Administration Of Systemic Corticosteroids Research Articles

Efficacy and Safety of Prostaglandin D2 Receptor 2 Antagonism with Fevipiprant for Patients with Asthma: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

Accumulating evidence has shown that prostaglandin D2 (PGD2)-chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTH2) pathway plays an important role in promoting eosinophilic airway inflammation in asthma. We aimed to assess the efficacy and safety of CRTH2 antagonist fevipiprant in patients with persistent asthma compared with placebo. We identified eligible studies by searching PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. The study was registered as CRD 42020221714 ( http://www.crd.york.ac.uk/PROSPERO ). Ten randomized controlled trials with 7902 patients met our inclusion criteria. A statistically significant benefit of fevipiprant compared with placebo was shown in improving forced expiratory volume in 1 s (MD 0.05 L, 95% CI: 0.02 to 0.07; p < 0.0001), Asthma Control Questionnaire score (MD -0.10, 95% CI: -0.16 to -0.04; p = 0.001), and Asthma Quality of Life Questionnaire score (MD 0.08, 95% CI: 0.03 to 0.13; p = 0.003). Fevipiprant decreased number of patients with at least one asthma exacerbation requiring administration of systemic corticosteroids for 3 days or more (RR 0.86, 95% CI: 0.77 to 0.97; p = 0.01). Some benefits were a little more pronounced in the high eosinophil population (with an elevated blood eosinophil count or sputum eosinophil percentage) and in the 450 mg dose group. Fevipiprant was well tolerated with no safety issues compared with placebo. Fevipiprant could safely improve asthma outcomes compared to placebo. However, most of the differences didn't reach the minimal clinically important difference (MCID), thus the clinical benefits remained to be confirmed.

PND70 Procedure Coding Versus Pharmacy-Dispensing Claims for Assessing Steroid Use in Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) and Primary Immunodeficiency Diseases (PIDD)

Accounting for high-dose systemic corticosteroid (SCS) use is critical for unbiased real-world studies of patients with inflammatory or immunological disorders. SCS administration may be recorded as procedural codes for injections/infusions (Healthcare Common Procedural Coding System; HCPCS) or pharmacy-dispensed medications (National Drug Code; NDC). Understanding the patterns of SCS coding is important for the valid design of real-world studies. US patients initiating immunoglobulin (IG) treatment for CIDP or PIDD were identified in IBM MarketScan Research Databases from 2008–2018 and 2012–2018, respectively; high-dose SCS use was determined. Patients identified by each coding system were compared. Among 3975 patients with CIDP and initiating IG, 1382 (34.8%) had prior high-dose SCS use, identified by HCPCS in 925 (23.3%) patients and NDC in 646 (16.3%) patients (non-mutually exclusive). Compared with NDC-identified patients, HCPCS-identified patients were older, more likely to be male, from Southern US, receiving outpatient IG, and have had back pain, central nervous system disorders, diabetes, dyslipidemia, hypertension, and osteoarthritis. HCPCS-identified patients were less likely to have deep vein thrombosis (DVT), opioid use, or prior use of immunomodulating agents. Among 17,931 PIDD patients initiating IG, 11,576 (64.6%) had prior high-dose SCS use, identified by HCPCS in 8826 (49.2%) patients and NDC in 6342 (35.4%) patients (non-mutually exclusive). Compared with NDC-identified patients, HCPCS-identified patients were older, more likely to be female, from Southern US, receiving outpatient IG, using Medicare, and more often had low Risk Vital Sign scores (disease severity algorithm) and have had cancer, fibromyalgia, inflammatory bowel disease, and obesity. HCPCS-identified patients were less likely to have had pneumonia or DVT. HCPCS and NDC identification of high-dose SCS use may elucidate differences in patient populations, which should be considered in real-world studies.

Systemic Corticosteroid Administration in Coronavirus Disease 2019 Outcomes: An Umbrella Meta-Analysis Incorporating Both Mild and Pulmonary Fibrosis-Manifested Severe Disease.

