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Scheduled asthma management in general practice generally improve asthma control in those who attend.

https://arctichealth.org/en/permalink/ahliterature126849
Source
Respir Med. 2012 May;106(5):635-41
Publication Type
Article
Date
May-2012
Author
Vibeke Backer
Maja Bornemann
Dorte Knudsen
Henrik Ommen
Author Affiliation
Dept of Respiratory Medicine L, Respiratory Research Unit, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark. backer@dadlnet.dk
Source
Respir Med. 2012 May;106(5):635-41
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - physiopathology - therapy
Delivery of Health Care - organization & administration
Denmark
Female
Forced Expiratory Volume - physiology
General Practice - organization & administration
Guideline Adherence
Humans
Long-Term Care - organization & administration
Male
Medication Adherence
Middle Aged
Practice Guidelines as Topic
Smoking - adverse effects
Treatment Outcome
Young Adult
Abstract
Successful asthma management involves guideline-based treatment and regular follow-up. We aimed to study the level of disease control in asthmatic individuals managed by their GP and a dedicated nurse when using a systematic asthma consultation guide based on Global Initiative of Asthma guidelines (GINA guidelines).
Patients aged 18-79 years with doctor-diagnosed asthma were included. When managing the patients, the clinics were instructed to follow a consultation guide based on the principles of the GINA guidelines. This included evaluation of symptoms, treatment, compliance, lung function, and a scheduled follow-up appointment based on the level of asthma control:
At the initial visit (baseline), 684 patients (36.8%) were classified as well-controlled, 740 (39.8%) as partly controlled and 434 (23.4%) as uncontrolled. 1784 patients had been offered a follow-up visit and 623 (35%) had attended. A response analysis was performed, and those participating were older (46 versus 45 years, p 
PubMed ID
22349066 View in PubMed
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[Possibility of achieving and maintaining asthma control in patients with bronchial cold hyperreactivity].

https://arctichealth.org/en/permalink/ahliterature104383
Source
Ter Arkh. 2014;86(3):40-4
Publication Type
Article
Date
2014
Author
V P Kolosov
A B Pirogov
Iu M Perel'man
T A Mal'tseva
A G Prikhod'ko
Source
Ter Arkh. 2014;86(3):40-4
Date
2014
Language
Russian
Publication Type
Article
Keywords
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - epidemiology - physiopathology
Beclomethasone - therapeutic use
Bronchial Hyperreactivity - diagnosis - epidemiology - etiology
Cold Temperature - adverse effects
Discriminant Analysis
Disease Management
Disease Progression
Emergency Medical Services - methods - statistics & numerical data
Female
Humans
Longitudinal Studies
Male
Middle Aged
Respiratory Function Tests - methods
Russia - epidemiology
Seasons
Abstract
To evaluate the clinical efficiency of tactics to widen the scope of monotherapy with inhaled glucocorticosteroids (IGCS) in asthmatic patients with bronchial cold hyperreactivity (BCHR) during winter to achieve control of the disease in real clinical practice.
An open-label longitudinal study was conducted in a cold period in 106 asthmatics divided into 2 groups: 1) those with BCHR and 2) those with unchanged bronchial reactivity to a cold stimulus. The study involved monitoring the symptoms by the asthma control test, peak expiratory flow rate (PEFR), and spirometry results before and after cold bronchoprovocation testing; assessment of the pattern of bronchial inflammation from the ratios of induced sputum (IS) cell populations; and estimation of the number of asthma exacerbations and emergency care recourses. Group 1 used a stepwise increase of the scope of basic therapy with beclomethasone dipropionate 1000 microg/day until asthma control was achieved, which was followed by the therapy with the stable dose. Group 2 received monotherapy with beclomethasone dipropionate as the stable dosage of
PubMed ID
24779069 View in PubMed
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Redemption of asthma pharmaceuticals among stainless steel and mild steel welders: a nationwide follow-up study.

