Asthma Medication Research Articles

Characteristics of patients with severe asthma in primary and secondary care settings considered eligible for biological therapy - the Bulgarian RECOGNISE study.

Asthma is a major non-communicable disease. It affects both children and adults, but is the most common chronic condition among the former. While inhaled controller drugs stabilize the disease in most asthma patients, there are a certain number of people who suffer from severe asthma, which requires treatment escalation. Oral corticosteroids are usually added, but they are associated with various side effects that may limit their application. The introduction of biologicals targeting inflammatory mediators has opened a new era of asthma treatment highlighting the importance of patient characterization.

The Association of Periconception Asthma Medication Discontinuation with Adverse Obstetric Outcomes.

This study aimed to investigate asthma medication reduction in the periconceptional period as it relates to asthma status and adverse outcomes in pregnancy. In a prospective cohort study, self-reported current and past asthma medications were collected and analyzes compared measures of asthma status in women who discontinued asthma medication in the 6 months prior to enrollment ("step-down") versus those who did not ("no change"). Evaluation of asthma was done at three study visits (one per trimester) and by daily diaries, including measures of lung function (percent predicted forced expiratory volume in 1 and 6 s [%FEV1, %FEV6], peak expiratory flow [%PEF], forced vital capacity [%FVC], FEV1 to FVC ratio [FEV1/FVC]), lung inflammation (fractional exhaled nitric oxide [FeNO], ppb), rate of asthma symptoms (activity limitation, night symptoms, rescue inhaler use, wheeze, shortness of breath, cough, chest tightness, chest pain), and rate of asthma exacerbations. Adverse pregnancy outcomes were also evaluated. Adjusted regression analyses examined whether adverse outcomes differed by periconceptional asthma medication changes. Of 279 participants included in analyses, 135 (48.4%) did not change asthma medication in the periconceptional period, whereas 144 (51.6%) reported a step down in medication. Those in the step-down group were more likely to have milder disease (88 [61.1%] in the step-down vs. 74 [54.8%] in the no change group), exhibited less activity limitation (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and experienced fewer asthma attacks (RR: 0.53, 95% CI: 0.34-0.84) during pregnancy. The step-down group had a nonsignificant increase in overall odds of experiencing an adverse pregnancy outcome (odds ratio: 1.62, 95% CI: 0.97-2.72). Over half of women with asthma reduce asthma medication in the periconceptional period. Although these women typically have milder disease, a step down in medication may be associated with an increased risk of adverse pregnancy outcomes. · Many women reduce their asthma medication in pregnancy.. · Reduction is more common among those with mild disease.. · Medication reduction may lead to adverse pregnancy outcomes..

P-697 Pre-pregnancy complications - associated factors and wellbeing in early pregnancy: A Swedish cohort study

Abstract Study question Which factors are associated with pre-pregnancy complications and poor well-being in early pregnancy? Summary answer We identified different risk profiles for different pre-pregnancy complications. Besides age and body mass index, exposure to certain prescribed drugs was a modifiable risk factor. What is known already Many couples experience difficulties to become pregnant or carry a pregnancy to term due to unknown causes. Complications including recurrent pregnancy loss (RPL), subfertility (failure to conceive within one year of unprotected intercourse) and the need for artificial reproductive technologies (ART) are increasing worldwide. Previously identified risk factors for involuntary childlessness include higher age, irregular menstruation, endometriosis and polycystic ovary syndrome – however, none of these are modifiable and there are still many cases unexplained. Study design, size, duration Online questionnaires were collected for 5330 unique pregnancies in Sweden from November 2017 – February 2021, collected before 20 weeks of gestation. Participants/materials, setting, methods Participants were defined as having pre-pregnancy complication(s) if they had any of the following: prior RPL (> 3) or late miscarriage, subfertility, or the use of ART. Multivariable logistic regression modelling was used to investigate potential risk factors for pre-pregnancy complications and poor well-being in early pregnancy, reported as odds ratios (OR) with 95% confidence intervals. Main results and the role of chance Pre-pregnancy complications were identified in 1142 participants (21%), with the most common one being subfertility (n = 790, 69%). Risk factors included diagnosed endometriosis (OR 4.43, CI 3.33-5.91), thyroid medication (OR 2.20, CI 1.76-2.74), opioids and other strong pain medication (OR 1.97, CI 1.19-3.19), asthma and allergy medication (OR 1.23, CI 1.03-1.46), body mass index > 25 kg/m2 (OR 1.35, CI 1.07 for BMI 25-29.9 and OR 1.58, CI 1.19-2.07 for BMI ≥ 30) and age over 35 years (OR 1.35, CI 1.07-1.72). Different subgroups of pre-pregnancy complications had unique risk factors. The groups also experienced different symptoms in early pregnancy. Women that had experienced recurrent pregnancy loss were at higher risk of depression during their current pregnancy (OR 1.71, CI 1.21-2.38). All groups were at higher risk for reporting any complications in their current pregnancy (OR 1.33, CI 1.11-1.59), as well as vaginal bleeding (OR 1.72, CI 1.15-2.55). Limitations, reasons for caution We have a high prevalence of participants with RPL, and participants that needed in vitro fertilization (IVF), which indicates a selection bias towards participants with pre-pregnancy complications. Furthermore, we did not collect information on the partner’s medical history, which might play a role in the need for ART. Wider implications of the findings The identified risk factors could be used to identify women at risk for pre-pregnancy complications and help them earlier in the process of trying to conceive, thus assisting them to reduce stress and depression during the pregnancy. Trial registration number Not applicable

