Richard Stanford - Academia.edu (original) (raw)
Papers by Richard Stanford
Journal of The American Chemical Society, 1974
The Open Respiratory Medicine Journal, 2010
Objective: The objective of this survey was to assess adult primary care physicians' and pediatri... more Objective: The objective of this survey was to assess adult primary care physicians' and pediatricians' perceptions of asthma exacerbation management, including beliefs concerning the discharge of patients from the emergency department (ED) following asthma exacerbations.
C58. ASTHMA EPIDEMIOLOGY: ETIOLOGY AND OUTCOMES, 2009
Journal of the American College of Cardiology, 2004
Background: Randomized clinical trials (RCT) are performed in a very different environment from c... more Background: Randomized clinical trials (RCT) are performed in a very different environment from community practice. Heart failure patients in the community tend to be older, have more comorbidities and are not cared for by the teams of heart failure specialists who recruit patients into RCT, which may be especially important when beta-adrenergic blocking drugs are prescribed to patients with heart failure. Methods: In order to explore these prescribing effects we determined the dose of carvedilol at end-titration in 4,113 patients in the practice setting and related this to physician type (cardiologists vs. non-cardiologists), heart failure severity, and the risks of hospitalization and death. Results: Dose achieved was not related to patients' age, sex, race, history of diabetes or other major demographic/clinical factors. The table shows factors that are influenced by dose.
Journal of Asthma, 2010
Despite the availability of effective asthma treatments and evidence-based management guidelines ... more Despite the availability of effective asthma treatments and evidence-based management guidelines focusing on asthma control, many patients have asthma that is inadequately controlled. The objective of this analysis was to identify risk factors for uncontrolled asthma among adult and pediatric patients. Two cross-sectional surveys assessing asthma control status were conducted between January 25 and May 2, 2008, among adult and pediatric patients with asthma. Participants completed a self-administered questionnaire including demographics, medical history, and current asthma medication use. In addition, participants completed either the Asthma Control Test (ACT) or Childhood ACT (C-ACT). Uncontrolled asthma was defined as a score of < or = 19 on the ACT or C-ACT. Multiple logistic regression was used to identify factors related to uncontrolled asthma. A sample of 64 primary care provider sites (35 for adults and 29 for pediatric patients) across the United States enrolled. One study enrolled 2238 adults (aged > or = 18 years) and the other 2429 children (aged 4-17 years) with asthma. The patients were visiting their health care provider for a scheduled appointment for any reason. The overall prevalence of uncontrolled asthma was 58% and 46% in adult and pediatric patients, respectively. Multivariate analysis identified predictors of uncontrolled asthma in both adults and children including self-reported asthma severity, lack of adherence, and recent history of cold, flu, or sinus infection. The predictors of uncontrolled asthma seen only in adults were less education, insurance status, current smoker, body mass index (BMI) >30 kg/m(2), and history of gastroesophageal symptoms. The predictors of uncontrolled asthma seen only in children were female aged 12-17 years, caregiver unemployment, and history of asthma exacerbation. A high proportion of patients with asthma seen in primary care settings are not well controlled. Recognition of specific predictors can signal who may be at higher risk of uncontrolled asthma and provide the opportunity for early interventions.
