Category Archives: Asthma : Part 5

Outcomes of a Web-Based Patient Education Program for Asthmatic Children and Adolescents: Study Design

The current investigation was a nonrandomized, nonstratified, multicenter, real-life study comprising two intervention groups and one control group (Fig 1). The investigation was conducted between July 2001 and December 2002 in 36 study centers nationwide, including general practitioner (GP) and specialist offices as well as asthma outpatient facilities of hospitals.
AU eligible patients were invited to join a standardized patient management program (SPMP). They had the option to self select additional educational activities with the additional IEP, provided that individual access to the Internet was possible at home, at the study centers, or at school. Data collection in the intervention groups was completed at two subsequent visits scheduled at 6 months (visit 2) and 12 months (visit 3) after enrollment. in detail

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Outcomes of a Web-Based Patient Education Program for Asthmatic Children and Adolescents

Outcomes of a Web-Based Patient Education Program for Asthmatic Children and AdolescentsAsthma is the most common chronic disease in children, affecting approximately 10% of the German pediatric population. There is a distinct social burden of asthma, not only for the sick child, but also for the caregiver and the society in general. At the same time, the economic impact due to extensive health-care utilization is high. Health-care expenditures for asthmatic children are roughly three times higher compared to children without asthma. A positive correlation has been described between average total costs and degree of asthma severity in several investigations. canadian pharmacy

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The Role of Methotrexate in the Management of Steroid-dependent Asthma – Conclusion

Although there was no significant difference between the methotrexate group and placebo group with regard to steroid-sparing ability, 3 of the 11 subjects demonstrated some response to methotrexate. No distinguishing features separated responders from nonresponders. The largest study to date suggested that the response to methotrexate occurs only after 12 weeks of study, since at this point in their study there was no significat reduction in steroid dosage in the methotrexate group compared with the placebo group, but at 24 weeks a significant difference existed. It is possible that by using a larger study population treated with methotrexate for a longer period, statistical significance might be achieved.
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The Role of Methotrexate in the Management of Steroid-dependent Asthma – Discussion

The Role of Methotrexate in the Management of Steroid-dependent Asthma - DiscussionIn our study, low-dose methotrexate therapy did not have a significant steroid-sparing effect in severe asthma. In addition, aggressive management of asthma with close clinical follow-up improved asthma control. Furthermore, there was a small subgroup of asthmatic patients who responded to methotrexate with a significant reduction in their steroid dosage although these asthmatics had many subjective complications of their medication therapy, low-dose methotrexate does not demonstrate a significant toxicity profile.
Because the natural history of asthma is variable and compliance with medications is often poor, we designed the study so that the patient’s asthma would be optimally treated and stabilized prior to entering the study phase. This important initialization phase was not a part of many of the earlier studies. Our study extends the data of a previous study that cast doubt on the efficacy of methotrexate in asthma, utilizing a parallel study design. We chose to use a crossover study to ensure that patients were acting as their own controls. To overcome the potential cany-over of one drug effect into the following phase, we compared the parameters during the last 4 weeks of each treatment period, ensuring an effective 8-week washout period. Analysis of our results indicated that this was adequate with no carryover effect from one phase into the other. In addition, we studied patients who did not have seasonal variation in their asthma to ensure that the natural history of their asthma did not interfere with our comparison of the methotrexate with the placebo phase. buy allegra

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The Role of Methotrexate in the Management of Steroid-dependent Asthma – Corticosteroid Data

As demonstrated in Figure 1, the mean dose of prednisone decreased in both treatment phases compared with the initial period (p<0.001), with a mean of 20 percent reduction in steroid dosage using placebo alone. There was no significant difference in mean steroid reduction comparing the methotrexate and placebo group (Table 2). Of the 11 patients who completed the study, only three responded to methotrexate. These patients reduced their steroid dose by 33 percent or more while receiving methotrexate, but they had no significant change in steroid dosing while receiving placebo (Table 3). The three patients deemed to be responders did not demonstrate any predicting factors compared with nonresponders. Specifically, there was no significant difference in the duration of asthma, FEV1 percent, although there was a trend toward a lower baseline steroid dose. All three responders had received methotrexate during the first phase, indicating that it was unlikely a placebo effect. For all parameters studied, including steroid dosage, pulmonary function testing, and symptom score, there was no evidence of a carryover effect from one phase into the other.
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The Role of Methotrexate in the Management of Steroid-dependent Asthma – Statistical Analysis

