Formoterol in clinical practice—safety issues

AbstractWhile short-acting β2-agonists are seen as the cornerstone of treatment as relief medication for asthma, current guidelines recommend long-acting β2-agonists as maintenance therapy in combination with inhaled corticosteroids in patients with moderate to severe asthma, poorly controlled on present treatment. Although evidence has shown that formoterol, with its fast- and long-acting profile, is effective when used both as regular and as-needed therapy in all types of asthma, there has been some concern about the potential of β2-agonists with long-acting profiles to produce side effects with a longer duration than seen with short-acting β2-agonists. Also, where formoterol is used as needed, a higher total daily dose would be anticipated than when taken twice daily for regular maintenance therapy and this again has led to some concern. In a number of studies, formoterol has been shown to be well tolerated, and although systemic effects expected with this class of drugs did occur, formoterol had significantly less effect on serum potassium, pulse, blood pressure, cardiac frequency and QT interval compared with terbutaline. In addition, the duration of effects was equivalent to that observed with terbutaline and salbutamol and the relative therapeutic index of formoterol compared with salbutamol was found to be 2.5. Furthermore, studies looking at long-term use of formoterol have shown there is no reduction in bronchodilatory effect, and thus, no development of tolerance. In conclusion, formoterol is well tolerated in high doses, producing side effects typical of its class, but with a duration no longer than occurs with short-acting β2-agonists. These observations, and the lack of tolerance development, suggest that formoterol may be appropriate treatment for patients with asthma of all types and severities on an as-needed basis or as regular treatment

Trust not in money: The effect of financial conflict of interest disclosure on dietary behavioural intention

Purpose To determine the impact of financial conflict of interest (FCI) disclosure on dietary behavioural intention related to the glycaemic index (GI) of food. Design/methodology/approach Seventy-two participants were randomly allocated to two conditions by reading an academic journal article about GI that contained an FCI disclosure (conflict) or a statement detailing that the authors had no FCI to declare (no-conflict). Using a questionnaire, participants made judgments about the article and authors as well as intention to perform GI-related behaviour. These were then analysed for significant differences between the two conditions. Findings Although no significant differences emerged between group means of judgments about the article, those in the conflict condition judged the authors as significantly less trustworthy and credible than those in the conflict condition. Contrary to expectation, those in the conflict condition reported significantly higher intentions to perform GI-related behaviour. Research limitations/implications The present research must be conducted in other populations of interest in order to establish if the results can be generalised. Practical implications The results suggest that FCI disclosure might be best placed at the beginning of articles and that education about FCI be made available to the general public. Originality/value This paper examines the practical implications of FCI disclosure. It also focuses on a readership beyond an academic community who is well-acquainted with the subject area and issues pertaining to FCI

Cost-Effectiveness of Internet-Based Self-Management Compared with Usual Care in Asthma

BACKGROUND: Effectiveness of Internet-based self-management in patients with asthma has been shown, but its cost-effectiveness is unknown. We conducted a cost-effectiveness analysis of Internet-based asthma self-management compared with usual care. METHODOLOGY AND PRINCIPAL FINDINGS: Cost-effectiveness analysis alongside a randomized controlled trial, with 12 months follow-up. Patients were aged 18 to 50 year and had physician diagnosed asthma. The Internet-based self-management program involved weekly on-line monitoring of asthma control with self-treatment advice, remote Web communications, and Internet-based information. We determined quality adjusted life years (QALYs) as measured by the EuroQol-5D and costs for health care use and absenteeism. We performed a detailed cost price analysis for the primary intervention. QALYs did not statistically significantly differ between the Internet group and usual care: difference 0.024 (95% CI, -0.016 to 0.065). Costs of the Internet-based intervention were $254 (95$243 to $265) during the period of 1 year. From a societal perspective, the cost difference was$641 (95% CI, $-1957 to$3240). From a health care perspective, the cost difference was $37 (95$-874 to $950). At a willingness-to-pay of$50,000 per QALY, the probability that Internet-based self-management was cost-effective compared to usual care was 62% and 82% from a societal and health care perspective, respectively. CONCLUSIONS: Internet-based self-management of asthma can be as effective as current asthma care and costs are similar. TRIAL REGISTRATION: Current Controlled Trials ISRCTN79864465

Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study

Background: Internet-based self-management has shown to improve asthma control and asthma related quality of life, but the improvements were only marginally clinically relevant for the group as a whole. We hypothesized that self-management guided by weekly monitoring of asthma control tailors pharmacological therapy to individual needs and improves asthma control for patients with partly controlled or uncontrolled asthma. Methods: In a 1-year randomised controlled trial involving 200 adults (18-50 years) with mild to moderate persistent asthma we evaluated the adherence with weekly monitoring and effect on asthma control and pharmacological treatment of a self-management algorithm based on the Asthma Control Questionnaire (ACQ). Participants were assigned either to the Internet group (n = 101) that monitored asthma control weekly with the ACQ on the Internet and adjusted treatment using a self-management algorithm supervised by an asthma nurse specialist or to the usual care group (UC) (n = 99). We analysed 3 subgroups: patients with well controlled (ACQ ACQ 1.5) asthma at baseline. Results: Overall monitoring adherence was 67% (95% CI, 60% to 74%). Improvements in ACQ score after 12 months were -0.14 (p = 0.23), -0.52 (p < 0.001) and -0.82 (p < 0.001) in the Internet group compared to usual care for patients with well, partly and uncontrolled asthma at baseline, respectively. Daily inhaled corticosteroid dose significantly increased in the Internet group compared to usual care in the first 3 months in patients with uncontrolled asthma (+278 mu g, p = 0.001), but not in patients with well or partly controlled asthma. After one year there were no differences in daily inhaled corticosteroid use or long-acting beta(2)-agonists between the Internet group and usual care. Conclusions: Weekly self-monitoring and subsequent treatment adjustment leads to improved asthma control in patients with partly and uncontrolled asthma at baseline and tailors asthma medication to individual patients' needs.Pathogenesis and treatment of chronic pulmonary disease

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma a

Anticholinergic Drugs for the Treatment of COPD Are Safe ... Are They?

Pathogenesis and treatment of chronic pulmonary disease

Theophylline for Chronic Obstructive Pulmonary Disease? .... Time to Move On

Pathogenesis and treatment of chronic pulmonary disease