What is "more effective asthma control"?
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Acetates↗
Biomedical subjects
D Bukstein
Publications and source records attributed to D Bukstein.
The relationship between prescribed and delivered doses of inhaled corticosteroids in adult asthmatics.
A model was developed to estimate the impact of adherence and inhalation technique over time on delivered doses of inhaled corticosteroids (ICS) for asthmatics using metered-dose inhalers (MDIs) and dry powder inhalers (DPIs). Factors affecting inhalation technique include ongoing training, inhalation device, spacer use (with MDIs), and natural ability. Model parameters were derived from a literature review or were estimated from clinical experience. Analyses demonstrated that most patients receive a fraction of prescribed ICS doses over time. The model may be used to better understand the impact of increasing ICS dosages and to estimate the likelihood of patients being underdosed.
Administration, Inhalation↗
Pediatric Asthma Study of the State Medical Society of Wisconsin.
PROBLEM: Asthma management should follow evidence-based national guidelines. We compared patient self-reports of usual care to clinical practice guidelines. METHODS: Cross-sectional survey of parents of 245 children age 2-14 years with asthma seen by physicians at 13 practices in Wisconsin. RESULTS: Most children with asthma were atopic and a substantial number experienced psychosocial problems. Families infrequently used written care plans. Knowledge about asthma triggers, especially tobacco smoke, was deficient. Increasing asthma severity was associated with poorer health. Although most parents rated their physician's expertise as excellent or very good, one-third of children with persistent symptoms used no daily control medication. Significant differences were observed between primary care and specialty care with the best asthma self-management done by patients of specialists. CONCLUSION: Care of Wisconsin children with asthma inconsistently follows national guidelines. They and their families require improved education, written care plans, appropriate medications, and psychosocial support.
Adolescent↗
Evidence for Chlamydia pneumoniae infection in steroid-dependent asthma.
BACKGROUND: Chlamydia pneumoniae is an obligate intracellular respiratory pathogen capable of persistent infection. Seroepidemiologic studies and the results of open-label antimicrobial treatment of patients with non-steroid-dependent asthma have suggested a potential role for C. pneumoniae in asthma. OBJECTIVE: To evaluate the results of antimicrobial treatment in patients with uncontrolled steroid-dependent asthma and serologic evidence suggesting C. pneumoniae infection. METHODS: Three nonsmoking asthmatic patients (aged 13 to 65 years) whose symptoms remained poorly controlled despite daily administration of inhaled and oral steroid (10 to 40 mg/d). All met serologic criteria for current or recent C. pneumoniae infection. RESULTS: After prolonged treatment (6 to 16 weeks) with clarithromycin or azithromycin all three patients were able to discontinue oral steroids. All three patients have remained well controlled with inhaled antiasthma therapy only during 3 to 24 months of postantibiotic therapy observation. CONCLUSIONS: In adolescent and adult asthmatic patients, Chlamydia pneumoniae infection may contribute to symptoms of asthma that are poorly controlled by steroids. Serologic evidence for C. pneumoniae infection should be sought in such patients. A trial of appropriate antibiotic therapy may be helpful in those patients with high titers of anti-C. pneumoniae IgG antibodies.
Administration, Inhalation↗
Point-of-service outcomes data and its effect on asthma treatment: a salmeterol pilot investigation.
Outcomes data have enabled physicians to have a much more complete overview of the patient's quality of life and health than their predecessors. One medical center has sought to develop a comprehensive point-of-service outcomes measurement tool for the assessment of patients with asthma. This information may provide a real-time overview on a desktop computer system of the patient's progress. A pilot project involving a therapeutic intervention in patients with asthma was conducted to test the utility of this outcomes tool in a practice setting.
Albuterol↗
Albuterol protects against exercise-induced asthma longer than metaproterenol sulfate.
Both metaproterenol sulfate and albuterol are inhaled medications commonly used to prevent exercise-induced bronchospasm. Their efficacy and duration of action in controlling exercise-induced bronchospasm were compared with placebo in 18 asthmatic children (age range: 12 to 17 years) in a single-blind randomized crossover study. Standardized treadmill exercise challenges were repeated every two hours for up to six hours following the initial exercise test. With the initial exercise challenge, both active medications blocked exercise-induced bronchospasm with equal efficacy. On the other hand, when the duration of action of the medications was compared: albuterol blocked exercise-induced bronchospasm longer than metaproterenol sulfate in eight subjects, the reverse was true in only one patient, and the medications blocked for equal duration in nine subjects. Thus, although both active agents were equally efficacious in blocking exercise-induced bronchospasm initially, the duration of action of albuterol was significantly (P less than .05) longer on serial testing than that of metaproterenol sulfate. Both medications were significantly better than placebo in efficacy and duration of action.
Adolescent↗