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Biomedical subjects

Shaun Holt

Publications and source records attributed to Shaun Holt.

13 recordsLinked to original sources
PubMed2005

PHARMAC and tobacco control in New Zealand: government policy 'up in smoke'.

There is increasing concerning amongst the medical profession in New Zealand about the adverse effect that PHARMAC has on the health of New Zealanders through restricting the availability of medications. In this article, the circumstances surrounding the restrictions limiting the availability of the smoking cessation treatment bupropion are presented. The authors conclude that the decision by PHARMAC not to fund bupropion is directly contrary to Government policy and is inconsistent with evidence-based medicine and international recommendations. It is suggested that the PHARMAC decision seriously questions the Ministry of Health's commitment to smoking cessation and the health of disadvantaged groups in New Zealand, particularly Maori.

Antidepressive Agents, Second-Generation↗
PubMed2005

Metered dose inhalers: a need for dose counters.

OBJECTIVES: This study investigated the ability of patients to assess when a metered dose inhaler (MDI) is empty. METHODOLOGY: A total of 17 patients assessed, by shaking, the number of doses remaining in a salbutamol MDI that had been partially emptied. Another 100 patients were asked to collect all salbutamol MDIs they considered to be empty and would have thrown away. These MDI canisters were weighed and the number of doses that had been used was estimated. RESULTS: Using the 'shaking method', patients overestimated the amount remaining by around 40 doses. The mean number of doses delivered from an MDI labelled to contain 200 doses before it was discarded was 224 (range, 155-289). CONCLUSIONS: These findings confirm that patients are unable to determine when an MDI should be discarded, resulting in insufficient drug delivery at the end of the life of an MDI for the majority of patients, and wastage of the drug for others.

Administration, Inhalation↗
PubMed2005

Fixed and adjustable dose asthma action plans based on combination therapy: a pilot study.

OBJECTIVE: The use of combination inhaled corticosteroid/long-acting beta-agonist therapy within the framework of a self-management plan has yet to be investigated. METHODOLOGY: In this randomized open-label study, 69 adult asthmatic patients taking >or= 1,000 microg per day of beclomethasone dipropionate (BDP) or equivalent were treated for 3 months with Symbicort Turbuhaler (200 microg budesonide/6 microg formoterol). Patients were assigned to one of two self-management plans, based on either a fixed or adjustable dose regimen. The primary outcome variable was episode-free days. RESULTS: Both regimens resulted in good asthma control, at least comparable to that obtained with previous high dose inhaled corticosteroid therapy. There were no significant differences in clinical outcome measures between the regimens. The mean (+/- SD) usage of Symbicort was similar for the fixed and adjustable dose regimens (3.8 +/- 0.68 vs 3.6 +/- 1.54 puffs per day, respectively). CONCLUSION: We conclude that Symbicort is effective when administered as either a fixed or adjustable dose regimen as part of a self-management plan.

Adolescent↗
PubMed2004

The dose-response relationship of inhaled corticosteroids in asthma.

Inhaled corticosteroids are the only class of asthma medication that can reduce symptoms, improve lung function, reduce the frequency of severe exacerbations, including hospital and ICU admissions, and decrease the risk of mortality. The therapeutic dose range for all clinical outcome measures in adults is 100 to 1000 mg/d of beclomethasone dipropionate or budesonide, or 50 to 500 mg/d of fluticasone propionate. Doses in excess of this range are not recommended for routine use because they are likely to increase the risk of systemic side-effects without further major improvement in efficacy. The recommendations are qualified by the recognition that there is considerable individual variability in the response to inhaled corticosteroids in asthma, which would suggest that some patients might obtain greater benefit at higher doses, just as some might obtain maximum benefit at lower doses.

Administration, Inhalation↗
PubMed2004

The use of the self-management plan system of care in adult asthma.

The development of self-management plans arose as clinicians tried to design better methods by which they could deliver asthma care and reduce the significant mortality and morbidity associated with this disease. The basic principles that resulted have been widely endorsed, and self-management plans are now recommended in the long-term management of adult asthma. Self-management plans essentially focus on the early recognition of unstable or deteriorating asthma, by monitoring peak flow or symptoms. Through the use of written guidelines, patients are then able to determine when it is necessary to adjust therapy or obtain medical assistance. There is now convincing evidence that the use of self-management plans by patients with asthma leads to a marked reduction in morbidity and a reduced requirement for acute medical treatment including hospital admissions. Recent research has also clarified many of the different issues concerning their structure and implementation. In some respects the skill in the use of the asthma self-management plan system of care is the ability to modify the standard plans to meet the particular needs of the individual asthmatic patient, including their preferences.

Journal Article↗
PubMed2004

The pulmonary and extra-pulmonary effects of high-dose formoterol in COPD: a comparison with salbutamol.

