Biomedical subjects

E Van Ganse

Publications and source records attributed to E Van Ganse.

26 records · Page 2Linked to original sources

PubMed1995

Asthma medications and disease exacerbations: an epidemiological study as a method for asthma surveillance.

Recent experimental and epidemiological studies have suggested that outcomes of asthma are significantly influenced by treatment patterns. This study was conducted in order to investigate the links between treatment patterns in asthmatics and occurrence of disease exacerbations. We performed a nested case-control study in a cohort of 680 asthmatics identified between 1986 and 1991 in a drug dispensing database. After validation in a pilot study, the intermittent use of oral corticosteroids was used as a proxy for asthma exacerbations. Cases with an exacerbation (n=133) were pair-wise matched with controls. The type of medications used for the usual treatment of asthma were examined in relation to the risk of asthma exacerbation. The use of oral xanthines and inhaled fenoterol but not of inhaled salbutamol, corticosteroids, cromoglycate and ipratropium bromide was associated with an increased probability of asthma exacerbation. Within the cohort, the proportion of subjects dispensed inhaled corticosteroids rose from 12 to 27% between 1986 and 1991. The proportion of subjects using inhaled bronchodilators without inhaled corticosteroids also decreased over this period of time. The identification of markers of asthma exacerbations made it possible to link the probability of adverse outcome risk for such exacerbations with treatment patterns. This method could be useful in further development of asthma surveillance using drug dispensing databases.

Adolescent↗

PubMed1992

Influence of lansoprazole treatment on diazepam plasma concentrations.

The possible influence of long-term treatment with lansoprazole on the single-dose pharmacokinetics of diazepam was investigated in 12 healthy male volunteers. In this double-blind randomized crossover study, 60 mg lansoprazole or placebo was administered once daily for 10 days. One hour after administration on day 7, 0.1 mg/kg diazepam was administered intravenously, and blood was collected up to 96 hours after the injection for plasma diazepam and desmethyldiazepam measurement. During the placebo session, the plasma elimination half-life, clearance, and volume of distribution of diazepam were 26.0 +/- 1.6 hours, 22.5 +/- 1.1 ml/hr/kg, and 0.82 +/- 0.04 L/kg, respectively. These parameters were not significantly different during the lansoprazole session. The mean plasma concentrations of desmethyldiazepam were similar in both sessions. These findings illustrate that long-term treatment with a therapeutic dose of lansoprazole does not interfere with the metabolism of diazepam.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed1989

Interaction between nonsteroidal anti-inflammatory drugs and loop diuretics: modulation by sodium balance.

Nonsteroidal anti-inflammatory drugs have been shown to decrease the natriuretic response to loop diuretics in many but not all studies. Recently, indomethacin was shown not to affect the natriuretic response to the new loop diuretic torasemide in healthy volunteers. Inasmuch as sodium balance has been reported to modify the effect of indomethacin on furosemide-induced natriuresis in dogs, we investigated the effect of indomethacin, under two sodium balances (50 and 150 mEq/day), on the natriuretic response to two doses of torasemide in six healthy volunteers. Under the low sodium diet, indomethacin reduced the natriuretic response to torasemide like that to furosemide. In contrast, on the normal sodium diet, indomethacin failed to affect the natriuretic response to torasemide. Indomethacin reduced base-line and diuretic-induced increase in plasma renin activity, plasma angiotensin II levels and urinary excretion of prostaglandin 6-keto F1 alpha to a similar extent under the two sodium diets. Our data show that indomethacin reduces the natriuretic response to torasemide in humans. Dietary sodium restriction is a significant determinant of the interaction between nonsteroidal anti-inflammatory drugs and loop diuretics in healthy volunteers, presumably because it allows loop diuretics to provoke an increase in renal blood flow which participates in their natriuretic action and is blocked by nonsteroidal anti-inflammatory drugs.

Adult↗

PubMedDate not supplied

Responses of the immune system to injury.

Three categories of immunotoxic effects are identified: direct immunotoxicity, hypersensitivity, and autoimmunity. Direct immunotoxicity consists of immunosuppression and immunostimulation. Total abrogation of the immune response (immunosuppression) results in more frequent, severe, and often atypical and relapsing infections and lymphomas. Immunostimulation is associated with febrile reactions, the induction/facilitation of autoimmune diseases and allergic reactions to unrelated allergens, and impaired hepatic drug biotransformation. Hypersensitivity is manifested by a variety of symptoms involving either antigen-specific or non-antigen-specific humoral and cellular adverse responses. Autoimmune reactions are divided into organ-specific and systemic reactions. Because of the involvement of many redundant mechanisms, it is difficult to predict responses of the immune system to a given immunotoxic injury. In laboratory animals, histologic but also functional changes are necessary to show evidence of and to predict such adverse responses.

