Login to your account

Username *
Password *
Remember Me

Blog With Right Sidebar

    Vous êtes ici :  
  1. Accueil
  2. Blog With Right Sidebar

The Emerging Role of Tiotropium for Patients with Asthma (May).

Related Articles

The Emerging Role of Tiotropium for Patients with Asthma (May).

Ann Pharmacother. 2013 Apr 23;

Authors: Gielow Bollmeier S, Lee SY

Abstract
OBJECTIVE:To review clinical data on the use of the long-acting anticholinergic agent tiotropium in patients with asthma.DATA SOURCES:A literature search was performed via EMBASE and MEDLINE (1966-November 2012). The search was limited to human data published in the English language. Search terms included asthma, tiotropium, and long-acting anticholinergics.STUDY SELECTION AND DATA EXTRACTION:Relevant information related to the use of tiotropium in patients with asthma was reviewed. Randomized controlled trials and open-label trials were included. The references of published articles identified in the search were also examined for additional studies appropriate to include in the review. Data were prioritized if they originated from human studies, especially if derived from randomized, placebo-controlled trials. Trials and case reports involving the use of long-acting anticholinergic tiotropium in asthma patients were included; conversely, trials involving ipratropium were not.DATA SYNTHESIS:Two large randomized controlled trials support the safety and efficacy of adding tiotropium to the treatment regimen of select patients with poorly controlled asthma already receiving combination high-dose glucocorticosteroid/long-acting β-agonist (LABA) therapy. Pharmacogenomic studies have shown that patients with polymorphisms of the β2-adrenoreceptor (ADRB2; 16 Arg/Arg and 16 Arg/Gly) are particularly responsive to treatment with tiotropium. Smaller studies indicate that the advantages may be most pronounced in patients with a predominance of sputum neutrophils and that tiotropium can assist with decreasing the inhaled corticosteroid (ICS) dose. An increased risk of cardiovascular events was not identified.CONCLUSIONS:Tiotropium should be considered in patients with asthma who remain symptomatic while receiving high-dose ICS and LABA therapy. Specifically, patients with high sputum neutrophil levels or with 16 Arg/Arg or 16 Arg/Gly polymorphism of the ADRB2 gene appear to respond best.

PMID: 23613100 [PubMed - as supplied by publisher]

Effects of a written asthma action plan on caregivers' management of children with asthma: a cross-sectional questionnaire survey.

Caregivers of children with asthma provided with a written asthma action plan (WAAP) are reported to be more confident in their ability to provide care for their child during an asthma exacerbation. However, little is known about how a WAAP impacts on their care processes that contributed to this increased confidence. AIMS: To determine the effects of a WAAP on caregivers' understanding of asthma symptoms, their use of asthma medications for their children, and acute care visits to consult their physicians.

METHODS: A questionnaire survey to caregivers of children with a WAAP (CW) and without a WAAP (CNW) who were followed up at nine public primary care clinics in Singapore. χ2 test was used to determine the differences in outcomes between the CW and CNW groups, followed by logistic regression to adjust for potential covariates.

RESULTS: A total of 169 caregivers were surveyed (75 CNW, 94 CW). Caregivers in the CW group were more likely to understand bronchoconstriction (adjusted odds ratio (AOR) 4.51, p=0.025), to feel capable (AOR 2.77, p=0.004), safe (AOR 2.63, p=0.004), and had increased confidence (AOR 2.8, p=0.003) to change doses of inhaled medications during an asthma exacerbation. The CW group perceived inhaled asthma medication to be safe (AOR 3.42, p=0.015) and understood the use of controller medication (AOR 3.28, p=0.006). No difference was noted between caregivers in their likelihood to stop medications without consulting their physician, seek acute care consultation, and confidence in self-management of their children's asthma at home.

CONCLUSIONS: The WAAP improved caregivers' understanding of the disease and use of inhaled asthma medications during asthma exacerbations but did not affect their decision regarding acute visits to their physician.

Immunoglobulin G4-related disease mimicking asthma.

Related Articles

Immunoglobulin (Ig) G4-related disease (also known as 'IgG4-related sclerosing disease', 'IgG4-related systemic disease' or 'hyper-IgG4-disease') is a recently recognized systemic fibroinflammatory disease associated with IgG4-positive plasma cells in tissue lesions. IgG4-related disease was initially described as autoimmune pancreatitis, but it is now known to affect virtually any organ.