https://arctichealth.org/en/permalink/ahliterature272123
Source
Int Arch Occup Environ Health. 2015 Aug;88(6):743-50
Publication Type
Article
Date
Aug-2015
Author
Pernille Kristiansen
Kristian Tore Jørgensen
Johnni Hansen
Jens Peter Bonde
Source
Int Arch Occup Environ Health. 2015 Aug;88(6):743-50
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Adult
Air Pollutants, Occupational - toxicity
Anti-Asthmatic Agents - therapeutic use
Asthma, Occupational - drug therapy - epidemiology - etiology
Cohort Studies
Denmark - epidemiology
Drug Prescriptions - statistics & numerical data
Follow-Up Studies
Humans
Incidence
Inhalation Exposure - adverse effects
Male
Middle Aged
Particulate Matter - toxicity
Proportional Hazards Models
Registries
Risk factors
Smoking
Steel
Surveys and Questionnaires
Time Factors
Welding
Abstract
The purpose was to examine bronchial asthma according to cumulative exposure to fume particulates conferred by stainless steel and mild steel welding through a proxy of redeemed prescribed asthma pharmaceuticals.
A Danish national company-based historical cohort of 5,303 male ever-welders was followed from 1995 to 2011 in the Danish Medicinal Product Registry to identify the first-time redemption of asthma pharmaceuticals including beta-2-adrenoreceptor agonists, adrenergic drugs for obstructive airway diseases and inhalable glucocorticoids. Lifetime exposure to welding fume particulates was estimated by combining questionnaire data on welding work with a welding exposure matrix. The estimated exposure accounted for calendar time, welding intermittence, type of steel, welding methods, local exhaustion and welding in confined spaces. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a Cox proportional hazards model adjusting for potential confounders and taking modifying effects of smoking into account.
The average incidence of redemption of asthma pharmaceuticals in the cohort was 16 per 1,000 person year (95% CI 10-23 per 1,000 person year). A moderate nonsignificant increased rate of redemption of asthma medicine was observed among high-level exposed stainless steel welders in comparison with low-level exposed welders (HR 1.54, 95% CI 0.76-3.13). This risk increase was driven by an increase risk among non-smoking stainless steel welders (HR 1.46, 95% CI 1.06-2.02). Mild steel welding was not associated with increased risk of use asthma pharmaceuticals.
The present study indicates that long-term exposure to stainless steel welding is related to increased risk of asthma in non-smokers.
PubMed ID
25408460 View in PubMed
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Suboptimal asthma control: prevalence, detection and consequences in general practice.

https://arctichealth.org/en/permalink/ahliterature160627
Source
Eur Respir J. 2008 Feb;31(2):320-5
Publication Type
Article
Date
Feb-2008
Author
K R Chapman
L P Boulet
R M Rea
E. Franssen
Author Affiliation
University of Toronto, Canada. kchapman@ca.inter.net
Source
Eur Respir J. 2008 Feb;31(2):320-5
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - drug therapy - epidemiology
Attitude of Health Personnel
Bronchodilator Agents - therapeutic use
Chi-Square Distribution
Confidence Intervals
Cross-Sectional Studies
Family Practice - standards - trends
Female
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Office visits - statistics & numerical data
Ontario - epidemiology
Patient satisfaction
Physician's Practice Patterns - statistics & numerical data
Physician-Patient Relations
Prevalence
Questionnaires
Respiratory Function Tests
Risk assessment
Severity of Illness Index
Treatment Outcome
Abstract
Telephone surveys describing suboptimal asthma control may be biased by low response rates. In order to obtain an unbiased assessment of asthma control and assess its impact in primary care, primary care physicians used a 1-page control questionnaire in 50 consecutive asthma patients. Of the 10,428 patients assessed by 354 physicians, 59% were uncontrolled, 19% well-controlled and 23% totally controlled. Physicians overestimated control, regarding only 42% of patients as uncontrolled. Physicians were more likely to report plans to alter the regimens of uncontrolled patients than controlled patients (1.29 versus 0.20 medication changes per patient) doing so in a fashion consistent with guideline recommendations. Of the uncontrolled patients, 59% required one or more urgent care or specialist visits versus 26 and 15% of well-controlled or totally controlled patients, respectively. Patients were more likely to report short-term symptom control when they had not required urgent or specialist care (odds ratio 5.68; 95% confidence interval 4.91-6.58). The majority of asthma patients treated in general practice are uncontrolled. Lack of control can be recognised by physicians who are likely to consider appropriate changes to therapy. A lack of short-term symptom control of asthma is associated with excess healthcare utilisation.
Notes
Comment In: Eur Respir J. 2008 Feb;31(2):229-3118238943
PubMed ID
17959642 View in PubMed
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Asthma control in Canada: no improvement since we last looked in 1999.

