scholarly journals Effective Asthma Management: Is It Time to Let the AIR out of SABA?

2020 ◽  
Vol 9 (4) ◽  
pp. 921
Author(s):  
Alan Kaplan ◽  
Patrick D. Mitchell ◽  
Andrew J. Cave ◽  
Remi Gagnon ◽  
Vanessa Foran ◽  
...  
Keyword(s):  
Asthma Management ◽  
Beta Agonist ◽  
Inhaled Corticosteroid ◽  
Short Acting ◽  
Asthma Symptoms ◽  
Beta Agonists ◽  
Global Initiative For Asthma ◽  
Global Initiative ◽  
Poor Outcomes ◽  
Fast Acting

For years, standard asthma treatment has included short acting beta agonists (SABA), including as monotherapy in patients with mild asthma symptoms. In the Global Initiative for Asthma 2019 strategy for the management of asthma, the authors recommended a significant departure from the traditional treatments. Short acting beta agonists (SABAs) are no longer recommended as the preferred reliever for patients when they are symptomatic and should not be used at all as monotherapy because of significant safety concerns and poor outcomes. Instead, the more appropriate course is the use of a combined inhaled corticosteroid–fast acting beta agonist as a reliever. This paper discusses the issues associated with the use of SABA, the reasons that patients over-use SABA, difficulties that can be expected in overcoming SABA over-reliance in patients, and our evolving understanding of the use of “anti-inflammatory relievers” in our patients with asthma.

scholarly journals Prevalence of overuse of short-acting beta-2 agonists (SABA) and associated factors among patients with asthma in Germany

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Heinrich Worth ◽  
Carl-Peter Criée ◽  
Claus F. Vogelmeier ◽  
Peter Kardos ◽  
Eva-Maria Becker ◽  
...  
Keyword(s):  
Beta Agonist ◽  
General Physician ◽  
Short Acting ◽  
Healthcare Data ◽  
Global Initiative For Asthma ◽  
Multivariable Regression ◽  
Beta 2 ◽  
Global Initiative ◽  
Long Acting ◽  
Underlying Inflammation

Abstract Background Overuse of short-acting beta-2 agonists (SABA), which do not treat the underlying inflammation of asthma, is linked to poor clinical outcomes such as increased exacerbation risk. This study, as part of the SABINA program, estimated the prevalence of SABA overuse and associated variables in outpatients in Germany. Methods This retrospective study used anonymized electronic healthcare data from the Disease Analyzer database (IQVIA). A total of 15,640 patients aged ≥ 12 years with asthma who received ≥ 1 SABA prescription(s) between July 2017 and June 2018 in 924 general physician and 22 pneumologist (PN) practices were included. SABA overuse was defined as ≥ 3 prescribed inhalers (~ 200 puffs each) during the study period. The associations between SABA overuse and physician specialty, Global Initiative for Asthma (GINA) steps (based on asthma medications), age, sex, and inhaled corticosteroid (ICS)/long-acting beta agonist (LABA) use were estimated using multivariable regression for patients with probable moderate (GINA step 2) and probable severe (GINA steps 3–5) asthma. Results Annually, 36% of all patients (GINA steps 1–5) in general and 38% in PN practices received ≥ 3 SABA inhalers. The risk of SABA overuse was 14% higher in patients treated by a general practitioner vs. a PN; 34% and 85% higher in GINA steps 4 and 5, respectively, vs. GINA step 3; and 40% higher in male vs. female patients. Conclusions SABA overuse is prevalent among patients with asthma across all GINA steps in Germany, which may indicate suboptimal asthma control. Further studies are needed to investigate the reasons behind SABA overuse.

scholarly journals Phenotyping of obstructive airways disease

2021 ◽  
Author(s):  
◽  
James Fingleton
Keyword(s):  
Cluster Analysis ◽  
Respiratory Health ◽  
Airflow Obstruction ◽  
Beta Agonist ◽  
Response To Treatment ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Obstructive Pulmonary Disease ◽  
Short Acting ◽  
Obstructive Airways Disease