The Role of Methotrexate in the Management of Steroid-dependent Asthma - Statistical AnalysisTo overcome the possible carryover effect of methotrexate, the last 4 weeks of each treatment period were used for analysis of steroid requirement and pulmonary function. These variables were compared with the last 2 weeks of the initialization phase using analysis of variance. The paired t test was used to compare parametric data, including prednisone dose and pulmonary functions (FEVj and FVC) between the methotrexate group and the placebo group. On completion of the study, patients were subdivided into those who received methotrexate first (A) and those who received placebo first (B). Comparisons of parametric data of steroid dose and pulmonary functions were made with each subgroup, using the paired t test and the Student’s t test when appropriate. Toxicity data were compared between each treatment group using the McNemer’s x2 test on each individual symptom. mycanadianpharmacy

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The Role of Methotrexate in the Management of Steroid-dependent Asthma – Experimental Approach

A prospective, randomized, double-blind, placebo-controlled, crossover trial was performed. Prior to administration of methotrexate or placebo, all patients were initially followed up for 4 to 10 weeks during which their pulmonary function was optimized with maximal conventional asthma therapy, including high dose inhaled steroids. Oral steroid dosage was increased initially to attain optimum pulmonary function and then oral steroid dosages were tapered slowly maintaining pulmonary function. In this way we established the minimum steroid dosage that was necessary to maintain optimal pulmonary function. Patients were seen by a pulmonary physician at least every 2 weeks and often weekly during this period. At the end of the initial period, baseline studies, including spirometry, FEVr FVC, peak flow rate measurements, chest radiograph, complete blood cell count and differential, platelets, serum urea nitrogen, creatinine, liver function tests, and a 24-h creatinine clearance were performed. In addition, all patients were asked to record peak flowmeter readings before and after bronchodilator therapy each morning and complete a daily diary card documenting their asthma medications and symptom score of 1 to 4 (1 = no problems; 2 = minor difficulty; 3 = moderate difficulty; 4 = severe difficulty breathing). canadianfamilypharmacy

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The Role of Methotrexate in the Management of Steroid-dependent Asthma – Methods

The Role of Methotrexate in the Management of Steroid-dependent Asthma - MethodsBronchial asthma is characterized clinically by wheeze, dyspnea, or cough secondary to reversible airways obstruction from airway smooth muscle contraction, mucosal edema, and increased mucus production. These clinical and physiologic changes are associated with increased airway hyperresponsiveness to nonspecific stimuli. Airway inflammation has been shown to play an important role in the pathogenesis of this bronchial hyperreactivity. Corticosteroids have been effective in reducing airway inflammation and controlling the symptoms of asthma. In a subset of patients, prolonged therapy with high-dose systemic corticosteroids may be required to control moderate to severe asthma. However, the side effects of longterm steroid therapy are common and may lead to debilitating complications, including infection, osteopenia, muscle weakness, hypertension, and peptic ulceration. Therefore, other anti-inflammatory agents that control asthma have been investigated to reduce the dependence on high-dose steroid therapy.
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Inhaled Albuterol and Oral Prednisone Therapy in Hospitalized Adult Asthmatics: Discussion (2)

Inhaled Albuterol and Oral Prednisone Therapy in Hospitalized Adult Asthmatics: Discussion (2)Although a larger study might show a small benefit of aminophylline therapy, any potential benefits must be weighed against the risk of serious adverse effects. Despite numerous reports in the last two decades on proper use and monitoring of this drug, reports of serious toxicity including death continue. Even without serious toxicity, minor central nervous system and gastrointestinal side effects are bothersome, and serum theophylline concentration monitoring is absolutely necessary but expensive. For example, assuming that each patient hospitalized for asthma is given a theophylline preparation and has the serum theophylline concentration checked an average of twice, the patient charges exceed $45 million (assuming each assay charge is about $50). Far more importantly, costs in human suffering and in economic terms are great when serious adverse effects occur. canadian family pharmacy
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Inhaled Albuterol and Oral Prednisone Therapy in Hospitalized Adult Asthmatics: Discussion (1)

The lack of benefit of aminophylline therapy observed in this study is consistent with previous emergency room investigations. In both the placebo and aminophylline groups, there were highly significant improvements over time, including spirometry and subjective patient ratings. It is noteworthy that both groups had a duration of hospital stay less than half the national average of 4.8 days. This finding cannot be attributed to a lack of severity of illness at baseline, but rather to the specific albuterol and prednisone regimen used in this study. If our mean hospital stay of roughly two days less than the US national average is applied to potential cost savings (assume $200 per day bed charge for about 450,000 admissions), $180 million could be saved annually.
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