Journal of Asthma, 2011
The benefits of inhaled corticosteroids in asthma are well established. Early use of inhaled anti... more The benefits of inhaled corticosteroids in asthma are well established. Early use of inhaled anti-inflammatories following and exacerbation could be beneficial. A retrospective observational cohort study compared the risk of asthma-related exacerbations [hospitalization, emergency department visit, and/or treatment with systemic corticosteroid] in patients receiving treatment with fluticasone propionate/salmeterol in a single inhaler (FSC) within 90 days following an initial asthma-related exacerbation (early treatment) versus patients receiving the treatment subsequently (late treatment). Data were from a large health insurance claims database spanning from January 1998 to April 2008. Subjects included patients with ≥1 prescription for FSC ≤ 1 year after first asthma-related exacerbation. Patients with early treatment were matched to those with late treatment by propensity score and compared in terms of healthcare utilization and costs after initiation of FSC. A total of 14,861 patients met study inclusion criteria, including 10,793 early and 4068 late treatment patients. After matching, 3555 pairs were well matched on all pretreatment characteristics and duration of follow-up (mean 722 vs. 717 days, p = .634). Early versus late treatment was associated with longer time to first asthma-related exacerbation (hazard ratio = 0.82, 95% CI 0.75-0.88, p < .001), fewer short-acting β-agonists prescriptions (3.3 vs. 3.6, p = .031), higher outpatient yearly per patient pharmacy costs ($1320 vs. 1163,p=.008),andloweryearlyperpatientasthma−relatedemergencydepartmentvisitcosts(1163, p = .008), and lower yearly per patient asthma-related emergency department visit costs (1163,p=.008),andloweryearlyperpatientasthma−relatedemergencydepartmentvisitcosts(80 vs. 105,p=.032).Totalyearlyperpatientasthma−relatedcostsweresimilar(105, p = .032). Total yearly per patient asthma-related costs were similar (105,p=.032).Totalyearlyperpatientasthma−relatedcostsweresimilar(2197 vs. $2064, p = .203). Earlier use of FSC following an asthma exacerbation was associated with reduced risk of future asthma-related exacerbation and lower use of rescue medications.
Journal of Asthma, 2013
National asthma treatment guidelines recommend low/medium-dose inhaled corticosteroids (ICSs) as ... more National asthma treatment guidelines recommend low/medium-dose inhaled corticosteroids (ICSs) as initial therapy in mild asthma patients. However, low doses of a fixed-dose combination of ICS and long-acting β-agonists are sometimes used. This study compares asthma-related outcomes and health care utilization and costs in clinical practice in patients starting fluticasone propionate 100 μg and salmeterol 50 μg via Diskus (FSC) or mometasone furoate (MF). A retrospective cohort study was conducted to compare asthma-related outcomes in asthma patients who received FSC or MF, using a large health insurance claims dataset spanning January 2004-December 2008. Patients with ≥1 claim with an asthma ICD-9-CM diagnosis code and ≥2 FSC or MF prescriptions were included, stratified into FSC or MF groups by study drug received first and matched using propensity score. A total of 18,283 patients met inclusion criteria (14,044 FSC and 4239 MF); 3799 matched pairs were identified (mean follow-up: FSC 548 days, MF 537 days). FSC patients had lower risk of asthma-related exacerbation (Hazard ratio = 0.88, 95% CI 0.81-0.95, p = .002), defined as either asthma-related emergency department (ED) visits/hospitalizations or receipt of systemic corticosteroids (SCSs); fewer SCS claims (mean 0.28 vs. 0.33, p = .021); and fewer asthma-related physician office (PO) and hospital outpatient (HO) visits (mean 1.17 vs. 1.63, p < .001). However, asthma-related ED visits were higher with FSC (p = .004), and FSC patients had higher total costs of asthma-related health care ($953 vs. $862, p = .002). In asthma patients initiating ICS therapy, MF had lower asthma-related ED visits. However, FSC may reduce the use of SCS and asthma-related PO/HO visits.
The American journal of managed care, 2013
To assess the predictive ability of the ratio of controller-to-total asthma medication in commerc... more To assess the predictive ability of the ratio of controller-to-total asthma medication in commercially insured and Medicaid patients. Retrospective cohort. Medical and pharmacy claims were used to identify asthma patients between 2004 and 2006. Ratios were computed during 3-, 6-, and 12-month assessment periods and asthma exacerbations were assessed during a subsequent 12-month follow-up period. Receiver operating characteristic curve analyses and logistic regression were used to select optimal ratio number, assessment time period, and incremental ratio analysis. The ratio significantly predicted future asthma exacerbations. An optimal value of >0.7 was identified in pediatric and adult Medicaid patients with a shorter assessment period in adults (3 months) than in children (6 months). In commercially insured patients, an optimal value of >0.5 during a 6-month assessment period was identified for children and adults. In commercially insured patients, a 0.1-unit increase in the...
