European Clinical Respiratory Journal最新文献

{"title":"Sedating antihistamine treatment with promethazine in patients with severe COPD with and without asthma: death and severe exacerbations in a nationwide register study.","authors":"Barbara Bonnesen,&nbsp;Valdemar Rømer,&nbsp;Sidse Graff Jensen,&nbsp;Jon Torgny Wilcke,&nbsp;Julie Janner,&nbsp;Jens Bak,&nbsp;Sofie Johansson,&nbsp;Christian B Laursen,&nbsp;Lars Pedersen,&nbsp;Josefin Eklof,&nbsp;Pradeesh Sivapalan,&nbsp;Jens-Ulrik Stæhr Jensen","doi":"10.1080/20018525.2023.2250604","DOIUrl":"https://doi.org/10.1080/20018525.2023.2250604","url":null,"abstract":"<p><strong>Background: </strong>Sedating antihistamines such as promethazine are used as anxiolytics and hypnotic agents for patients with chronic obstructive pulmonary disease (COPD) with and without asthma despite limited knowledge of its effects and side effects. We evaluated if treatment with promethazine had a lower risk of harmful outcome.</p><p><strong>Methods: </strong>Nationwide retrospective cohort study of Danish specialist diagnosed outpatients with COPD treated with promethazine or an active comparator (melatonin). Patients with collection of promethazine or melatonin were propensity score matched 1:1. The primary outcome was a composite of severe COPD exacerbations and death from all causes analyzed by Cox proportional hazards regression. We performed an interaction analysis for comorbid asthma.</p><p><strong>Results: </strong>In our registry of 56,523 patients with COPD, 5,661 collected promethazine (<i>n</i> = 3,723) or melatonin (<i>n</i> = 1,938). A cohort of 3,290 promethazine- or melatonin-treated patients matched 1:1 was available for the primary analysis.Within 1-year patients treated with promethazine were at higher risk of the primary outcome than matched controls with a Hazard Ratio (HR) of 1.42 (CI 1.27-1.58, <i>p</i> < 0.0001). Similarly, the risk of death was higher for promethazine-treated patients (HR 1.53, CI 1.32-1.77, <i>p</i> < 0.0001). An interaction analysis for comorbid asthma showed no interaction between comorbid asthma and the likelihood of a primary outcome when collecting promethazine (<i>p</i> = 0.19). Adjusted Cox analysis on the entire population indicated a further increased risk with more promethazine (HR for primary outcome among patients collecting ≥ 400 promethazine tablets/year=2.15, CI 1.94-2.38, <i>p</i><0.0001).</p><p><strong>Conclusions: </strong>Promethazine-treated patients with COPD had a concerning excess risk of a composite outcome of severe exacerbations and death from all causes compared to melatonin.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cf/da/ZECR_10_2250604.PMC10481760.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10192504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccine effectiveness of the pneumococcal polysaccharide and conjugated vaccines in elderly and high-risk populations in preventing invasive pneumococcal disease: a systematic search and meta-analysis.","authors":"Melina Gade Sikjær,&nbsp;Andreas Arnholdt Pedersen,&nbsp;Mari Stenvold Wik,&nbsp;Synne Smith Stensholt,&nbsp;Ole Hilberg,&nbsp;Anders Løkke","doi":"10.1080/20018525.2023.2168354","DOIUrl":"https://doi.org/10.1080/20018525.2023.2168354","url":null,"abstract":"<p><strong>Background: </strong>Invasive pneumococcal disease (IPD) is a major cause of morbidity and mortality globally. However, the literature on the vaccine effectiveness (VE) of 23-valent polysaccharide vaccine (PPV23) and 13-valent conjugated vaccine (PCV13) against IPD in adults is sparse. The aim was to summarize the available evidence on the VE of the PPV23 and the PCV13 in elderly individuals against IPD and to investigate how age and comorbidities influence VE against IPD.</p><p><strong>Methods: </strong>A systematic search was conducted in Medline and Embase in February 2021. We used combinations of terms related to PPV23, PCV13, elderly, high-risk populations, and IPD. Eligible articles published since 2010 were included. Two authors reviewed and extracted data.