Anti-asthmatic prescription variability in children according to age

Casares-Alonso, Irene; Garcinuño, Alfredo Cano; Blanco‐Quirós, Alfredo; Pérez-García, I.

doi:10.1016/j.aller.2014.05.010

Cited by 9 publications

(12 citation statements)

References 21 publications

(17 reference statements)

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“…The MetPA analysis revealed seven involved metabolic pathways: arginine and proline metabolism; taurine and hypotaurine metabolism; glycine, serine and threonine metabolism; glyoxylate and dicarboxylate metabolism; methane metabolism; citrate cycle; and pyruvate metabolism. The perturbed metabolic profiles suggest potential metabolic reprogramming associated with a combination treatment of inhaled budesonide and salbutamol in asthmatic children.Glucocorticoids and beta2 agonists represent the most important and frequently used drugs for symptom control in asthmatic children during acute exacerbation [1,2]. Current guidelines recommend the combined use of glucocorticoids and beta2 agonists as the preferred therapy for asthmatic children during acute exacerbation [3,4].…”

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confidence: 99%

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Distinct Metabolic Profile of Inhaled Budesonide and Salbutamol in Asthmatic Children during Acute Exacerbation

Yang

Zhang

et al. 2017

Basic Clin Pharma Tox

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Inhaled budesonide and salbutamol represent the most important and frequently used drugs in asthmatic children during acute exacerbation. However, there is still no consensus about their resulting metabolic derangements; thus, this study was conducted to determine the distinct metabolic profiles of these two drugs. A total of 69 children with asthma during acute exacerbation were included, and their serum and urine were investigated using high-resolution nuclear magnetic resonance (NMR). A metabolomics analysis was performed using a principal component analysis and orthogonal signal correction-partial least squares using SIMCA-P. The different metabolites were identified, and the distinct metabolic profiles were analysed using MetPA. A high-resolution NMR-based serum and urine metabolomics approach was established to study the overall metabolic changes after inhaled budesonide and salbutamol in asthmatic children during acute exacerbation. The perturbed metabolites included 22 different metabolites in the serum and 21 metabolites in the urine. Based on an integrated analysis, the changed metabolites included the following: increased 4-hydroxybutyrate, lactate, cis-aconitate, 5-hydroxyindoleacetate, taurine, trans-4-hydroxy-l-proline, tiglylglycine, 3-hydroxybutyrate, 3-methylhistidine, glucose, cis-aconitate, 2-deoxyinosine and 2-aminoadipate; and decreased alanine, glycerol, arginine, glycylproline, 2-hydroxy-3-methylvalerate, creatine, citrulline, glutamate, asparagine, 2-hydroxyvalerate, citrate, homoserine, histamine, sn-glycero-3-phosphocholine, sarcosine, ornithine, creatinine, glycine, isoleucine and trimethylamine N-oxide. The MetPA analysis revealed seven involved metabolic pathways: arginine and proline metabolism; taurine and hypotaurine metabolism; glycine, serine and threonine metabolism; glyoxylate and dicarboxylate metabolism; methane metabolism; citrate cycle; and pyruvate metabolism. The perturbed metabolic profiles suggest potential metabolic reprogramming associated with a combination treatment of inhaled budesonide and salbutamol in asthmatic children.Glucocorticoids and beta2 agonists represent the most important and frequently used drugs for symptom control in asthmatic children during acute exacerbation [1,2]. Current guidelines recommend the combined use of glucocorticoids and beta2 agonists as the preferred therapy for asthmatic children during acute exacerbation [3,4]. The glucocorticoid and beta2 agonist therapies are effective at controlling airway inflammation, reducing asthma symptoms, decreasing airway hyper-responsiveness and reducing the frequency and severity of exacerbations as well as asthma mortality. Despite their undoubted effectiveness and safety, there is still no consensus about the resulting metabolic derangements, including the development of dyslipidaemia, insulin resistance, glucose intolerance, diabetes, central adiposity and skeletal muscle wasting [5][6][7].Both glucocorticoids and beta2 agonists have the potential to influence glucose, lipid and protein...

