Low-Dose Inhaled Corticosteroids and the Prevention of Death From Asthma

Suissa, Samy; Ernst, Philipp; Benayoun, Serge; Baltzan, Marc; Cai, Bing

doi:10.1097/00008483-200101000-00011

Cited by 124 publications

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“…These databases have been described in detail elsewhere (16,(23)(24)(25). Briefly, Saskatchewan Health is a provincial government department providing universal health coverage for ϳ1 million people in Saskatchewan, Canada.…”

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“…Databases include the demographic and vital statistics, outpatient prescription drugs, hospital claims, and outpatient physician services. These databases have been used in numerous epidemiological studies evaluating safety of drug therapies and are considered to be both high quality and comprehensive (16,(23)(24)(25). First, we identified 12,272 new users of oral antidiabetic agents based on prescription claims between 1 January 1991 and 31 December 1996 who were aged Ն30 years and who had health coverage and were eligible for drug benefits at least 1 year before the index prescription (16,23).…”

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Improved Clinical Outcomes Associated With Metformin in Patients With Diabetes and Heart Failure

et al. 2005

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OBJECTIVE -Metformin is considered contraindicated in patients with heart failure because of concerns over lactic acidosis, despite increasing evidence of potential benefit. The aim of this study was to evaluate the association between metformin and clinical outcomes in patients with heart failure and type 2 diabetes.RESEARCH DESIGN AND METHODS -Using the Saskatchewan Health databases, 12,272 new users of oral antidiabetic agents were identified between the years 1991 and 1996. Subjects with incident heart failure (n ϭ 1,833) were identified through administrative records based on ICD-9 code 428 and grouped according to antidiabetic therapy: metformin monotherapy (n ϭ 208), sulfonylurea monotherapy (n ϭ 773), or combination therapy (n ϭ 852). Multivariate Cox proportional hazards models were used to assess differences in all-cause mortality, all-cause hospitalization, and the combination (i.e., all-cause hospitalization or mortality).RESULTS -Average age of subjects was 72 years, 57% were male, and average follow-up was 2.5 Ϯ 2.0 (SD) years. Compared with sulfonylurea therapy, fewer deaths occurred in subjects receiving metformin: 404 (52%) for sulfonylurea monotherapy versus 69 (33%) for metformin monotherapy (hazard ratio CONCLUSIONS -Metformin, alone or in combination, in subjects with heart failure and type 2 diabetes was associated with lower morbidity and mortality compared with sulfonylurea monotherapy.[

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Improved Clinical Outcomes Associated With Metformin in Patients With Diabetes and Heart Failure

et al. 2005

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“…9 -12 Addressing asthma medication utilization disparities is particularly important because it is known that asthma morbidity can be prevented and that emergency department visits and hospitalizations may be reduced by appropriate asthma treatment. [13][14][15] The undertreatment of asthma among racial and ethnic minorities is well-documented. 16 Among racial and ethnic minorities in the United States, asthma treatment has 2 consistent and enduring characteristics: 1) lack of access to treatment and 2) health care inconsistent with the guidelines of the National Asthma Education and Prevention Program of the National Heart, Lung, and Blood Institute.…”

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Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

et al. 2002

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ABSTRACT. Objective. To understand the importance of source of care and other factors that influence differences in asthma medication use by race and Hispanic ethnicity.Methods. The Childhood Asthma Severity Study provided 12-month, retrospective, parent-reported questionnaire data on a monthly basis for children ages <12 years in a community sample of 1002 children and their families from Connecticut and Massachusetts. Medications considered included cromolyn, ␤2-agonist, inhaled steroids, anticholinergics, theophylline, and systemic steroids. Information was available on demographics, insurance status, symptom severity, primary care contact, and provider practice types.Results. Black and Hispanic children received fewer ␤2-agonists, and Hispanic children received fewer inhaled steroids than white children after adjusting for patients' race, age, gender, insurance status, symptom severity, number of primary care visits for asthma, number of urgent visits to the regular provider, family income, maternal education, and site of care. When multivariate analyses were restricted to patients in private practice, the significant association between Hispanic ethnicity and low inhaled steroid use persisted, whereas differences in ␤2-agonist use by race and ethnicity changed little but became nonsignificant.Conclusion. Even within private practices, patients' race and ethnicity are associated with clinician nonadherence to national guidelines. Programs to eliminate these disparities will need both to focus on site of care and to intervene at the provider and patient levels to be successful. Pediatrics 2002;109(1). URL: http://www. pediatrics.org/cgi/content/full/109/1/e1; asthma, child, practice guidelines, health insurance, Hispanic Americans.

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“…A large number of other biases can distort true associations [21]; therefore, pharmacoepidemiology is strongest when searching for adverse drug effects. A good example of this is the seminal paper by SUISSA et al [22] on the risk associated with not taking low doses of inhaled corticosteroids in asthma.…”

Section: Pharmacoepidemiologymentioning

confidence: 99%

Natural experiments and large databases in respiratory and cardiovascular disease

Vestbo

2016

Eur Respir Rev

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A number of scientific questions cannot be tested in a laboratory, clinic or clinical trial setting. In many cases, observational data can be used to test such hypotheses.This article illustrates how epidemiology can contribute and shows the different ways of using observational data through three approaches: 1) prospective cohort study design; 2) time series analysis; and 3) a nested case-control design in pharmacoepidemiology.In a prospective cohort study design, three cohorts were merged to study lung function decline, testing the importance of different trajectories of lung function decline for developing chronic obstructive pulmonary disease (COPD). Using these three well-described cohorts it was documented that maximally attained lung function in early adulthood is as important as excess decline in forced expiratory volume in 1 s for the development of COPD. Time series analysis is used to examine exposures and disease over time. In a recent review of cardiovascular disease some interesting associations, and not least lack of associations, were presented. Assessing effects of drugs in database studies is challenging. In a nested casecontrol design in a large cohort study, statins were found to reduce the risk of COPD exacerbations. These findings will be discussed.Observational data from large databases, as well as carefully collected data in cohort studies, can be used to test hypotheses that may not be addressed in a traditional experimental setting. @ERSpublications Natural experiments using large databases with observational data can be of significant use in respiratory research

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Low-Dose Inhaled Corticosteroids and the Prevention of Death From Asthma

Cited by 124 publications

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Improved Clinical Outcomes Associated With Metformin in Patients With Diabetes and Heart Failure

Improved Clinical Outcomes Associated With Metformin in Patients With Diabetes and Heart Failure

Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

Natural experiments and large databases in respiratory and cardiovascular disease

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