Division , Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
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Vogelmeier C, Worth H, Buhl R, Criée CP, Lossi NS, Mailänder C, Kardos P. "Real-life" inhaled corticosteroid withdrawal in COPD: a subgroup analysis of DACCORD. Int J Chron Obstruct Pulmon Dis 2017; 12:487-494. [PMID: 28203072 PMCID: PMC5295250 DOI: 10.2147/copd.s125616] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many patients with chronic obstructive pulmonary disease (COPD) receive inhaled corticosteroids (ICSs) without a clear indication, and thus, the impact of ICS withdrawal on disease control is of great interest. DACCORD is a prospective, noninterventional 2-year study in the primary and secondary care throughout Germany. A subgroup of patients were taking ICS prior to entry - 1,022 patients continued to receive ICS for 2 years; physicians withdrew ICS on entry in 236 patients. Data from these two subgroups were analyzed to evaluate the impact of ICS withdrawal. Patients aged ≥40 years with COPD, initiating or changing COPD maintenance medication were recruited, excluding patients with asthma. Demographic and disease characteristics, prescribed COPD medication, COPD Assessment Test, exacerbations, and lung function were recorded. There were few differences in baseline characteristics; ICS withdrawn patients had shorter disease duration and better lung function, with 74.2% of ICS withdrawn patients not exacerbating, compared with 70.7% ICS-continued patients. During Year 1, exacerbation rates were 0.414 in the withdrawn group and 0.433 in the continued group. COPD Assessment Test total score improved from baseline in both groups. These data suggest that ICS withdrawal is possible with no increased risk of exacerbations in patients with COPD managed in the primary and secondary care.
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Affiliation(s)
- Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg
| | | | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz
| | - Carl-Peter Criée
- Department of Sleep and Respiratory Medicine, Evangelical Hospital Göttingen-Weende, Bovenden
| | - Nadine S Lossi
- Clinical Research, Respiratory, Novartis Pharma GmbH, Nürnberg
| | | | - Peter Kardos
- Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, Frankfurt am Main, Germany
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Abstract
Purpose The aim of this study was to evaluate the first initiation, sequence of addition, and appropriate prescribing of COPD medications in Manitoba, Canada. Patients and methods A population-based cohort study of COPD medication use was conducted using administrative health care data (1997–2012). Those aged ≥35 years with COPD based on three or more COPD-related outpatient visits over a rolling 24-month window or at least one COPD-related hospitalization were included. The first medication(s) dispensed on or after the date of COPD diagnosis were determined based on pharmacy claims. The next medication(s) in sequence were determined to be additions or switches to the previous regimen. Evaluation of guideline-based appropriateness to receive inhaled corticosteroids (ICS) was based on exacerbation history and past medication use. Results Of 13,369 patients dispensed COPD medications after diagnosis, 66.0% were dispensed short-acting bronchodilators as first medications. Although long-acting bronchodilators alone were uncommonly used as first or subsequent medications, ICS were dispensed as first medications in 28.2% of patients. Over the study period, use of short-acting bronchodilators as first medications declined from 70.6% to 59.4% (P<0.0001), whereas the use of ICS as a first medication increased from 23.5% to 34.4% (P<0.0001). Dispensation of an ICS plus a long-acting β-agonist increased dramatically from 1.2% to 27.3% (P<0.0001). By the end of the study period, the majority of patients (53.3%) were being initiated on two or more medications. Of 5,823 patients dispensed an ICS, 52.4% met Canadian guideline criteria for initiating an ICS, whereas 0.3% met Global Initiative for Chronic Obstructive Lung Disease guideline criteria. Conclusion The use of first-line medications has declined over time, replaced primarily by combination inhalers prescribed early without prior trials of appropriate next step medications. This, along with an increasingly predominant use of multiple first medications, indicates a significant degree of medication burden in this already complex patient population.
