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Long-acting beta agonist and children

Christian Vogelberg
Asthma is a chronic inflammatory airway disease, and its treatment is frequently challenging despite detailed national and international guidelines. While basic anti-inflammatory therapy usually consists of inhaled corticosteroids in doses adapted to the asthma severity, add-on treatment with bronchodilators is essential in more severe asthma. Only recently, the long-acting anticholinergic tiotropium was introduced into the GINA guidelines. This review reports on the studies that have been performed with tiotropium in adult asthmatic patients...
September 9, 2016: Therapeutic Advances in Respiratory Disease
Laurent Laforest, Manon Belhassen, Gilles Devouassoux, Alain Didier, Marine Ginoux, Eric Van Ganse
BACKGROUND: Although the use of inhaled corticosteroids (ICS) in asthma is known to be overall erratic, the long-term use of ICS by patients selected during an episode of regular use is poorly documented. OBJECTIVE: In a cohort of patients with asthma regularly acquiring ICS therapy over several months, we verified whether these patients remained treated in the following 12 months. The correlates of regular ICS use over this period were investigated. METHODS: A historical cohort of patients with asthma was identified from the Echantillon généraliste de bénéficiaires national French health care reimbursement data (2007-2012)...
September 2016: Journal of Allergy and Clinical Immunology in Practice
Andrew Bush, Urs Frey
No abstract text is available yet for this article.
September 1, 2016: New England Journal of Medicine
David A Stempel, Stanley J Szefler, Søren Pedersen, Robert S Zeiger, Anne M Yeakey, Laurie A Lee, Andrew H Liu, Herman Mitchell, Kenneth M Kral, Ibrahim H Raphiou, Barbara A Prillaman, Kathleen S Buaron, Suyong Yun Kirby, Steven J Pascoe
BACKGROUND: Long-acting beta-agonists (LABAs) have been shown to increase the risk of asthma-related death among adults and the risk of asthma-related hospitalization among children. It is unknown whether the concomitant use of inhaled glucocorticoids with LABAs mitigates those risks. This trial prospectively evaluated the safety of the LABA salmeterol, added to fluticasone propionate, in a fixed-dose combination in children. METHODS: We randomly assigned, in a 1:1 ratio, children 4 to 11 years of age who required daily asthma medications and had a history of asthma exacerbations in the previous year to receive fluticasone propionate plus salmeterol or fluticasone alone for 26 weeks...
September 1, 2016: New England Journal of Medicine
Erwin C Vasbinder, Svetlana V Belitser, Patrick C Souverein, Liset van Dijk, Arnold G Vulto, Patricia Mla van den Bemt
BACKGROUND: Non-adherence to inhaled corticosteroids (ICSs) is a major risk factor for poor asthma control in children. However, little is known about the effect of adherence to ICS on the incidence of asthma exacerbations. The objective of this study was to examine the effect of poor adherence to ICS on the risk of exacerbations in children with asthma. METHODS: In this nested case-control study using data from the Dutch PHARMO Record Linkage System, children aged 5-12 years who had an asthma exacerbation needing oral corticosteroids or hospital admission were matched to patients without exacerbations...
2016: Patient Preference and Adherence
Amanda J Oliver, Ronina A Covar, Caroline H Goldfrad, Ryan M Klein, Søren E Pedersen, Christine A Sorkness, Susan A Tomkins, César Villarán, Jonathan Grigg
BACKGROUND: Inhaled corticosteroids (ICS) are effective maintenance treatments for childhood asthma; however, many children remain uncontrolled. Vilanterol (VI) is an inhaled long-acting beta-2 agonist which, in combination with the ICS fluticasone furoate, is being explored as a once-daily treatment for asthma in children. We evaluated the dose-response, efficacy, and safety of once-daily VI (6.25 μg, 12.5 μg and 25 μg) administered in the evening over 4 weeks, on background fluticasone propionate (FP) in children with asthma inadequately controlled on ICS...
2016: Respiratory Research
Bhupendrasinh F Chauhan, Caroline Chartrand, Muireann Ni Chroinin, Stephen J Milan, Francine M Ducharme
BACKGROUND: Long-acting beta2-agonists (LABA) in combination with inhaled corticosteroids (ICS) are increasingly prescribed for children with asthma. OBJECTIVES: To assess the safety and efficacy of adding a LABA to an ICS in children and adolescents with asthma. To determine whether the benefit of LABA was influenced by baseline severity of airway obstruction, the dose of ICS to which it was added or with which it was compared, the type of LABA used, the number of devices used to deliver combination therapy and trial duration...