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mentioning

confidence: 99%

“…Glucocorticoids and beta2 agonists represent the most important and frequently used drugs for symptom control in asthmatic children during acute exacerbation [1,2]. Current guidelines recommend the combined use of glucocorticoids and beta2 agonists as the preferred therapy for asthmatic children during acute exacerbation [3,4].…”

mentioning

confidence: 99%

Distinct Metabolic Profile of Inhaled Budesonide and Salbutamol in Asthmatic Children during Acute Exacerbation

Yang

Zhang

et al. 2017

Basic Clin Pharma Tox

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“…Comparando estos datos con los registrados en 2008 (17,41 DHD), el consumo permanece estable 26 . Sin embargo, al tomar como referencia otras regiones se observan diferencias, siendo inferiores las cifras en Castilla y León (6,27 DHD), al igual que ocurre con la prevalencia de asma 27 . La vía inhalada es la más empleada en todas las regiones, lo cual estaría en consonancia con las recomendaciones vigentes.…”

Section: Discussionunclassified

Variabilidad e idoneidad del tratamiento antiasmático en pediatría de atención primaria

2017

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“…2 Porcentaje de prescripciones off-label por dosis altas de corticoides inhalados. en el uso de los antiasmáticos también apoya esta hipótesis, dado que el consumo en lactantes y prescolares fue mayor en otoño-invierno, periodo en el que son más frecuentes las infecciones respiratorias y disminuyó a la mitad en primavera-verano 37 . En primavera es cuando predominan los pólenes de gramíneas, que son los alérgenos más frecuentes en el asma infantil en nuestra comunidad autónoma.…”

Section: Discussionunclassified

“…Para medir la intensidad del consumo por edad se ha utilizado la dosis diaria prescrita por mil habitantes y día (PDHD) que representa el promedio de dosis diarias prescritas cada día a 1000 personas expuestas. Más información sobre la metodología se expone en otro trabajo reciente 37 .…”

Section: Población Y Métodosunclassified

Prescripción off-label de antiasmáticos en Atención Primaria

Alonso¹,

Garcinuño²,

Quirós³

et al. 2015

Rev Pediatr Aten Primaria

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Off-label prescription of anti-asthmatic agents in Primary CareIntroducción y objetivos: se denomina prescripción off-label a la realizada fuera de las condiciones autorizadas en la ficha técnica de un medicamento. En Atención Primaria se publican cifras globales de prescripción off-label en diferentes países del 3-67%. El objetivo del estudio ha sido conocer la intensidad de este tipo de prescripción en el caso de los antiasmáticos en un periodo reciente, en Castilla-León (España). Métodos: se analizaron las prescripciones correspondientes al subgrupo terapéutico R03 (medicamentos para enfermedades obstructivas respiratorias) realizadas a menores de 14 años entre 2005-2010 en el sistema público de salud autonómico. La información sobre el uso off-label se presenta en número de prescripciones consumidas de antiasmáticos a dosis y/o edades no recomendadas en su ficha técnica. Resultados: se realizaron 394 876 prescripciones de antiasmáticos a una población expuesta de 1 580 229 personas/año. Los menores de cuatro años fueron los que más antiasmáticos recibieron. La máxima prescripción de broncodilatadores ocurrió en menores de dos años, la de montelukast y corticoides inhalados monofármaco al año de edad. El 46% de las prescripciones de salbutamol sistémico y el 15,9% de las de la terapia de mantenimiento se prescribieron off-label. Conclusiones: el estudio muestra un uso importante de antiasmáticos a edades muy tempranas en las que es difícil hacer el diagnóstico de asma y un consumo notable de fármacos controladores a dosis y/o edades no autorizadas. La prescripción off-label no presupone una prescripción inadecuada, pero debería tener un beneficio real para el paciente y estar apoyada por avales científicos que justifiquen su uso.Introduction and objectives: off-label prescribing is when performed outside of the official information of the product. Overall figures of off-label prescribing in primary care in different countries are 3-67%. The aim of the study was to determine the intensity of this type of prescription in anti-asthmatic agents in a recent period of time, in Castilla y León. Methods: the requirements for the therapeutic subgroup R03 (anti-asthmatic agents) prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 were analyzed. Information on off-label prescribing is shown in number of anti-asthmatic prescriptions consumed at doses and/or at ages not recommended in its technical specifications. Results: a total of 394 876 prescriptions for anti-asthmatic agents were performed to an exposed population of 1 580 229 person-years. Children under four years received the highest levels of antiasthmatic agents. The maximum prescription of bronchodilators occurred in children under 2 years, and of montelukast and single inhaled corticosteroids at one year of age. 46% of prescriptions of systemic salbutamol and 15.9% of maintenance therapy prescriptions were made in an off-label manner. Conclusions: the study shows an important and very early use of anti-asthmat...

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Anti-asthmatic prescription variability in children according to age

Cited by 9 publications

References 21 publications

Distinct Metabolic Profile of Inhaled Budesonide and Salbutamol in Asthmatic Children during Acute Exacerbation

Distinct Metabolic Profile of Inhaled Budesonide and Salbutamol in Asthmatic Children during Acute Exacerbation

Variabilidad e idoneidad del tratamiento antiasmático en pediatría de atención primaria

Prescripción off-label de antiasmáticos en Atención Primaria

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