Pharmacological Management to Reduce Exacerbations in Adults With Asthma

Abstract

STHMA IS COMMON, AFFECTing 5% to 12% of the adult population. 1,2 In the United States alone, asthma affects more than 200 000 adults and accounted for approximately 465000 hospitalizations, 1.8 million emergency department visits, 10.4 million physician office visits, and 4487 deaths in 2000. 3 For largely unknown reasons, US women have a 30% higher prevalence and 40% more asthma attacks than men, and blacks have a 10% higher prevalence and 20% more asthma attacks than whites. 3 The prevalence of self-reported asthma has increased 74% over the past 2 decades, 2 with a doubling in the number of office visits and a 61% increase in asthma-related deaths. 2 The current total annual costs of asthma are $11 billion. 2-5 Asthma is characterized clinically by repeated episodes of wheezing, breathlessness, chest tightness, and coughing, usually in the presence of variable (and reversible) airflow obstruction. 6 Most patients also demonstrate air-Author Affiliations and Financial Disclosures are listed at the end of this article.

Systematic review and meta-analysis of budesonide/formoterol in a single inhaler

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Quantifying the proportion of severe asthma exacerbations attributable to inhaled corticosteroid nonadherence

“…Not surprisingly, ICS adherence appears to be protective for these events. While these findings are consistent with the results of clinical trials involving the use of ICS medication for asthma, (27) even these trials do not account for varying degrees of ICS use by participants. In this manner we were able to ascertain that the primary treatment benefit was experienced by those with relatively high degrees of use (>75% of the prescribed dose) over a 6-month period.…”

Comparative effectiveness of long term drug treatment strategies to prevent asthma exacerbations: network meta-analysis

“…The meta-analysis concluded that the addition of long acting β agonists to inhaled corticosteroids was favoured over the addition of leukotriene receptor antagonists. In our network meta-analysis, in which inhaled corticosteroid doses were classified as either low or moderate or high, we were unable to confirm the previously reported positive effects of increasing doses of inhaled corticosteroids in preventing exacerbations 13. This is probably because in the included studies the intervention of inhaled corticosteroid dose was typically double that of the control inhaled corticosteroid dose, but both doses may still have fallen within either our low dose or moderate or high dose inhaled corticosteroid categories.…”