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Are young adults with asthma treated sufficiently with inhaled steroids? A population-based study of prescription data from 1991 and 1994.

https://arctichealth.org/en/permalink/ahliterature15857
Source
Br J Clin Pharmacol. 1996 Apr;41(4):285-9
Publication Type
Article
Date
Apr-1996
Author
D. Gaist
J. Hallas
N C Hansen
L F Gram
Author Affiliation
Department of Clinical Pharmacology, Odense University, Denmark.
Source
Br J Clin Pharmacol. 1996 Apr;41(4):285-9
Date
Apr-1996
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adrenergic beta-Agonists - therapeutic use
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Cross-Sectional Studies
Denmark
Drug Information Services
Female
Humans
Male
Pharmacoepidemiology
Abstract
1. We conducted a descriptive cross-sectional study of asthma therapy among young adults to assess to what extent the current guidelines for asthma therapy have been implemented. In particular, we examined the use of inhaled corticosteroids in heavy users of inhaled beta-adrenoceptor agonists. 2. Data were retrieved from a population-based prescription database. For each of the years 1991 and 1994, all 20 to 44-year-olds who redeemed anti-asthma medication in the Odense area (210,000 inhabitants) were studied. 3. We identified the number of users and total sales volume for specific anti-asthma medications in defined daily doses (DDD) as well as the number of users and median annual doses of common regimens. Combined use of inhaled corticosteroids and inhaled beta-adrenoceptor agonists was also described. 4. The annual sales volume of anti-asthma drugs increased by 23% to 927,636 DDD from 1991 to 1994. Inhaled corticosteroids were mainly responsible for this with a 52% increase in number of users and an 88% increase in DDD. Inhaled beta-adrenoceptor agonists used in monotherapy remained the most popular regimen in 1994 (1685 users = 39%). Inhaled corticosteroids in combination with inhaled beta-adrenoceptor agonist were the second most popular regimen in 1994 (1308 users = 30%), increasing by 64% as compared with 1991. However, among patients with an annual use of inhaled beta-adrenoceptor agonist of 200 DDD (1600 "puffs') or more the percent of patients not receiving inhaled corticosteroids at all only fell from 37 to 33%. Though the number of patients being treated with inhaled corticosteroids has increased, there is still evidence of a substantial underuse.
PubMed ID
8730973 View in PubMed
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Interaction between asthma and lung function growth in early life.

https://arctichealth.org/en/permalink/ahliterature125681
Source
Am J Respir Crit Care Med. 2012 Jun 1;185(11):1183-9
Publication Type
Article
Date
Jun-1-2012
Author
Hans Bisgaard
Signe M Jensen
Klaus Bønnelykke
Author Affiliation
Copenhagen Prospective Studies on Asthma in Childhood; Health Sciences, University of Copenhagen, Copenhagen, Denmark. bisgaard@copsac.com
Source
Am J Respir Crit Care Med. 2012 Jun 1;185(11):1183-9
Date
Jun-1-2012
Language
English
Publication Type
Article
Keywords
Age Factors
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - physiopathology - prevention & control
Breath Tests
Bronchial Hyperreactivity - diagnosis - physiopathology
Child Development - physiology
Child, Preschool
Denmark
Disease Progression
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Nitric Oxide - analysis
Prospective Studies
Respiratory Function Tests
Risk assessment
Severity of Illness Index
Spirometry - methods
Treatment Outcome
Abstract
The causal direction between asthma and lung function deficit is unknown, but important for the focus of preventive measures and research into the origins of asthma.
To analyze the interaction between lung function development and asthma from birth to 7 years of age.
The Copenhagen Prospective Studies on Asthma in Childhood is a prospective clinical study of a birth cohort of 411 at-risk children. Spirometry was completed in 403 (98%) neonates and again by age 7 in 317 children (77%).
Neonatal spirometry and bronchial responsiveness to methacholine was measured during sedation by forced flow-volume measurements. Asthma was diagnosed prospectively from daily diary cards and clinic visits every 6 months. Children with asthma by age 7 (14%) already had a significant airflow deficit as neonates (forced expiratory flow at 50% of vital capacity second in neonates reduced by 0.34 z score by 1 mo; P = 0.03). This deficit progressed significantly during early childhood (forced expiratory flow at 0.5 seconds in neonates at age 7 reduced by 0.82 z score by age 7; P
PubMed ID
22461370 View in PubMed
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Interrelationships between diagnosed asthma, asthma-like symptoms, and abnormal airway behaviour in adolescence: the Odense Schoolchild Study.

