Beta-agonist overuse and delay in obtaining medical review in high risk asthma: A secondary analysis of data from a randomised controlled trial. Pilcher, J., Patel, M., Pritchard, A., Thayabaran, D., Ebmeier, S., Shaw, D., Black, P., Braithwaite, I., Weatherall, M., & Beasley, R. npj Primary Care Respiratory Medicine, 27(1):1–7, 2017. Number: 1 Publisher: Springer US![Beta-agonist overuse and delay in obtaining medical review in high risk asthma: A secondary analysis of data from a randomised controlled trial [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Asthma mortality surveys report delays in seeking medical review and overuse of beta-agonist therapy as factors contributing to a fatal outcome. However, the strength of these associations is limited because many asthma deaths are unwitnessed. We undertook a secondary analysis of data from a 24-week randomised controlled trial of 303 patients with high-risk asthma, randomised to combination budesonide/formoterol inhaler according to a single maintenance and reliever therapy regimen or fixed dose budesonide/formoterol with salbutamol as reliever (Standard) regimen. Medication use was measured by electronic monitors. The thresholds for high, marked and extreme beta-agonist use days were defined in the single maintenance and reliever therapy arm as: \textgreater8, \textgreater12 and \textgreater16 actuations of budesonide/formoterol in excess of four maintenance doses, respectively; and in the Standard arm as: \textgreater16, \textgreater24 and \textgreater32 actuations of salbutamol, respectively. Whether a medical review was obtained within 48h of an overuse episode was determined by review of data collected during the study by participant report. The mean (standard deviation) proportion of days in which high, marked and extreme beta-agonist overuse occurred without medical review within 48h was 0.94(0.20), 0.94(0.15) and 0.94(0.17), and 0.92(0.19), 0.90(0.26) and 0.94(0.15) for single maintenance and reliever therapy and Standard regimens, respectively. In at least 90% of days, in which beta-agonist overuse occurred, patients did not obtain medical review within 48h of beta-agonist overuse, regardless of the magnitude of overuse or the inhaled corticosteroid/long-acting beta-agonist regimen., RELIEVER INHALER OVERUSE AND DELAY IN MEDICAL REVIEW IN ASTHMA: In asthma, overuse of beta-agonist reliever medication and delay in seeking medical review in an exacerbation are linked to asthma deaths. Janine Pilcher at the Medical Research Institute of New Zealand, and co-workers, conducted a review of data from a study of 303 adult patients with severe asthma, followed over 24 weeks. The patients were allocated to either a budesonide/formoterol, or a salbutamol inhaler to take for symptom relief, in addition to their maintenance treatment. Inhalers were fitted with electronic monitors, to accurately document every use. In both groups, on 90% of days when an exacerbation requiring excess use of an inhaler occurred, patients did not follow-up with medical professionals within 48h as advised. Further, in both groups, 'extreme' reliever inhaler use was recorded at least once in around one in four patients.