OBJECTIVES: Formoterol, a beta(2) agonist with a rapid onset of effect and long duration of action, can be used as maintenance and reliever medication for asthma and COPD. We compared the pulmonary and extra-pulmonary effects of cumulative doses of formoterol and salbutamol in patients with COPD to assess efficacy and safety. METHODOLOGY: In a randomized, double-blind, cross-over study, 12 patients with moderate to severe COPD inhaled, via Turbuhaler, 10 doses of formoterol (total metered dose, 120 microg, equivalent to a 90- microg delivered dose), salbutamol (total metered dose 2000 microg) or placebo at 2-min intervals on separate days. The effects on lung function (FEV(1) and PEF), heart rate, blood pressure, oxygen saturation, corrected QT interval (QTc), T-wave height and plasma potassium were assessed before each dose, 15 min after each dose, and at half-hourly intervals for 3 h following the final dose. RESULTS: Inhalation of formoterol or salbutamol resulted in significant improvement in lung function (measured 30 min after the last dose) when compared with placebo. There were no clinically important or statistically significant changes in heart rate, QTc, T-wave height, plasma potassium, oxygen saturation, or systolic and diastolic blood pressures with formoterol or salbutamol. One patient developed ventricular trigeminy after both formoterol and salbutamol. She had had ventricular ectopics on her screening electrocardiogram. CONCLUSION: Formoterol and salbutamol both produced significant improvement in lung function and were similarly well tolerated in high doses, as might be taken by a patient for relief of COPD symptoms.

Adrenergic beta-Agonists↗
PubMed2004

Budesonide once versus twice-daily administration: meta-analysis.

OBJECTIVES: The aim of this study was to examine the efficacy of budesonide administered once daily compared to twice daily in asthma. METHODOLOGY: Meta-analysis of randomised controlled trials comparing budesonide administered once versus twice a day that presented data on at least one clinical outcome measure was conducted. RESULTS: A total of 10 studies, with 1922 children and adults with asthma, met the inclusion criteria. These studies were performed predominantly with mild to moderate asthmatic patients, using doses of budesonide ranging from 200 to 800 microg per day. There was no significant difference between daily dosing once or twice for all the clinical outcome variables, including withdrawals due to asthma, for which the odds ratio was 1.0 (95% confidence interval, 0.65-1.52). CONCLUSIONS: In mild to moderate asthma a once-daily budesonide regimen has a similar efficacy to a twice-daily regimen in doses up to 800 microg per day. A once-daily regimen has potential advantages in terms of patient compliance and satisfaction, when used in clinical practice.

Adolescent↗
PubMed2003

Asthma morbidity, control and treatment in New Zealand: results of the Patient Outcomes Management Survey (POMS), 2001.

AIMS: To determine the magnitude of morbidity from asthma within the New Zealand population, the degree of satisfaction of patients with their asthma control, and the level of asthma control achieved in relation to treatment. METHODS: Participants were randomly selected from 29 randomly chosen general practices throughout New Zealand. Information was collected from demographic and clinical questionnaires and from lung function tests. Criteria based on GINA guidelines were developed to define the level of asthma control for each participant, their opinion of their level of control, and to define which participants were under-treated. RESULTS: A total of 445 patients (327 adults, age 16-68; 118 children, age 7-15) took part in the study. Ninety three per cent of adults had asthma that was sub-optimally controlled, 71% had asthma that was not well controlled, and 19% had asthma that was markedly out of control. For children, these figures were 90%, 42% and 4% respectively. These results were consistent regardless of asthma severity. In adults and children whose asthma was not well controlled, 49% and 71% respectively were under-treated. For those whose asthma was markedly out of control, 89% and 75% of adults and children respectively were under-treated. CONCLUSIONS: A significant proportion of patients have asthma that is not well controlled or that is markedly out of control, and the majority are under-treated.

Administration, Inhalation↗
PubMed2002

Do natural health food stores require regulation?

AIM: To compare advice provided by health food stores (HFS) and pharmacies in relation to medical conditions and assess the need for regulation of HFS. METHODS: We assessed the advice provided by 26 health food stores (HFS) and 26 pharmacies to an individual presenting with symptoms suggestive of moderate to severe asthma who had not seen a general practitioner. RESULTS: The advice provided by the two stores differed markedly. 22/26 pharmacy staff diagnosed asthma/probable asthma, whereas only 15/26 HFS staff reached the same conclusion. 92.3% of pharmacy staff compared to 34.6% of HFS staff referred the investigator to a doctor; 5 HFS advised the investigator against seeing a doctor. A wide variety of remedies were recommended by the HFS, none of which are known to be beneficial in the treatment of asthma. CONCLUSION: HFS promoting herbal products for medical conditions should be regulated in a similar fashion to shops that dispense pharmaceutical products.

Adult↗