2015: Cochrane Database of Systematic Reviews
Heather E Hoch, Stanley J Szefler
Inhaled corticosteroids have long been considered a mainstay of therapy for asthma in children. However, concerns over long-term side effects of chronic steroid administration have led providers to turn to intermittent dosing of these medications in an attempt to treat exacerbations while limiting total corticosteroid received. The data have been somewhat mixed in this area, likely at least partially due to the difficulty providers have in classifying asthma phenotypes in young children. This review will analyze the evidence for chronic daily inhaled corticosteroid use, intermittent inhaled corticosteroid use, and dynamic dosing approaches utilizing inhaled corticosteroid/long-acting beta agonist combination therapy...
February 2016: Expert Review of Clinical Immunology
Charlene M Prazma, James E Gern, Steven F Weinstein, Barbara A Prillaman, David A Stempel
BACKGROUND: A seasonal peak in asthma exacerbations in the fall has previously been reported. The association between fall exacerbations and viral respiratory tract infections (RTI) remains uncertain. OBJECTIVE: To investigate the number of fall exacerbations and the incidence of RTIs in a pediatric asthmatic population using an at-home mucus collection methodology. METHODS: This was a 16-week, multicenter, randomized, double-blind, parallel-group exploratory study...
October 2015: Respiratory Medicine
Steve W Turner, Kathryn Richardson, Annie Burden, Mike Thomas, Clare Murray, David Price
BACKGROUND: When standard doses of inhaled corticosteroids (ICS) fail to control symptoms in children aged >4 years, guidelines recommend the addition of a long-acting β2-agonist (LABA), with other treatment options being available if symptoms persist. AIMS: To determine the proportion of initial 'step-up' episodes where LABAs were prescribed and to describe characteristics of individuals not stepped up with LABA. METHODS: Between 1999 and 2011, initial step-up episodes from ICS monotherapy were identified in children aged 5-12 years with asthma and in receipt of ICS...
2015: NPJ Primary Care Respiratory Medicine
Yile Zhao, Sheng Han, Jinxin Shang, Xizi Zhao, Run Pu, Luwen Shi
OBJECTIVE: To determine the effectiveness and safety of current maintenance therapies that include inhaled corticosteroids (ICS), long-acting β-agonists (LABA) and/or leukotriene receptor antagonists (LTRAs) in preventing exacerbations and improving symptoms in pediatric asthma. METHODS: A systematic review with network meta-analysis was conducted after a comprehensive search for relevant studies in the PubMed, Cochrane Library, Embase and Clinical Trials databases, up to July 2014...
October 2015: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Kayleigh M Kew, Sean Beggs, Shaleen Ahmad
BACKGROUND: Asthma is the most common chronic medical condition among children and is one of the most common causes of hospitalisation and medical visits. Poorly controlled asthma often leads to preventable exacerbations that require additional medications, hospital stays, or treatment in the emergency department.Long-acting beta2-agonists (LABA) are the preferred add-on treatment for children with asthma whose symptoms are not well controlled on inhaled corticosteroids (ICS). The US Food and Drug Administration has issued a 'black box' warning for LABA in asthma, and now recommends that they be used "for the shortest duration of time required to achieve control of asthma symptoms and discontinued, if possible, once asthma control is achieved"...
2015: Cochrane Database of Systematic Reviews
Ann Chen Wu, Lingling Li, Vicki Fung, Elyse O Kharbanda, Emma K Larkin, William M Vollmer, Melissa G Butler, Irina Miroshnik, Donna Rusinak, Robert L Davis, Tina Hartert, Scott T Weiss, Tracy A Lieu
BACKGROUND: Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS. OBJECTIVE: To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy...
September 2014: Journal of Allergy and Clinical Immunology in Practice
Sven Schmiedl, Rainald Fischer, Luisa Ibáñez, Joan Fortuny, Olaf H Klungel, Robert Reynolds, Roman Gerlach, Martin Tauscher, Petra Thürmann, Joerg Hasford, Marietta Rottenkolber
Respiratory drugs are widely used in children to treat labeled and non-labeled indications but only some data are available quantifying comprehensively off-label usage. Thus, we aim to analyse drug utilisation and off-label prescribing of respiratory drugs focusing on age- and indication-related off-label use. Patients aged ≤18 years documented in the Bavarian Association of Statutory Health Insurance Physicians database (approx. 2 million children) between 2004 and 2008 were included in our study. Annual period prevalence rates (PPRs) per 10,000 children and the proportion of age- and indication-related off-label prescriptions were calculated and stratified by age and gender...