@article{pilcher_beta-agonist_2017,
title = {Beta-agonist overuse and delay in obtaining medical review in high risk asthma: {A} secondary analysis of data from a randomised controlled trial},
volume = {27},
issn = {20551010},
url = {http://dx.doi.org/10.1038/s41533-017-0032-z},
doi = {10.1038/s41533-017-0032-z},
abstract = {Asthma mortality surveys report delays in seeking medical review and overuse of beta-agonist therapy as factors contributing to a fatal outcome. However, the strength of these associations is limited because many asthma deaths are unwitnessed. We undertook a secondary analysis of data from a 24-week randomised controlled trial of 303 patients with high-risk asthma, randomised to combination budesonide/formoterol inhaler according to a single maintenance and reliever therapy regimen or fixed dose budesonide/formoterol with salbutamol as reliever (Standard) regimen. Medication use was measured by electronic monitors. The thresholds for high, marked and extreme beta-agonist use days were defined in the single maintenance and reliever therapy arm as: {\textbackslash}textgreater8, {\textbackslash}textgreater12 and {\textbackslash}textgreater16 actuations of budesonide/formoterol in excess of four maintenance doses, respectively; and in the Standard arm as: {\textbackslash}textgreater16, {\textbackslash}textgreater24 and {\textbackslash}textgreater32 actuations of salbutamol, respectively. Whether a medical review was obtained within 48h of an overuse episode was determined by review of data collected during the study by participant report. The mean (standard deviation) proportion of days in which high, marked and extreme beta-agonist overuse occurred without medical review within 48h was 0.94(0.20), 0.94(0.15) and 0.94(0.17), and 0.92(0.19), 0.90(0.26) and 0.94(0.15) for single maintenance and reliever therapy and Standard regimens, respectively. In at least 90\% of days, in which beta-agonist overuse occurred, patients did not obtain medical review within 48h of beta-agonist overuse, regardless of the magnitude of overuse or the inhaled corticosteroid/long-acting beta-agonist regimen., RELIEVER INHALER OVERUSE AND DELAY IN MEDICAL REVIEW IN ASTHMA: In asthma, overuse of beta-agonist reliever medication and delay in seeking medical review in an exacerbation are linked to asthma deaths. Janine Pilcher at the Medical Research Institute of New Zealand, and co-workers, conducted a review of data from a study of 303 adult patients with severe asthma, followed over 24 weeks. The patients were allocated to either a budesonide/formoterol, or a salbutamol inhaler to take for symptom relief, in addition to their maintenance treatment. Inhalers were fitted with electronic monitors, to accurately document every use. In both groups, on 90\% of days when an exacerbation requiring excess use of an inhaler occurred, patients did not follow-up with medical professionals within 48h as advised. Further, in both groups, 'extreme' reliever inhaler use was recorded at least once in around one in four patients.},
number = {1},
journal = {npj Primary Care Respiratory Medicine},
author = {Pilcher, Janine and Patel, Mitesh and Pritchard, Alison and Thayabaran, Darmiga and Ebmeier, Stefan and Shaw, Dominick and Black, Peter and Braithwaite, Irene and Weatherall, Mark and Beasley, Richard},
year = {2017},
pmid = {28496190},
note = {Number: 1
Publisher: Springer US},
pages = {1--7},
}
Downloads: 0
{"_id":"aFWtad46LLBy7HZ8M","bibbaseid":"pilcher-patel-pritchard-thayabaran-ebmeier-shaw-black-braithwaite-etal-betaagonistoveruseanddelayinobtainingmedicalreviewinhighriskasthmaasecondaryanalysisofdatafromarandomisedcontrolledtrial-2017","downloads":0,"creationDate":"2017-12-20T21:19:43.488Z","title":"Beta-agonist overuse and delay in obtaining medical review in high risk asthma: A secondary analysis of data from a randomised controlled trial","author_short":["Pilcher, J.","Patel, M.","Pritchard, A.","Thayabaran, D.","Ebmeier, S.","Shaw, D.","Black, P.","Braithwaite, I.","Weatherall, M.","Beasley, R."],"year":2017,"bibtype":"article","biburl":"https://api.zotero.org/users/6607533/collections/TTBWENIN/items?key=hSjrOPQRRHHWY81SKs6CEz45&format=bibtex&limit=100","bibdata":{"bibtype":"article","type":"article","title":"Beta-agonist