Background: Effective treatments for coronavirus disease 2019 (COVID-19) are urgently needed. The real role of corticosteroid use in COVID-19 has long been of interest and is disputable. Methods: We aimed to quantitatively reevaluate the efficacy of corticosteroids on COVID-19. Databases were searched for eligible meta-analyses/systematic reviews with available outcome data. For each association, we estimated the summary effect size with fixed- and random-effects models, 95% confidence intervals, and 95% prediction intervals. Heterogeneity, Egger’s test, evidence of small-study effects and excess significance bias, and subgroup analyses were rigorously evaluated. Results: Intended outcomes of 12 eligible studies were mortality, clinical improvement, hospitalization, mechanical ventilation (MV), adverse events (AEs), intensive care unit (ICU) stay, hospital stay, virus clearance time (VCT), and negative conversion. Corticosteroid administration was associated with a 27% risk reduction in MV [hazard ratio (HR): 0.73 (0.64–0.83)] and a 20% reduction in mortality of critically ill/severe COVID-19 patients [HR: 0.80 (0.65–0.98)]. Interestingly, shorter ICU stays and, conversely, potentially longer hospital stays, a longer VCT, and a longer time to negative conversion were associated with corticosteroid use. There was no significant impact of different corticosteroid doses on mortality. Only one study showed slightly excess significant bias. Caution should be applied given the weak nature of the evidence, and it has been confirmed by sensitivity analyses too. Conclusion: This umbrella study found benefits from corticosteroids on MV and especially the mortality of critically ill/severe patients with shorter ICU stays but prolonged hospital stays and VCT. The benefits and harms should be reevaluated and balanced before corticosteroids are cautiously prescribed in clinical practice.

Corticosteroids for hospitalized patients with mild to critically-ill COVID-19: a multicenter, retrospective, propensity score-matched study

Corticosteroids use in coronavirus disease 2019 (COVID-19) is controversial, especially in mild to severe patients who do not require invasive/noninvasive ventilation. Moreover, many factors remain unclear regarding the appropriate use of corticosteroids for COVID-19. In this context, this multicenter, retrospective, propensity score–matched study was launched to evaluate the efficacy of systemic corticosteroid administration for hospitalized patients with COVID-19 ranging in the degree of severity from mild to critically-ill disease. This multicenter, retrospective study enrolled consecutive hospitalized COVID-19 patients diagnosed January–April 2020 across 30 institutions in Japan. Clinical outcomes were compared for COVID-19 patients who received or did not receive corticosteroids, after adjusting for propensity scores. The primary endpoint was the odds ratio (OR) for improvement on a 7-point ordinal score on Day 15. Of 1092 COVID-19 patients analyzed, 118 patients were assigned to either the corticosteroid and non-corticosteroid group, after propensity score matching. At baseline, most patients did not require invasive/noninvasive ventilation (85.6% corticosteroid group vs. 89.8% non-corticosteroid group). The odds of improvement in a 7-point ordinal score on Day 15 was significantly lower for the corticosteroid versus non-corticosteroid group (OR, 0.611; 95% confidence interval [CI], 0.388–0.962; p = 0.034). The time to improvement in radiological findings was significantly shorter in the corticosteroid versus non-corticosteroid group (hazard ratio [HR], 1.758; 95% CI, 1.323–2.337; p < 0.001), regardless of baseline clinical status. The duration of invasive mechanical ventilation was shorter in corticosteroid versus non-corticosteroid group (HR, 1.466; 95% CI, 0.841–2.554; p = 0.177). Of the 106 patients who received methylprednisolone, the duration of invasive mechanical ventilation was significantly shorter in the pulse/semi-pulse versus standard dose group (HR, 2.831; 95% CI, 1.347–5.950; p = 0.006). In conclusion, corticosteroids for hospitalized patients with COVID-19 did not improve clinical status on Day 15, but reduced the time to improvement in radiological findings for all patients regardless of disease severity and also reduced the duration of invasive mechanical ventilation in patients who required intubation.Trial registration: This study was registered in the University hospital Medical Information Network Clinical Trials Registry on April 21, 2020 (ID: UMIN000040211).

Improving Administration of Prehospital Corticosteroids for Pediatric Asthma.