Animals↗

PubMedDate not supplied

Gastrointestinal tolerability of ibuprofen compared with paracetamol and aspirin at over-the-counter doses.

This multicentre, randomized, investigator-blinded, parallel-group study compared the gastrointestinal (GI) tolerability of ibuprofen, paracetamol and aspirin at over-the-counter doses for common pain indications. Patients (of whom 8633 were evaluable) took either ibuprofen up to 1200 mg daily, or paracetamol or aspirin, each up to 3000 mg daily, for 1-7 days. The main outcome was the proportion of patients with GI adverse events. There were significantly more patients who suffered GI adverse events, principally abdominal pain, dyspepsia, nausea and diarrhoea, with aspirin (18.5%) than with ibuprofen (11.5%), but the difference between ibuprofen and paracetamol (13.1%) was not significant. Significantly more of those patients with a history of non-ulcer GI disease (n = 371) developed GI adverse events than did those with no such history; the incidence of GI adverse events in both groups was lowest with ibuprofen. More women than men experienced GI adverse events (15.5% versus 12.8%). The higher incidence of GI adverse events with aspirin was evident from the first day of treatment. In conclusion, the GI tolerability of ibuprofen, at over-the-counter doses of up to 1200 mg daily for up to 7 days, was at least as good as that of paracetamol and significantly better than that of aspirin.

Acetaminophen↗

PubMedDate not supplied

[Use of computerized data in pharmacoepidemiology].

Positive and negative effects of long-term therapy are sometimes difficult to highlight, for instance in gerontology or in respiratory medicine, and the use of computerized data may be a good alternative. Data collection is made of three steps. First, a study population is identified from disease criteria. All treatments used during a given study period are then extracted from computerized files; these data may be linked, when needed, to detailed patient surveys. Finally, all outcomes of the study period are retrieved, possibly using validated proxies. This method also allows for assessment of the quality of prescribing and the burden of disease. Asthma studies are used as examples.

Anti-Asthmatic Agents↗

PubMedDate not supplied

[Use of databases in pharmacovigilance: two examples].

The association between asthma exacerbations and use of antiasthmatics has been studied with a drug dispensing database. Exacerbations were identified through use of oral corticosteroids and the risk was determined for each medication. use of fenoterol and oral xanthines increases the frequency of exacerbations, but a channelling phenomenon is not excluded. This method could be used in the study of treatment combinations or new treatments, facilitating the monitoring of asthmatic populations. A second study collects ambulatory drug use data (POM and OTC drugs) of elderly patients. These data are analysed for the distribution of several variables, such as concomitant use of several medications of the same therapeutic class. As an example, about 15 per cent of NSAIDs users also use aspirin, exposing themselves to increased risk for gastrointestinal effects. These studies illustrate the use of drug dispensing databases in monitoring populations at risk and assessing treatment quality.

Adolescent↗

PubMedDate not supplied

Antiallergic and antitussive medications: extent of use and relationship to asthma exacerbations.

BACKGROUND: Asthma patients are frequently exposed to antiallergic and antitussive medications, in addition to their respiratory treatment. These medications interfere with inflammatory pathways common to all atopic diseases and could affect asthma. OBJECTIVES: To investigate associations between antiallergic and antitussive medications and the occurrence of asthma exacerbations and to assess the extent of use of these medications in asthma. METHODS: Regular users of anti-asthma medications were identified in a drug dispensing database. A base-cohort of asthma patients was identified using age and exposure criteria. A nested case-control study was performed within the base-cohort: the outcome was defined as a new dispensing of oral corticosteroids and matched cases and controls were compared regarding exposure to antiallergic medications. Odds ratios (OR) were computed by conditional logistic regression and adjustment incorporated markers for asthma severity. RESULTS: 680 asthma patients were followed in the base-cohort for an average duration of 1390 days. Antitussives, antihistamines and nasal corticosteroids were used by respectively 40, 30 and 13 per cent of the asthma population. Among the patients, 134 cases were pair matched with controls. In these pairs, antitussives showed a significant association with asthma exacerbations, with an OR of 3.1. The association had borderline significance for antihistamines and was not significant for nasal corticosteroids. The results were not modified by adjustment for disease severity. CONCLUSIONS: This study confirms that antitussives and antihistamines are commonly used by asthmatics and indicates that both classes are associated with increased occurrence of asthma exacerbations; assessing causality from present data is, however, difficult. Nasal corticosteroids are used less often and are not associated with the outcome. Antihistamine and antitussive medications should be more thoroughly investigated in asthma patients.

Administration, Intranasal↗