Efficacy and safety of subcutaneous immunotherapy in asthmatic children allergic to house dust mite: a meta-analysis and systematic review.

Subcutaneous immunotherapy (SCIT) has been proved to be effective and safe in adult asthma. But it is still controversial in children. To evaluate the efficacy and safety of SCIT in asthmatic children with allergy to house dust mite. We searched the databases of Cochrane Library, EMBASE and MEDLINE (from 1 January 1990 to 1 December 2022). Two reviewers independently screened studies, extracted data and critically appraised the risk of bias. We used the Revman 5 to synthesize the effect sizes. We finally selected 38 eligible studies including 21 randomized controlled trials to evaluate the efficacy and safety of SCIT and 17 observational studies to assess the safety. The results revealed that short-term asthma symptom scores were declined with a standardized mean difference (SMD) of -1.19 (95% CI: -1.87, -0.50) in 12 researches with high heterogeneity. Short-term asthma medication scores were decreased with SMD -1.04 (95% CI: -1.54, -0.54) in 12 heterogeneous researches. One study showed no significant reduction in combined symptom and medication scores without providing details. No studies we reviewed reported long-term efficacy. SCIT resulted in an obviously increased risk of adverse reactions compared with placebo. For secondary outcomes, SCIT improved life quality and reduced the numbers of annual asthma attacks and allergen-specific airway hyperreactivity, but without significant improvement in pulmonary function, asthma control or hospitalization. SCIT can reduce the short-term symptom scores and medication scores regardless of different treatment duration or mono/polysensitization, but with an increased incidence of local and systemic adverse effects. Further studies on pediatric asthma are needed to evaluate the long-term efficacy, and clarify the effectiveness of SCIT in specific population using mix allergen extracts or with severe asthma. Overall, it is recommended for children with mild-moderate HDM-driven allergic asthma.

Physical Activity Engagement: Perspectives From Adolescents With Comorbid Asthma and Overweight/Obesity and Their Caregivers.

Most adolescents do not meet physical activity (PA) guidelines, and engagement rates are even lower among adolescents with asthma and overweight/obesity (OW/OB). Understanding barriers and facilitators to PA engagement that are unique to youth with comorbid asthma and OW/OB is important for PA promotion. The current qualitative study identified caregiver- and adolescent-reported factors contributing to PA among adolescents with comorbid asthma and OW/OB across the four domains of the Pediatric Self-Management Model: individual, family, community, and health care system. Participants were 20 adolescents (Mage = 16.01; 55% male) with asthma and OW/OB and their caregiver (90% mothers). Caregivers and adolescents participated in separate semistructured interviews about influences, processes, and behaviors related to adolescent PA engagement. Interviews were analyzed using thematic analysis. Factors contributing to PA varied across four domains. The individual domain included influences (e.g., weight status, psychological and physical challenges, asthma triggers and symptoms) and behaviors (e.g., taking asthma medications, self-monitoring). At the family level, influences included support, lack of modeling, and independence; processes included prompts and praise; and behaviors included engaging in shared PA and providing resources. Community-level influences included surrounding and settings, social support, and cornonavirus disease-2019-related changes, while behaviors included engaging in PA with others and extracurricular activities. Influences, processes, and behaviors across multiple domains interact to impact adolescent PA engagement, highlighting factors that may be potential leverage points in prevention and intervention efforts to promote adolescent PA.