2014: PloS One
Ole D Wolthers, Tushar Shah
BACKGROUND: A combination of the inhaled corticosteroid budesonide and the long-acting β2-agonist formoterol has been formulated in a novel dry powder inhaler, Spiromax(®). The objective was to compare lower leg growth in children with asthma treated with inhaled budesonide+formoterol (BF) delivered from the Spiromax inhaler with BF from the Symbicort Turbohaler(®). METHODS: Prepubescent children with persistent asthma (n=75, aged 6-11 years) were included in a randomized, double-blind, double-dummy, placebo-controlled, three-way crossover study with active treatment and placebo periods of 2 weeks duration...
June 2015: Journal of Aerosol Medicine and Pulmonary Drug Delivery
Hatice S Zahran, Cathy M Bailey, Xiaoting Qin, Jeanne E Moorman
INTRODUCTION: Monitoring the level of asthma control is important in determining the effectiveness of current treatment which may decrease the frequency and intensity of symptoms and functional limitations. Uncontrolled asthma has been associated with decreased quality of life and increased health care use. The objectives of this study were to assess the level of asthma control and identify related risk factors among persons with current asthma. METHODS: Using the 2006 to 2010 BRFSS child and adult Asthma Call-back Survey, asthma control was classified as well-controlled or uncontrolled (not-well-controlled or very-poorly-controlled) using three impairment measures: daytime symptoms, night-time symptoms, and taking short-acting β2-agonists for symptom control...
April 2015: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Ying Xia, Christina M L Kelton, Liang Xue, Jeff J Guo, Boyang Bian, Patricia R Wigle
The introduction of long-acting beta agonists (LABAs) was considered a major advance in bronchodilator therapy for adult, as well as pediatric, patients with asthma. However, the use of LABAs has raised safety concerns, especially the potential for severe asthma exacerbations (SAEs) resulting in hospitalizations or even death. Meanwhile, the use of inhaled corticosteroids (ICSs), a cornerstone in the treatment of mild-to-severe persistent asthma, has been associated with growth suppression in children. The purpose of this review was to identify and discuss the major published safety studies surrounding LABA, ICS, and combined LABA/ICS usage in children...
December 2013: Therapeutic Advances in Drug Safety
Sandy Durrani
Asthma is one of the most common childhood diseases in the world and a significant cause of morbidity and health care expenditures. United States and international evidence-based guidelines created and updated in the past 2 decades have significantly improved the consistency and effectiveness of asthma care in children. Assessing severity and monitoring control using the impairment and risk domains is fundamental to effective management. At every visit, the provider should assess environmental triggers and comorbid conditions, review inhaler technique and adherence, and provide an updated asthma action plan...
August 2014: Pediatric Annals
Gimena Hernández, Mónica Avila, Angels Pont, Olatz Garin, Jordi Alonso, Laurent Laforest, Christopher J Cates, Montserrat Ferrer
BACKGROUND: Although several systematic reviews investigated the safety of long-acting beta-agonists (LABAs) in asthma, they mainly addressed randomized clinical trials while evidence from non-randomized studies has been mostly neglected. We aim to assess the risk of serious adverse events in adults and children with asthma treated with LABAs and Inhaled Corticosteroids (ICs), compared to patients treated only with ICs, from published non-randomized studies. METHODS: The protocol registration number was CRD42012003387 (http://www...
July 19, 2014: Respiratory Research
Björn Nordlund, Erik Melén, Erica S Schultz, Hans Grönlund, Gunilla Hedlin, Inger Kull
BACKGROUND: The World Health Organization (WHO) recently proposed a new definition of severe asthma to facilitate standardized characterization of patients, and enable more accurate estimations of the prevalence of severe asthma. The aim of this study was to estimate the prevalence of severe asthma according to the WHO definition in children aged 12 years, in Stockholm, Sweden. METHODS: The birth cohort BAMSE enrolled 4089 children during 1994-96. Parental questionnaires provided information on asthma-related symptoms, diagnosis and medication from 3015 enrolled children at the age of 12 years...
August 2014: Respiratory Medicine
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