<p>Background  Asthma and Chronic Obstructive Pulmonary Disease (COPD) are heterogeneous disorders which may be made up of different sub-types, or phenotypes, of airflow obstruction with distinct clinical characteristics. To facilitate personalised treatment the different phenotypes and their response to treatment must be clearly defined and sound diagnostic rules developed.  In this thesis I explore the evidence supporting candidate phenotypes and report the results of my research, known as the New Zealand Respiratory Health Survey (NZRHS). The NZRHS was designed to determine candidate phenotypes, compare these phenotypes to those previously described, characterize their response to inhaled medication, and develop a method for allocating patients to the most appropriate phenotype.  Research Aims  -To explore clinical phenotypes of chronic airways disease by cluster analysis. -To examine if phenotypes identified by a previous cluster analysis exist in the independent NZRHS sample. -To compare the response to a short-acting beta-agonist inhaler between phenotype groups. -To compare the response to a short-acting muscarinic antagonist inhaler between phenotype groups. -To compare the response to an inhaled corticosteroid between phenotype groups. -To generate allocation rules and determine their predictive value for the different disorders of airways disease.  Conclusions  This research has identified phenotypes of airways disease that differ significantly in their clinical and pathophysiological characteristics. Evidence is presented to support the existence of the asthma/COPD overlap and obesity/co-morbid phenotypes and provide data of their responsiveness to inhaled corticosteroid, beta agonist and anti-muscarinic treatments, which may guide future management of patients with these phenotypes of obstructive airways disease.</p>

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,

scholarly journals Comparing LAMA with LABA and LTRA as add-on therapies in primary care asthma management

2020 ◽  
Vol 30 (1) ◽  
Author(s):  
Alan Kaplan ◽  
J. Mark FitzGerald ◽  
Roland Buhl ◽  
Christian Vogelberg ◽  
Eckard Hamelmann
Keyword(s):  
Primary Care ◽  
Lung Function ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Global Initiative For Asthma ◽  
Control Asthma ◽  
Global Initiative ◽  
Long Acting ◽  
Randomised Controlled ◽  
Meta Analyses

Abstract The Global Initiative for Asthma recommends a stepwise approach to adjust asthma treatment to the needs of individual patients; inhaled corticosteroids (ICS) remain the core pharmacological treatment. However, many patients remain poorly controlled, and evidence-based algorithms to decide on the best order and rationale for add-on therapies are lacking. We explore the challenges of asthma management in primary care and review outcomes from randomised controlled trials and meta-analyses comparing the long-acting muscarinic antagonist (LAMA) tiotropium with long-acting β2-agonists (LABAs) or leukotriene receptor antagonists (LTRAs) as add-on to ICS in patients with asthma. In adults, LAMAs and LABAs provide a greater improvement in lung function than LTRAs as add-on to ICS. In children, results were positive and comparable between therapies, but data are scarce. This information could aid decision-making in primary care, supporting the use of add-on therapy to ICS to help improve lung function, control asthma symptoms and prevent exacerbations.

scholarly journals The Global Initiative for Asthma (GINA): 25 years later

2019 ◽  
Vol 54 (2) ◽  
pp. 1900598 ◽  
Author(s):  
Louis-Philippe Boulet ◽  
Helen K. Reddel ◽  
Eric Bateman ◽  
Søren Pedersen ◽  
J. Mark FitzGerald ◽  
...  
Keyword(s):  
Point Of Care ◽  
Scientific Information ◽  
Asthma Management ◽  
Treatment Guideline ◽  
Global Strategy ◽  
World Health ◽  
Care Practice ◽  
Evidence Based ◽  
Global Initiative For Asthma ◽  
Global Initiative

