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The use of β2-agonist therapy before hospital attendance for severe asthma exacerbations: a post-hoc analysis.

Patel M, Pilcher J, Hancox RJ, Sheahan D, Pritchard A, Braithwaite I, Shaw D, Black P, Weatherall M, Beasley R, SMART Study Gro - NPJ Prim Care Respir Med (2015)

Bottom Line: In both regimens, β2-agonist use increased before hospital attendance, with a median (range) maximum daily number of actuations of 14 (9 to 63) budesonide/formoterol in SMART and 46 (6 to 95) salbutamol in Standard with 4 (0 to 10) budesonide/formoterol actuations on the day of maximal salbutamol use.Different patterns of use were observed, including repeated days of no inhaled corticosteroid despite marked salbutamol use, which occurred in 3/9 patients in the Standard group.The SMART regimen reduced nonadherence with inhaled corticosteroid therapy during severe exacerbations.

View Article: PubMed Central - PubMed

Affiliation: 1] Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK [2] Medical Research Institute of New Zealand, Wellington, New Zealand.

ABSTRACT

Background: Patterns of inhaled β2-agonist therapy use during severe asthma exacerbations before hospital attendance are poorly understood.

Aims: To assess β2-agonist use prior to hospital attendance.

Methods: We undertook an exploratory post hoc analysis of data from a 6-month clinical trial of 303 patients randomised to combination budesonide/formoterol inhaler according to a Single combination inhaler as Maintenance And Reliever Therapy regimen ('SMART') or fixed-dose budesonide/formoterol with salbutamol as reliever ('Standard'). Patterns of β2-agonist use for 14 days before hospital attendance with a severe asthma exacerbation were determined by electronic monitoring of inhaler use.

Results: There were 22 hospital attendances in 16 patients during the study. Seven and nine hospital attendances were eligible for analysis in the SMART and Standard groups, respectively. In both regimens, β2-agonist use increased before hospital attendance, with a median (range) maximum daily number of actuations of 14 (9 to 63) budesonide/formoterol in SMART and 46 (6 to 95) salbutamol in Standard with 4 (0 to 10) budesonide/formoterol actuations on the day of maximal salbutamol use. There was delay in obtaining medical review despite high β2-agonist use, in 9/16 patients. Different patterns of use were observed, including repeated days of no inhaled corticosteroid despite marked salbutamol use, which occurred in 3/9 patients in the Standard group.

Conclusions: Delay in obtaining medical review in association with high β2-agonist use is common in patients before hospital presentation with severe exacerbations of asthma. The SMART regimen reduced nonadherence with inhaled corticosteroid therapy during severe exacerbations.

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Related in: MedlinePlus

Individual patterns of daily budesonide/formoterol use in the 14 days before hospital attendance in the SMART group. Hospital attendances owing to Emergency Department (ED) visit or hospital admission are specified for each participant. The x axis is days preceding or following the first hospital attendance (i.e., day −1 refers to the 24 h before the first hospital attendance, and day 1 refers to the 24 h following the first hospital attendance). Data extraction was for fourteen 24-h periods before the attendance time at hospital. The y axis is the number of actuations per 24 h. Dashed horizontal lines represent the thresholds of β2-agonist use per day above which self-management plans recommend medical review (>12 actuations of budesonide/formoterol per day for SMART patients). (d) The participant self-initiated prednisone for asthma (40 mg per day for 4 days) on day −4 (without subsequent medical review until hospital attendance). (g) The participant had four hospital attendances, identified by the solid arrows (hospital admissions occurred for the first and last attendances; ED visits occurred for the second and third attendances). Before the first ED visit, the participant who attended was seen by their general practitioner (GP). The participant was prescribed prednisone (40 mg per day for 7 days, followed by a weaning course over the next 21 days).
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fig2: Individual patterns of daily budesonide/formoterol use in the 14 days before hospital attendance in the SMART group. Hospital attendances owing to Emergency Department (ED) visit or hospital admission are specified for each participant. The x axis is days preceding or following the first hospital attendance (i.e., day −1 refers to the 24 h before the first hospital attendance, and day 1 refers to the 24 h following the first hospital attendance). Data extraction was for fourteen 24-h periods before the attendance time at hospital. The y axis is the number of actuations per 24 h. Dashed horizontal lines represent the thresholds of β2-agonist use per day above which self-management plans recommend medical review (>12 actuations of budesonide/formoterol per day for SMART patients). (d) The participant self-initiated prednisone for asthma (40 mg per day for 4 days) on day −4 (without subsequent medical review until hospital attendance). (g) The participant had four hospital attendances, identified by the solid arrows (hospital admissions occurred for the first and last attendances; ED visits occurred for the second and third attendances). Before the first ED visit, the participant who attended was seen by their general practitioner (GP). The participant was prescribed prednisone (40 mg per day for 7 days, followed by a weaning course over the next 21 days).

Mentions: In the run-up to the first hospital attendance, two patients self-initiated prednisone: one Standard (who subsequently had GP review) and one SMART. Two patients (both Standard) were prescribed prednisone by a GP (Figures 2 and 3). One patient in the SMART group went to their GP and was then referred in to the hospital that same day.