Introduction:Early administration of systemic corticosteroids for asthma exacerbations in children is associated with improved outcomes. Implementation of a new emergency medical services (EMS) protocol guiding the administration of systemic corticosteroids for pediatric patients with asthma exacerbations went into effect in January 2016 in Southwest Ohio. Our SMART aim was to increase the proportion of children receiving systemic prehospital corticosteroids for asthma exacerbations from 0% to 70% over 2 years.Methods:Key drivers were derived and tested using multiple plan-do-study-act cycles. Interventions included community EMS outreach and education, improved clarity in the prehospital protocol language, distribution of pocket-sized educational cards, and ongoing individualized EMS agency feedback on protocol adherence. Eligible patients included children age 3–16 years, who were transported by EMS to the pediatric emergency department with diagnoses consistent with asthma exacerbation. Manual chart review assessed eligibility to receive prehospital corticosteroids. Statistical process control charts tracked adherence to corticosteroid recommendations.Results:A total of 256 encounters met the criteria for receiving prehospital corticosteroids for pediatric asthma exacerbations between January 1, 2016, and April 30, 2019. Special cause variation was demonstrated following education at high-volume EMS stations, and the centerline shifted to 34%. This shift has been sustained for 28 months.Conclusion:Improvement methodology increased prehospital corticosteroid administration for pediatric asthma exacerbations, although we failed to achieve our aim of increasing use to 70%. Many barriers exist in pediatric prehospital protocol implementation, many of which can be improved with quality improvement tools.

Effects of Glycemic Control on Hearing Outcomes in Diabetes Patients With Idiopathic Sudden Sensorineural Hearing Loss.

Objective: This study aimed to analyze the effects of glycemic control on the hearing outcomes of type 2 diabetes patients with idiopathic sudden sensorineural hearing loss (ISSHL).Methods: Type 2 diabetes patients with ISSHL were enrolled. All patients were admitted for 5 days and received systemic corticosteroid treatment. Patients were divided into groups according to their degree of glycemic control pre- (glycosylated hemoglobin) and post- (mean blood glucose) onset of ISSHL. Demographic, audiometric, and hearing outcome data were analyzed. Furthermore, a multivariate analysis was performed to determine the prognostic factors affecting the hearing outcomes in these patients.Results: One hundred forty-four patients were enrolled. The hearing recovery rates were as follows: complete recovery, 19%; partial recovery, 15%; slight improvement, 22%; and no improvement, 44%. Initial hearing levels and diabetes duration were significantly higher in the pre-onset poor-controlled group (glycosylated hemoglobin ≥ 7.0%) than those in the well-controlled group. The hearing recovery rates did not differ significantly pre- or post-onset. In a multivariate analysis, duration from hearing loss onset to treatment, presence of vertigo, and initial hearing level were negative prognostic factors that affected hearing recovery.Conclusion: The degree of pre- or post-onset glycemic control did not affect hearing outcomes in patients with ISSHL and type 2 diabetes. Therefore, the administration of systemic corticosteroid is required for diabetes patients with ISSHL within allowable blood glucose levels.

Factors Associated with Survival in Patients Undergoing Invasive Mechanical Ventilation in an Intensive Care Unit in Colombia, 2017-2018: A Retrospective Cohort Study.

BackgroundCritically ill patients are admitted to intensive care units so they can be comprehensively managed and provided with services not covered in general hospital wards, with the aim to increase their chances of survival. These procedures include invasive mechanical ventilation.ObjectiveThe aim of this study was to identify the factors associated with survival in critically ill patients who required invasive mechanical ventilation in an intensive care unit of a tertiary-level hospital in Colombia.MethodsThis was a retrospective follow-up study of a cohort of adult patients who required invasive mechanical ventilation in an intensive care unit in San José de Buga Hospital, between 2017 and 2018. Sociodemographic, clinical, and pharmacological variables were identified. Using Cox regression, variables associated with survival and complications were identified.ResultsA total of 357 patients were analyzed. The average age was 64.8 ± 18.9 years, and 52.9% were male. The most frequent diagnoses were sepsis/septic shock (38.4%) and trauma (17.4%). The main factors associated with shorter survival were advanced age (HR 0.97; 95% CI 0.96–0.99), a diagnosis of septic shock (HR 0.29; 95% CI 0.18–0.48) or diabetes mellitus at admission (HR 0.57; 95% CI 0.33–0.98), a healthcare-associated infection (HR 0.51; 95% CI 0.33–0.80), and the need for vasopressors (HR 0.36; 95% CI 0.22–0.59). The administration of systemic corticosteroids was associated with a higher probability of survival (HR 1.93; 95% CI 1.15–3.25).ConclusionsThe use of systemic corticosteroids was associated with a greater probability of survival in critically ill patients who required invasive mechanical ventilation in an intensive care unit. The identification of the variables associated with a higher risk of dying should allow care protocols to be improved, thereby extending the life expectancy of these patients.