https://arctichealth.org/en/permalink/ahliterature161311
Source
Can Fam Physician. 2007 Apr;53(4):672-7
Publication Type
Article
Date
Apr-2007
Author
R Andrew McIvor
Louis-Philippe Boulet
J Mark FitzGerald
Sabrina Zimmerman
Kenneth R Chapman
Author Affiliation
McMaster University and Firestone Institute for Respiratory Health, St Joseph's Healthcare, 50 Charlton Ave E, Hamilton, ON L8N 4A6. amcivor@stjosham.on.ca
Source
Can Fam Physician. 2007 Apr;53(4):672-7
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Administration, Oral
Adolescent
Adult
Age Distribution
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - epidemiology - therapy
Canada
Confidence Intervals
Delivery of Health Care
Family Practice - methods
Female
Health Services Research
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Patient Compliance - statistics & numerical data
Patient Education as Topic
Questionnaires
Risk assessment
Severity of Illness Index
Sex Distribution
Survival Analysis
Treatment Outcome
Abstract
To determine whether asthma control in Canada had improved since the last major survey in 1999 by exploring how well patients' asthma was controlled, how much they knew about asthma control, and how they used health care resources.
National telephone survey of patients between April and August 2004.
Canada.
Eight hundred ninety-three adults 18 to 54 years old diagnosed with asthma more than 6 months before the survey.
Patients' control of their asthma, patients' knowledge about asthma, the frequency and duration of periods of worsening asthma, and patients' use of health care resources to manage those periods.
In total, 26,210 households listed in a consumer database were contacted. Excluding ineligible households and households with a language barrier, a member of 13% of the households completed the 35-minute survey. Based on definitions in Canadian guidelines, 53% of patients had symptomatic uncontrolled asthma. In the previous year, almost all asthma patients had experienced worsening of symptoms that lasted on average 13.6 days for patients with uncontrolled asthma and 8.0 days for patients with controlled asthma (P
Notes
Cites: Int Arch Allergy Immunol. 2000;121 Suppl 1:I-VIII, 1-7710824704
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Cites: CMAJ. 1999 Nov 30;161(11 Suppl):S1-6110906907
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Comment In: Can Fam Physician. 2010 Oct;56(10):976-7, e355-620944031
PubMed ID
17872718 View in PubMed
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Attenuation of the September epidemic of asthma exacerbations in children: a randomized, controlled trial of montelukast added to usual therapy.

https://arctichealth.org/en/permalink/ahliterature161582
Source
Pediatrics. 2007 Sep;120(3):e702-12
Publication Type
Article
Date
Sep-2007
Author
Neil W Johnston
Piush J Mandhane
Jennifer Dai
Joanne M Duncan
Justina M Greene
Kim Lambert
Malcolm R Sears
Author Affiliation
Firestone Institute for Respiratory Health, St Joseph's Healthcare, 50 Charlton Ave E, Hamilton, Ontario, Canada L8N 4A6. njohnsto@mcmaster.ca
Source
Pediatrics. 2007 Sep;120(3):e702-12
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Acetates - therapeutic use
Adolescent
Adrenal Cortex Hormones - therapeutic use
Adrenergic beta-Agonists - therapeutic use
Age Factors
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - epidemiology
Child
Child, Preschool
Common Cold - epidemiology
Disease Outbreaks - prevention & control
Double-Blind Method
Drug Therapy, Combination
Female
Humans
Male
Multivariate Analysis
Office visits - statistics & numerical data
Ontario - epidemiology
Questionnaires
Quinolines - therapeutic use
Schools
Seasons
Severity of Illness Index
Sex Factors
Abstract
A recurring epidemic of asthma exacerbations in children occurs annually in September in North America when school resumes after summer vacation.
Our goal was to determine whether montelukast, added to usual asthma therapy, would reduce days with worse asthma symptoms and unscheduled physician visits of children during the September epidemic.
A total of 194 asthmatic children aged 2 to 14 years, stratified according to age group (2-5, 6-9, and 10-14 years) and gender, participated in a double-blind, randomized, placebo-controlled trial of the addition of montelukast to usual asthma therapy between September 1 and October 15, 2005.
Children randomly assigned to receive montelukast experienced a 53% reduction in days with worse asthma symptoms compared with placebo (3.9% vs 8.3%) and a 78% reduction in unscheduled physician visits for asthma (4 [montelukast] vs 18 [placebo] visits). The benefit of montelukast was seen both in those using and not using regular inhaled corticosteroids and among those reporting and not reporting colds during the trial. There were differences in efficacy according to age and gender. Boys aged 2 to 5 years showed greater benefit from montelukast (0.4% vs 8.8% days with worse asthma symptoms) than did older boys, whereas among girls the treatment effect was most evident in 10- to 14-year-olds (4.6% [montelukast] vs 17.0% [placebo]), with nonsignificant effects in younger girls.
Montelukast added to usual treatment reduced the risk of worsened asthma symptoms and unscheduled physician visits during the predictable annual September asthma epidemic. Treatment-effect differences observed between age and gender groups require additional investigation.
Notes
Comment In: Pediatrics. 2008 Jun;121(6):1289; author reply 1289-9018519503
PubMed ID
17766511 View in PubMed
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Impact on patients' health status following early identification of a COPD exacerbation.

