The blue one takes a battering why do young adults with asthma overuse bronchodilator inhalers? A qualitative study

Objective: Overuse of short-acting bronchodilators is internationally recognised as a marker of poor asthma control, high healthcare use and increased risk of asthma death. Young adults with asthma commonly overuse short-acting bronchodilators. We sought to determine the reasons for overuse of bronchodilator inhalers in a sample of young adults with asthma. Design: Qualitative study using a purposive extreme case sample. Setting: A large urban UK general practice. Participants: Twenty-one adults with moderate asthma, aged 20-32 years. Twelve were high users of short-acting bronchodilators, nine were low users. Results: Asthma had a major impact on respondents' lives, disrupting their childhood, family life and career opportunities. High users of short-acting bronchodilators had adapted poorly to having asthma and expressed anger at the restrictions they experienced. Overuse made sense to them: shortacting bronchodilators were a rapid, effective, cheap 'quick-fix' for asthma symptoms. High users had poorer control of asthma and held explanatory models of asthma which emphasised short-term relief via bronchodilation over prevention. Both high and low users held strong views about having to pay for asthma medication, with costs cited as a reason for not purchasing anti-inflammatory inhalers. Conclusions: Young adults who were high users of short-acting bronchodilators had adapted poorly to having asthma and had poor asthma control. They gave coherent reasons for overuse. Strategies that might address high bronchodilator use in young adults include improving education to help young people accept and adapt to their illness, reducing stigmatisation and providing free asthma medication to encourage the use of anti-inflammatory inhalers

Formoterol versus short-acting beta-agonists as relief medication for adults and children with asthma

Background Formoterol is a long-acting beta(2)-agonist but because it has a fast onset of action it can also be used as a relief medication. Objectives To asses the efficacy and safety of formoterol as reliever therapy in comparison to short-acting beta(2)-agonists in adults and children with asthma. Search strategy We searched the Cochrane Airways Group Specialised Register and websites of clinical trial registers (for unpublished trial data), and we checked the Food and Drug Administration (FDA) submissions in relation to formoterol. The date of the most recent search was February 2010. Selection criteria Randomised, parallel-arm trials of at least 12 weeks duration in patients of any age and severity of asthma. Studies randomised patients to any dose of as-needed formoterol versus short-acting beta(2)-agonist. Concomitant use of inhaled corticosteroids or other maintenance medication was allowed, as long as this was not part of the randomised treatment regimen. Data collection and analysis Two authors independently selected trials for inclusion in the review. Outcome data were extracted by one author and checked by the second author. We sought unpublished data on primary outcomes. Main results This review includes eight studies conducted in 22,604 participants (mostly adults). Six studies compared formoterol as-needed to terbutaline whilst two studies compared formoterol with salbutamol as-needed. Background maintenance therapy varied across the trials. Asthma exacerbations and serious adverse events showed a direction of treatment effect favouring formoterol, of which one outcome reached statistical significance (exacerbations requiring a course of oral corticosteroids). In patients on short-acting beta(2)-agonists, 117 people out of 1000 had exacerbations requiring oral corticosteroids over 30 weeks, compared to 101 (95% CI 93 to 108) out of 1000 for patients on formoterol as-needed. In patients on maintenance inhaled corticosteroids there were also significantly fewer exacerbations requiring a course of oral corticosteroids on formoterol as-needed (Peto OR 0.75; 95% CI 0.62 to 0.91). There was one death per 1000 people on formoterol or on short-acting beta(2)-agonists. Authors' conclusions In adults, formoterol was similar to short-acting beta(2)-agonists when used as a reliever, and showed a reduction in the number of exacerbations requiring a course of oral corticosteroids. Clinicians should weigh the relatively modest benefits of formoterol as-needed against the benefits of single inhaler therapy and the potential danger of long-term use of long-acting beta(2)-agonists in some patients. We did not find evidence to recommend changes to guidelines that suggest that long-acting beta(2)-agonists should be given only to patients already taking inhaled corticosteroids.There was insufficient information reported from children in the included trials to come to any conclusion on the safety or efficacy of formoterol as relief medication for children with asthma

Emotion regulation among adults with asthma: Links with short-acting inhaler medication overuse and utilization of acute medical care

