Chest
Clinical InvestigationsASTHMAAmbulatory Use of Inhaled β2-Agonists for the Treatment of Asthma in Quebec: A Population-Based Utilization Review
Section snippets
Materials and Methods
This study was a retrospective drug utilization review of ISAB and ILAB in Quebec, the second largest Canadian province (population 7.4 million).7 Data came from the Prescription Drug Insurance Plan administered by the Régie de l'assurance maladie du Québec (RAMQ), the Quebec health insurance board. The RAMQ plan covers about 3 million people classified into three groups: the elderly (≥ 65 years old), welfare recipients, and those who do not have access to a private group plan.
The study
Results
Results are presented separately for ISAB and ILAB. Table 2shows the demographic characteristics of the study population using ISAB and the proportion of appropriate use according to these characteristics. Most users are adult female patients, and most have had their prescriptions written by general practitioners.
In the group not concurrently taking ICS, the overall proportion of appropriate use was 75%. Appropriateness was higher among female and younger subjects and those treated by
Discussion
The three main findings of this study are that, compared to the recommendations of the Canadian Asthma Consensus Conference, (1) ISAB are overused, (2) ICS seem to be underused, and (3) ILAB are often used improperly. This means that, despite their dissemination among physicians, the Canadian consensus guidelines are far from having been put into practice. Other studies131415161718 also have shown that treatment for asthma was suboptimal. More generally, it has often been demonstrated that
Appendix
In addition to Dr. Blais and Dr. Grégoire, the members of the Comité de revue de l'utilisation des médicaments are Dr. Michelle Lussier-Montplaisir, Mrs. Diane Lamarre, Mr. Élie Assal, Mrs. Danielle Doyon, Dr. Yvon Grand'Maison, Dr. Serge Langlois, and Mr. Pierre Madore. Mrs. Diane Blais, Mrs. Louise Barnard, Mrs. Joelle Mimeault, and Mr. Marc Saindon acted as support staff.
ACKNOWLEDGMENT
The clinicians of the expert panel who worked on the criteria of appropriate use of the study drugs were Dr. Jacques Bouchard, general practitioner; Dr. Louis-Philippe Boulet, respirologist; Dr. André Cartier, respirologist; Dr. Pierre Larivée, respirologist; and Mrs. Rachel Rouleau, pharmacist.
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2017, Revista Brasileira de FarmacognosiaCitation Excerpt :Characterized by airway hyper-responsiveness, bronchospasm and airway inflammation with edema and mucus production, the therapy of asthma is based on the use of β-agonists and other bronchodilators that target bronchospasm, leukotriene antagonists, anti-IgE and corticosteroids that reduce the immune-inflammatory responses (Busse and Lemanske, 2001; Bosnjak et al., 2011; Schäper et al., 2011). However, these anti-asthmatic therapeutics are associated with many adverse effects related mainly the use of corticosteroids (Eggleston et al., 1998; Blais et al., 2001; Wise, 2014). Unwanted side effects of corticosteroids and decreased glucocorticoid responsiveness found in patients with severe asthma have increased the need to develop new anti-asthmatic drugs.
Controlling Asthma by Training of Capnometry-Assisted Hypoventilation (CATCH) vs slow breathing: A randomized controlled trial
2014, ChestCitation Excerpt :Change in perception of obstruction was based on dyspnea and distress differences between maxima during provocation vs saline. Control variables were prescribed inhaled corticosteroid intake (converted to beclomethasone equivalent),27 leukotriene modifier prescription (0 = none and 1 = any use), reported frequency of corticosteroid and leukotriene intake as an indicator of adherence, and cold and flu symptoms in the week prior to assessment (presence = 1, absence = 0). Adverse events were assessed at each visit.
Socioeconomic status and medication prescription patterns in pediatric asthma in Canada
2006, Journal of Adolescent HealthRegular use of corticosteroids and low use of short-acting β<inf>2</inf>-agonists can reduce asthma hospitalization
2005, ChestCitation Excerpt :One canister of salbutamol per month is equivalent to 200 inhalations (100 μg per inhalation) per month or approximately 7 inhalations (700 μg) per day; and according to the National Institutes of Health guidelines, more than one canister use per month is considered to be overreliance on ISABA and inappropriate use of ISABA.3 ICS medications were converted to beclomethasone (aerosol) equivalent using the formula suggested by Blais et al.30,31 One milligram of beclomethasone for nebulizer solution was assumed to be equivalent to 0.1 mg of beclomethasone by metered-dose aerosol. One milligram of beclomethasone for disk inhaler was assumed to be equivalent to 2 mg of beclomethasone by metered aerosol.
Asthma in older children and adolescents seen in an Emergency Room
2002, Revue Francaise d'Allergologie et d'Immunologie Clinique
This study was funded by the Comité de revue de l'utilisation des médicaments of the province of Quebec.
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A complete list of participants is given in the Appendix