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Faisabilité du « coaching » téléphonique dans l’appareillage du syndrome d’apnée du sommeil. Coaching téléphonique et SAS

L’application nocturne d’une pression positive continue (PPC) reste le traitement de référence du syndrome d’apnée du sommeil (SAS), malgré un taux d’acceptation d’environ 70 %.

Méthodes : Cette étude cas–témoin concerne une population de patients (n = 133) atteints de SAS et appareillés par PPC par un prestataire (SADIR). Une éducation thérapeutique (ET) dispensée par un intervenant compétent en ET et consistant en cinq appels à j3/10/30/60/90 a été proposée à 66 patients. La faisabilité de cette méthode a été évaluée ainsi que le bénéfice éventuel sur l’acceptation et l’observance de l’appareillage.

Résultats : Quatre-vingt-dix-huit pour cent des patients (65/66) ont accepté ce suivi personnalisé. Cinquante-sept patients (86 %) ont suivi la totalité du programme et 44 patients (66 %) ont répondu précisément aux dates d’appels définis par le protocole. Cet accompagnement téléphonique a permis d’augmenter l’acceptation (94 % versus 81 %,p = 0,027) et l’observance (4 h 39 ± 2 h 17 versus 3 h 45 ± 2 h 45,p = NS) pour ces patients par rapport aux patients bénéficiant d’un suivi classique.

Conclusions : La mise en place d’une ET par téléphone et par un personnel compétent est faisable et semble améliorer l’observance et l’adhésion des patients au traitement par PPC. Ces dernières données devront être confirmées sur une population de patients plus importante et randomisée.IntroductionThe most commonly used treatment for obstructive sleep apnea syndrome (OSA) is the application of continuous positive airway pressure (CPAP) during sleep. However compliance with this treatment is frequently below 70%.

Methods : The main aim of this study was to evaluate the feasibility of an educational intervention (EI) delivered in phone calls made to OSA patients (n = 66) treated with CPAP by a home care provider (SADIR). The educational intervention consisted of five sessions of telephone based counseling intervention by appropriately trained staff delivered on day 3, 10, 30, 60 and 90 after initiation of treatment. Secondary objectives were to compare, using a case-control design, CPAP compliance of OSA patients (n = 133) with or without EI.

Results : Ninety-eight percent of patients accepted the intervention to participate in the study. Fifty-seven patients (86%) received the full intervention program and 44 patients (66%) strictly respected the pre-defined timings per protocol. A higher adherence to CPAP at six months was observed in the EI group compared to patient without EI (94% versus 81%) (P < 0.05). CPAP compliance at three months was 54 minutes higher in the EI group compared to the control group (4 h 39 ± 2 h 17 and 3 h 45 ± 2 h 45 respectively) but this difference was not statistically significant.

Conclusion : An educational intervention dispensed by phone is applicable and would have an impact on CPAP compliance. Its efficacy on long-term compliance has to be confirmed in a larger group using a randomized procedure.

Quantifying the proportion of severe asthma exacerbations attributable to inhaled corticosteroid nonadherence

Background: Asthma is an inflammatory condition often punctuated by episodic symptomatic worsening, and accordingly, patients with asthma might have waxing and waning adherence to controller therapy.Objective: We sought to measure changes in inhaled corticosteroid (ICS) adherence over time and to estimate the effect of this changing pattern of use on asthma exacerbations.Methods: ICS adherence was estimated from electronic prescription and fill information for 298 participants in the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity. For each patient, we calculated a moving average of ICS adherence for each day of follow-up. Asthma exacerbations were defined as the need for oral corticosteroids, an asthma-related emergency department visit, or an asthma-related hospitalization. Proportional hazard models were used to assess the relationship between ICS medication adherence and asthma exacerbations.Results: Adherence to ICS medications began to increase before the first asthma exacerbation and continued afterward. Adherence was associated with a reduction in exacerbations but was only statistically significant among patients whose adherence was greater than 75% of the prescribed dose (hazard ratio, 0.61; 95% CI, 0.41-0.90) when compared with patients whose adherence was 25% or less. This pattern was largely confined to patients whose asthma was not well controlled initially. An estimated 24% of asthma exacerbations were attributable to ICS medication nonadherence.Conclusions: ICS adherence varies in the time period leading up to and after an asthma exacerbation, and nonadherence likely contributes to a large number of these exacerbations. High levels of adherence are likely required to prevent these events.

Histamine and H1-antihistamines: Celebrating a century of progress

In this review we celebrate a century of progress since the initial description of the physiologic and pathologic roles of histamine and 70 years of progress since the introduction of H1-antihistamines for clinical use. We discuss histamine and clinically relevant information about the molecular mechanisms of action of H1-antihistamines as inverse agonists (not antagonists or blockers) with immunoregulatory effects. Unlike first (old)–generation H1-antihistamines introduced from 1942 to the mid-1980s, most of the second (new)–generation H1-antihistamines introduced subsequently have been investigated extensively with regard to clinical pharmacology, efficacy, and safety; moreover, they are relatively free from adverse effects and not causally linked with fatalities after overdose. Important advances include improved nasal and ophthalmic H1-antihistamines with rapid onset of action (in minutes) for allergic rhinitis and allergic conjunctivitis treatment, respectively, and effective and safe use of high (up to 4-fold) doses of oral second-generation H1-antihistamines for chronic urticaria treatment. New H1-antihistamines introduced for clinical use include oral formulations (bilastine and rupatadine), and ophthalmic formulations (alcaftadine and bepotastine). Clinical studies of H3-antihistamines with enhanced decongestant effects have been conducted in patients with allergic rhinitis. Additional novel compounds being studied include H4-antihistamines with anti-inflammatory effects in allergic rhinitis, atopic dermatitis, and other diseases. Antihistamines have a storied past and a promising future.

Asthma exacerbations: Origin, effect, and prevention

Asthma is the most common chronic respiratory disease, affecting up to 10% of adults and 30% of children in the Western world. Despite advances in asthma management, acute exacerbations continue to occur and impose considerable morbidity on patients and constitute a major burden on health care resources. Respiratory tract viruses have emerged as the most frequent triggers for exacerbations in both children and adults; however, the mechanisms underlying these remain poorly understood. More recently, it has become increasingly clear that interactions might exist between viruses and other triggers, increasing the likelihood of an exacerbation. In this article we begin with an overview of the health, economic, and social burden that exacerbations of asthma carry with them. This is followed by a review of the pathogenesis of asthma exacerbations, highlighting the various triggers responsible and multiple interactions that exist between them. The final section first addresses what preventative measures are currently available for asthma exacerbations and subsequently examines which of the new treatments in development might lessen the burden of exacerbations in the future.

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