Daytime Sleepiness in Children With Asthma: Examining Respiratory and Non-respiratory Factors.

Objective Daytime sleepiness is common in youth with asthma (YWA). Treatments designed to mitigate daytime sleepiness in YWA require an understanding of the primary causes of this problem. We examined respiratory- and non-respiratory-related factors associated with daytime sleepiness in YWA. Methods One hundred YWA (eight to 17 years old) were included in a cross-sectional study. Daytime sleepiness, quality of life, anxiety, bedtime cellphone use, and respiratory symptoms were self-reported. Asthma severity, lung function, and the number of prescribed medications were obtained from electronic medical records. Multivariable regression models identifying variables associated with daytime sleepiness were generated. Results Participants were 54% male and 45% Black, with a mean age of 12.1 years. The multivariable regression model showed decreased quality of life (b = -0.328, p = 0.004) and increased bedtime cellphone use (b = 0.300, p = 0.004)were significantly related to daytime sleepiness, while anxiety (b = 0.213, p = 0.05), prescribed asthma medications (b = 0.173, p = 0.05), and worse lung function (b = -0.173, p = 0.05)weremarginally related to daytime sleepiness. Conclusions In addition to optimizing asthma control, strategies targeting anxiety, quality of life, and nocturnal cellphone use are important to mitigate daytime sleepiness in YWA.

Frequency of exacerbation and degree of required asthma medication can characterize childhood longitudinal asthma trajectories

BackgroundTo the best of our knowledge, there have been no investigations of longitudinal asthma trajectories based on asthma exacerbation frequency and medications required for asthma control in children. ObjectiveTo investigate longitudinal asthma trajectories based on the exacerbation frequency throughout childhood and asthma medication ranks. MethodsA total of 531 children aged 7 to 10 years were enrolled from the Korean childhood Asthma Study. Required asthma medications for control of asthma from 6 to 12 years of age and asthma exacerbation frequency from birth to 12 years of age were obtained from the Korean National Health Insurance System database. Longitudinal asthma trajectories were identified on the basis of asthma exacerbation frequency and asthma medication ranks. ResultsFour asthma clusters were identified: lesser exacerbation with low-step treatment (8.1%), lesser exacerbations with middle-step treatment (30.7%), highly frequent exacerbations in early childhood with small-airway dysfunction (5.7%), and frequent exacerbations with high-step treatment (55.6%). The frequent exacerbations with high-step treatment cluster were characterized by a high prevalence of male sex, increased blood eosinophil (counts) with fractional exhaled nitric oxide, and high prevalence of comorbidities. The highly frequent exacerbation in early childhood with small-airway dysfunction cluster was characterized by recurrent wheeze in preschool age, with high prevalence of acute bronchiolitis in infancy and a greater number of family members with small-airway dysfunction at school age. ConclusionThe present study identified 4 longitudinal asthma trajectories on the basis of the frequency of asthma exacerbation and asthma medication ranks. These results would help clarify the heterogeneities and pathophysiologies of childhood asthma.

Assessing the interrelationship between asthma and obesity self-management behaviors.

Asthma and obesity are common coexisting conditions with increasing prevalence and substantial morbidity. This study examines the inter-relationship between illness and treatment beliefs in asthma and obesity and how they influence self-management behaviors. Overweight and obese adults ≥ 18years with asthma were recruited from primary care and pulmonary practices in New York, NY and Denver, CO (n = 219). Path analysis was used to examine the relationship between asthma, weight and exercise-related illness and medication beliefs and SMB. Necessity beliefs about asthma medications and diet were associated with better medication adherence and healthier dietary behaviors (β = 0.276, p = < 0.001, β = 0.148, p = 0.018 respectively) whereas concerns about these self-care activities were associated with poorer adherence and worse dietary behaviors (β = - 0.282, p < 0.001, β = - 0.188, p = 0.003 respectively). We found no statistically significant association of exercise behaviors with any other weight or asthma illness or treatment beliefs. Our study demonstrates that necessity and concerns about treatment are associated with adherence in asthma and obesity. The lack of association of exercise behaviors with any asthma or weight related beliefs may reflect limited awareness of the impact of weight on asthma and warrants additional research.

Severe Asthma Standard-of-Care Background Medication Reduction With Benralizumab: ANDHI in Practice Substudy.