The authors describe a patient presenting with multi-organ manifestations, including airway inflammation mimicking asthma, pulmonary parenchymal infiltrates, intrathoracic lymphadenopathy, submandibular gland swelling and a kidney mass.

Transferability of Indirect Cost of Chronic Disease: A Systematic Review and Meta-Analysis.

Indirect cost is an important component in economic evaluations. The variation in the magnitude of indirect costs across studies and countries is substantial and affects the transferability of results across jurisdictions.

OBJECTIVE: This study explored the factors involved in the variation of reported indirect cost and investigated the feasibility of transferring indirect costs across settings.

METHODS: A systematic literature review was conducted to identify studies estimating indirect costs for four selected chronic diseases, namely, asthma (AS), diabetes (DI), rheumatoid arthritis (RA) and schizophrenia (SC). A multiple linear regression analysis was run to identify the factors that potentially explain the variation in reported indirect costs. Parametric (fixed- and random-effect models) and non-parametric (bootstrapping method) meta-analyses were applied to local gross domestic product (GDP)/capita-adjusted indirect costs for each disease. Results from the three different analytical methods were compared to ascertain the robustness of estimation.

RESULTS: The systematic literature review identified 77 articles that reported indirect costs of AS (n = 18), DI (n = 20), RA (n = 25) and SC (n = 14) for literature synthesis. Substantial inter- and intra-disease variations among the indirect cost studies were observed with respect to geographic distribution, methodology and magnitude of cost estimation. Regression analysis showed that disease categories and local GDP/capita significantly (p < 0.001) contributed to the variance of indirect cost. The range of intra-disease variation in indirect costs was substantially reduced after adjusting by and expressing values as local GDP/capita. The GDP-adjusted indirect cost in terms of percentage of local GDP/capita of AS was the lowest and that of SC was the highest. Bootstrapping estimation was relatively conservative, with slightly wider confidence intervals (CIs) than the parametric method, with a mean (95 % CI) of 2.12 % (1.4089-2.9332) for AS, 10.65 % (7.215-14.7438) for DI, 21.98 % (17.4360-27.0631) for RA, and 79.19 % (52.4243-117.833) for SC.

CONCLUSION: It would be convenient and feasible to construct a universal reference range of indirect cost for a specific disease based on existing data and present this as a percentage of local GDP to assist local decision making in jurisdictions where indirect cost data are not available.

Inappropriate prescribing of inhaled corticosteroids: are they being prescribed for respiratory tract infections? A retrospective cohort study.

Related Articles

Inappropriate prescribing of inhaled corticosteroids: are they being prescribed for respiratory tract infections? A retrospective cohort study.

Prim Care Respir J. 2013 Apr 25;

Authors: Poulos LM, Ampon RD, Marks GB, Reddel HK

Abstract
BACKGROUND: Guidelines recommend regular use of inhaled corticosteroid (ICS)-containing medications for all patients with persistent asthma and those with moderate to severe chronic obstructive pulmonary disease. It is important to identify indicators of inappropriate prescribing. AIMS: To test the hypothesis that ICS are prescribed for the management of respiratory infections in some patients lacking evidence of chronic airways disease. METHODS: Medication dispensing data were obtained from the Australian national Pharmaceutical Benefits Scheme (PBS) for concessional patients dispensed any respiratory medications during 2008. We identified people dispensed only one ICS-containing medication and no other respiratory medications in a year, who were therefore unlikely to have chronic airways disease, and calculated the proportion who were co-dispensed oral antibiotics. RESULTS: In 2008, 43.6% of the 115,763 patients who were dispensed one-off ICS were co-dispensed oral antibiotics. Co-dispensing was seasonal, with a large peak in winter months. The most commonly co-dispensed ICS among adults were moderate/high doses of combination therapy, while lower doses of ICS alone were co-dispensed among children. In this cohort, one-off ICS co-dispensed with oral antibiotics cost the government $2.7 million in 2008. CONCLUSIONS: In Australia, many people who receive one-off prescriptions for ICS-containing medications do not appear to have airways disease. In this context, the high rate of co-dispensing with antibiotics suggests that ICS are often inappropriately prescribed for the management of symptoms of respiratory infection. Interventions are required to improve the quality of prescribing of ICS and the management of respiratory infections in clinical practice.

PMID: 23616052 [PubMed - as supplied by publisher]

Search

Search