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Affiliation(s)
- Jamie Falk
- College of Pharmacy, Rady Faculty of Health Sciences
| | - Natalia Dik
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Shawn Bugden
- College of Pharmacy, Rady Faculty of Health Sciences
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Kenyon CC, Chang J, Wynter SA, Fowler JC, Long J, Bryant-Stephens TC. Electronic Adherence Monitoring in a High-Utilizing Pediatric Asthma Cohort: A Feasibility Study. JMIR Res Protoc 2016; 5:e132. [PMID: 27335355 PMCID: PMC4935791 DOI: 10.2196/resprot.5362] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 04/30/2016] [Accepted: 05/19/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inner-city, minority children with asthma have the highest rates of morbidity and death from asthma and the lowest rates of asthma controller medication adherence. Some recent electronic medication monitoring interventions demonstrated dramatic improvements in adherence in lower-risk populations. The feasibility and acceptability of such an intervention in the highest-risk children with asthma has not been studied. OBJECTIVE Our objective was to assess the feasibility and acceptability of a community health worker-delivered electronic adherence monitoring intervention among the highest utilizers of acute asthma care in an inner-city practice. METHODS This was a prospective cohort pilot study targeting children with the highest frequency of asthma-related emergency department and hospital care within a local managed care Medicaid plan. The 3-month intervention included motivational interviewing, electronic monitoring of controller and rescue inhaler use, and outreach by a community health worker for predefined medication alerts. We measured acceptability by using a modified technology acceptability model and changes in asthma control using the Asthma Control Test (ACT). Given prominent feasibility issues, we describe qualitative patterns of medication use at baseline only. RESULTS We enrolled 14 non-Hispanic black children with a median age of 3.5 years. Participants averaged 7.8 emergency or hospital visits in the year preceding enrollment. We observed three distinct patterns of baseline controller use: 4 patients demonstrated sustained use, 5 patients had periodic use, and 5 patients lapsed within 2 weeks. All participants initiated use of the electronic devices; however, no modem signal was transmitted for 5 or the 14 participants after a mean of 45 days. Of the 9 (64% of total) caregivers who completed the final study visit, all viewed the electronic monitoring device favorably and would recommend it to friends, and 5 (56%) believed that the device helped to improve asthma control. ACT scores improved by a mean of 2.7 points (P=.05) over the 3-month intervention. CONCLUSIONS High-utilizer, minority families who completed a community health worker-delivered electronic adherence intervention found it generally acceptable. Prominent feasibility concerns, however, such as recruitment, data transmission failure, and lost devices, should be carefully considered when designing interventions in this setting.
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Affiliation(s)
- Chén Collin Kenyon
- Center for Pediatric Clinical Effectiveness and PolicyLab, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
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16
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Abstract
INTRODUCTION One of the most widely used fixed combinations in asthma management is dry powder budesonide+formoterol fumarate dihydrate which is commercially available as Symbicort Turbuhaler(®) (and generic products), Easyhaler Bufomix(®) and DuoRespSpiromax(®) inhaler. The aim of this paper was to review the fixed dry powder combination of inhaled budesonide+formoterol fumarate dihydrate for asthma treatment in adolescents and adults. AREAS COVERED A literature search using relevant search terms, reference lists for reviews and meta-analyses was performed. EXPERT OPINION In symptomatic adolescent and adult patients with asthma maintenance and reliever therapy with a single-inhaler fixed combination of dry powder budesonide+formoterol fumarate dihydrate is an evidenced option. The combination treatment is convenient to patients. It reduces the number of exacerbations requiring treatment with oral corticosteroids. In some patients the strategy may also reduce the total intake of inhaled corticosteroids over time. Whether important outcome measures of asthma treatment, such as hospital admission and emergency room visit rates, may be reduced is less well documented since the published studies may have been influenced by publication bias. Non-pharmaceutical company-sponsored research evaluating such measures is needed. There is no evidence for the use of single inhaler fixed combinations of inhaled corticosteroids+long-acting β(2)-agonists in children (<12 years of age), and budesonide+formoterol fumarate dihydrate should not be prescribed to the age group.