overuse and delay in obtaining medical review in high risk asthma: A secondary analysis of data from a randomised controlled trial","volume":"27","issn":"20551010","url":"http://dx.doi.org/10.1038/s41533-017-0032-z","doi":"10.1038/s41533-017-0032-z","abstract":"Asthma mortality surveys report delays in seeking medical review and overuse of beta-agonist therapy as factors contributing to a fatal outcome. However, the strength of these associations is limited because many asthma deaths are unwitnessed. We undertook a secondary analysis of data from a 24-week randomised controlled trial of 303 patients with high-risk asthma, randomised to combination budesonide/formoterol inhaler according to a single maintenance and reliever therapy regimen or fixed dose budesonide/formoterol with salbutamol as reliever (Standard) regimen. Medication use was measured by electronic monitors. The thresholds for high, marked and extreme beta-agonist use days were defined in the single maintenance and reliever therapy arm as: \\textgreater8, \\textgreater12 and \\textgreater16 actuations of budesonide/formoterol in excess of four maintenance doses, respectively; and in the Standard arm as: \\textgreater16, \\textgreater24 and \\textgreater32 actuations of salbutamol, respectively. Whether a medical review was obtained within 48h of an overuse episode was determined by review of data collected during the study by participant report. The mean (standard deviation) proportion of days in which high, marked and extreme beta-agonist overuse occurred without medical review within 48h was 0.94(0.20), 0.94(0.15) and 0.94(0.17), and 0.92(0.19), 0.90(0.26) and 0.94(0.15) for single maintenance and reliever therapy and Standard regimens, respectively. In at least 90% of days, in which beta-agonist overuse occurred, patients did not obtain medical review within 48h of beta-agonist overuse, regardless of the magnitude of overuse or the inhaled corticosteroid/long-acting beta-agonist regimen., RELIEVER INHALER OVERUSE AND DELAY IN MEDICAL REVIEW IN ASTHMA: In asthma, overuse of beta-agonist reliever medication and delay in seeking medical review in an exacerbation are linked to asthma deaths. Janine Pilcher at the Medical Research Institute of New Zealand, and co-workers, conducted a review of data from a study of 303 adult patients with severe asthma, followed over 24 weeks. The patients were allocated to either a budesonide/formoterol, or a salbutamol inhaler to take for symptom relief, in addition to their maintenance treatment. Inhalers were fitted with electronic monitors, to accurately document every use. In both groups, on 90% of days when an exacerbation requiring excess use of an inhaler occurred, patients did not follow-up with medical professionals within 48h as advised. Further, in both groups, 'extreme' reliever inhaler use was recorded at least once in around one in four patients.","number":"1","journal":"npj Primary Care Respiratory Medicine","author":[{"propositions":[],"lastnames":["Pilcher"],"firstnames":["Janine"],"suffixes":[]},{"propositions":[],"lastnames":["Patel"],"firstnames":["Mitesh"],"suffixes":[]},{"propositions":[],"lastnames":["Pritchard"],"firstnames":["Alison"],"suffixes":[]},{"propositions":[],"lastnames":["Thayabaran"],"firstnames":["Darmiga"],"suffixes":[]},{"propositions":[],"lastnames":["Ebmeier"],"firstnames":["Stefan"],"suffixes":[]},{"propositions":[],"lastnames":["Shaw"],"firstnames":["Dominick"],"suffixes":[]},{"propositions":[],"lastnames":["Black"],"firstnames":["Peter"],"suffixes":[]},{"propositions":[],"lastnames":["Braithwaite"],"firstnames":["Irene"],"suffixes":[]},{"propositions":[],"lastnames":["Weatherall"],"firstnames":["Mark"],"suffixes":[]},{"propositions":[],"lastnames":["Beasley"],"firstnames":["Richard"],"suffixes":[]}],"year":"2017","pmid":"28496190","note":"Number: 1 Publisher: Springer US","pages":"1–7","bibtex":"@article{pilcher_beta-agonist_2017,\n\ttitle = {Beta-agonist overuse and delay in obtaining medical review in high risk asthma: {A} secondary analysis of data from a randomised controlled trial},\n\tvolume = {27},\n\tissn = {20551010},\n\turl = {http://dx.doi.org/10.1038/s41533-017-0032-z},\n\tdoi = {10.1038/s41533-017-0032-z},\n\tabstract = {Asthma mortality surveys report delays in