https://arctichealth.org/en/permalink/ahliterature161771
Source
Eur Respir J. 2007 Nov;30(5):907-13
Publication Type
Article
Date
Nov-2007
Author
J. Bourbeau
G. Ford
H. Zackon
N. Pinsky
J. Lee
G. Ruberto
Author Affiliation
Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, 3650 St Urbain, Montréal, QC, Canada. jean.bourbeau@mcgill.ca
Source
Eur Respir J. 2007 Nov;30(5):907-13
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adrenal Cortex Hormones - therapeutic use
Adult
Aged
Aged, 80 and over
Anti-Asthmatic Agents - therapeutic use
Budesonide - therapeutic use
Canada
Drug Combinations
Ethanolamines - therapeutic use
Female
Health status
Humans
Logistic Models
Male
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive - drug therapy - physiopathology
Questionnaires
Treatment Outcome
Abstract
The current study aimed to assess the impact on patient health status during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A total of 421 COPD patients were enrolled in a multicentre, single-arm study with a 6-month observational follow-up period. Patients received two inhalations of Symbicort 200 Turbuhaler(R) twice a day. Patients were assessed before the run-in period, at baseline and at 1, 3 and 6 months. Patients were instructed to report a change in respiratory symptoms lasting >24 h. This defined an AECOPD. In addition to the initial call, the St George's Respiratory Questionnaire (SGRQ), COPD Control Questionnaire (CCQ), Medical Research Council (MRC) dyspnoea scale and activities of daily living (ADL) were completed at 5-7 and 12-14 days. A group of 176 patients reported at least one AECOPD. Exacerbations were associated with statistically significant mean changes (worsening) in the SGRQ activity and impact domains at onset (mean +/- sd 12.1 +/- 18.1 and 14.0 +/- 15.2), during the first (9.8 +/- 19.0 and 9.4 +/- 16.6) and second weeks (3.1 +/- 15.5 and 3.3 +/- 14.7). Clinically significant deterioration in SGRQ impact scores was shown in 71% of patients following early identification, with 55 and 37% during the first and second weeks of an AECOPD, respectively. Acute exacerbation severely impacts on health status. The current study provides valuable information on the change in health status during an acute exacerbation of chronic obstructive pulmonary disease that can be utilised for future trials that evaluate therapeutic intervention.
PubMed ID
17715163 View in PubMed
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Risk of asthma in young adults who were born preterm: a Swedish national cohort study.

https://arctichealth.org/en/permalink/ahliterature136014
Source
Pediatrics. 2011 Apr;127(4):e913-20
Publication Type
Article
Date
Apr-2011
Author
Casey Crump
Marilyn A Winkleby
Jan Sundquist
Kristina Sundquist
Author Affiliation
Department of Medicine, Stanford University, Palo Alto, California, USA. kccrump@stanford.edu
Source
Pediatrics. 2011 Apr;127(4):e913-20
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - epidemiology
Child
Child, Preschool
Cohort Studies
Female
Gestational Age
Health Surveys
Humans
Infant
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature, Diseases - drug therapy - epidemiology
Infant, Very Low Birth Weight
Longitudinal Studies
Male
Pregnancy
Risk factors
Sex Factors
Socioeconomic Factors
Sweden
Young Adult
Abstract
Preterm birth is associated with asthma-like symptoms in childhood and possibly in adolescence, but the longer-term risk of asthma is unknown and increasingly relevant as larger numbers of these individuals enter adulthood. Our objective was to evaluate whether those who were born preterm are more likely to be prescribed asthma medications in young adulthood than those who were born term.
We conducted a national cohort study of all singleton infants born in Sweden from 1973 through 1979 (n = 622 616), followed to ages 25.5 to 35.0 years to determine whether asthma medications were prescribed in 2005-2007. Asthma medication data were obtained from all outpatient and inpatient pharmacies throughout Sweden. To improve the positive predictive value for asthma, the outcome was defined as prescription of (1) both a ß-2 agonist inhalant and a glucocorticoid inhalant or (2) a combination inhalant containing a ß-2 agonist and other drugs for obstructive airway diseases.
Young adults who were born extremely preterm (23-27 weeks' gestation) were 2.4 times more likely (adjusted 95% CI: 1.41-4.06) to be prescribed asthma medications than those who were born term. No association was found between later preterm birth (28-32 or 33-36 weeks' gestation) and asthma medications in young adulthood.
This is the first study with sufficient statistical power to evaluate the risk of asthma beyond adolescence in individuals who were born extremely preterm. The results suggest that extreme preterm birth (23-27 weeks' gestation), but not later preterm birth, is associated with an increased risk of asthma at least into young adulthood.
Notes
Cites: Respir Res. 2005;6:11716223446
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PubMed ID
21422091 View in PubMed
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Corticosteroid therapy and need for hospital care in wheezing preschool children.

https://arctichealth.org/en/permalink/ahliterature196128
Source
Eur J Clin Pharmacol. 2000 Nov;56(8):591-6
Publication Type
Article
Date
Nov-2000
Author
P. Csonka
J. Mertsola
T. Klaukka
M. Kaila
M R Ståhlberg
P. Ashorn
Author Affiliation
University of Tampere, Medical School, P.O. Box 607, FIN-33101 Tampere, Finland. peter.csonka@uta.fi
Source
Eur J Clin Pharmacol. 2000 Nov;56(8):591-6
Date
Nov-2000
Language
English
Publication Type
Article
Keywords
Adrenal Cortex Hormones - economics - therapeutic use
Anti-Asthmatic Agents - therapeutic use
Anti-Inflammatory Agents - economics - therapeutic use
Asthma - complications - drug therapy - epidemiology
Child
Child, Preschool
Emergency Service, Hospital
Female
Finland - epidemiology
Hospitalization
Humans
Incidence
Infant
Length of Stay
Male
Respiratory Sounds - etiology
Retrospective Studies
Treatment Outcome
Abstract
To study the frequency of corticosteroid therapy and the use of inpatient care for preschool children with wheezing in two regions in Finland.
The Finnish Social Insurance Institution database on refundable asthma medication indicated that 1.18% of children in Tampere and 2.37% in Turku used inhaled corticosteroids regularly. To clarify the difference, hospital records of 800 randomly chosen 0.5-6.9-year-old children who had been treated for wheezing in Tampere or Turku University Hospital during 1995-1996 were retrospectively analysed.
The incidences of wheezing-related emergency room (ER) index visits were 11.0 visits/year/1000 children both in Tampere and Turku. Oral corticosteroids were given to 2.5% versus 24.2% of children in ER and 10.6% versus 89.7% in hospital ward in Tampere and Turku, respectively. Hospitalisation rates were 44.8% in Tampere and 36.8% in Turku (95% confidence interval for the difference 1.2-14.8%). In both regions, children with prior inhaled corticosteroid therapy needed less inpatient care. Mean duration of hospitalisation was 3.4 days in Tampere and only 1.4 days in Turku. Recurrent visits in 6 months were more common in Tampere.
There were marked regional differences in the management of preschool children with wheezing. On a population level, frequent use of corticosteroid therapy was associated with reduced hospital admissions.
PubMed ID
11151750 View in PubMed
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Medication persistence among patients with asthma/COPD drugs.

https://arctichealth.org/en/permalink/ahliterature93683
Source
Pharm World Sci. 2008 Oct;30(5):509-14
Publication Type
Article
Date
Oct-2008
Author
Haupt Dan
Krigsman Kristin
Nilsson J Lars G
Author Affiliation
Health Sciences, Luleå Tecnical University, 971 87 Lulea, Sweden.
Source
Pharm World Sci. 2008 Oct;30(5):509-14
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Databases, Factual
Female
Glucocorticoids - therapeutic use
Humans
Male
Medication Adherence - statistics & numerical data
Middle Aged
Pulmonary Disease, Chronic Obstructive - drug therapy
Sweden - epidemiology
Treatment Outcome
Young Adult
Abstract
OBJECTIVE: To determine medication possession ratio (MPR) of patients with asthma/COPD drugs. METHOD: Individual patient's volumes of asthma/COPD drugs (ATC-code R03) for 2000-2004 were obtained from a pharmacy record database. For each patient the MPR was calculated as the percentage of the treatment time that the patient had drugs available. MAIN OUTCOME MEASURE: Medication possession ratio (MPR). RESULTS: A total of 1,812 patients, 20 years and older, with dispensed asthma/COPD drugs were registered in the database, 928 patients (51%) had acquired drugs less than once per year (68% for 20-29 years old) during the 5-year study. Only 13% of the patients had steroids and steroid combinations available to allow continuous treatment. Eight percent of the patients 20-29 years old had MPR > or = 80% of all the included drugs and 5% when only steroids and steroid combinations were considered. About 25% of the patients had acquired 80% of the total volume of asthma/COPD drugs. CONCLUSION: The majority of the patients, and particularly those in the youngest age group used asthma/COPD drugs only sporadically. This may indicate undermedication which is likely to have a negative impact on patient outcome.
PubMed ID
18247154 View in PubMed
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124 records – page 1 of 13.