Effective control of asthma symptoms requires daily self-management activities, including use of short-acting or “rescue” inhaled medications. Overuse of short-acting inhaled medications, such as albuterol, can have negative side-effects, including respiratory infections and worse asthma symptom control. Existing research suggests that emotion plays an important role in airway inflammation and asthma symptom control. The objective of this study was to determine whether difficulties regulating emotion was associated with overuse of short-acting inhaled medications and acute medical care usage in adults with asthma. The sample included 401 adults with asthma recruited from an online panel of adults with chronic respiratory disease. Respondents completed a survey that included measures of short-acting medication use, acute medical service use, and emotion regulation (Difficulties in Emotion Regulation Scale [DERS]). Sequential binary logistic regression models were used to examine the association between DERS scores with two indicators of short-acting inhaled medication overuse: using \u3e3 canisters of short-acting inhaled medications in the past three months or self-reported overuse (i.e., using short-acting inhaled medications more than prescribed) while controlling for patient characteristics (current smoking and health insurance status) and comorbid mental health conditions (probable depression and probable anxiety). The results showed that greater difficulties in emotion regulation was significantly associated with greater odds of using more than three canisters in the past three months (AOR = 1.023, 95%CI [1.012, 1.035], p \u3c .001) and using short-acting inhaled medications more than prescribed (AOR = 1.024, 95%CI [1.014, 1.035], p \u3c .001) as well as with greater odds of emergency department visits (AOR = 1.018, 95%CI [1.009, 1.028], p AOR = 1.017, 95%CI [1.007, 1.028], p=.001) in the prior 12-months – even after adjusting for probable depression and probable anxiety, current smoking, and health insurance status. In conclusion, emotion dysregulation may play an important role in overuse of short-acting inhaled medications and acute medical care utilization among adults with asthma. Evidence-based interventions to reduce difficulties in emotion regulation may help improve problematic patterns of short-acting medication overuse among adults with asthma

Histamine release after intravenous application of short-acting hypnotics. A comparison of etomidate, Althesin (CT1341) and propanidid

The subject of histamine release was investigated in 16 volunteers by means of plasma histamine determination after the administration of etornidate, Althesin, propanidid, and Cremophor EL. Althesin and propanidid caused release of histamine in various degrees of frequency. Blood pressure changes were rather pronounced with both anaesthetic agents; tachycardia reached its maximum in the first and second minute, which seems to be an argument against histamine release as the underlying cause of this reaction. Histamine was, indeed, only released to such an extent (with the exception of one borderline case) that no clinical symptoms other than secretion of gastric juice and erythema were to be expected. After the application of etomidate and Cremophor EL an increase in plasma histamine was not detectable. Changes in the differential blood picture in terms of a decrease in basophils only occurred after Althesin and propanidid; not, however, after etomidate and Cremophor EL. Etomidate is, therefore, the first hypnotic drug for intravenous application which is unlikely to cause chemical histamine release

Women’s Empowerment and Contraceptive Method Use in Egypt

Egypt’s fertility rate reached a 25-year high of 3.5 births per woman in 2014.It is assumed that women’s empowerment plays an important role in women’s choice of a specific contraceptive method. This research brief, by former PRC postdoctoral fellow Goleen Samari, found that use of long-acting methods fell in Egypt between 2005 and 2014, while use of short-acting methods increased. She also found that women’s empowerment increases the likelihood of contraceptive use in Egypt.Population Research Cente

Over-use of short-acting inhalers for uncontrolled asthma

Why asthma still kills is the National Review of Asthma Deaths' first national investigation of asthma deaths in the UK and the largest study worldwide to date (Royal College of Physicians (RCP), 2015). The primary aim was to understand the circumstances surrounding asthma deaths to identify avoidable factors and make recommendations to improve care and reduce the number of deaths. Some of the recommendations involve prescribing and medicines use. One of these specifically states, ‘All asthma patients who have been prescribed more than 12 short-acting reliever inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment, if required’ (RCP, 2015). The reason for this is that over-use of short-acting relievers can be an indication of uncontrolled asthma. An additional concern due to over-use can be explained by the pharmacology of short-acting relievers. These medicines, such as salbutamol and terbutaline, are beta-2 receptor agonists, and their over-use can lead to the ‘down-regulation’ of receptors, which can result in an insufficient therapeutic effect in an emergency situation (Joint Formulary Committee, 2016). Furthermore, the over-use of medicines can lead to side effects (e.g. palpitations or anxiety), and is a waste of NHS resources