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Cardet JC, Busse PJ, Carroll JK, Casale TB, Coyne-Beasley T, Dixon-Williams S, Fagan M, Forth VE, Fuhlbrigge AL, Hernandez ML, Kaelber D, Kaplan B, Lorenzi M, Madison S, Maher NE, Majewski K, Manning B, McKee MD, Nazario S, Pace WD, Pencina MJ, Rand CS, Rodriguez-Louis J, She L, Shields J, Teng JE, Wechsler ME, Wisnivesky JP, Yawn BP, Israel E. Adherence to adding inhaled corticosteroids to rescue therapy in a pragmatic trial with adults with asthma: A pilot study. Ann Allergy Asthma Immunol 2020; 124:487-493.e1. [PMID: 31923550 DOI: 10.1016/j.anai.2019.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/19/2019] [Accepted: 12/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Underuse of guideline-recommended inhaled corticosteroids (ICS) controller therapy is a risk factor for greater asthma burden. ICS concomitantly used with rescue inhalers (Patient-Activated Reliever-Triggered ICS ['PARTICS']) reduced asthma exacerbations in efficacy trials, but whether PARTICS is effective in pragmatic trials is unknown. OBJECTIVE We conducted this pilot to determine the feasibility of executing a large-scale pragmatic PARTICS trial and to improve study protocols. METHODS Four sites recruited 33 Hispanic or black adults with persistent asthma, randomized them approximately 3:1 to intervention or usual care, and followed them for 12 weeks. All participants received asthma guideline-based educational videos; intervention participants received video-based instructions on implementing PARTICS plus usual medications. The study involved 1 randomization visit and monthly questionnaires. Timely questionnaire responses (±2 weeks) were monitored. Participants underwent qualitative phone interviews to assess self-reported adherence to PARTICS and understand barriers to completing study procedures. RESULTS Timely questionnaire response rates were 61%, 64%, and 70% at 4, 8, and 12 weeks, respectively. Self-reported adherence to PARTICS was 76% (95% confidence interval [CI], 58%-94% [n = 21]), 88% (95%CI, 72%-100% [n = 16]), and 62% (95%CI, 36%-88% [n = 13]) at weeks 1, 6, and 12, respectively. Barriers to completing study procedures included difficulties with questionnaire access, remembering to use ICS and rescue inhalers together, and obtaining refills. Only 22% of participants recognized their short-acting bronchodilator as "reliever" or "rescue." CONCLUSION Recruitment was feasible within the allocated period. Adherence to PARTICS was incomplete, questionnaire completion was suboptimal, and common rescue inhaler nomenclature usage was limited. We have modified the full study protocol to attempt to improve adherence to PARTICS and minimize barriers to study procedures. CLINICAL TRIALS REGISTRATION pilot study for 'PeRson EmPowered Asthma Relief' (PREPARE, NCT02995733).
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Affiliation(s)
- Juan Carlos Cardet
- University of South Florida, Morsani College of Medicine, Division of Allergy and Immunology, Tampa, Florida.
| | - Paula J Busse
- Department of Medicine, Mount Sinai School of Medicine, New York, New York
| | | | - Thomas B Casale
- University of South Florida, Morsani College of Medicine, Division of Allergy and Immunology, Tampa, Florida
| | - Tamera Coyne-Beasley
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sherrie Dixon-Williams
- Center for Clinical Informatics Research and Educations, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio
| | - Maureen Fagan
- University of Miami Hospital and Clinics, Miller School of Medicine, Miami, Florida
| | - Victoria E Forth
- Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts
| | | | - Michelle L Hernandez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill. Chapel Hill, North Carolina
| | - David Kaelber
- Center for Clinical Informatics Research and Educations, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio
| | | | - Margarita Lorenzi
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Suzanne Madison
- Patient-Centered Outcomes Research Institute, Minneapolis, Minnsesota
| | - Nancy E Maher
- Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts
| | - Karen Majewski
- Center for Clinical Informatics Research and Educations, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio
| | - Brian Manning
- The American Academy of Family Physicians' National Research Network, Leawood, Kansas
| | | | - Sylvette Nazario
- Department of Internal Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Wilson D Pace
- Department of Family Medicine, University of Colorado, Denver, Colorado
| | | | - Cynthia S Rand
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Lilin She
- Duke Clinical Research Institute, Durham, North Carolina
| | - Joel Shields
- The American Academy of Family Physicians' National Research Network, Leawood, Kansas
| | - Jessica E Teng
- Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts
| | | | - Juan P Wisnivesky
- Department of Medicine, Mount Sinai School of Medicine, New York, New York
| | - Barbara P Yawn
- Department of Family Medicine, University of Minnesota, Blaine, Minnesota
| | - Elliot Israel
- Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts
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Krishnan V, Dixon-Williams S, Thornton JD. Where there is smoke…there is sleep apnea: exploring the relationship between smoking and sleep apnea. Chest 2015; 146:1673-1680. [PMID: 25451354 DOI: 10.1378/chest.14-0772] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Smoking and OSA are widely prevalent and are associated with significant morbidity and mortality. It has been hypothesized that each of these conditions adversely affects the other, leading to increased comorbidity while altering the efficacy of existing therapies. However, while the association between smoking and OSA is plausible, the evidence is less than conclusive. Cigarette smoking may increase the severity of OSA through alterations in sleep architecture, upper airway neuromuscular function, arousal mechanisms, and upper airway inflammation. Conversely, some evidence links untreated OSA with smoking addiction. Smoking cessation should improve OSA, but the evidence to support this is also limited. This article reviews the current evidence linking both conditions and the efficacy of various treatments. Limitations of the current evidence and areas in need of future investigation are also addressed.
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Affiliation(s)
- Vidya Krishnan
- Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, OH.
| | - Sherrie Dixon-Williams
- Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - J Daryl Thornton
- Division of Pulmonary, Critical Care, and Sleep Medicine, Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, OH
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