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria for PPV23. The meta-analysis showed a reduced OR for all-type IPD with the use of PPV23 vaccine compared with unvaccinated controls (OR 0.69; 95%CI 0.54, 0.88) and a reduced OR for vaccine-type IPD compared with non-vaccine type IPD (0.69; 95%CI 0.63, 0.76). VE against vaccine-type IPD ranged from 28% to 54.1% for individuals aged 65-79 and from 7.5% to 34% for those aged ≥80-85 years. Most studies found a lower VE of PPV23 in populations with comorbidities and in immunocompromised populations compared with the VE for individuals without comorbidities.One study met the inclusion criteria for PCV13. The vaccine efficacy of PCV13 against IPD in individuals aged ≥65 was 75.0% (95% CI, 41.4 to 90.8).</p><p><strong>Conclusion: </strong>The results from this review show a reduction of IPD in elderly and high-risk populations vaccinated with PPV23 and PCV13. The protective effect may be lower in elderly individuals aged >80 and in individuals with comorbidities. However, the literature is sparse; large-scale prospective studies are required to evaluate the VE of PPV23 and PCV13 vaccination in adults against IPD.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/31/ZECR_10_2168354.PMC9870017.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10627791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous recovery of anosmia after 2.5 years in a young COVID-19 patient.","authors":"Erfan Ghadirzadeh,&nbsp;Lotfollah Davoodi,&nbsp;Fatemeh Khazaei,&nbsp;Amirmasoud Taheri","doi":"10.1080/20018525.2023.2178598","DOIUrl":"https://doi.org/10.1080/20018525.2023.2178598","url":null,"abstract":"To the Editor: It has been 3 years since the world was confronted with a new challenge: coronavirus disease 2019 (COVID-19) [1]. COVID-19 typically manifests with respiratory symptoms, such as dry cough and dyspnea; however, it is not unusual for other organ signs and symptoms to appear [2]. A 2020 meta-analysis found that 53% of COVID19 patients suffer from taste and smell impairments [3]. Anosmia, the loss of the sense of smell, is one of them and is regarded both as a symptom and as a complication of COVID-19, which may remain even after the patient is no longer infected [3]. Sixty to seventy percent of patients recover from this disorder within 4 weeks after having COVID19, either entirely or partially [2]. Seventy-eight percent of patients recover their sense of smell entirely after 2 months, while 95% do so after 6 months [2,3]. Nonetheless, some people may endure anosmia for more than a year. These patients undergo numerous diagnostic and therapeutic procedures but do not heal completely [4]. Several therapy approaches might be pursued when anosmia persists for longer than 2 weeks [4]. Current options for treatment include intranasal corticosteroids, sodium citrate, and olfactory exercises [2]. Some patients do not respond to these treatments and have permanent olfactory loss. These patients may be candidates for other experimental therapies, such as stem cell therapy [2]. On 10 April 2020, a 23-year-old woman presented to the pulmonology clinic of Imam Khomeini Hospital in Sari, Mazandaran Province, Iran, with a complaint of a dry cough, fever, and loss of smell. On physical examination, her vital signs and organ examinations were normal. She tested positive for COVID-19 with a PCR test. The patient was ultimately diagnosed with mild COVID19. On the subsequent follow-up, her respiratory symptoms improved, but her anosmia did not. On 1 November 2022, she returned and reported that she could once again detect odors. She stated that approximately a month ago, she occasionally detected odors for a short period. Over time, the duration and intensity of the odor from these episodes began to increase. Now, she has regained her original sense of smell. Several hypotheses have been proposed as potential anosmic mechanisms. A study by Torabi et al. [5]. Based on the fact that TNFand IL-1 are high in COVID-19 patients, they suggested that inflammation of the olfactory epithelium could be a cause of short-term anosmia. This can explain why intranasal corticosteroids have the desired effects on COVID-19 anosmia. Cazzolla et al. [6] evaluated the IL-6 levels in venous blood samples of anosmic COVID-19 patients and concluded that recovery of the sense of smell correlates with a decrease in IL-6 blood levels. Other pathways associated with persistent anosmia in COVID-19 patients include olfactory cleft syndrome, olfactory epithelium or bulbar injury, microglial cell destruction, and apoptosis of olfactory neurons and stem cells [2]. Moreover, prolonged S","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/2b/ZECR_10_2178598.PMC9930803.