BackgroundCurrent asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain.MethodsAn observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®.Results2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively.For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain).ConclusionsIn both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.
Since the first reports demonstrating the ability of a total dose of 2 g/kg body weight (b.w.) of intravenous immunoglobulin (IVIg) to increase the platelet count in patients with autoimmune thrombocytopenic purpura (AITP), the optimal dose has remained controversial. We report the results of a randomized study which compared two low doses of IVIg (0.5 g/kg b.w., group A, n = 19, and 1 g/kg b.w., group B, n = 18) in 37 adults with AITP and platelet count <50 × 109/l, in preparation for surgery or in a situation with a risk of bleeding. On day 4 the proportion of responses, defined by a platelet count > 80 × 109/l and at least twice the initial platelet count, was significantly higher in the group receiving 1 g/kg b.w. (12/18 in group B versus 4/19 in group A, P = 0.005). All but one of the day 4 responders had already responded on day 3. The daily changes in the platelet count from the beginning of IVIg treatment were larger in group B, with a significant difference relative to group A on day 3 (92 × 109/l in group B versus 50 × 109/l in group A, P = 0.03) and on day 4 (106 × 109/l in group B versus 55 × 109/l in group A, P = 0.03). Patients who had not responded by day 4 subsequently received 1.5 g IVIg/kg b.w. (group A) or 1 g IVIg/kg b.w. (group B). A response was observed in 11/13 initial non‐responders in group A, and in 2/6 initial non‐responders in group B. Finally, on day 8, the proportion of responders was 78% (29/37) in the entire group and was similar in the two subgroups. In conclusion, (1) initial treatment with 1 g/kg b.w. of IVIg appeared to be more effective than 0.5 g/kg b.w. in adults with AITP; (2) infusion of a low dose of IVIg did not jeopardize the efficacy of IVIg reinfusion; (3) some adults who did not respond to 1 g IVIg/kg b.w. responded to a higher dose.
Using intravital microscopy of the rat cremaster muscle, we studied the effects of changing red blood cell (RBC) aggregation on RBC arteriolar velocity and perfused capillary density (PCD). To modify RBC aggregation, 2 and/or 10% dextran (molecular weights 40,000, 70,000 or 480,000) or fresh rat plasma was infused into adult male rats via a normovolemic hemodilution procedure. The high-molecular-weight dextrans (70,000 and 480,000) both induced RBC hyperaggregation associated with similar dose-dependent decreases in RBC arteriolar velocity (30 and 40% for dextran concentrations of 2 and 10%, respectively) and in PCD (35 and 37%, respectively, for the two concentrations). Conversely, with 40,000 molecular weight dextran or plasma, we observed a 30% increase in RBC arteriolar velocity, but no change in PCD or hyperaggregation. Intravenous injection of the antiaggregating drug troxerutin (10-3M), either before or after 2% dextran 70,000, significantly inhibited the effects of this dextran on RBC arteriolar velocity and on PCD. We conclude that RBC hyperaggregation can lead to changes in both arteriolar velocity and PCD and may, therefore, impair tissue oxygenation.
Background: The purpose of this study was to evaluate the correlation between immediate responsiveness with the short-acting β 2 -agonist salbutamol and effects of treatment with the ultra-long-acting β 2 -agonist indacaterol in patients with chronic obstructive pulmonary disease (COPD).
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