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Biomedical subjects

Stuart W Stoloff

Publications and source records attributed to Stuart W Stoloff.

6 recordsLinked to original sources
PubMed2006

Severity, control, and responsiveness in asthma.

Guidelines for asthma management have proposed that initial treatment should be based on assessment of asthma severity. The treatments proposed for different degrees of asthma severity are essentially estimates of the intensity of treatment needed to achieve asthma control. Responsiveness to treatment is heterogeneous, however, even among asthmatic patients with asthma of similar severity. This heterogeneity calls attention to the importance of assessing asthma control and adjusting treatment accordingly. Application of a guidelines-based approach to asthma management thus requires general agreement on what is meant by severity, control, and responsiveness and requires further an awareness of asthma as causing symptoms and functional impairment in the present and also as causing risk of adverse events in the future.

Anti-Asthmatic Agents↗
PubMed2004

Improved refill persistence with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies.

BACKGROUND: Improved adherence to inhaled corticosteroids (ICSs) has also been associated with decreased asthma-associated morbidity and mortality. OBJECTIVE: The purpose of this study was to assess patient medication refill persistence with fluticasone propionate (FP) and salmeterol combination in a single inhaler (FSC), FP and salmeterol in combination from 2 separate inhalers, FP and montelukast in combination, FP as monotherapy, and montelukast as monotherapy. METHODS: We performed a retrospective, observational, 24-month (12-month baseline and 12-month follow-up) database study using medical and pharmacy claims from a large managed care organization. We identified 2511 subjects 12 years of age or older with a claim for asthma (International Classification of Diseases, Ninth Revision: 493.XX): 563 patients receiving FSC, 224 receiving FP plus salmeterol, 75 receiving FP plus montelukast, 798 receiving FP only, and 776 receiving montelukast only. Refill rates of FP, as a measure of adherence, were compared for each FP-containing cohort during the 12-month follow-up period. In addition, refill rates were compared between FSC, an inhaler, and montelukast, an oral medication. RESULTS: Twelve-month baseline asthma medication use and patient demographics were comparable among cohorts. Patients in the FSC cohort obtained significantly more refills compared with the number of FP refills in the other FP-containing cohorts (4.06 for FSC vs 2.35 for FP plus salmeterol, 1.83 for FP plus montelukast, and 2.27 for FP alone) over the 12-month follow-up period. In addition, patients taking FSC had similar refill persistence compared with patients taking the oral leukotriene modifier montelukast (4.51). CONCLUSION: FSC might increase ICS refill persistence compared with FP alone in a single inhaler, FP in combination with salmeterol from 2 separate inhalers, and FP in combination with montelukast. In addition, FSC in a dry powdered inhaler had similar refill rates compared with an oral asthma agent, montelukast. Use of a single inhaler containing both an ICS (FP) and a long-acting bronchodilator (salmeterol) might increase the likelihood that patients are getting more optimal ICS therapy, as well as the benefits from the long-acting bronchodilator, with patient adherence comparable to an oral agent.

Acetates↗
PubMed2004

The utility of the Health Plan Employer Data and Information Set (HEDIS) asthma measure to predict asthma-related outcomes.

BACKGROUND: The Health Plan Employer Data and Information Set (HEDIS) measures are used extensively to measure quality of care. OBJECTIVE: To evaluate selected aspects of the HEDIS measure of appropriate use of asthma medications. METHODS: Claims data were analyzed for commercial health plan members who met HEDIS criteria for persistent asthma in 1999. The use of asthma medications was evaluated in the subsequent year with stratification by controller medication and a measure of adherence (days' supply). Multivariate logistic regressions were used to evaluate the association among long-term controller therapy for persistent asthma, adherence to therapy, and asthma-related hospitalizations or emergency department (ED) visits, controlling for demographic, preindex utilization, and other confounding characteristics. RESULTS: Of the 49,637 persistent asthma patients, approximately 35.7% were using 1 class of long-term controller medications, 18.4% were using more than 1 class, and 45.9% were not using such medication. More than 25% of the persistent asthma patients did not use any asthma medication in the subsequent year. Patients with low adherence to controller medication had a significantly higher risk (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.42-2.08) of ED visit or hospitalization relative to patients not using any controllers compared with persons with moderate (OR, 0.84; 95% CI, 0.57-1.23) or high (OR, 0.70; 95% CI, 0.34-1.44) adherence. Patients receiving a high days' supply of inhaled corticosteroids had the lowest risk of ED visit or hospitalization (OR, 0.37; 95% CI, 0.05-2.69). CONCLUSIONS: Our findings suggest that refinements to the HEDIS measure method for identifying patients with persistent asthma may be needed.

Adult↗