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9328787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fixed-dose combination fluticasone/formoterol for asthma treatment in a real-world setting: meta-analysis of exacerbation rates and asthma control.","authors":"Alberto Papi,&nbsp;Murtaza Qasuri,&nbsp;Ernestine Chung,&nbsp;Mohamed Abdelbaset,&nbsp;Mohamed Aly Moussa,&nbsp;Vibeke Backer,&nbsp;Olaf Schmidt,&nbsp;Omar Usmani","doi":"10.1080/20018525.2023.2174642","DOIUrl":"https://doi.org/10.1080/20018525.2023.2174642","url":null,"abstract":"<p><strong>Background: </strong>Treatment guidelines for asthma management are derived almost exclusively from the results of controlled clinical trials undertaken in carefully selected patient populations; meaning that their outcomes may not reflect the true performance of treatments when used in general daily medical practice. The aim of this meta-analysis was to combine the results of observational studies investigating the fluticasone propionate/formoterol (FP/FORM) fixed-dose combination in real-world asthma patients.</p><p><strong>Methods: </strong>A systemic literature review was completed in March 2019 using the PubMed database. We identified 394 studies. Five studies, which included a total of 4756 patients treated with FP/FORM, were judged eligible and included in the meta-analysis.</p><p><strong>Results: </strong>The estimated severe asthma exacerbation rate was 11.47% (95% CI, 5.8 to 18.72%), calculated from the random effect model. A sensitivity analysis excluding 2 studies (one was an outlier, and the exacerbation rate for the studied treatment alone could not be determined in the other) showed a 7.04% rate of severe asthma exacerbations. The estimated relative risk of the incidence of severe asthma exacerbations was 0.323 (95% CI, 0.159 to 0.658). The estimated asthma control rate was 60.6% (95% CI, 55.7% to 65.6%). The odds of achieving asthma control significantly increased by FP/FORM compared with pre-study conditions (estimated odds ratio: 2.214 [95% CI, 1.292 to 3.795]; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The findings of this meta-analysis confirm the effectiveness of FP/FORM for the treatment of asthma patients in a real-world setting beyond the limitations of RCTs.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/d8/ZECR_10_2174642.PMC9930770.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10766489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defined daily dose definition in medication adherence assessment in asthma.","authors":"Päivi Saukkosalmi,&nbsp;Hannu Kankaanranta,&nbsp;Iida Vähätalo,&nbsp;Lauri Sillanmäki,&nbsp;Markku Sumanen","doi":"10.1080/20018525.2023.2207335","DOIUrl":"https://doi.org/10.1080/20018525.2023.2207335","url":null,"abstract":"<p><p>Adherence to inhaled corticosteroids (ICS) has been described as poor. In adherence studies, if the actual prescribed dosing is not available, generic defined daily doses (DDD) are applied instead when assessing adherence. We evaluated asthma patients' adherence in a large prospective follow-up survey. We also analysed whether World Health Organization (WHO) and Global Initiative for Asthma (GINA) reference doses give different results. The current study was cross-sectional and included respondents attending to HeSSup follow-up questionnaire in 2012. Altogether 1,141 of 12,854 adult participants answered positively to the question about having asthma. According to the Finnish Social Insurance Institutions' medication register, 686 of them had purchased ICS medication during 2011. DDDs for ICS by WHO as well as medium doses from GINA report were used as reference doses to evaluate adherence. To estimate adherence to ICS, the proportion of days covered (PDC) over one