Complications of Cardiovascular Events in Patients Hospitalized with Influenza-Related Pneumonia.

PurposeInfluenza virus infections are a key cause of community-acquired pneumonia (CAP). Cardiovascular events (CVEs) are common among CAP and influenza patients, but there have been few population-based studies of influenza-related pneumonia (Flu-p) patients published to date.MethodsA retrospective analysis of 1191 immunocompetent hospitalized adult Flu-p patients from January 2012 to December 2018 in five teaching hospitals in China was conducted.ResultsA total of 24.6% (293/1191) of patients developed at least one form of CVE-related complication while hospitalized. In a multivariate logistic regression analysis, hypertension, cerebrovascular disease, coronary artery disease, preexisting heart failure, systolic blood pressure <90 mmHg, respiratory rates ≥30 breaths/min, a lymphocyte count <0.8×109/L, PaO2/FiO2 <300 mmHg, and systemic corticosteroid administration were independently associated with the incidence of CVEs; while early neuraminidase inhibitor treatment and angiotensin converting enzyme inhibitors/angiotensin II receptor blocker treatment were associated with a lower risk of CVEs. After controlling for potential confounding variables, we determined that CVEs were linked to a higher risk of 30-day mortality (OR 3.307, 95% CI 2.198–4.975, p < 0.001) in Flu-p patients.ConclusionCVE-related complications are common among hospitalized Flu-p patients and are associated with negative patient outcomes. Clarifying these CVE-related risk factors can aid in their clinical prevention and management.

High rates of antibiotic prescriptions in children with COVID-19 or multisystem inflammatory syndrome: A multinational experience in 990 cases from Latin America.

AimThis study aims to assess rates of antibiotic prescriptions and its determinants in in children with COVID‐19 or Multisystem Inflammatory Syndrome (MIS‐C).MethodsChildren <18 years‐old assessed in five Latin Americas countries with a diagnosis of COVID‐19 or MIS‐C were enrolled. Antibiotic prescriptions and factors associated with their use were assessed.ResultsA total of 990 children were included: 921 (93%) with COVID‐19, 69 (7.0%) with MIS‐C. The prevalence of antibiotic use was 24.5% (n = 243). MIS‐C with (OR = 45.48) or without (OR = 10.35) cardiac involvement, provision of intensive care (OR = 9.60), need for hospital care (OR = 6.87), pneumonia and/or ARDS detected through chest X‐rays (OR = 4.40), administration of systemic corticosteroids (OR = 4.39), oxygen support, mechanical ventilation or CPAP (OR = 2.21), pyrexia (OR = 1.84), and female sex (OR = 1.50) were independently associated with increased use of antibiotics. There was significant variation in antibiotic use across the hospitals.ConclusionOur study showed a high rate of antibiotic prescriptions in children with COVID‐19, in particular in those with severe disease or MIS‐C. Prospective studies are needed to provide better evidence on the recognition and management of bacterial infections in COVID‐19 children.

Articles That May Change Your Practice: Current Evidence for Coronavirus Disease 2019 Therapies

Articles That May Change Your Practice: Current Evidence for Coronavirus Disease 2019 Therapies

Tocilizumab did not reduce hypoxemic respiratory failure or death in hospitalized patients with COVID-19.

Stone JH, Frigault MJ, Serling-Boyd NJ, et al. Efficacy of tocilizumab in patients hospitalized with Covid-19. N Engl J Med. 2020;383:2333-44. 33085857.