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Affiliation(s)
- Ole D Wolthers
- a Asthma and Allergy Clinic , Children´s Clinic Randers , Randers , Denmark
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Abstract
The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4–6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function.
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Affiliation(s)
- Naheed Azhar
- Department of Anaesthesiology, Stanley Medical College and Government RSRM Hospital, Chennai, Tamil Nadu, India
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18
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Abstract
Background: Recent research using serum high sensitivity C-reactive protein (hs-CRP) has evidenced existence of low grade systemic inflammation in asthmatics whose correlation with various clinical indices is not fully studied. Objective: To investigate the relationship between systemic inflammation and various clinical and treatment characteristics of asthma. Materials and Methods: Forty asthmatics (22 steroid inhaling and 18 steroid naïve) and 40 healthy subjects matched for age and sex were examined cross-sectionally. Along with clinical assessment, serum hs-CRP levels were measured for all subjects using latex enhanced immunoturbidometry method. Results: Serum hs CRP levels were significantly higher in steroid naïve asthmatics when compared to normal subjects (0.93 ± 1.18 vs 0.24 ± 0.31 mg/dL, respectively; Mann-Whitney U test, P < 0.001). This association persisted after adjusting for age, gender, body mass index (BMI), and socioeconomic status (adjusted odds ratio 10.47; 95% CI 1.88-58.3; P < 0.01). Steroid inhaling asthmatics had serum hs-CRP levels comparable with control group (0.17 ± 0.18 vs 0.24 ± 0.31 mg/dL respectively, P > 0.05). Among the clinical and treatment related variables, duration of inhaled steroids usage alone correlated significantly with serum hs-CRP levels (Pearson correlation coefficient r = 0.449, P < 0.05), which was independent of age, BMI, duration of illness, and frequency of emergency visits. Conclusion: This study confirms the existence of low grade systemic inflammation in asthma which is effectively controlled by inhaled steroids. Such an effect of inhaled steroids appears to be more pronounced in recent users than that of long-term users, possibly due to lower adherence rate among the latter.
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Affiliation(s)
- Ramaraju Karthikeyan
- Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Srikanth Krishnamoorthy
- Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Smrithi Maamidi
- Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Anupama Murthy Kaza
- Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Nithilavalli Balasubramanian
- Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Stokes FJ, Bailey LM, Ganguli A, Davison AS. Assessment of endogenous, oral and inhaled steroid cross-reactivity in the Roche cortisol immunoassay. Ann Clin Biochem 2013; 51:503-6. [PMID: 24150482 DOI: 10.1177/0004563213509793] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inhaled steroids are widely used for the treatment of asthma. Concerns over adrenal suppression when used at high doses or in combination with drugs such as ritonavir exist, requiring the measurement of serum cortisol. Herein, we investigate the cross-reactivity of the inhaled steroids betamethasone, fluticasone and beclomethasone in the Roche cortisol immunoassay, in addition to five other steroids. METHODS Five replicates were produced from a serum pool for each of the eight steroids at a final concentration of 0.1 and 1 µg/mL. Each steroid was dissolved in 50% methanol, with 50% methanol of the same volume added to the control sample. The cross-reactivity of each steroid in the cortisol assay was calculated. RESULTS There was no statistically or clinically significant cross-reactivity in the measurement of cortisol when fluticasone, beclomethasone or betamethasone were spiked at 0.1 and 1.0 µg/mL, except for beclomethasone at a concentration of 1 µg/mL (1490 nmol/L) with a cross-reactivity of 1.6%, which is unlikely to be clinically significant. At both steroid concentrations investigated, prednisolone, 17-hydroxyprogesterone and 11-deoxycortisol exhibited statistically significant cross-reactivities that were greater than the least significant change of the assay (13.1%), whereas dexamethasone and metyrapone did not. Mean inter-assay precision was 1.5% (405-1586 nmol/L). CONCLUSION The cross-reactivity of the inhaled steroids; betamethasone, fluticasone and beclomethasone in the Roche cortisol immunoassay are unlikely to be clinically significant at the concentrations found in patients on therapeutic doses. This will enable confident assessment of adrenal status in patients at risk of adrenal suppression.
