Biomedical subjects

Roy A Pleasants

Publications and source records attributed to Roy A Pleasants.

3 recordsLinked to original sources

PubMed2006

Review of guidelines and the literature in the treatment of acute bronchospasm in chronic obstructive pulmonary disease.

In 2002, an estimated 11.2 million adults in the United States had chronic obstructive pulmonary disease (COPD). Guidelines for the management of the disease have been published by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the American Thoracic Society-European Respiratory Society. Several other organizations are in the process of preparing guidelines for COPD, most based on the GOLD report. The most important pharmacologic intervention in COPD is treatment with bronchodilator drugs. This intervention applies not only to stable COPD, but also to exacerbations (flares) of the disease. Prevention strategies have been developed for acute exacerbations, and management strategies include using short-acting beta(2)-agonists, systemic corticosteroids, and antibiotics, in both at home and hospital settings.

Adrenergic beta-Agonists↗

PubMed2005

Outcomes associated with initiation of different controller therapies in a Medicaid asthmatic population: a retrospective data analysis.

BACKGROUND: Outcomes in asthmatic patients may vary depending on the controller medication used. Observational studies of outcomes of asthma therapy are needed to understand the implications of choice of controller in different populations. OBJECTIVES: To determine whether there are differences in health care use and costs of asthma treatment in asthma patients treated with montelukast compared with fluticasone proponiate 44 microg. METHOD: Using data from the North Carolina Medicaid program, we compared continuously enrolled asthmatic patients starting either fluticasone propionate 44 microg (FP44), an inhaled corticosteroid (ICS) (n = 312), or montelukast 5 and 10 mg, an oral leukotriene modifier (LM) (n = 398) between the years 1998 and 1999. A secondary analysis compared continuously enrolled asthmatic patients already using ICS as controller therapy initiating either salmeterol (long-acting beta-agonist) (n = 97) or montelukast (n = 101) in the year 1998. Patients were followed for 1 year pre- and postcontroller or additional controller initiation for health care service use, medication refill patterns, and costs. RESULTS: There were no significant differences in the adjusted asthma-related health care costs between the montelukast and FP44 groups. In both groups, physician visits were significantly higher in year 2 (p < 0.01) than in year 1. We found montelukast users to be more adherent with prescription refills (using measures of medication possession) even after allowing for a wider adherence range for FP (RR = 2.53; 95% CI = 1.50-4.26), although patients using montelukast were more likely than patients with fluticasone to switch controller pharmacotherapy (RR = 1.53; 95% CI = 1.12-2.09). Similarly, there were no differences in health care service use and costs between the montelukast and salmeterol groups, with the exception of a 33% reduction (p < 0.01) in number of inhaled corticosteroid refills in the second year in the salmeterol group. CONCLUSION: There were no cost and major health care use differences between the two primary or secondary controller therapies in the postinitiation year. Although FP was associated with lower rate of controller switch, montelukast use was associated with significantly better treatment adherence in patients with treatment persistence in this population of Medicaid-enrolled asthmatic patients. The addition of salmeterol as additional controller was associated with a significant decrease in inhaled corticosteroid use, suggesting decreased adherence in patients on the two-drug regimen.

Acetates↗

PubMed2005

An update on chronic obstructive pulmonary disease.

OBJECTIVE: Provide an update on the diagnosis and management of chronic obstructive pulmonary disease (COPD) based on new international and national guidelines. COPD affects approximately 5% to 7% of adults in the United States, with a higher prevalence in elderly persons (10% in elderly males). DATA SOURCE: A Medline search of relevant articles and the Global Initiative for Obstructive Lung Disease and the American Thoracic Society/European Respiratory Society COPD Guidelines. STUDY SELECTION: Articles and current guidelines relevant to pharmacists working with COPD patients in extended-care facilities. DATA SYNTHESIS: COPD is a chronically progressive disease that ultimately leads to major health impairment. New international and national guidelines recently have become available; these guidelines provide extensive insight into many aspects of the disease. Key interventions include early diagnosis, use of pulmonary-function testing, smoking cessation, supplemental oxygen, pulmonary rehabilitation, optimization of pharmacological therapies, and preventing--as well as minimizing--the impact of acute exacerbations of COPD. Optimizing the use of bronchodilators and, in selected patients, the use of corticosteroids are especially important pharmacological interventions in the management of COPD. Patients are started on short-acting bronchodilators; long-acting agents can be added and, in some patients, inhaled corticosteroids can be added as well. Other pharmacological interventions include smoking cessation therapies and the use of anti-infective and mucolytics/expectorants. CONCLUSION: Pharmacists can assist in proper drug selection and administration in COPD patients in long-term care facilities. In addition, they can assist in preventing complications of drug therapy such as steroid-induced osteoporosis.

Journal Article↗