scholarly journals Use of the inhaled corticosteroid to bronchodilator ratio in an audit of the treatment of asthma in an academic family medicine residency programme

2010 ◽  
Vol 2 (1) ◽  
pp. 22
Author(s):  
Paul Pisarik
Keyword(s):  
Family Medicine ◽  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
The United States ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Asthma Care ◽  
Bronchodilator Agents ◽  
Obstructive Pulmonary Disease ◽  
The Difference

INTRODUCTION: Asthma affects around 5% of the United States population, with 50% having uncontrolled symptoms. AIM: To improve asthma care by seeing if the inhaled corticosteroid to bronchodilator ratio (RATIO) is associated with asthma control and if non-clinical factors were associated with adherence to asthma guidelines. METHOD: A retrospective study using University of Oklahoma-Tulsa, School of Community Medicine Family Medicine Clinic electronic medical records of a random sample of 49 patients with asthma who were seen at least twice from July 2003 through June 2007 and did not have a diagnosis of chronic obstructive pulmonary disease or exercise-induced asthma. RESULTS: The RATIO for those prescribed corticosteroid inhalers was directly related to the actual step of asthma care (STEP) but inversely related to the number of prednisone courses prescribed per year (R2=.30, p=0.0012). The difference between the actual STEP and ideal STEP (had corticosteroid inhalers been prescribed for all the months in the study) was directly related to the percent of available salbutamol (albuterol) inhalers that non-clinicians refilled and inversely related to the actual STEP (R2=.45, p=1.8 x 10-5). The available corticosteroid inhalers prescribed was directly related to the actual STEP and inversely related to the number of comorbid diagnoses addressed at the last asthma visit (R2=.70, p=5.8 x 10-10). DISCUSSION: Efforts to both limit salbutamol medications, especially by non-clinicians, and simultaneously prescribe appropriate amounts of inhaled corticosteroids, through a dedicated asthma visit, should improve asthma control. A higher RATIO implies better asthma control. KEYWORDS: Asthma; anti-inflammatory agents; albuterol; bronchodilator agents; drug therapy, combination; medical audit

scholarly journals Asthma Control in Canada Remains Suboptimal: The Reality of Asthma Control (TRAC) Study

2006 ◽  
Vol 13 (5) ◽  
pp. 253-259 ◽  
Author(s):  
J Mark FitzGerald ◽  
Louis-Philippe Boulet ◽  
R Andrew McIvor ◽  
Sabrina Zimmerman ◽  
Kenneth R Chapman
Keyword(s):  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Guideline Implementation ◽  
Effective Means ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Action Plans ◽  
Obstructive Pulmonary Disease ◽  
Asthma Knowledge ◽  
Almost All

BACKGROUND: Two Canadian studies showed that 55% of patients with asthma had daily symptoms (in 1996) and that 57% of patients suffered from poorly controlled asthma (in 1999).OBJECTIVES: To assess the state of asthma control of adult Canadians, and asthma knowledge and practices of Canadian physicians actively involved in the care of patients with asthma.METHODS: Telephone interviews were conducted with adults 18 to 54 years of age who had been diagnosed with asthma at least six months before the survey, who did not have chronic obstructive pulmonary disease and who had a smoking history of fewer than 20 pack-years. Physicians were surveyed by telephone and mail. The surveys took place between April and August 2004.RESULTS: Almost all (97%) of the 893 patients believed that they had controlled asthma; however, only 47% had controlled disease according to symptom-based guideline criteria. Just 39% of 463 physicians based their treatment recommendations on the Canadian asthma guidelines most or all of the time, despite having a high awareness of them. Only 11% of patients had written action plans, and one-half of patients with action plans did not use them regularly. Almost three-quarters of patients expressed concerns about taking inhaled corticosteroids.CONCLUSIONS: Since the last major national survey, guideline implementation has not resulted in significant changes in asthma-related morbidity. Effective means of knowledge transfer should be developed and implemented to improve the translation of guideline recommendations into care.