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Affiliation(s)
- F J Stokes
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - L M Bailey
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - A Ganguli
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - A S Davison
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
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20
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Abstract
Inhaled corticosteroids (ICS) have proven to be the most effective and essential therapy for the treatment of bronchial asthma. The 2007 National Asthma Education and Prevention Program guidelines recommend ICS as preferred therapy for patients with mild to severe persistent asthma. Mometasone furoate (MF) is a relatively new ICS agent with high affinity for the glucocorticoid receptor. It is approved in the US for maintenance treatment of asthma for patients 4 years of age and older. It has been shown to be well tolerated with no significant adverse side effects observed in clinical trials and post-marketing surveillance. The efficacy of mometasone furoate has been established in large, well-designed studies. In patients with persistent asthma previously treated either with short-acting beta-agonists alone or twice-daily maintenance therapy with ICS, once-daily MF has been shown to be superior to placebo in improving lung function, symptom control, and quality of life; and has shown comparable efficacy compared with budesonide, beclomethasone, and fluticasone. Twice-daily dosing with MF has been demonstrated to successfully allow for reduction or elimination of oral corticosteroids in severe asthmatics.
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Affiliation(s)
- Ricardo A Tan
- California Allergy and Asthma Medical Group, Los Angeles, CA
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21
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Seemungal TAR, Hurst JR, Wedzicha JA. Exacerbation rate, health status and mortality in COPD--a review of potential interventions. Int J Chron Obstruct Pulmon Dis 2009; 4:203-23. [PMID: 19554195 PMCID: PMC2699821 DOI: 10.2147/copd.s3385] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Indexed: 12/05/2022] Open
Abstract
COPD is prevalent in Western society and its incidence is rising in the developing world. Acute exacerbations of COPD, about 50% of which are unreported, lead to deterioration in quality of life and contribute significantly to disease burden. Quality of life deteriorates with time; thus, most of the health burden occurs in more severe disease. COPD severity and frequent and more severe exacerbations are all related to an increased risk of mortality. Inhaled corticosteroids (ICS) have similar effects on quality of life but ICS/long-acting bronchodilator combinations and the long-acting antimuscarinic tiotropium all improve health status and exacerbation rates and are likely to have an effect on mortality but perhaps only with prolonged use. Erythromycin has been shown to decrease the rate of COPD exacerbations. Pulmonary rehabilitation and regular physical activity are indicated in all severities of COPD and improve quality of life. Noninvasive ventilation is associated with improved quality of life. Long-term oxygen therapy improves mortality but only in hypoxic COPD patients. The choice of an inhaler device is a key component of COPD therapy and this requires more attention from physicians than perhaps we are aware of. Disease management programs, characterized as they are by patient centeredness, improve quality of life and decrease hospitalization rates. Most outcomes in COPD can be modified by interventions and these are well tolerated and have acceptable safety profiles.
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Affiliation(s)
- Terence A R Seemungal
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago.