The Global Initiative for Asthma (GINA) was launched in 1993 under the auspices of the National Heart, Lung, and Blood Institute, National Institutes of Health, USA, and the World Health Organization to produce a global strategy on asthma management and prevention. Now constituted as a non-profit entity, it continues to produce, on an annual basis, the most widely cited evidence-based report on the optimal management of asthma in both adults and children intended for global use. Although the GINA Report is often viewed and used as an asthma treatment guideline, it is designed to be a clinically oriented strategy document that supports the development of practice guidelines in different countries and regions.Other GINA products, including the report's pocket guides, teaching slide kits and implementation tools, are also offered free of charge for public use. The GINA Scientific Committee comprises recognised international experts from primary, secondary and tertiary centres of care who are actively involved in both the care of patients and research in asthma. The GINA Assembly is a forum for exchange of scientific information and discussions on initiatives to improve asthma care in various countries, focusing on implementation strategies. GINA plays a role in shaping research on the diagnosis and treatment of asthma and informs the development of point of care practice guides and decision support tools. GINA supports the objectives of raising awareness of asthma and improving access to therapy and quality of care for asthmatic patients, in addition to presenting and promoting continuously updated evidence-based treatment approaches for global use.

Pharmacology Update: Emergency and Controller Medications for Treatment of Asthma

2021 ◽  
pp. 1942602X2110369
Author(s):  
Anil Nanda ◽  
Anne F. Russell ◽  
Theresa A. Bingemann
Keyword(s):  
The United States ◽  
Dose Inhaler ◽  
Inhaled Corticosteroid ◽  
Multiple Forms ◽  
Beta Agonists ◽  
Metered Dose ◽  
Long Acting ◽  
Controller Medications ◽  
Fast Acting ◽  
Chronic Childhood

Asthma is the most common noncommunicable chronic childhood disease, affecting more than 5 million children in the United States. Asthma is the leading cause of school absenteeism. Treatments for asthma are divided into fast-acting medications that are used to relieve symptoms and slower acting (controller) medications that prevent symptoms. Albuterol is the most common fast acting medication for asthma, and it exists in multiple forms, including metered-dose inhaler and nebulized therapy. The use of spacers and holding chambers can further improve medication deposition in the airway. The cornerstone controller therapy for asthma is inhaled corticosteroid. Other medications for asthma include long-acting beta agonists, long-acting antimuscarinics, and antileukotrienes. The newest agents for controller asthma therapies are biologics.

scholarly journals Phenotyping of obstructive airways disease

2021 ◽  
Author(s):  
◽  
James Fingleton
Keyword(s):  
Cluster Analysis ◽  
Respiratory Health ◽  
Airflow Obstruction ◽  
Beta Agonist ◽  
Response To Treatment ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Obstructive Pulmonary Disease ◽  
Short Acting ◽  
Obstructive Airways Disease

<p>Background  Asthma and Chronic Obstructive Pulmonary Disease (COPD) are heterogeneous disorders which may be made up of different sub-types, or phenotypes, of airflow obstruction with distinct clinical characteristics. To facilitate personalised treatment the different phenotypes and their response to treatment must be clearly defined and sound diagnostic rules developed.  In this thesis I explore the evidence supporting candidate phenotypes and report the results of my research, known as the New Zealand Respiratory Health Survey (NZRHS). The NZRHS was designed to determine candidate phenotypes, compare these phenotypes to those previously described, characterize their response to inhaled medication, and develop a method for allocating patients to the most appropriate phenotype.  Research Aims  -To explore clinical phenotypes of chronic airways disease by cluster analysis. -To examine if phenotypes identified by a previous cluster analysis exist in the independent NZRHS sample. -To compare the response to a short-acting beta-agonist inhaler between phenotype groups. -To compare the response to a short-acting muscarinic antagonist inhaler between phenotype groups. -To compare the response to an inhaled corticosteroid between phenotype groups. -To generate allocation rules and determine their predictive value for the different disorders of airways disease.  Conclusions  This research has identified phenotypes of airways disease that differ significantly in their clinical and pathophysiological characteristics. Evidence is presented to support the existence of the asthma/COPD overlap and obesity/co-morbid phenotypes and provide data of their responsiveness to inhaled corticosteroid, beta agonist and anti-muscarinic treatments, which may guide future management of patients with these phenotypes of obstructive airways disease.</p>