Short-Term Versus Long-Term Systemic Corticosteroid Use in the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients.

BackgroundThe administration of systemic corticosteroids in chronic obstructive pulmonary disease (COPD) exacerbation is the first line of management. The duration of this administration, however, is not well established in clinical practice. The objective of this study is to compare the clinical outcomes between short-term and long-term corticosteroid use in the acute exacerbation of COPD patients.MethodsA single-centre, retrospective cohort study was conducted. From 2014 to 2018, all patients over 40 years old with COPD who were admitted to the hospital with a case of COPD exacerbation and received systemic corticosteroids at presentation were included. The subjects were divided into two groups according to the duration of systemic corticosteroid therapy. The primary outcome was hospital re-admission within 180 days. The secondary outcomes were 30 days mortality and length of hospitalisation. The two groups were compared using an independent sample t-test, a Chi-square test, and a Mann-Whitney U test, according to the data type.ResultsEighty patients met the inclusion criteria. A total of 52 (65%) patients completed long-term therapy, while 28 (35%) patients were on short-term treatment. A total of 15 (28.8%) patients reached the primary endpoint in the long-term treatment group versus 19 (67.9%) in the short-term treatment group (P = 0.001). The 30-day mortality was 4 (7.7%) and 0 (0%), respectively, and the median length of hospitalisation was 6.5 and 7.5 days in the long-term group and short-term group, respectively (P = 0.32, P = 0.88).ConclusionLong-term corticosteroid use in the management of acute COPD exacerbation was significantly associated with fewer 180 days re-admission. The duration of corticosteroid use remains controversial, and further studies are recommended to assess the relationship between patient profile and adherence to therapy post-discharge with re-exacerbation.

Thromboses and COVID-19: reducing inflammation in addition to thromboprophylaxis.

Thromboses and COVID-19: reducing inflammation in addition to thromboprophylaxis.

Причины развития остеоартрита тазобедренного сустава у пациентов с ювенильным идиопатическим артритом: результаты ретроспективного исследования и анализ литературных данных

Osteoarthritis (OsA) of the hip joint (HJ) is one of the most serious structural complications of juvenile idiopathic arthritis (JIA). Objective. Assess risk factors for OsA of the HJ in patients with JIA. Patients and methods. This retrospective study included 753 JIA patients aged 2 to 17 years. The diagnosis of JIA was based on the ILAR criteria. The diagnosis of HJ OsA (n = 48) was based on the Dale radiological classification; the indications for joint replacement were formed according to the WOMAC scale and Oxford hip score. Results. The development of HJ OsA was registered within 5 years (range 2,4; 9,4 years) after JIA onset in 6.4% of patients with JIA (n = 48) or 31.4% of patients who had hip joint lesions. The frequency of HJ replacement (n = 16) was 2.1%, 10.5%, 33.3% in all children with JIA, among patients with HJ arthritis, and patients with HJ osteoarthritis, respectively. The main predictors of HJ OsA included systemic arthritis, administration of systemic corticosteroids, &gt;4 active joints, total alkaline phosphatase &lt;165 U/L, long time without remission, involvement of joints of the upper half of the body, and no timely initiation of biologicals. The predictors of HJ replacement were systemic arthritis, pulse therapy with methylprednisolone, and late administration of biologicals. Conclusion. Timely control of JIA activity, achievement of remission, avoidance of glucocorticosteroid therapy or its early replacement with biologicals reduced the risks of developing structural lesions of the HJ in patients with JIA. Key words: osteoarthritis, hip joint, ischemic osteonecrosis, juvenile idiopathic arthritis, risk factors, corticosteroids