scholarly journals Inhaled corticosteroids and FEV1 decline in chronic obstructive pulmonary disease: a systematic review

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hannah R. Whittaker ◽  
Debbie Jarvis ◽  
Mohamed R. Sheikh ◽  
Steven J. Kiddle ◽  
Jennifer K. Quint
Keyword(s):  
Inhaled Corticosteroids ◽  
Risk Of Bias ◽  
Long Term Results ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Follow Up Studies ◽  
The Difference ◽  
Rate Of Decline

AbstractRate of FEV1 decline in COPD is heterogeneous and the extent to which inhaled corticosteroids (ICS) influence the rate of decline is unclear. The majority of previous reviews have investigated specific ICS and non-ICS inhalers and have consisted of randomised control trials (RCTs), which have specific inclusion and exclusion criteria and short follow up times. We aimed to investigate the association between change in FEV1 and ICS-containing medications in COPD patients over longer follow up times.MEDLINE and EMBASE were searched and literature comparing change in FEV1 in COPD patients taking ICS-containing medications with patients taking non-ICS-containing medications were identified. Titles, abstract, and full texts were screened and information extracted using the PICO checklist. Risk of bias was assessed using the Cochrane Risk of Bias tool and a descriptive synthesis of the literature was carried out due to high heterogeneity of included studies.Seventeen studies met our inclusion criteria. We found that the difference in change in FEV1 in people using ICS and non-ICS containing medications depended on the study follow-up time. Shorter follow-up studies (1 year or less) were more likely to report an increase in FEV1 from baseline in both patients on ICS and in patients on non-ICS-containing medications, with the majority of these studies showing a greater increase in FEV1 in patients on ICS-containing medications. Longer follow-up studies (greater than 1 year) were more likely to report a decline in FEV1 from baseline in patients on ICS and in patients on non-ICS containing medications but rates of FEV1 decline were similar.Further studies are needed to better understand changes in FEV1 when ICS-containing medications are prescribed and to determine whether ICS-containing medications influence rate of decline in FEV1 in the long term. Results from inclusive trials and observational patient cohorts may provide information more generalisable to a population of COPD patients.

scholarly journals The Role of ICS/LABA Fixed-Dose Combinations in the Treatment of Asthma and COPD: Bioequivalence of a Generic Fluticasone Propionate-Salmeterol Device

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Donald P. Tashkin ◽  
Jill A. Ohar ◽  
Arkady Koltun ◽  
Richard Allan ◽  
Jonathan K. Ward
Keyword(s):  
Fluticasone Propionate ◽  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
The United States ◽  
Fixed Dose ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Beta Agonists ◽  
Treatment Plans ◽  
Long Acting

Both asthma and chronic obstructive pulmonary disease (COPD) are inflammatory chronic respiratory conditions with high rates of morbidity and mortality worldwide. The objectives of this review are to briefly describe the pathophysiology and epidemiology of asthma and COPD, discuss guideline recommendations for uncontrolled disease, and review a new generic option for the treatment of asthma and COPD. Although mild forms of these diseases may be controlled with as-needed pharmacotherapy, uncontrolled or persistent asthma and moderate or severe COPD uncontrolled by bronchodilators with elevated eosinophilia or frequent exacerbations may require intervention with combination therapy with inhaled corticosteroids (ICS) and long-acting beta agonists (LABAs), according to international guidelines. Fixed-dose combinations of ICS/LABA are commonly prescribed for both conditions, with fluticasone propionate (FP) and salmeterol forming a cornerstone of many treatment plans. An oral inhalation powder containing the combination of FP and salmeterol has been available as Advair Diskus® in the United States for almost 20 years, and the first and only substitutable generic version of this product has recently been approved for use: Wixela™ Inhub™. Bioequivalence of Wixela Inhub and Advair Diskus has been established. Furthermore, the Inhub inhaler was shown to be robust and easy to use, suggesting that Wixela Inhub may provide an alternative option to Advair Diskus for patients with asthma or COPD requiring intervention with an ICS/LABA.