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Yanık B, Ayrım A, Ozol D, Koktener A, Gokmen D. Influence of obesity on bone mineral density in postmenopausal asthma patients undergoing treatment with inhaled corticosteroids. Clinics (Sao Paulo) 2009; 64:313-8. [PMID: 19488588 PMCID: PMC2694454 DOI: 10.1590/s1807-59322009000400008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 01/06/2009] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The etiology of osteoporosis in asthma is complex as various factors contribute to its pathogenesis. The purpose of our study was to investigate the effects of obesity and inhaled steroids, as well as the severity and duration of asthma, on osteoporosis in postmenopausal asthma patients as compared to healthy controls. METHODS A total of 46 patients with asthma and 60 healthy female controls, all postmenopausal, were enrolled in our study. Bone mineral density was assessed at the lumbar spine and hip using a Lunar DPX-L densitometer. RESULTS Bone mineral density (BMD) scores were comparable between the asthmatic and control groups, with average scores of 0.95 +/- 0.29 and 0.88 +/- 0.14 g/cm(2), respectively. Likewise, osteoporosis was diagnosed in a similar percentage of patients in the asthmatic (39.1%) and control (43.3%) groups. Bone fracture was identified in four patients with asthma (8.6%) and in six patients from the control group (10%). We could not detect any relationship between BMD and duration of asthma, asthma severity, inhaled steroids or body mass index (BMI). There was no difference between the two groups with respect to age or years since menopause. Although asthma patients were more likely to be overweight and presented higher BMD scores on average than the control subjects, these differences were not statistically significant. CONCLUSIONS There is a slight positive protective effect of high BMI against osteoporosis in asthma patients, but this effect is overcome by time and menopause status. Therefore, the protective effect of obesity against osteoporosis in asthma patients seems to not be significant.
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Affiliation(s)
- Burcu Yanık
- Department of Physical Therapy and Rehabilitation, Fatih University Faculty of Medicine - Ankara, Turkey
| | - Aylin Ayrım
- Department of Obstetrics and Gynecology, Fatih University Faculty of Medicine - Ankara, Turkey
| | - Duygu Ozol
- Department of Pulmonology, Fatih University Faculty of Medicine - Ankara, Turkey
- , Phone: 00905324439693
| | - Asli Koktener
- Department of Radiology, Fatih University Faculty of Medicine - Ankara, Turkey
| | - Derya Gokmen
- Department of Biostatistics, Ankara University Faculty of Medicine - Ankara, Turkey
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Aburuz S, Heaney LG, Millership J, Gamble J, McElnay J. A cross-sectional study evaluating the relationship between cortisol suppression and asthma control in patients with difficult asthma. Br J Clin Pharmacol 2007; 63:110-5. [PMID: 17229041 PMCID: PMC2000719 DOI: 10.1111/j.1365-2125.2006.02745.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 06/12/2006] [Indexed: 12/01/2022] Open
Abstract
AIM To examine the relationship between cortisol suppression and asthma symptoms in patients with difficult asthma. METHODS Patients, referred to a specialist difficult asthma service and who fulfilled the criteria for difficult asthma, were recruited to the study in a sequential, unselected manner. At each clinic visit, all patients completed a validated asthma control questionnaire. For measuring cortisol suppression, early morning urinary cortisol [corrected for creatinine to give urinary cortisol creatinine ratio (UCC ratio)] was used. The urine samples were collected and stored at -70 degrees C until ready for analysis. Urinary cortisol was extracted (solid-phase extraction) and analysed using high-performance liquid chromatography. The Pearson correlation coefficient was used for correlation analysis while t-tests were used for between-group differences for normally distributed data. If the data were not normally distributed, nonparametric statistics were used. A P-value < 0.05 was considered statistically significant. RESULTS During the study period all the patients who attended the difficult asthma clinic and fulfilled the criteria for difficult asthma (n = 66) agreed to take part in the study. There were moderate to strong and significant associations between several measures of asthma control and UCC ratio. The correlation coefficient with five indicators of asthma control ranged between 0.3 and 0.5 (P < 0.05). CONCLUSIONS We have demonstrated a relationship between cortisol suppression and asthma control in difficult asthmatics on high-dose steroid therapy. We have proposed a model based on the relationship between symptom control and cortisol suppression, whereby both adherence and therapeutic adjustments could potentially be made. A properly controlled prospective clinical trial should examine the utility of this approach in clinical practice.
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Affiliation(s)
- S Aburuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan.
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