76. Effect of Early Administration of Systemic Corticosteroids on Outcomes in Patients with COVID-19 Pneumonia

BackgroundSystemic corticosteroids (steroids) have been empirically used in acute respiratory distress syndrome, an entity also present in coronavirus disease 19 (COVID-19). Early steroids administration could accelerate resolution of symptoms and reduce intensive care unit (ICU) stay in these patients, but practice varies widely as evidence is scant.MethodsWe reviewed the records of 498 adults admitted to Stony Brook University Hospital, NY, from 3/1 to 4/15, 2020 with COVID-19 requiring high-flow O2 (non-rebreather mask, Venturi mask with FiO2 >50%, or high-flow nasal cannula). We excluded those (N=29) who received mechanical ventilation (MV) or died within 24h of admission. We followed patients until death or discharge. We compared outcomes between patients who received early steroids (i.e. prior to MV) and those who did not. We used adjusted Cox models to evaluate the composite of death or need for MV. We also evaluated healthcare resources utilization.ResultsOf 469 patients, 175 (37.3%) received steroids while on high flow O2. Table 1 summarizes the baseline characteristics. Patients who received steroids were more likely to have asthma, had slightly longer duration of symptoms, lower O2 saturation, higher NT-proBNP and lower IL-6 levels at baseline. In total, 228 patients (48.6%) reached the composite endpoint (123 died and 105 received MV). By 7 days, 32.5% of patients who received steroids died or were intubated vs. 44.8% of those who did not (log-rank P=0.008), Figure 1. In models adjusted for race, age, sex, comorbidities, baseline O2 saturation and procalcitonin, steroids reduced risk for death or MV by 44% (hazard ratio [HR] 0.56; 95%CI 0.42–0.76; P< 0.001). The effect was time-dependent with initial HR 0.34 (95%CI 0.21–0.56; P< 0.001) and daily attenuation by 10.2% (95%CI 1.7%–19.4%; P=0.017). Mortality at 7 and 14 days did not differ between groups (8.1% vs. 8.3% and 19.1% vs. 21.0%, respectively, log-rank P=0.75). Among discharged patients, length of hospital stay was longer, but ICU stay was shorter with steroids, Table 2.Patient Characteristics According to Use of Early Steroids Healthcare Resources Utilization According to Use of Early Steroids Among Discharged Patients ConclusionEarly administration of steroids reduced primarily the need for MV in our high-risk COVID-19 patients, with shorter ICU utilization, at the expense of longer hospital stay. Further studies are needed to optimize the use of steroids in these patients.Disclosures All Authors: No reported disclosures

13955 Recalcitrant lower-extremity ulcerations: Importance of rebiopsy

Lower-extremity ulcerations have an estimated prevalence of 1%-2% in the United States and are a common cause of inpatient hospitalization. A systematic approach beginning with the most frequent etiologies is essential to avoiding misdiagnosis and excessive health care expenditure, as more than 90% of cases may be explained by chronic arterial or venous disease alone. The differential diagnosis for the remaining minority of non-healing leg ulcers is extraordinarily broad and includes infection, panniculitis, calciphylaxis, vasculitis or other immune-mediated etiologies (eg, neutrophilic dermatoses such as pyoderma gangrenosum or Behçet disease), and malignancy, among numerous other causes. Herein, we present the case of a 36-year-old woman with a several year history of bilateral lower extremity erythema nodosum (previously responsive to prednisone tapers and hydroxychloroquine) and bilateral leg ulcerations secondary to thrombotic vasculopathy (confirmed on skin biopsy), known chronic venous insufficiency, steroid-induced diabetes mellitus, and obesity was admitted to our hospital with acute on chronic worsening of longstanding leg ulcerations. Physical examination was notable for two large bilateral lower extremity ulcerations accompanied by faintly erythematous, blanching macules and papules coalescing into patches and plaques on the bilateral thighs as well as oral and genital ulcerations. Laboratory evaluation was notable for leukocytosis of unclear significance in the setting of high-dose systemic corticosteroid administration. A repeat skin biopsy revealed an intravascular lymphoid infiltrate ultimately consistent with T-cell prolymphocytic leukemia (T-PLL). Our case demonstrates the importance of repeat skin biopsy in cases of atypically presenting, recalcitrant to therapy, or acutely worsened lower extremity ulcerations.