Over-prescription of short-acting beta agonists in the treatment of asthma

2021 ◽  
Author(s):  
Ingrid Looijmans-van den Akker ◽  
Anouk Werkhoven ◽  
Theo Verheij
Keyword(s):  
Asthma Control ◽  
Asthma Medication ◽  
Health Centers ◽  
Short Acting ◽  
Asthma Symptoms ◽  
Beta Agonists ◽  
Asthma Exacerbations ◽  
Systemic Corticosteroids ◽  
Clear Guideline ◽  
Β2 Agonists

Abstract Background Despite a clear guideline for asthma medication, excessive use of short-acting β2-agonists (SABAs) is common in clinical practice. Previous research has shown that excessive use of SABAs is associated with poor asthma control. Objective This study examines current use of asthma medication in primary care and whether excessive use of SABAs is associated with exacerbations. Methods The study design was a retrospective analysis using information from electronical medical records from patients aged 18 and older of five Julius Health Centers located in Utrecht, the Netherlands, in the period of 1 July 2018 through 1 July 2019. Excessive SABA use was defined as ≥400 inhalations per year. An exacerbation was defined as an acute worsening of asthma symptoms with the need for systemic corticosteroids. Results A total of 1161 patients were included in the study. Of the patients using SABAs (n = 766), 193 (25%) overused SABAs. Among the patients with inappropriate SABA use (n = 193), 19% had an exacerbation compared with 7% of the appropriate SABA users. For patients using asthma medication the odds of having an exacerbation were 2.9 times higher if they used an inappropriate number of SABAs than if SABAs were used appropriately (odds ratio, 2.897; 95% confidence interval, 1.87–4.48). Conclusions This study shows that overuse of SABAs is still common and that it is associated with asthma exacerbations. It highlights that clinicians need to be aware of inappropriate SABA use as it is a sign of and can even contribute to poor asthma control.

scholarly journals Change of bronchial hyperresponsiveness in asthmatic children

2011 ◽  
Vol 139 (5-6) ◽  
pp. 316-321 ◽  
Author(s):  
Andjelka Stojkovic-Andjelkovic ◽  
Slobodan Obradovic ◽  
Biljana Vuletic ◽  
Nedeljko Radlovic
Keyword(s):  
Home Environment ◽  
Bronchial Hyperresponsiveness ◽  
Bronchial Reactivity ◽  
Inflammation Markers ◽  
Crucial Point ◽  
Asthmatic Children ◽  
Asthma Symptoms ◽  
Global Initiative For Asthma ◽  
Fast Change ◽  
Global Initiative

Introduction. Bronchial hyperresponsiveness (BHR) is a factor in predicting bronchial asthma independently of inflammation markers. Objective. The aims were to determine the frequency and important predictive facts of BHR and the effect of prophylaxis by Global Initiative for Asthma (GINA) and National Asthma Education and Prevention Program (NAEPP) on BHR in asthmatic children. Methods. BHR in 106 children was evaluated by the bronchoprovocation test with methacholine. Results. The prevalence rate of symptomatic BHR is 18% for crucial point of PC20=4.1?3.03 mg/ml and PD20=3.22?2.59 ?mol methacholine. On average asthmatic children express moderate BHR, which persists even two years after administering prophylaxis. After two years bronchial reactivity is significantly smaller, the change of FEV1 is significantly smaller, the velocity of change of slope dose response curve (sDRC) is faster and the provocative concentration of methacholine that causes wheezing is 2-3 times lower. A mild sDRC shows milder bronchoconstriction after two years. The fast change of bronchial reactivity in 41% of asthmatic children is contributed to aero-pollution with sulfur dioxide and/ or, possible insufficient and/or inadequate treatment during two years of administering prophylaxis. A simultaneous effect of allergens from home environment and grass and tree pollens and of excessive aero-pollution on children?s airways is important in the onset of symptomatic BHR. After two years of treatment by GINA and NAEPP children do not show asthma symptoms or show mild asthma symptoms, however bronchial sensitivity remains unchanged. Conclusion. Optimal duration of anti-inflammatory treatment in asthmatic children who show moderate bronchial hyperresponsiveness should be longer than two years.

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