Background Severe asthma is a serious condition with a significant burden on patients' morbidity, mortality, and quality of life. Some biological therapies targeting the IgE and interleukin-5 (IL5) mediated pathways are now available. Due to the lack of direct comparison studies, the choice of which medication to use varies. We aimed to explore the beliefs and practices in the use of biological therapies in severe asthma, hypothesizing that differences will occur depending on the prescribers’ specialty and experience. Methods We conducted an online survey composed of 35 questions in English. The survey was circulated via the INterasma Scientific Network (INESNET) platform as well as through social media. Responses from allergists and pulmonologists, both those with experience of prescribing omalizumab with (OMA/IL5) and without (OMA) experience with anti-IL5 drugs, were compared. Results Two hundred eighty-five (285) valid questionnaires from 37 countries were analyzed. Seventy-on percent (71%) of respondents prescribed biologics instead of oral glucocorticoids and believed that their side effects are inferior to those of Prednisone 5 mg daily. Agreement with ATS/ERS guidelines for identifying severe asthma patients was less than 50%. Specifically, significant differences were found comparing responses between allergists and pulmonologists (Chi-square test, p < 0.05) and between OMA/IL5 and OMA groups (p < 0.05). Conclusions Uncertainties and inconsistencies regarding the use of biological medications have been shown. The accuracy of prescribers to correctly identify asthma severity, according to guidelines criteria, is quite poor. Although a substantial majority of prescribers believe that biological drugs are safer than low dose long-term treatment with oral steroids, and that they must be used instead of oral steroids, every effort should be made to further increase awareness. Efficacy as disease modifiers, biomarkers for selecting responsive patients, timing for outcomes evaluation, and checks need to be addressed by further research. Practices and beliefs regarding the use of asthma biologics differ between the prescriber's specialty and experience; however, the latter seems more significant in determining beliefs and behavior. Tailored educational measures are needed to ensure research results are better integrated in daily practice.
Introduction Sepsis is a diagnostic challenge in critically ill patients; especially so in the burn population because the signs and symptoms of sepsis are pervasive after injury. The Sepsis-3 criteria identify organ dysfunction as an acute change in SOFA score ≥ 2 points consequent to infection. The objective of this study was to evaluate if Sepsis-3 criteria were fulfilled when broad-spectrum antimicrobial therapy was started in a burn cohort. Methods We included all adult (≥ 18 years) patients with an acute burn admitted to our burn centre within 2 days of injury between 2016 and 2019. Only patients that received meropenem or piperacillin/tazobactam during their acute hospitalization period were included. Patients were stratified based on the Sepsis-3 definition using evidence of infection and evaluation of organ failure in the 48-hour period prior to the administration of antibiotics. Results We studied 70 patients, with 24 patients in the control group and 46 patients in the Sepsis-3 group. Demographics were similar among the control and Sepsis-3 groups: mean age was 44 ± 18 versus 48 ± 18 years (p=0.372); but injury severity was significantly different: median percent TBSA burn 18% vs. 32% (p=0.003) and proportion of inhalation injury 13% vs. 50% (p=0.002). Length of stay (LOS) was significantly longer in the Sepsis-3 group, control group median 23 days vs. median 43 days (p< 0.001). However, LOS/TBSA was not significantly different in the control group compared to the Sepsis-3 group: median 1.6 vs. 1.4 days per percent TBSA burn (p=0.777). Mortality was similar among the groups: 13% vs. 20% (p=0.526). The proportion of patients diagnosed by a physician with sepsis was also similar with 21% in the control group vs. 33% in the Sepsis-3 group (p=0.406). Conclusions Though the Sepsis-3 group had greater injury severity, mortality, and LOS in-hospital, when normalized to TBSA, was similar. Patients were diagnosed by a physician with sepsis in less than a third of cases. This raises the question of why broad-spectrum antibiotics were started. Potentially, patients were treated based on clinical suspicion of sepsis instead of delaying treatment until diagnosis was confirmed. Benefits of early antibiotic administration must be considered in conjunction with antimicrobial stewardship.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.