year was calculated for every patient. If the lower limit of GINA medium ICS dose was used as a reference, 65% of the patients were adherent (PDC ≥ 80%). Use of WHO's DDD as reference halved the proportion of adherent patients. Adherence was higher among those using a combination inhaler of corticosteroid and long-acting β₂-agonist compared to those using steroid only inhalers. Use of WHO's daily defined doses as reference values may lead to underestimation of adherence to inhaled corticosteroids. Thus, attention should be paid when choosing the reference doses for the evaluation of adherence to inhaled corticosteroids in asthma.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/18/c3/ZECR_10_2207335.PMC10150619.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9416794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the time to diagnosis and treatment influence outcome in adults with pleural infections.","authors":"Mads Brögger Klausen,&nbsp;Christian Laursen,&nbsp;Morten Bendixen,&nbsp;Babu Naidu,&nbsp;Eihab O Bedawi,&nbsp;Najib M Rahman,&nbsp;Thomas Decker Christensen","doi":"10.1080/20018525.2023.2174645","DOIUrl":"https://doi.org/10.1080/20018525.2023.2174645","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of early diagnosis and intervention in adult patients with complicated parapneumonic pleural effusion or pleural empyema and the impact on outcomes.</p><p><strong>Methods: </strong>A systematic review based on a literature search of the PubMed database was performed.</p><p><strong>Results: </strong>Eleven eligible studies were included; nine observational studies and two randomised controlled trials totalling a study population of 10,717 patients. The studies were conducted from 1992 to 2018, all in Europe and Northern America except one. Results varied between studies, but a trend towards better outcome in patients with shorter duration of symptoms and quicker initiation of treatment was found. We found that duration of symptoms before treatment may affect length of hospital stay, rate of conversion to open surgery, and frequency of complications.</p><p><strong>Conclusion: </strong>We found that an earlier intervention in adults suffering from complicated parapneumonic pleural effusion and pleural empyema may potentially improve the outcome of patients in terms of length of stay, conversion to open surgery, and general complications following treatment, but not regarding mortality. Further studies are required to specify the timing of each intervention, and direct comparison in early management of interventions.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/61/ZECR_10_2174645.PMC9897775.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9104513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-genome sequencing of the clinical isolate of <i>Legionella pneumophila</i> ALAW1 from the West Bank allows high-resolution typing and determination of pathogenicity mechanisms.","authors":"Ashraf R Zayed,&nbsp;Boyke Bunk,&nbsp;Lina Jaber,&nbsp;Hadeel Abu-Teer,&nbsp;Mousa Ali,&nbsp;Michael Steinert,&nbsp;Manfred G Höfle,&nbsp;Ingrid Brettar,&nbsp;Dina M Bitar","doi":"10.1080/20018525.2023.2168346","DOIUrl":"https://doi.org/10.1080/20018525.2023.2168346","url":null,"abstract":"<p><strong>Background: </strong><i>Legionella pneumophila</i> is water-based bacterium causing Legionnaires' disease (LD). We describe the first documented case of nosocomial LD caused by <i>L. pneumophila</i> sequence type (ST) 461 and serogroup 6. The etiology of LD was confirmed by culturing the bronchoalveolar lavage sample retrieving <i>L. pneumophila</i> strain ALAW1. A 7-days treatment of the LD patient with Azithromycin and Levofloxacin allowed complete recovery.</p><p><strong>Methods: </strong>In details, we sequenced the whole genome of the <i>L. pneumophila</i> ALAW1 using Illumina HiSeq platform. The sequence of ALAW1 was aligned with the genome sequence from the closely related reference strain Alcoy 2300/99 and a whole-genome phylogeny based on single nucleotide polymorphisms (SNPs) was created using Parsnp software. Also, the TYGS web-server was used in order to compare the genome with type strain.