Asthma patient satisfaction with different dry powder inhalers

Altres ajuts: The study was supported by Orion Pharma, which also funded the writing.Background: The preferences and opinions of patients are important when choosing the optimal inhaler device for asthma management. We compared patient satisfaction of three dry powder inhalers in patients with moderate to severe asthma. Methods: We selected a group of patients treated with Easyhaler (n = 164) and a second group of patients treated with Turbuhaler (n = 100) or Diskus (Accuhaler ) (n = 64) from the register of an observational, multicenter study. Data of patients were paired according to age, gender, and asthma severity. Patient satisfaction with the inhaler type was assessed with the specific 'Feeling of Satisfaction with Inhaler' (FSI-10) questionnaire. Results: Specific satisfaction with inhaler was statistically significantly higher with Easyhaler , as well as the percentage of patients with high satisfaction with inhaler. (FSI-10 score ≥43). Scores for Easyhaler were also statistically significantly better for individual FSI-10 items such as learning how to use, inhaler preparation, inhaler use, weight and size, and portability. There were no significant differences in asthma control (ACT, Mini-AQLQ) and adherence (TAI global score). Conclusions: Specific satisfaction with inhaler was higher with Easyhaler in a homogeneous population of patients with moderate to severe asthma. However, the relationship between satisfaction with the inhaler and adherence and asthma control deserves more investigation

An interaction between Nrf2 polymorphisms and smoking status affects annual decline in FEV1: a longitudinal retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>An Nrf2-dependent response is a central protective mechanism against oxidative stress. We propose that particular genetic variants of the <it>Nrf2 </it>gene may be associated with a rapid forced expiratory volume in one second (FEV₁) decline induced by cigarette smoking.</p> <p>Methods</p> <p>We conducted a retrospective cohort study of 915 Japanese from a general population. Values of annual decline in FEV₁were computed for each individual using a linear mixed-effect model. Multiple clinical characteristics were assessed to identify associations with annual FEV₁decline. Tag single-nucleotide polymorphisms (SNPs) in the <it>Nrf2 </it>gene (rs2001350, rs6726395, rs1962142, rs2364722) and one functional SNP (rs6721961) in the <it>Nrf2 </it>promoter region were genotyped to assess interactions between the <it>Nrf2 </it>polymorphisms and smoking status on annual FEV₁decline.</p> <p>Results</p> <p>Annual FEV₁decline was associated with smoking behavior and inversely correlated with FEV₁/FVC and FEV₁% predicted. The mean annual FEV₁declines in individuals with rs6726395 G/G, G/A, or A/A were 26.2, 22.3, and 20.8 mL/year, respectively, and differences in these means were statistically significant (p_corr= 0.016). We also found a significant interaction between rs6726395 genotype and smoking status on the FEV₁decline (p for interaction = 0.011). The haplotype rs2001350T/rs6726395A/rs1962142A/rs2364722A/rs6721961T was associated with lower annual decline in FEV₁(p = 0.004).</p> <p>Conclusions</p> <p>This study indicated that an Nrf2-dependent response to exogenous stimuli may affect annual FEV₁decline in the general population. It appears that the genetic influence of <it>Nrf2 </it>is modified by smoking status, suggesting the presence of a gene-environment interaction in accelerated decline in FEV₁.</p

Relationship between the anti-inflammatory properties of salmeterol/fluticasone and the expression of CD4+CD25+Foxp3+ regulatory T cells in COPD

<p>Abstract</p> <p>Background</p> <p>Salmeterol and fluticasone combination (SFC) has anti-inflammatory effects and improves clinical symptoms in patients with chronic obstructive pulmonary disease (COPD). However, the anti-inflammatory mechanism of SFC remains unclear. In this study, we investigated the inflammatory responses of COPD, as well as the relationship of the inflammatory factors with the levels of CD4⁺CD25⁺Foxp3⁺regulatory T cells (Foxp3⁺Tregs) after SFC therapy.</p> <p>Methods</p> <p>Twenty-one patients with moderate or severe COPD received treatment with 50/500 μg of SFC twice a day for 12 weeks. Before and after treatment, the patients were evaluated using the Modified Medical Research Council (MMRC) dyspnea scale and by conducting a 6-min walk test. The number of neutrophils, monocytes and lymphocytes in induced sputum were counted. Levels of cytokines, including pre-inflammatory IL-8, TNF-α, IL-17A and cytokine IL-10, in the sputum supernatant and peripheral blood were measured by ELISA. The proportion of Foxp3⁺Tregs in the total CD4⁺T cell of the peripheral blood was determined by flow cytometry. The relationship between IL-17A levels and the percentage of Foxp3⁺Tregs was analyzed by statistical analysis.</p> <p>Results</p> <p>After treatment with SFC, the forced expiratory volume in 1 s as a percentage of predicted values (FEV1%) and the 6-min walk distance in the COPD patients significantly increased, while dyspnea scores decreased. The total number of cells, neutrophils, and the percentage of neutrophils in induced sputum reduced notably, while the proportion of monocytes was significantly increased. Levels of the inflammatory cytokines IL-8, TNF-α, and IL-17A in the sputum supernatant and in the blood were markedly lowered, while IL-10 levels were unchanged. The proportion of Foxp3⁺Tregs in the total CD4⁺T cell population in the peripheral blood was drastically higher than that before treatment. The level of IL-17A was negatively correlated with the proportion of Foxp3⁺Tregs in CD4⁺T cells.</p> <p>Conclusion</p> <p>SFC can reduce the levels of inflammatory factors and improve symptoms of COPD. The levels of inflammatory factors are associated with the variation of Foxp3⁺Tregs in COPD.</p> <p>Trial registration</p> <p>This study was registered with <url>http://www.chictr.org</url> (Chinese Clinical Trial Register) as follows: ChiCTR-TNC-10001270</p

Asthma patient satisfaction with different dry powder inhalers

Altres ajuts: The study was supported by Orion Pharma, which also funded the writing.Background: The preferences and opinions of patients are important when choosing the optimal inhaler device for asthma management. We compared patient satisfaction of three dry powder inhalers in patients with moderate to severe asthma. Methods: We selected a group of patients treated with Easyhaler (n = 164) and a second group of patients treated with Turbuhaler (n = 100) or Diskus (Accuhaler ) (n = 64) from the register of an observational, multicenter study. Data of patients were paired according to age, gender, and asthma severity. Patient satisfaction with the inhaler type was assessed with the specific 'Feeling of Satisfaction with Inhaler' (FSI-10) questionnaire. Results: Specific satisfaction with inhaler was statistically significantly higher with Easyhaler , as well as the percentage of patients with high satisfaction with inhaler. (FSI-10 score ≥43). Scores for Easyhaler were also statistically significantly better for individual FSI-10 items such as learning how to use, inhaler preparation, inhaler use, weight and size, and portability. There were no significant differences in asthma control (ACT, Mini-AQLQ) and adherence (TAI global score). Conclusions: Specific satisfaction with inhaler was higher with Easyhaler in a homogeneous population of patients with moderate to severe asthma. However, the relationship between satisfaction with the inhaler and adherence and asthma control deserves more investigation