The phase IIIb, randomized, parallel-group, placebo-controlled ANDHI double-blind (DB) study extended understanding of the efficacy of benralizumab for patients with severe eosinophilic asthma. Patients from ANDHI DB could join the 56-week ANDHI in Practice (IP) single-arm, open-label extension substudy. Assess potential for standard-of-care background medication reductions while maintaining asthma control with benralizumab. Following ANDHI DB completion, eligible adults were enrolled in ANDHI IP. After an 8-week run-in with benralizumab, there were 5 visits to potentially reduce background asthma medications for patients achieving and maintaining protocol-defined asthma control with benralizumab. Main outcome measures for non-oral corticosteroid (OCS)-dependent patients were the proportions with at least 1 background medication reduction (ie, lower inhaled corticosteroid dose, background medication discontinuation) and the number of adapted Global Initiative for Asthma (GINA) step reductions at end of treatment (EOT). Main outcomes for OCS-dependent patients were reductions in daily OCS dosage and proportion achieving OCS dosage of 5 mg or lower at EOT. For non-OCS-dependent patients, 53.3% (n= 208 of 390) achieved at least 1 background medication reduction, increasing to 72.6% (n= 130 of 179) for patients who maintained protocol-defined asthma control at EOT. A total of 41.9% (n= 163 of 389) achieved at least 1 adapted GINA step reduction, increasing to 61.8% (n= 110 of 178) for patients with protocol-defined EOT asthma control. At ANDHI IP baseline, OCS dosages were 5 mg or lower for 40.4% (n= 40 of 99) of OCS-dependent patients. Of OCS-dependent patients, 50.5% (n= 50 of 99) eliminated OCS and 74.7% (n= 74 of 99) achieved dosages of 5 mg or lower at EOT. These findings demonstrate benralizumab's ability to improve asthma control, thereby allowing background medication reduction.

Real-World Dispensing Patterns of Inhalation Medication in Young Adult Asthma: An Inception Cohort Study.

The Global Initiative for Asthma (GINA) suggests a step-wise approach for pharmacological treatment of asthma. Valid study of real-world treatment patterns using dispensing databases includes proper measurement of medication adherence. We aim to explore such patterns by applying a time-varying proportion of days covered (tPDC)-based algorithm. We designed a retrospective inception cohort study using the University of Groningen IADB.nl community pharmacy dispensing database. Included were 19,184 young adults who initiated asthma medication anywhere between 1994 and 2021, in the Netherlands. Main treatment steps were defined as: 1 - SABA/ICS-formoterol as needed, 2 - low dose ICS, 3 - low dose ICS + LABA or tiotropium, or intermediate dose ICS, 4 - intermediate to high dose ICS + LABA or tiotropium, triple therapy, or high dose ICS, 5 - treatment prescribed by a specialist. Changes in treatment steps were determined using a time-varying proportion of days covered (tPDC)-based algorithm. Individual drug treatment trajectories were visualized over time using a lasagna plot. At initiation, of the 19,184 included individuals, 52%, 7%, 15%, 16%, and 10% started treatment in steps 1 to 5, respectively. The median (IQR) follow-up time was 3 (1-7) years. Median (IQR) number of switches was 1 (0-3). Comparing starting step to last observed step, 37% never switched between treatment steps, 20% of individuals stepped down and 22% stepped up. The low proportion of treatment switches between steps indicates that tailoring of treatment to patients' needs might be suboptimal. The tPDC-based algorithm functions well in translating dispensing data into continuous drug-utilization data, enabling a more granular assessment of treatment patterns among asthma patients.

Extracorporeal membrane oxygenation (ECMO) and beyond in near fatal asthma: A comprehensive review

The treatment of choice in severe asthma exacerbations with respiratory failure includes ventilatory support, both invasive and/or non-invasive, along with different kinds of asthma medication. Of note, the rate of mortality of patients with asthma has decreased substantially in recent years mainly due to significant advances in pharmacological treatment and other management strategies. However, the risk of death in patients with severe asthma who require invasive mechanical ventilation has been estimated between 6.5% and 10.3%. When conventional measures fail, rescue strategies, such as extracorporeal membrane oxygenation (ECMO) or extracorporeal CO2 removal (ECCO2R) may need to be implemented. While ECMO does not constitute a definitive treatment per se, it can minimize further ventilator associated lung injury (VALI) and can enable diagnostic-therapeutic maneuvers that cannot be performed without ECMO such as bronchoscopy and transfer for diagnostic imaging. Asthma is one of the diseases that is associated with excellent outcomes for patients with refractory respiratory failure requiring ECMO support, as shown by the Extracorporeal Life Support Organization (ELSO) registry. Moreover, in such situations, the use of ECCO2R for rescue has been described and utilized in both children and adults and is more widely spread in different hospitals than ECMO. In this article, we aim to review the evidence for the usefulness of extracorporeal respiratory support measures in the management of severe asthma exacerbations that lead to respiratory failure.