https://arctichealth.org/en/permalink/ahliterature15851
Source
Thorax. 1996 May;51(5):503-509
Publication Type
Article
Date
May-1996
Author
H C Siersted
G. Mostgaard
N. Hyldebrandt
H S Hansen
J. Boldsen
H. Oxhøj
Author Affiliation
Odense Schoolchild Study Group, Odense University Hospital, Denmark.
Source
Thorax. 1996 May;51(5):503-509
Date
May-1996
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Asthmatic Agents - therapeutic use
Asthma - diagnosis - physiopathology - therapy
Bronchial Provocation Tests
Child
Cohort Studies
Denmark
Exercise Test
Forced expiratory volume
Humans
Peak Expiratory Flow Rate
Prospective Studies
Research Support, Non-U.S. Gov't
Respiratory Tract Diseases - diagnosis - physiopathology
Abstract
BACKGROUND: The diagnosis of asthma is based on several characteristics including symptoms and suitable tests of airway lability. However, it is neither clear to what degree various tests and symptoms identify the same subjects, nor how these characteristics are best combined to diagnose asthma. The interrelationships between physician-diagnosed asthma, asthma-like symptoms, and abnormal airway function, as defined by four commonly used tests, have therefore been assessed. METHODS: A population based sample of 495 Danish schoolchildren aged 12-15 years, comprising 292 randomly selected subjects and 203 subjects considered at risk of having or developing asthma, was examined. Symptoms and background information were recorded by questionnaire. The test panel consisted of baseline forced expiratory volume in one second (FEV1%), provocation with treadmill exercise (EXE) and with inhaled methacholine (PD15), and monitoring of peak expiratory flow (PEF) twice daily for two weeks. RESULTS: The sensitivity for diagnosed asthma was highest for PD15 followed by PEF monitoring, whereas specificity for asthma or asthma-like symptoms was marginally higher with the other two tests. Most symptomatic subjects with any positive test were identified by PD15 alone (75%) or in combination with PEF monitoring (89%). PEF variability was more susceptible to treatment with inhaled steroids than the PD15 index. Although inter-test agreement was weak (kappa
PubMed ID
8711678 View in PubMed
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Management of asthma in adults: do the patients get what they need--and want?

https://arctichealth.org/en/permalink/ahliterature77249
Source
Allergy Asthma Proc. 2007 May-Jun;28(3):375-81
Publication Type
Article
Author
Backer Vibeke
Ulrik Charlotte S
Harving Henrik
Lange Peter
Søes-Petersen Ulrik
Plaschke Peter P
Author Affiliation
Respiratory and Allergy Research Unit, Department of Internal Medicine, Bispebjerg Hospital, Copenhagen NV, Denmark. backer@dadlnet.dk
Source
Allergy Asthma Proc. 2007 May-Jun;28(3):375-81
Language
English
Publication Type
Article
Keywords
Adolescent
Adrenergic beta-Agonists - therapeutic use
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - therapy
Denmark
Female
Humans
Middle Aged
Patient Compliance - statistics & numerical data
Patient Education - statistics & numerical data
Questionnaires
Self Care - statistics & numerical data
Abstract
Suboptimal asthma control may be caused by a combination of factors, such as nonadherence to guidelines, lack of compliance, and poor asthma education. The aim was to assess patients' knowledge of asthma and different management strategies, including patients' attitudes toward involvement in treatment decisions. The participants (n=509) were recruited from all parts of Denmark through a web-based panel (Zapera Danmarkspanel). A questionnaire concerning asthma knowledge, compliance, and treatment was fulfilled through the Internet. Among the participating adult asthmatic patients, signs of uncontrolled disease with night asthma (16%), daily symptoms (18%), or exercise-induced asthma (11%) were found. Of 285 participants with persistent asthma, 70% used inhaled corticosteroids. Lung function was measured within the preceding 6 months in 24% of patients, whereas 7% had never had their lung function measured and peak flow monitoring was reported by 5%. Written action plans were provided for 12% of patients and 50% had had their inhaler technique checked. Although 59% of patients were instructed to adjust their controller therapy if needed, only 23% reported that they had done so. In conclusion, this study of adult asthmatic patients revealed an important deficit in patient education, little use of lung function measurements, and poor compliance with guidelines for asthma management. Furthermore, asthmatic patients want more education, although they do not use it when provided by their doctor, indicating that change in educational strategy is needed.
PubMed ID
17619570 View in PubMed
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Prematurity and prescription asthma medication from childhood to young adulthood: a Danish national cohort study.

