scholarly journals Does adherence to inhaled corticosteroids predict asthma-related outcomes over time? A cohort study

2019 ◽  
Vol 54 (6) ◽  
pp. 1900901 ◽  
Author(s):  
Alexandra L. Dima ◽  
Eric van Ganse ◽  
Gertraud Stadler ◽  
Marijn de Bruin
Keyword(s):  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Persistent Asthma ◽  
Text Messages ◽  
Current Evidence ◽  
Computer Assisted ◽  
Longitudinal Models ◽  
The Impact ◽  
Over Time

Inhaled corticosteroids (ICS) adherence is important for asthma management. Current evidence on the impact of ICS adherence on outcomes is mostly based on correlational analyses of between-person data. Although it is widely acknowledged that asthma outcomes fluctuate over time, evidence on predictors of within-person change is scarce. We aimed to quantify these fluctuations and the longitudinal relationships between ICS adherence and outcomes at both between- and within-person levels.A prospective cohort of persistent asthma patients in France and the UK (n=847, age 6−40 years) provided 3756 reports over up to 2 years via computer-assisted telephone interviews and text messages on ICS adherence, asthma control, reliever medication use and exacerbations. We examined adherence−outcome relationships via longitudinal models, controlling for confounders, including severity.Considerable within-person variability was found for exacerbations (91%), asthma control (59%) and reliever use (52%); 431 (11.5%) reports signalled exacerbations and 2046 (54.5%) poor control. At between-person level, patients with higher average adherence were more likely to report asthma control (OR 1.25, 95% CI 1.06−1.47), but not asthma exacerbations (OR 0.99, 95% CI 0.87−1.12) or lower reliever use (b −0.0004, 95% CI −0.089−0.088). At within-person level, higher-than-usual adherence was associated with higher concomitant reliever use (b 0.092, 95% CI 0.053−0.131) and lower subsequent reliever use (b −0.047, 95% CI −0.005− −0.088); it was unrelated to asthma control (OR 0.93, 95% CI 0.84−1.02) or exacerbations (OR 1.04, 95% CI 0.94−1.16).Patients maintaining high ICS adherence over time have better asthma control. Temporarily increasing ICS adherence tends to be simultaneous to higher reliever use and reduces reliever use later on. Causes of within-person variation in outcomes require more investigation.

scholarly journals What Is New Since the Last (1999) Canadian Asthma Consensus Guidelines?

2001 ◽  
Vol 8 (suppl a) ◽  
pp. 5A-27A ◽  
Author(s):  
Louis-Philippe Boulet ◽  
Tony R Bai ◽  
Allan Becker ◽  
Denis Bérubé ◽  
Robert Beveridge ◽  
...  
Keyword(s):  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Environmental Control ◽  
Treatment Plan ◽  
Airflow Obstruction ◽  
Asthma Management ◽  
Consensus Guidelines ◽  
Number Of Patients ◽  
The Impact

The objective of the present document is to review the impact of new information on the recommendations made in the last (1999) Canadian Asthma Consensus Guidelines. It includes relevant published studies and observations or comments regarding what are considered to be the main issues in asthma management in children and adults in office, emergency department, hospital and clinical settings. Asthma is still insufficiently controlled in a large number of patients, and practice guidelines need to be integrated better with current care. This report re-emphasises the need for the following: objective measures of airflow obstruction to confirm the diagnosis of asthma suggested by the clinical evaluation; identification of contributing factors; and the establishment of a treatment plan to rapidly obtain and maintain optimal asthma control according to specific criteria. Recent publications support the essential role of asthma education and environmental control in asthma management. They further support the role of inhaled corticosteroids as the mainstay of anti-inflammatory therapy of asthma, and of both long acting beta2-agonists and leukotriene antagonists as effective means to improve asthma control when inhaled corticosteroids are insufficient. New developments, such as combination therapy, and recent major trials, such as the Children’s Asthma Management Project (CAMP) study, are discussed.

scholarly journals Higher Omega-3 Index Is Associated with Better Asthma Control and Lower Medication Dose: A Cross-Sectional Study

Nutrients ◽  
2019 ◽  
Vol 12 (1) ◽  
pp. 74 ◽  
Author(s):  
Isobel Stoodley ◽  
Manohar Garg ◽  
Hayley Scott ◽  
Lesley Macdonald-Wicks ◽  
Bronwyn Berthon ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Airway Disease ◽  
Cross Sectional Study ◽  
Erythrocyte Membranes ◽  
Omega 3 ◽  
Asthma Control Questionnaire ◽  
Cross Sectional

Asthma is a chronic inflammatory airway disease, associated with systemic inflammation. Omega-3 polyunsaturated fatty acids (n-3 PUFA) have established anti-inflammatory effects, thus having potential as an adjunct therapy in asthma. This study aimed to compare erythrocyte n-3 PUFA in adults with (n = 255) and without (n = 137) asthma and determine the relationship between erythrocyte n-3 PUFA and clinical asthma outcomes. Subjects had blood collected, lung function measured and Juniper Asthma Control Questionnaire (ACQ) score calculated. Fatty acids were measured in erythrocyte membranes by gas chromatography, and the omega-3 index (O3I) was calculated (% eicosapentaenoic acid + % docosahexaenoic acid). O3I was similar in subjects with and without asthma (p = 0.089). A higher O3I was observed in subjects with controlled or partially controlled asthma (ACQ < 1.5) compared to subjects with uncontrolled asthma (ACQ ≥ 1.5) (6.0% (5.4–7.2) versus 5.6% (4.6–6.4) p = 0.033). Subjects with a high O3I (≥8%) had a lower maintenance dose of inhaled corticosteroids (ICS) compared to those with a low O3I (<8%) (1000 μg (400–1000) versus 1000 μg (500–2000) p = 0.019). This study demonstrates that a higher O3I is associated with better asthma control and with lower ICS dose, suggesting that a higher erythrocyte n-3 PUFA level may have a role in asthma management.

scholarly journals Comparative adherence between DOAC and VKA in patients with atrial fibrillation: a 23-year retrospective observational study in Canada

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Salmasi ◽  
A Safari ◽  
M.A De Vera ◽  
L Lynd ◽  
M Koehoorn ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Drug Class ◽  
Oral Anticoagulants ◽  
Current Evidence ◽  
Mixed Effect ◽  
Medication Discontinuation ◽  
The Impact ◽  
Rolling Windows ◽  
Over Time

Abstract Background A recent systematic review highlighted significant gaps in the evidence on atrial fibrillation (AF) patients' adherence to oral anticoagulants (OAC). Current evidence suffers from short follow-up times, focuses on the first OAC and does not take switching into account. There is also lack of observational data on adherence to warfarin due to its varying dose that complicates the calculations. As such there is lack of evidence on comparative adherence between VKAs and DOACs and whether the convenience of DOACs translates into better adherence in AF patients. Purpose Our objective was to measure AF patients' long-term OAC adherence and compare the impact of taking direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) on adherence, while accounting for switching. Methods Using linked, population-based administrative data containing physician billings, hospitalization and prescription records of 4.8 million British Columbians (1996–2019), incident adult cases of AF were identified. The primary measure of adherence was proportion of days covered (PDC). Consecutive rolling 90-day windows were created for each patient starting from their first OAC prescription fill date until the end of their follow-up. The PDC for each 90-day rolling window was calculated and averaged to yield mean adherence over the follow-up period for each patient. Permanent medication discontinuation resulted in a PDC of 0 for all subsequent rolling windows after their supply ran out. As such, both poor execution and non-persistence were measured simultaneously. The association between drug class and adherence was assessed using generalized mixed effect linear regression models with drug class treated as time-varying covariate to account for switching. Results The study cohort was 30,264 AF patients [mean age 72.2 years (SD11.0), 44.6% female, mean CHA2DS2-VASc 2.94 (SD1.4)] with mean follow-up of 7.7 (SD 4.8) years. The mean PDC was 0.71 (SD 0.27) with 51% of the cohort having mean PDC values below the conventional threshold of adherence (PDC&lt;0.8). Adherence dropped over time with the greatest decline in the first two years after therapy initiation. After controlling for all other confounders and accounting for switching, taking VKA compared to DOAC was, on average, associated with a 1-day decrease in number of days of medication-taking per year. Conclusion AF patients' OAC adherence was below the conventional threshold of 0.8, and dropped over time, particularly in the first two years. Drug class had no clinically meaningful impact on medication adherence. Our study highlights the need for effective adherence interventions particularly early in OAC therapy. Our findings also emphasizes that prescribers should not assume inherently better adherence for DOACs and should instead choose OAC in conversation with the patient and in accordance with their values and preferences. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research grant