Antenatal size, early childhood growth, and asthma within a cohort created by data linkage.

The gestation when small for gestational age (SGA) is first associated with asthma is not well understood. Here, we use routinely acquired data from 10 weeks gestation to up to 28 years of age to test the hypothesis that SGA before birth is associated with an increased risk for asthma in a large population born between 1987 and 2015. Databases were linked to produce a single database that heldantenatal fetal ultrasound measurements; maternal characteristics; birth measurements; childhood anthropometric measurements at age 5 years; hospital admission data (1987-2015); and family doctor prescribing (2009-2015). Asthma admission and receipt of any asthma medications were the outcomes. Analyses related single and then multiple anthropometric measurements to asthma outcomes. Outcome data were available for63,930 individuals. Increased length in the first-trimester size was associated with a reduced odds ratio (OR) for asthma admission of 0.991 [0.983, 0.998] per mm increaseand also a shorter time to first admission, with a hazard ratio risk of 0.987 [0.980, 0.994] per mm increase. Independent of all earlier measurements, increased height at 5 years (available in a subset of 15,760) was associated with reduced OR for an asthma admission, withORof 0.874 [0.790, 0.967] per z score. Longitudinal measurements of weight were not related to asthma outcomes. Longer first-trimester length is associated with more favorable asthma outcomes, and subsequently, increased height in childhood is also independently associated with more favorable asthma outcomes. Interventions that reduce SGA and encourage healthy postnatal growth might improve asthma outcomes.

Evaluation of Knowledge and Counseling on Metered-Dose Inhalers and Nebulisers among Community Pharmacists in Ibadan - An Intervention Study

This study evaluated the impact of an educational intervention on knowledge and counseling on metered-dose inhalers (MDIs) and nebulisers among community pharmacists in Ibadan, Nigeria. A validated semi-structured questionnaire was utilised for data collection on study participants’ baseline knowledge and counseling on the selected asthma medication devices. The community pharmacists were randomised into control and intervention groups. An online educational intervention was carried out among pharmacists in the intervention group. The intervention comprised updates on basic information vis-à-vis knowledge and patient counseling on MDIs and nebulisers. A post-intervention assessment was carried out a month later to evaluate the impact of the intervention. Data was summarised using descriptive and inferential statistics, with level of significance set as p &lt; 0.05. Response rate was 77.2% (112/145). Study findings showed significant improvement on knowledge and counseling among the community pharmacists in the intervention group, postintervention. Pharmacists’ knowledge of MDIs and nebulisers (control versus intervention) was comparable at baseline (5.83 ± 2.46 versus 6.34 ± 2.16) but significantly different postintervention (5.87 ± 2.34 versus 7.10 ± 2.21). Similarly, pharmacists’ counselling on asthma medication devices was comparable at baseline (3.59 ± 2.54 versus 3.63 ± 1.83) but significantly different postintervention (3.35 ± 3.13 versus 7.93 ± 2.58). Work experience as community pharmacists did not influence participants’ knowledge and counseling on MDIs and nebulisers. The educational intervention significantly improved knowledge and counseling on MDIs and nebulisers among community pharmacists in Ibadan, Nigeria. There is need for regular educational updates to improve the quality of care offered by community pharmacists.

Digital interventions to improve adherence to maintenance medication in asthma.

The authors have no conflicts of interest to declare.