https://arctichealth.org/en/permalink/ahliterature267390
Source
PLoS One. 2015;10(2):e0117253
Publication Type
Article
Date
2015
Author
Anne Louise Damgaard
Bo Mølholm Hansen
René Mathiasen
Frederik Buchvald
Theis Lange
Gorm Greisen
Source
PLoS One. 2015;10(2):e0117253
Date
2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - etiology
Bronchopulmonary Dysplasia - complications
Child
Child, Preschool
Cohort Studies
Cross-Sectional Studies
Denmark
Female
Gestational Age
Humans
Infant
Infant, Newborn
Male
Odds Ratio
Pregnancy
Premature Birth
Prescription Drugs - therapeutic use
Respiratory Distress Syndrome, Newborn - complications
Young Adult
Abstract
Preterm birth is associated with increased risk of asthma-like symptoms and purchase of prescription asthma medication in childhood. We investigated whether this association persists into adulthood and whether it is affected by accounting for neonatal respiratory morbidity (acute respiratory disease and bronchopulmonary dysplasia).
A national cohort of all infants born in Denmark in the period 1980-2009 was included in this register study. Data on purchase of asthma medication (combination of inhaled ?-2 agonists and other drugs for obstructive airway disease) in 2010-2011 were obtained from the Danish National Prescription Registry. Associations between gestational age (GA), neonatal respiratory morbidity and a cross-sectional evaluation of asthma medication purchase were explored by multivariate logistic regressions.
A full dataset was obtained on 1,790,241 individuals, 84.6% of all infants born in the period. Odds-ratios (95% CI) for the association between GA and purchase of asthma medication during infancy were: 3.86 (2.46-6.04) in GA 23-27 weeks, 2.37 (1.84-3.04) in GA 28-31 weeks and 1.59 (1.43-1.77) in GA 32-36 weeks compared to term infants with GA 37-42 weeks. Associations weakened in older age groups and became insignificant in young adults born extremely and very preterm with odds-ratios: 1.41 (0.63-3.19) and 1.15 (0.83-1.60) in GA 23-27 and 28-31 respectively. When adjusting for neonatal respiratory morbidity, the associations weakened but persisted both in childhood and adolescence.
There was a strong dose-response association between gestational age and the purchase of prescription asthma medication in infancy and childhood. This association weakened during adolescence and was mostly non-significant in young adulthood. The increased risk of prescription asthma medication purchase in ex-preterm children could only partly be explained by neonatal respiratory morbidity.
Notes
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PubMed ID
25651521 View in PubMed
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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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Treatment of exercise-induced asthma with beclomethasone dipropionate in children with asthma.

https://arctichealth.org/en/permalink/ahliterature15113
Source
Eur Respir J. 2004 Dec;24(6):932-7
Publication Type
Article
Date
Dec-2004
Author
R. Petersen
L. Agertoft
S. Pedersen
Author Affiliation
Dept of Paediatrics, Kolding Hospital, 6000 Kolding, Denmark. sumsar68@hotmail.com
Source
Eur Respir J. 2004 Dec;24(6):932-7
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adolescent
Aerosol Propellants - therapeutic use
Aerosols
Analysis of Variance
Anti-Asthmatic Agents - therapeutic use
Area Under Curve
Asthma, Exercise-Induced - drug therapy
Beclomethasone - therapeutic use
Child
Child, Preschool
Cross-Over Studies
Denmark
Double-Blind Method
Exercise Test
Female
Forced expiratory volume
Humans
Hydrocarbons, Fluorinated - therapeutic use
Male
Nitric Oxide - metabolism
Research Support, Non-U.S. Gov't
Respiratory Function Tests
Treatment Outcome
Abstract
A new hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP) aerosol markedly increases drug delivery to the airways. Therefore, even low doses of HFA-BDP should be effective, and the present study assesses this. A randomised, double-blind, crossover study was used to compare the effect of placebo, HFA-BDP 50 microg or 100 microg given q.d. (QVAR(TM) Autohaler(TM); 3M Pharmaceuticals, St. Paul, MN, USA) on exercise-induced bronchoconstriction and exhaled nitric oxide (eNO). After a 14-day run-in, 25 children (5-14 yrs old) entered three 4-week treatment periods, separated by a 1-week washout. After each period, the fall in forced expiratory volume in one second (FEV1), after an exercise test, and eNO were measured. Significant treatment effects with no carry-over or period effects were seen for both eNO and maximum fall in FEV1 after exercise. Differences were seen between placebo (fall in FEV1=27.9%; eNO=14.4 parts per billion (ppb)) and either dose of HFA-BDP, but not between the two active doses (50 microg: fall in FEV1=20.8%, eNO=9.3 ppb; 100 microg: fall in FEV1=20.9%, eNO=8.9 ppb). In conclusion, low q.d. doses of hydrofluoroalkane-beclomethasone dipropionate reduced exhaled nitric oxide and exercise-induced bronchoconstriction. Further studies are needed to assess whether q.d. administration of beclomethasone dipropionate is as effective as b.i.d. administration.
PubMed ID
15572534 View in PubMed
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7 records – page 1 of 1.