seeking medical review and overuse of beta-agonist therapy as factors contributing to a fatal outcome. However, the strength of these associations is limited because many asthma deaths are unwitnessed. We undertook a secondary analysis of data from a 24-week randomised controlled trial of 303 patients with high-risk asthma, randomised to combination budesonide/formoterol inhaler according to a single maintenance and reliever therapy regimen or fixed dose budesonide/formoterol with salbutamol as reliever (Standard) regimen. Medication use was measured by electronic monitors. The thresholds for high, marked and extreme beta-agonist use days were defined in the single maintenance and reliever therapy arm as: {\\textbackslash}textgreater8, {\\textbackslash}textgreater12 and {\\textbackslash}textgreater16 actuations of budesonide/formoterol in excess of four maintenance doses, respectively; and in the Standard arm as: {\\textbackslash}textgreater16, {\\textbackslash}textgreater24 and {\\textbackslash}textgreater32 actuations of salbutamol, respectively. Whether a medical review was obtained within 48h of an overuse episode was determined by review of data collected during the study by participant report. The mean (standard deviation) proportion of days in which high, marked and extreme beta-agonist overuse occurred without medical review within 48h was 0.94(0.20), 0.94(0.15) and 0.94(0.17), and 0.92(0.19), 0.90(0.26) and 0.94(0.15) for single maintenance and reliever therapy and Standard regimens, respectively. In at least 90\\% of days, in which beta-agonist overuse occurred, patients did not obtain medical review within 48h of beta-agonist overuse, regardless of the magnitude of overuse or the inhaled corticosteroid/long-acting beta-agonist regimen., RELIEVER INHALER OVERUSE AND DELAY IN MEDICAL REVIEW IN ASTHMA: In asthma, overuse of beta-agonist reliever medication and delay in seeking medical review in an exacerbation are linked to asthma deaths. Janine Pilcher at the Medical Research Institute of New Zealand, and co-workers, conducted a review of data from a study of 303 adult patients with severe asthma, followed over 24 weeks. The patients were allocated to either a budesonide/formoterol, or a salbutamol inhaler to take for symptom relief, in addition to their maintenance treatment. Inhalers were fitted with electronic monitors, to accurately document every use. In both groups, on 90\\% of days when an exacerbation requiring excess use of an inhaler occurred, patients did not follow-up with medical professionals within 48h as advised. Further, in both groups, 'extreme' reliever inhaler use was recorded at least once in around one in four patients.},\n\tnumber = {1},\n\tjournal = {npj Primary Care Respiratory Medicine},\n\tauthor = {Pilcher, Janine and Patel, Mitesh and Pritchard, Alison and Thayabaran, Darmiga and Ebmeier, Stefan and Shaw, Dominick and Black, Peter and Braithwaite, Irene and Weatherall, Mark and Beasley, Richard},\n\tyear = {2017},\n\tpmid = {28496190},\n\tnote = {Number: 1\nPublisher: Springer US},\n\tpages = {1--7},\n}\n\n","author_short":["Pilcher, J.","Patel, M.","Pritchard, A.","Thayabaran, D.","Ebmeier, S.","Shaw, D.","Black, P.","Braithwaite, I.","Weatherall, M.","Beasley, R."],"key":"pilcher_beta-agonist_2017","id":"pilcher_beta-agonist_2017","bibbaseid":"pilcher-patel-pritchard-thayabaran-ebmeier-shaw-black-braithwaite-etal-betaagonistoveruseanddelayinobtainingmedicalreviewinhighriskasthmaasecondaryanalysisofdatafromarandomisedcontrolledtrial-2017","role":"author","urls":{"Paper":"http://dx.doi.org/10.1038/s41533-017-0032-z"},"metadata":{"authorlinks":{"beasley, r":"https://www.mrinz.ac.nz/"}},"downloads":0},"search_terms":["beta","agonist","overuse","delay","obtaining","medical","review","high","risk","asthma","secondary","analysis","data","randomised","controlled","trial","pilcher","patel","pritchard","thayabaran","ebmeier","shaw","black","braithwaite","weatherall","beasley"],"keywords":[],"authorIDs":["5cf6f07b6db75fda010000f9","N3obYpqrxxsH3YJWN","XpthFsNinuhKsH7pw","aAr8RG55mgpbTJNwL","fkXvTs3mckAQTCNLq","reqj5nKrqAA7Ywbrs","wqgwP5AoWzbZ24aoX"],"dataSources":["kYYXvHrRzyTY8BfGZ","ya2CyA73rpZseyrZ8","8gshJYHcTFRwkXFvc","477QN6SvdKQPLJFBK","XcBwjMjkJbaSi3puN","2252seNhipfTmjEBQ"]}