The value of the medicine fenoterol + ipratropium bromide in the treatment of exacerbations of bronchial asthma and chronic obstructive pulmonary disease

The purpose of the article is to determine the place of the combined bronchodilator fenoterol + ipratropium bromide in the treatment of exacerbations of bronchial asthma, COPD and recommendations on various delivery methods. The treatment of exacerbations of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) is of interest to a general practitioner. Although this concept has lost most of its gloomy colors in the last decade thanks to the new concept of diagnosing and treating patients, the problem of providing qualified timely assistance at the time of an exacerbation remains acute and not always solvable. Often the basis for the treatment of exacerbation of asthma and COPD is repeated administration of a fast-acting inhaled short-acting b2-agonist or an anticholinergic drug, or their combination, early administration of systemic corticosteroids and oxygen inhalation. Exacerbation therapy should be as safe as possible for patients. Following the recommendations for the treatment of asthma and COPD exacerbations both on an outpatient basis and in a hospital can significantly reduce the frequency of asthma and COPD exacerbations. Medical care that a patient can receive at home depends on the experience of the physician and the patient, as well as on the possibilities of medicine and instrumental provision. Ideally, the level of peak expiratory flow (PEF) should be a measure of control over one’s well-being, both in remission and in an exacerbation.

Basic principles for the treatment of chronic rhinosinusitis with nasal polyps

Introduction. Chronic rhinosinusitis with nasal polyps (CRSwNP) is based on a chronic inflammatory hyperplastic process in the mucosa membrane of the nasal cavity and paranasal sinuses (SNPs). According to the consensus on the biological treatment of CRSwNP with or without asthma, which is one of the latest consensus documents of the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), which was published in December 2019, the need for surgical treatment or systemic administration of corticosteroids due to the active nasal polyps growth are conditional signs for the decompensation of clinical control. Currently, the basic treatment for patients with CRSwNP is the long-term use of intranasal corticosteroids (INCS), which leads to an improvement in the quality of life, while minimizing the risk of exacerbations and complications.Research purpose. To evaluate the effectiveness of the basic therapy of intranasal glucocorticosteroid mometasone furoate for different phenotypes of CRSwNP.Methods. All patients with recurrent CRSwNP were divided into 3 equal phenotypic groups of 40 people each: group 1 – CRSwNP without asthma and respiratory allergies, group 2 – CRSwNP + atopy, group 3 – CRSwNP + non-allergic asthma. The observation period was 3 years.Results. Using the algorithm of stepwise therapy of CRSwNP, dynamic monitoring of these patients by an ENT and an allergistimmunologist, basic therapy with corticosteroids with constant treatment correction once every 3 months, it was possible to stabilize the inflammatory process throughout the respiratory tract and reduce the need for surgical treatment.Conclusion. With CRSwNP, long-term use of Mometasone furoate INCS is the main drug of basic therapy to minimize the recurrence of nasal polyp growth and is accompanied by clinical efficacy and the absence of adverse side effects.

Effectiveness of Pediatric Asthma Pathways in Community Hospitals: A Multisite Quality Improvement Study.

This quality improvement study included children ages 2-17 years with a primary diagnosis of asthma. Data were collected before and after pathway implementation (total 28 mo). Pathway implementation involved local champions, educational meetings, audit/feedback, and electronic health record integration. Emergency department (ED) measures included severity assessment at triage, timely systemic corticosteroid administration (within 60 mins), chest radiograph (CXR) utilization, hospital admission, and length of stay (LOS). Inpatient measures included screening for secondhand tobacco and referral to cessation resources, early administration of bronchodilator via metered-dose inhaler, antibiotic prescription, LOS, and 7-day readmission/ED revisit. Analyses were done using statistical process control. We analyzed 881 ED visits and 138 hospitalizations from 2 community hospitals. Pathways were associated with increases in the proportion of children with timely systemic corticosteroid administration (Site 1: 32%-57%, Site 2: 62%-75%) and screening for secondhand tobacco (Site 1: 82%-100%, Site 2: 54%-89%); and decreases in CXR utilization (Site 1: 44%-29%), ED LOS (Site 1: 230-197 mins), and antibiotic prescription (Site 2: 23%-3%). There were no significant changes in other outcomes. Pathways improved pediatric asthma care quality in the ED and inpatient settings of community hospitals.

Dexamethasone in hospitalised patients with COVID-19: addressing uncertainties

Dexamethasone in hospitalised patients with COVID-19: addressing uncertainties