Introduction: how language works in politics

2018 ◽  
pp. 3-32
Author(s):  
Matthew Williams
Keyword(s):  
Computer Assisted ◽  
British Politics ◽  
Form And Function ◽  
It Impacts ◽  
Legislative Language ◽  
And Function ◽  
Assisted Analysis ◽  
The Impact ◽  
Over Time

This book examines how language works in democratic politics and how it impacts the effectiveness of policy. Using evidence from the first computer-assisted analysis of all 41.5 million words of legislation enacted from 1900 to 2015, it tracks the major changes in form and function that Parliament's use of language has undergone over time and the reasons for such changes. More importantly, it explores the policy and social implications of changes in legislative language as well as the issue of legislative indeterminacy. This introductory chapter discusses the questions, arguments and aims of the book and reviews the literature on the operation of language in British politics, along with the impact of legislative language on policy effectiveness. It also explains what specifically the book contributes to the existing literature, describes the research design, and provides an overview of the chapters that follow.

scholarly journals Association of Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists With Asthma Control in Patients With Uncontrolled, Persistent Asthma

JAMA ◽  
2018 ◽  
Vol 319 (14) ◽  
pp. 1473 ◽  
Author(s):  
Diana M. Sobieraj ◽  
William L. Baker ◽  
Elaine Nguyen ◽  
Erin R. Weeda ◽  
Craig I. Coleman ◽  
...  
Keyword(s):  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Persistent Asthma ◽  
Muscarinic Antagonists ◽  
Long Acting

scholarly journals Asthma and COVID-19: Emphasis on Adequate Asthma Control

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
David D. Nassoro ◽  
Leodegard Mujwahuzi ◽  
Issakwisa Habakkuk Mwakyula ◽  
Mwajabu K. Possi ◽  
Sylvester L. Lyantagaye
Keyword(s):  
Asthma Control ◽  
Seasonal Influenza ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Cell Mediated Immunity ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Wide Availability ◽  
The Relationship ◽  
Increased Susceptibility

Asthmatics are at an increased risk of developing exacerbations after being infected by respiratory viruses such as influenza virus, parainfluenza virus, and human and severe acute respiratory syndrome coronaviruses (SARS-CoV). Asthma, especially when poorly controlled, is an independent risk factor for developing pneumonia. A subset of asthmatics can have significant defects in their innate, humoral, and cell-mediated immunity arms, which may explain the increased susceptibility to infections. Adequate asthma control is associated with a significant decrease in episodes of exacerbation. Because of their wide availability and potency to promote adequate asthma control, glucocorticoids, especially inhaled ones, are the cornerstone of asthma management. The current COVID-19 pandemic affects millions of people worldwide and possesses mortality several times that of seasonal influenza; therefore, it is necessary to revisit this subject. The pathogenesis of SARS-CoV-2, the virus that causes COVID-19, can potentiate the development of acute asthmatic exacerbation with the potential to worsen the state of chronic airway inflammation. The relationship is evident from several studies that show asthmatics experiencing a more adverse clinical course of SARS-CoV-2 infection than nonasthmatics. Recent studies show that dexamethasone, a potent glucocorticoid, and other inhaled corticosteroids significantly reduce morbidity and mortality among hospitalized COVID-19 patients. Hence, while we are waiting for more studies with higher level of evidence that further narrate the association between COVID-19 and asthma, we advise clinicians to try to achieve adequate disease control in asthmatics as it may reduce incidences and severity of exacerbations especially from SARS-CoV-2 infection.