</p><p><strong>Results: </strong>An analysis of the population structure by SNP and TYGS comparison clustered ALAW1 with the reference genome Alcoy 2300/99. Blastp analysis of the type IV secretion Dot/Icm system genes showed that these genes were highly conserved with (≤25%) structural differences at the protein level.</p><p><strong>Conclusions: </strong>Overall, this study provides insights into detailed genome structure and demonstrated the value of whole-genome sequencing as the ultimate typing tool for <i>Legionella.</i></p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/9d/ZECR_10_2168346.PMC9869991.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10622342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The COVID-19 in athletes (COVA) study: a national study on cardio-pulmonary involvement of SARS-CoV-2 infection among elite athletes.","authors":"Hanne Kruuse Rasmusen, Mikkel Aarøe, Christoffer Valdorff Madsen, Helga Lillian Gudmundsdottir, Kenneth Hudlebusch Mertz, Astrid Duus Mikkelsen, Christian Have Dall, Christoffer Brushøj, Jesper Løvind Andersen, Maria Helena Dominguez Vall-Lamora, Ann Bovin, S Peter Magnusson, Jens Jakob Thune, Redi Pecini, Lars Pedersen","doi":"10.1080/20018525.2022.2149919","DOIUrl":"10.1080/20018525.2022.2149919","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 can cause cardiopulmonary involvement. Physical activity and cardiac complications can worsen prognosis, while pulmonary complications can reduce performance.</p><p><strong>Aims: </strong>To determine the prevalence and clinical implications of SARS-CoV-2 cardiopulmonary involvement in elite athletes.</p><p><strong>Methods: </strong>An observational study between 1 July 2020 and 30 June 2021 with the assessment of coronary biomarkers, electrocardiogram, echocardiography, Holter-monitoring, spirometry, and chest X-ray in Danish elite athletes showed that PCR-tested positive for SARS-CoV-2. The cohort consisted of male football players screened weekly (cohort I) and elite athletes on an international level only tested if they had symptoms, were near-contact, or participated in international competitions (cohort II). All athletes were categorized into two groups based on symptoms and duration of COVID-19: Group 1 had no cardiopulmonary symptoms and duration ≤7 days, and; Group 2 had cardiopulmonary symptoms or disease duration >7 days.</p><p><strong>Results: </strong>In total 121 athletes who tested positive for SARS-CoV-2 were investigated. Cardiac involvement was identified in 2/121 (2%) and pulmonary involvement in 15/121 (12%) participants. In group 1, 87 (72%), no athletes presented with signs of cardiac involvement, and 8 (7%) were diagnosed with radiological COVID-19-related findings or obstructive lung function. In group 2, 34 (28%), two had myocarditis (6%), and 8 (24%) were diagnosed with radiological COVID-19-related findings or obstructive lung function.</p><p><strong>Conclusions: </strong>These clinically-driven data show no signs of cardiac involvement among athletes who tested positive for SARS-CoV-2 infection without cardiopulmonary symptoms and duration <7 days. Athletes with cardiopulmonary symptoms or prolonged duration of COVID-19 display, exercise-limiting cardiopulmonary involvement.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/47/17/ZECR_10_2149919.PMC9744211.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10730541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to treatment guidelines and good asthma control in Finland.","authors":"Johanna Pakkasela,&nbsp;Petri Salmela,&nbsp;Pekka Juntunen,&nbsp;Jussi Karjalainen,&nbsp;Lauri Lehtimäki","doi":"10.1080/20018525.2022.2149918","DOIUrl":"https://doi.org/10.1080/20018525.2022.2149918","url":null,"abstract":"<p><strong>Background: </strong>Asthma program in Finland decreased asthma-related mortality and expenses of care on national level, but there is lack of data on adherence to treatment guidelines and disease control on individual level. We aimed to assess adherence to guidelines and disease control among Finnish adult asthmatics.