Anticipated barriers and facilitators for implementing smart inhalers in asthma medication adherence management

Smart inhalers are electronic monitoring devices which are promising in increasing medication adherence and maintaining asthma control. A multi-stakeholder capacity and needs assessment is recommended prior to implementation in healthcare systems. This study aimed to explore perceptions of stakeholders and to identify anticipated facilitators and barriers associated with the implementation of smart digital inhalers in the Dutch healthcare system. Data were collected through focus group discussions with female patients with asthma (n = 9) and healthcare professionals (n = 7) and through individual semi-structured interviews with policy makers (n = 4) and smart inhaler developers (n = 4). Data were analysed using the Framework method. Five themes were identified: (i) perceived benefits, (ii) usability, (iii) feasibility, (iv) payment and reimbursement, and (v) data safety and ownership. In total, 14 barriers and 32 facilitators were found among all stakeholders. The results of this study could contribute to the design of a tailored implementation strategy for smart inhalers in daily practice.

Receipt of Medications for Chronic Disease During the First 2 Years of the COVID-19 Pandemic Among Enrollees in Fee-for-Service Medicare

During the first 2 years of the COVID-19 pandemic, inpatient and ambulatory care declined dramatically. Little is known about prescription drug receipt during this period, particularly for populations with chronic illness and with high risk of adverse COVID-19 outcomes and decreased access to care. To investigate whether receipt of medications was maintained during the first 2 years of the COVID-19 pandemic among older people with chronic diseases, particularly Asian, Black, and Hispanic populations and people with dementia, who faced pandemic-related care disruptions. This cohort study used a 100% sample of US Medicare fee-for-service administrative data from 2019 to 2021 for community-dwelling beneficiaries aged 65 years or older. Population-based prescription fill rates were compared for 2020 and 2021 vs 2019. Data were analyzed from July 2022 to March 2023. The COVID-19 pandemic. Age- and sex-adjusted monthly prescription fill rates were calculated for 5 groups of medications commonly prescribed for chronic disease : angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins), oral diabetes medications, asthma and chronic obstructive pulmonary disease medications, and antidepressants. Measurements were stratified by race and ethnicity group and dementia diagnosis. Secondary analyses measured changes in the proportion of prescriptions dispensed as a 90-day or greater supply. Overall, the mean monthly cohort included 18 113 000 beneficiaries (mean [SD] age, 74.5 [7.4] years; 10 520 000 females [58.1%]; 587 000 Asian [3.2%], 1 069 000 Black [5.9%], 905 000 Hispanic [5.0%], and 14 929 000 White [82.4%]); 1 970 000 individuals (10.9%) were diagnosed with dementia. Across 5 drug classifications, mean fill rates increased by 2.07% (95% CI, 2.01% to 2.12%) in 2020 and decreased by 2.61% (95% CI, -2.67% to -2.56%) in 2021 compared with 2019. Fill rates decreased by less than the mean overall decrease for Black enrollees (-1.42%; 95% CI, -1.64% to -1.20%) and Asian enrollees (-1.05%; 95% CI, -1.36% to -0.77%) and people diagnosed with dementia (-0.38%; 95% CI, -0.54% to -0.23%). The proportion of fills dispensed as 90-day or greater supplies increased during the pandemic for all groups, with an increase per 100 fills of 3.98 fills (95% CI, 3.94 to 4.03 fills) overall. This study found that, in contrast to in-person health services, receipt of medications for chronic conditions was relatively stable in the first 2 years of the COVID-19 pandemic overall, across racial and ethnic groups, and for community-dwelling patients with dementia. This finding of stability may hold lessons for other outpatient services during the next pandemic.

The Association of Medicaid expansion with prescription drug utilization and expenditure among low-income participants with asthma

Objective This study estimated the association between the 2014 Medicaid expansion and asthma-related prescription drug utilization and expenditures among low-income adult participants with asthma, including those with uncontrolled asthma, in the United States. Methods In this national analysis, using a pooled dataset from 2007–2018 Medical Expenditure Panel Surveys (MEPS), regression discontinuity (D-RD) analyses estimated the association between Medicaid expansion and utilization of and expenditures for asthma-related prescription drugs among participants with asthma aged 26–64 with incomes below vs. at/above 138% of the federal poverty level (FPL). A sub-sample analysis was also conducted among participants with uncontrolled asthma. Utilization and expenditure outcomes were estimated using two-part models with logit as the first part and generalized linear models as the second part. Results Utilization of and total cost for asthma-related prescription drugs increased by 1.89 fills (p < 0.001) and $306.59 (p < 0.001) among participants with asthma with income below 138% FPL after Medicaid expansion. The utilization and total cost of both short-acting bronchodilators and inhaled corticosteroids (ICSs) increased after Medicaid expansion among participants with asthma with incomes below 138% FPL. Among participants with uncontrolled asthma with incomes below 138% FPL, utilization and expenditures increased after Medicaid expansion for all asthma-related prescription drugs and short-acting bronchodilators. Conclusion Medicaid expansion was associated with increased utilization of and total expenditures for both quick-relief and preventive asthma medications among all low-income participants with asthma, but not with utilization of preventive medications among those with uncontrolled asthma.

Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis.

The identification of risk factors associated with uncontrolled moderate-to-severe asthma is important to improve asthma outcomes. Aim of this study was to identify risk factors for uncontrolled asthma in United States cohort using electronic health record (EHR)-derived data. In this retrospective real-world study, de-identified data of adolescent and adult patients (≥12 years old) with moderate-to-severe asthma, based on asthma medications within 12 months prior to asthma-related visit (index date), were extracted from the Optum® Humedica EHR. The baseline period was 12 months prior to the index date. Uncontrolled asthma was defined as ≥2 outpatient oral corticosteroid bursts for asthma or ≥2 emergency department visits or ≥1 inpatient visit for asthma. A Cox proportional hazard model was applied. There were 402,403 patients in the EHR between January 1, 2012, and December 31, 2018, who met the inclusion criteria and were analyzed. African American (AA) race (hazard ratio [HR]: 2.08), Medicaid insurance (HR: 1.71), Hispanic ethnicity (HR: 1.34), age of 12 to <18 years (HR 1.20), body mass index of ≥35 kg/m2 (HR: 1.20), and female sex (HR 1.19) were identified as risk factors associated with uncontrolled asthma (P < 0.001). Comorbidities characterized by type 2 inflammation, including a blood eosinophil count of ≥300 cells/μL (as compared with eosinophil <150 cells/μL; HR: 1.40, P < 0.001) and food allergy (HR: 1.31), were associated with a significantly higher risk of uncontrolled asthma; pneumonia was also a comorbidity associated with an increased risk (HR: 1.35) of uncontrolled asthma. Conversely, allergic rhinitis (HR: 0.84) was associated with a significantly lower risk of uncontrolled asthma. This large study demonstrates multiple risk factors for uncontrolled asthma. Of note, AA and Hispanic individuals with Medicaid insurance are at a significantly higher risk of uncontrolled asthma versus their White, non-Hispanic counterparts with commercial insurance.

Advances in traditional Chinese medicine for the treatment of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and thus imposes heavy economic burden on patients, their families, and society. Furthermore, COPD seriously affects the quality of life of patients. The concept of "overall regulation" of traditional Chinese medicine (TCM) plays an important role in the prevention and treatment of COPD. The objective of this review is to summarize the TCM theories, experimental methods, TCM extracts, active TCM ingredients, and TCM formulas for the treatment of COPD and reveal the effects and mechanisms of TCM treatments on COPD. This article reviewed literature on TCM-based treatments for COPD reported from 2016 to 2021. Relevant scientific studies were obtained from databases that included PubMed, China National Knowledge Infrastructure, Web of Science, Google Scholar, The Plant List, ScienceDirect, and SciFinder. This review summarized TCM-based theory, experimental methods, active ingredients, and potential toxicities, the effects of TCM extracts and formulations, and their mechanisms for the treatment of COPD. Most investigators have used in vivo models of cigarette smoke combined with lipopolysaccharide induction in rats and in vitro models of cigarette smoke extract induction. The active ingredients of TCM used for the treatment of COPD in relevant studies were triterpenoids, flavonoids, phenolics, quinones, glycosides, and alkaloids. TCMs commonly used in the treatment of COPD include antipyretic drugs, tonic medicines, anticough medications, and asthma medications. TCM can treat COPD by suppressing inflammation, reducing oxidative stress, inhibiting apoptosis, and improving airway remodeling. This review enriches the theory of COPD treatments based on TCM, established the clinical significance and development prospects of TCM-based COPD treatments, and provided the necessary theoretical support for the further development of TCM resources for the treatment of COPD.

Biologic medications for asthma

Mary Barna Bridgeman is a clinical professor at the Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. She maintains a clinical practice as an adult internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, N.J. Kavitha S. Dalal is a critical care clinical pharmacist at Virtual Hospital – Marlton Campus. The authors have disclosed no financial relationships related to this article. Unless otherwise specified, the information in the preceding summaries applies to adults, not children. Consult the package insert for information about each drug's safety during pregnancy and breastfeeding. Also consult a pharmacist, the package insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions.