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Lugogo N, O'Connor M, George M, Merchant R, Bensch G, Portnoy J, Oppenheimer J, Castro M. Expert Consensus on SABA Use for Asthma Clinical Decision-Making: A Delphi Approach. Curr Allergy Asthma Rep 2023; 23:621-634. [PMID: 37991672 PMCID: PMC10716188 DOI: 10.1007/s11882-023-01111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE OF REVIEW A modified Delphi process was undertaken to provide a US expert-led consensus to guide clinical action on short-acting beta2-agonist (SABA) use. This comprised an online survey (Phase 1), forum discussion and statement development (Phase 2), and statement adjudication (Phase 3). RECENT FINDINGS In Phase 1 (n = 100 clinicians), 12% routinely provided patients with ≥4 SABA prescriptions/year, 73% solicited SABA use frequency at every patient visit, and 21% did not consult asthma guidelines/expert reports. Phase 3 experts (n = 8) reached consensus (median Likert score, interquartile range) that use of ≥3 SABA canisters/year is associated with increased risk of exacerbation and asthma-related death (5, 4.75-5); SABA use history should be solicited at every patient visit (5, 4.75-5); usage patterns over time, not absolute thresholds, should guide response to SABA overuse (5, 4.5-5). Future asthma guidelines should include clear recommendations regarding SABA usage, using expert-led thresholds for action.
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Affiliation(s)
- Njira Lugogo
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Maeve O'Connor
- Allergy Asthma and Immunology Relief, Charlotte, NC, USA
| | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | - Rajan Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, CA, USA
| | - Greg Bensch
- Allergy Immunology and Asthma Medical Group, Stockton, CA, USA
| | - Jay Portnoy
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - John Oppenheimer
- Department of Internal Medicine, New Jersey Medical School, Newark, NJ, USA
- Pulmonary and Allergy Associates, Morristown, NJ, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Mandovra NP, Vaidya PJ, Shah RS, Nighojkar AS, Chavhan VB, Lohiya A, Leuppi JD, Leuppi-Taegtmeyer A, Chhajed PN. Factors Affecting Best-Tolerated Dose of Pirfenidone in Patients with Fibrosing Interstitial Lung Disease. J Clin Med 2023; 12:6513. [PMID: 37892651 PMCID: PMC10606989 DOI: 10.3390/jcm12206513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of the study was to examine the best-tolerated dose of pirfenidone, the adverse effects profile, and potential factors other than drug dose influencing the tolerability of pirfenidone in patients with fibrosing interstitial lung diseases (ILDs). We performed an observational retrospective study of 113 patients with IPF and other fibrosing ILDs treated with pirfenidone. Baseline liver function tests (LFTs) and dose escalation of pirfenidone were recorded for all patients. The best-tolerated dose was continued if the patient did not tolerate full dose (2400 mg) despite repeated dose escalation attempts. Potential risk factors such as age, height, weight, body mass index (BMI), body surface area (BSA), gender, smoking, and presence of comorbidities were analyzed between 3 groups of best-tolerated pirfenidone doses: 2400 mg/day vs. <2400 mg/day, 2400 mg/day vs. 1800 mg/day, and 2400 mg/day vs. 1200 mg/day. A total of 24 patients tolerated 2400 mg/day, and 89 patients tolerated <2400 mg/day (43 tolerated 1800 mg/day, 45 tolerated 1200 mg/day and 1 tolerated 600 mg/day). Patients who tolerated 2400 mg/day were taller and had a larger BSA as compared to those tolerating <2400 mg/day. Overall, males tolerated the drug better. Presence of comorbidities or smoking did not affect the tolerance of pirfenidone, except for the presence of cerebrovascular diseases. Various adverse effects did not have any significantly different frequencies between the compared groups. Moreover, 71.7% of patients experienced at least one side effect. 1200 mg/day was the best-tolerated dose in the majority of the patients. Male patients with a larger BSA and greater height showed better tolerability of pirfenidone overall.
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Affiliation(s)
- Neha P. Mandovra
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
| | - Preyas J. Vaidya
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
| | - Ria S. Shah
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
| | - Aishwarya S. Nighojkar
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
| | - Vinod B. Chavhan
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
| | - Ayush Lohiya
- Kalyan Singh Super Speciality Cancer Institute, Lucknow 226002, India;
| | - Joerg D. Leuppi
- University Centre of Internal Medicine, Kantonsspital Baselland, 4410 Liestal, Switzerland; (J.D.L.); (A.L.-T.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland
| | - Anne Leuppi-Taegtmeyer
- University Centre of Internal Medicine, Kantonsspital Baselland, 4410 Liestal, Switzerland; (J.D.L.); (A.L.-T.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland
- Department of Patient Safety, Medical Directorate, University Hospital Basel, 4031 Basel, Switzerland
| | - Prashant N. Chhajed
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
- University Centre of Internal Medicine, Kantonsspital Baselland, 4410 Liestal, Switzerland; (J.D.L.); (A.L.-T.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland
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Hollmen M, Bromilow T, Smith AB, Mealing S, Lewis D, Galvin L, Jones S, Pacheco L, Soulard S, Froidure A. I-PreFer Study: A Questionnaire to Explore Patient, Caregiver and Pulmonologist Preferences of Idiopathic Pulmonary Fibrosis Treatment Options. Patient Prefer Adherence 2023; 17:1621-1639. [PMID: 37560148 PMCID: PMC10408661 DOI: 10.2147/ppa.s408857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/19/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Idiopathic Pulmonary Fibrosis (IPF) is a rare disease that causes shortness of breath, dry cough, and tiredness. While there is no cure for IPF, current therapeutic treatments aim to slow lung degeneration while managing side effects. There is little known about patient experience and attitude with regards to their disease and medication. PURPOSE To understand the perceptions, behaviors and drivers of treatment decision-making among patients, caregivers and pulmonologists in IPF. PATIENTS AND METHODS Online surveys to patients with IPF, caregivers and pulmonologists were developed and administered in Belgium, Finland, France, Greece (pulmonologists only), the Netherlands, Ireland and the United Kingdom between November 2021 and January 2022. RESULTS A total of 111 patients, 22 caregivers and 140 pulmonologists participated. Half (47%) of patients rated their disease as "severe", while pulmonologists reported that a quarter of their patients had a low Forced Vital Capacity (FVC) (below 50% of the predicted value). Between 21% and 42% of the patients do not take an IPF medication (patients' perception) or antifibrotic (physicians' perception). Pulmonologists reported that a total of 58% of their patients were receiving antifibrotic medication, any IPF medication, while around 53%, 55%, 35% and 73% of the patients limited their exposure (sometimes or often) to the sun due to IPF, considered taking medication against diarrhea, nausea/vomiting and heartburn, respectively. Treatment adherence was relatively high (81%), in line with the caregivers' view and the pulmonologists' expectations. Overall, cultural, clinical or socio-demographic factors impacted patients' perceptions or behaviors. CONCLUSION This study shows there is a significant proportion of IPF patients who remain untreated, a misalignment of disease severity between patients and their physicians and patient background impacts behavior. Overall, more in-depth patient-physician communication is needed to improve treatment experience.
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Affiliation(s)
- Maria Hollmen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tom Bromilow
- York Health Economics Consortium (YHEC), York, UK
| | - Adam B Smith
- York Health Economics Consortium (YHEC), York, UK
| | | | - Damian Lewis
- York Health Economics Consortium (YHEC), York, UK
| | - Liam Galvin
- European Pulmonary Fibrosis & Related Disorders Federation, Overijse, Belgium
| | - Steve Jones
- European Pulmonary Fibrosis & Related Disorders Federation, Overijse, Belgium
| | - Luís Pacheco
- Boehringer Ingelheim, Amsterdam, the Netherlands
| | | | - Antoine Froidure
- Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
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He J, Li X. Identification and Validation of Aging-Related Genes in Idiopathic Pulmonary Fibrosis. Front Genet 2022; 13:780010. [PMID: 35211155 PMCID: PMC8863089 DOI: 10.3389/fgene.2022.780010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/19/2022] [Indexed: 12/13/2022] Open
Abstract
Aging plays a significant role in the occurrence and development of idiopathic pulmonary fibrosis (IPF). In this study, we aimed to identify and verify potential aging-associated genes involved in IPF using bioinformatic analysis. The mRNA expression profile dataset GSE150910 available in the Gene Expression Omnibus (GEO) database and R software were used to identify the differentially expressed aging-related genes involved in IPF. Hub gene expression was validated by other GEO datasets. Gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed on differentially expressed aging-related genes. Subsequently, aging-related genes were further screened using three techniques (least absolute shrinkage and selection operator (LASSO) regression, support vector machine, and random forest), and the receiver operating characteristic curves were plotted based on screening results. Finally, real-time quantitative polymerase chain reaction (qRT-PCR) was performed to verify the RNA expression of the six differentially expressed aging-related genes using the blood samples of patients with IPF and healthy individuals. Sixteen differentially expressed aging-related genes were detected, of which the expression of 12 were upregulated and four were downregulated. GO and KEGG enrichment analyses indicated the presence of several enriched terms related to senescence and apoptotic mitochondrial changes. Further screening by LASSO regression, support vector machine, and random forest identified six genes (IGF1, RET, IGFBP2, CDKN2A, JUN, and TFAP2A) that could serve as potential diagnostic biomarkers for IPF. Furthermore, qRT-PCR analysis indicated that among the above-mentioned six aging-related genes, only the expression levels of IGF1, RET, and IGFBP2 in patients with IPF and healthy individuals were consistent with the results of bioinformatic analysis. In conclusion, bioinformatics analysis identified 16 potential aging-related genes associated with IPF, and clinical sample validation suggested that among these, IGF1, RET, and IGFBP2 might play a role in the incidence and prognosis of IPF. Our findings may help understand the pathogenesis of IPF.
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, China.,Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xiaoyan Li
- Clinical Medical College of Chengdu Medical College, Chengdu, China.,Department of Endocrinology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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