The use of β2-agonist therapy before hospital attendance for severe asthma exacerbations: a post-hoc analysis.

Patel M, Pilcher J, Hancox RJ, Sheahan D, Pritchard A, Braithwaite I, Shaw D, Black P, Weatherall M, Beasley R, SMART Study Gro - NPJ Prim Care Respir Med (2015)

Individual patterns of daily budesonide/formoterol use in the 14 days before hospital attendance in the SMART group. Hospital attendances owing to Emergency Department (ED) visit or hospital admission are specified for each participant. The x axis is days preceding or following the first hospital attendance (i.e., day −1 refers to the 24 h before the first hospital attendance, and day 1 refers to the 24 h following the first hospital attendance). Data extraction was for fourteen 24-h periods before the attendance time at hospital. The y axis is the number of actuations per 24 h. Dashed horizontal lines represent the thresholds of β2-agonist use per day above which self-management plans recommend medical review (>12 actuations of budesonide/formoterol per day for SMART patients). (d) The participant self-initiated prednisone for asthma (40 mg per day for 4 days) on day −4 (without subsequent medical review until hospital attendance). (g) The participant had four hospital attendances, identified by the solid arrows (hospital admissions occurred for the first and last attendances; ED visits occurred for the second and third attendances). Before the first ED visit, the participant who attended was seen by their general practitioner (GP). The participant was prescribed prednisone (40 mg per day for 7 days, followed by a weaning course over the next 21 days).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4532151&req=5

fig2: Individual patterns of daily budesonide/formoterol use in the 14 days before hospital attendance in the SMART group. Hospital attendances owing to Emergency Department (ED) visit or hospital admission are specified for each participant. The x axis is days preceding or following the first hospital attendance (i.e., day −1 refers to the 24 h before the first hospital attendance, and day 1 refers to the 24 h following the first hospital attendance). Data extraction was for fourteen 24-h periods before the attendance time at hospital. The y axis is the number of actuations per 24 h. Dashed horizontal lines represent the thresholds of β2-agonist use per day above which self-management plans recommend medical review (>12 actuations of budesonide/formoterol per day for SMART patients). (d) The participant self-initiated prednisone for asthma (40 mg per day for 4 days) on day −4 (without subsequent medical review until hospital attendance). (g) The participant had four hospital attendances, identified by the solid arrows (hospital admissions occurred for the first and last attendances; ED visits occurred for the second and third attendances). Before the first ED visit, the participant who attended was seen by their general practitioner (GP). The participant was prescribed prednisone (40 mg per day for 7 days, followed by a weaning course over the next 21 days).
Mentions: In the run-up to the first hospital attendance, two patients self-initiated prednisone: one Standard (who subsequently had GP review) and one SMART. Two patients (both Standard) were prescribed prednisone by a GP (Figures 2 and 3). One patient in the SMART group went to their GP and was then referred in to the hospital that same day.

Bottom Line: In both regimens, β2-agonist use increased before hospital attendance, with a median (range) maximum daily number of actuations of 14 (9 to 63) budesonide/formoterol in SMART and 46 (6 to 95) salbutamol in Standard with 4 (0 to 10) budesonide/formoterol actuations on the day of maximal salbutamol use.Different patterns of use were observed, including repeated days of no inhaled corticosteroid despite marked salbutamol use, which occurred in 3/9 patients in the Standard group.The SMART regimen reduced nonadherence with inhaled corticosteroid therapy during severe exacerbations.

View Article: PubMed Central - PubMed

Affiliation: 1] Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK [2] Medical Research Institute of New Zealand, Wellington, New Zealand.

ABSTRACT

Background: Patterns of inhaled β2-agonist therapy use during severe asthma exacerbations before hospital attendance are poorly understood.

Aims: To assess β2-agonist use prior to hospital attendance.

Methods: We undertook an exploratory post hoc analysis of data from a 6-month clinical trial of 303 patients randomised to combination budesonide/formoterol inhaler according to a Single combination inhaler as Maintenance And Reliever Therapy regimen ('SMART') or fixed-dose budesonide/formoterol with salbutamol as reliever ('Standard'). Patterns of β2-agonist use for 14 days before hospital attendance with a severe asthma exacerbation were determined by electronic monitoring of inhaler use.

Results: There were 22 hospital attendances in 16 patients during the study. Seven and nine hospital attendances were eligible for analysis in the SMART and Standard groups, respectively. In both regimens, β2-agonist use increased before hospital attendance, with a median (range) maximum daily number of actuations of 14 (9 to 63) budesonide/formoterol in SMART and 46 (6 to 95) salbutamol in Standard with 4 (0 to 10) budesonide/formoterol actuations on the day of maximal salbutamol use. There was delay in obtaining medical review despite high β2-agonist use, in 9/16 patients. Different patterns of use were observed, including repeated days of no inhaled corticosteroid despite marked salbutamol use, which occurred in 3/9 patients in the Standard group.

Conclusions: Delay in obtaining medical review in association with high β2-agonist use is common in patients before hospital presentation with severe exacerbations of asthma. The SMART regimen reduced nonadherence with inhaled corticosteroid therapy during severe exacerbations.

Show MeSH
Related in: MedlinePlus