Narrative Literature Review Guided Approach of Inhaled Corticosteroid de-escalation in Chronic Obstructive Pulmonary Disease

2021 ◽  
pp. 089719002110537
Author(s):  
Anamarie Tomaich ◽  
Shawnee Klatt ◽  
Michael W. Nagy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Inhaled Corticosteroid ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Long Acting

Objective To review the 2020 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report recommendations and create an algorithm to assist clinicians in determining which chronic obstructive pulmonary disease (COPD) patients qualify for inhaled corticosteroid (ICS) de-escalation. Data Sources: A literature search of MEDLINE/PubMed from 2002 to August 2021 was conducted using the search terms inhaled corticosteroids, chronic obstructive pulmonary disease, and de-escalation and review of the reference lists of identified articles for pertinent citations. Study Selection and Data Extraction Relevant studies and articles were included if they focused on the utilization of ICS in COPD. Data Synthesis The 2020 GOLD report only recommends triple therapy with ICS, long acting beta agonists, and long acting muscarinic antagonists for patients with frequent exacerbations, frequent hospitalizations, or elevated blood eosinophil counts. Despite this clear framework, patients are prescribed ICS without these characteristics. Available evidence suggests that these patients can be de-escalated from ICS therapy without concern for worsening lung function or exacerbations. Relevance to Patient Care and Clinical Practice: Patients with COPD may be experiencing more risk than benefit on ICS therapy. Clinicians should be knowledgeable on how to evaluate patient therapy for appropriateness and know how to safely deprescribe ICS given their limited efficacy in many COPD patients. Conclusion There remains no specific guidance on how to de-escalate patients off an ICS when the therapy is not indicated. Use of clinical evidence with stepwise algorithms can be models to approach de-escalation of ICS in patients with COPD.

scholarly journals Recent advances in the management of chronic obstructive pulmonary disease

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 863 ◽  
Author(s):  
Sharon R Rosenberg ◽  
Ravi Kalhan
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Obstructive Pulmonary Disease ◽  
Corticosteroid Withdrawal ◽  
Recent Advances ◽  
Additional Therapy

Novel pharmacotherapies introduce additional options to providers and patients in how to best treat chronic obstructive pulmonary disease (COPD). Emerging data question the role of inhaled corticosteroids in COPD treatment, particularly as combination dual bronchodilator pharmacotherapies demonstrate robust results. For those maximized on pharmacotherapy with continued dyspnea or exacerbations or both, emerging bronchoscopic procedures may offer additional therapy in select patients. This review focuses on data supporting the use of novel ultra bronchodilators, particularly in combination, and on the role for inhaled corticosteroid withdrawal and new bronchoscopic procedures.

scholarly journals Update on Pharmaceutical and Minimally Invasive Management Strategies for Chronic Obstructive Pulmonary Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Rokhsara Rafii ◽  
Timothy E. Albertson ◽  
Samuel Louie ◽  
Andrew L. Chan
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Minimally Invasive ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Management Strategies ◽  
The United States ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Pulmonary Disorder ◽  
The Right

Chronic obstructive pulmonary disease (COPD) is a debilitating pulmonary disorder with systemic effects, and it is the fourth leading cause of death in the United States. COPD patients not only develop respiratory limitations, but can also demonstrate systemic wasting, features of depression, and can succumb to social isolation. Smoking cessation is crucial, and pharmacotherapy with bronchodilators is helpful in symptom management. Inhaled corticosteroids may be beneficial in some patients. In addition, pulmonary rehabilitation and palliative care are important components under the right clinical circumstance. This review highlights current guidelines and management strategies for COPD and emphasizes novel pharmacotherapy and minimally invasive (nonsurgical) lung-volume reduction interventions that may prove to be of significant benefit in the future.

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