scholarly journals Assessment of Asthma Control and Severity among Children According to Global Initiative for Asthma Guidelines in Sulaimani City-Iraq

2016 ◽  
Vol 12 (3) ◽  
pp. 160
Author(s):  
Adnan M. H. Hamawandi ◽  
Kosar M Ali ◽  
Ali Z. Naji
Keyword(s):  
Asthma Control ◽  
Objective Assessment ◽  
Asthma Management ◽  
Persistent Asthma ◽  
Cross Sectional ◽  
Asthmatic Children ◽  
Global Initiative For Asthma ◽  
Severe Persistent Asthma ◽  
Global Initiative ◽  
Gina Guidelines

Background: Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families and the community. Objective: Assessment of the level of asthma control and severity in asthmatic children in Sulaimani city according to the global initiative for asthma (GINA) guidelines. Methods: A cross-sectional study of 82 patients who are known cases of asthma, aged 5 – 15 years , from 1st of March 2014 to 1st of August 2014. Results: Out of 82 patients in our study, 20.8%were classified as having intermittent asthma all of them have well controlled asthma, 42.7% of those classified as having mild persistent asthma 65.7% of them have well controlled asthma, 26.8% of those classified as having moderate persistent asthma 54.5% of them have partly controlled asthma, and 9.8%of those classified as having severe persistent asthma the majority of them 87.5% have uncontrolled asthma and none of them reached to the controlled asthma level according to GINA guidelines. Regarding the peak expiratory flow (PFT) we notice that 58.8% of asthmatic children who were classified as having intermittent severity, their PEF measurements ranged between 160- 250 l/min while those with severe persistent asthma 75% of them have readings between 50-150 l/min. Conclusion: Current levels of asthma control in the Sulaimani city fall far short of the goals specified in the GINA guidelines for asthma management. Also there is a strong correlation between PEF measurements and the level of asthma severity,

Examination of Barriers to Medication Adherence, Asthma Management, and Control Among Community Pharmacy Patients With Asthma

2019 ◽  
pp. 089719001984011
Author(s):  
Tatiana Makhinova ◽  
Jamie C. Barner ◽  
Carolyn M. Brown ◽  
Kristin M. Richards ◽  
Karen L. Rascati ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Community Pharmacy ◽  
Asthma Control ◽  
Action Plan ◽  
Asthma Management ◽  
Persistent Asthma ◽  
Poor Adherence ◽  
Convenience Sample ◽  
Study Objective ◽  
Patient Reported

Objective: To describe the prevalence of common barriers to asthma medication adherence and examine associations between patient-reported asthma controller adherence and asthma control, therapy adherence barriers, and asthma management characteristics. Methods: Previously developed asthma-specific tool was pilot tested on a convenience sample of adult patients with persistent asthma. The following data were collected via patient survey: demographic characteristics and comorbidities, adherence, asthma control, and asthma management characteristics. Descriptive and inferential statistics were used to address the study objective. Results: The patients (N = 93) were 45.4 (17.2) years of age, and 66.7% were female. The majority had poor (68.8%) adherence, with 61.3% of patients having controlled asthma. There was no significant association between adherence and asthma control. The mean number of barriers for good and poor adherence groups differed significantly: 2.0 ± 1.1 and 5.4 ± 2.4, respectively ( P < .0001). Having an asthma action plan (AAP) was the only asthma management characteristic significantly related to adherence. The majority of patients with poor adherence did not have an AAP (76.6%), whereas 81.5% of patients with good adherence did have an AAP ( P < 0.0001). Conclusions: The use of this survey tool confirmed presence of asthma-specific barriers, thus using this specialized approach may lead to more effective, targeted counseling in community pharmacy settings.

Sign in / Sign up

Export Citation Format

Share Document