</p><p><strong>Methods: </strong>Questionnaires were sent in Finland to 2000 randomly selected recipients aged 18-80 years, who had bought medication for obstructive airways disease during the previous 12 months. The questionnaire included questions on asthma medication, exacerbations, self-management and follow-up. Asthma symptom control was assessed by the Asthma Control Test (ACT).</p><p><strong>Results: </strong>A high proportion (82.4%) of the 541 responders with physician-diagnosed asthma reported regular use of asthma medication and 97.1% of them used inhaled corticosteroids. Almost all (97.0%) of the asthmatics were taught how to use their inhaler and 78.4% had an asthma self-management plan, but only 35.7% reported regular annual follow-up visits. According to symptoms, 60.0% had their asthma well-controlled (ACT score ≥20). On the other hand, 29.2% had a course of oral corticosteroid and 21.8% had an asthma-related unscheduled health care visit during the previous year, but only 2.6% reported a hospitalization. Asthma control was better in those not using regular asthma medication.</p><p><strong>Conclusions: </strong>The guidelines are well adopted in Finnish adult asthma care except for regular follow-up visits. Majority of patients had good symptom control and hospitalizations were rare. Better asthma control among those not using regular asthma medication implies they are not undertreated but have a mild disease.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c3/33/ZECR_10_2149918.PMC9707375.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40456973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to inhaled corticosteroids in relation to quality of life and symptoms of anxiety and depression in asthma.","authors":"Martino Renzi-Lomholt,&nbsp;Kjell Erik Julius Håkansson,&nbsp;Charlotte Suppli Ulrik","doi":"10.1080/20018525.2022.2149920","DOIUrl":"https://doi.org/10.1080/20018525.2022.2149920","url":null,"abstract":"<p><strong>Background: </strong>Poor asthma control, often caused by non-adherence with controller medication, is a well-known risk factor for impaired quality of life (QoL) and major mood disorders (MMD). Previous studies have shown a relationship between non-adherence, lower QoL, and MMD across chronic diseases, but the relationship remains uncertain in asthma.</p><p><strong>Methods: </strong>All asthma patients followed at the respiratory outpatient clinic at Copenhagen University Hospital - Hvidovre were invited to fill-in the Hospital Anxiety and Depression Scale (HADS) and the Mini Asthma Quality of Life Questionnaire (miniAQLQ). Medication Possession Ratio (MPR) was calculated using pharmacy redemption data. Relationships between questionnaire scores, inhaled corticosteroid MPR and use of rescue medication were investigated using Pearson correlation and multivariable linear regression adjusted for age, sex, FEV₁, and GINA Step. Data from scheduled visits were collected from patients' medical records.</p><p><strong>Results: </strong>A total of 308 patients (73% females, median age 51 years (interquartile range (IQR) 37, 62)) completed the questionnaires and had 1-year medication data available. Median adherence to inhaled corticosteroids (ICS) was 57% (35%, 75%) with 18% of patients having adherence above 80%. Of the participating patients, 14% and 27% reported depressive and anxiety-related symptoms, respectively, and 72% reported impaired QoL. In correlation analyses, ICS adherence was not significantly associated with either prevalence of MMD symptoms or impaired QoL in asthma patients. However, a strong correlation was found between ACQ-6 and both MMD symptoms and impaired QoL, as well as between rescue medication use and impaired QoL. In adjusted analysis, however, the latter correlation was no longer statistically significant.</p><p><strong>Conclusion: </strong>Our results suggest that ICS adherence is not directly correlated with either impaired quality of life or major mood disorder symptoms in asthma patients. Self-reported asthma control, on the other hand, is strongly correlated with both QoL and MMD.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/5f/ZECR_10_2149920.PMC9704108.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40493343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}