Journal of Allergy and Clinical Immunology, 2005
The goal of asthma therapy is to maintain consistent control. We sought to examine the patterns o... more The goal of asthma therapy is to maintain consistent control. We sought to examine the patterns of asthma control recorded over 3 years using administrative claims and resource utilization definition. We performed a retrospective observational study with a nationally representative patient-level database containing pharmacy and medical claims. Patients with asthma (International Classification of Diseases, Ninth Revision-Clinical Modification code 493.xx), patients undergoing treatment with at least 1 asthma medication, and patients with 36 months of continuous claims coverage during the calendar years 1996 through 2002 were identified. A total of 63,324 patients were included in the study. Patients were classified as having controlled asthma in year 1 if they had less than 4 claims for a short-acting beta 2 -agonist, no claims for an OCS, and no asthma-related emergency department visits or hospitalizations. Patients were then followed over the next 8 quarters (2 years) to observe whether control was maintained. Control during a quarter was defined with the same criteria, except the reliever threshold was adjusted to 2 or more claims per quarter. Thirty-nine thousand ninety-five (57%) patients were defined as having controlled asthma during year 1. During the 2-year follow-up period, a range of 10% to 14% of these patients with controlled asthma met the criteria of uncontrolled asthma during any given quarter. Overall, 46,227 (73%) patients identified met the criteria for uncontrolled asthma at least once during the 3-year period. This study demonstrates that almost 75% of asthmatic patients experience an uncontrolled asthma episode 1 or more times over a 3-year period. Furthermore, we found that significant fluctuations in asthma control exist, even in patients with prior controlled asthma.
Journal of Allergy and Clinical Immunology, 2001
Background: Randomized clinical trials have demonstrated that fluticasone propionate (FP) has bet... more Background: Randomized clinical trials have demonstrated that fluticasone propionate (FP) has better objective as well as subjective clinical outcomes than zafirlukast (ZA) in the treatment of asthma. Objective: The goal of this study was to determine whether the superiority of FP over ZA observed in clinical trials is supported under actual practice conditions. Methods: A retrospective cohort analysis of pharmacy and medical claims for asthma was performed. Patients were identified who had at least 1 ICD-9 (493.XX) claim for asthma and were recently prescribed inhaled FP or ZA. Subjects could not have had a claim for any inhaled corticosteroid or oral leukotriene modifier in the 9 months before initiation of FP or ZA. They were subsequently observed for 12 months. Results: A total of 725 persons were new users of FP and 309 of ZA. FP was associated with a 70% reduced risk for hospitalization (P = .0232), a 49% lower risk for an emergency department event (P = .0546), and a 51% reduction in combined emergency department events and hospitalizations (P = .0268) when compared with ZA. Adjusted annual asthma care costs declined significantly for FP and increased for ZA. The adjusted mean difference in annual asthma costs was $215 less per patient for FP (P < .0001). Conclusion: Asthma care costs decreased for patients treated with FP and increased for patients treated with ZA. Furthermore, FP-treated patients had significantly lower risks of asthma-related hospitalization than ZA patients. This study supports results seen in clinical trials comparing these two medications. (J Allergy Clin Immunol 2001;107:94-8.)
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2008
To assess the burden of nasal symptoms in the United States (U.S.) and the comorbid conditions as... more To assess the burden of nasal symptoms in the United States (U.S.) and the comorbid conditions associated with nasal symptoms. A self-administered screening questionnaire and follow-up survey was sent to targeted households from a representative sample of 15,000 households in the U.S. Subjects with comorbid asthma completed the Asthma Control Test (ACT). Out of 7024 evaluable subjects who responded, 3831 subjects were classified as rhinitis "sufferers." Individuals with active rhinitis symptoms were 1.5 to 4.5 times more likely to suffer from comorbid conditions including asthma, conjunctivitis, otitis media, sinusitis, eczema, food and insect bite allergies, migraine, and depression. Almost half of all respondents with moderate or severe rhinitis symptoms and comorbid asthma had poorly controlled asthma as defined by an ACT score of < or =19. A strong relationship exists between rhinitis symptoms and various comorbidities, including asthma, in the U.S. population. Poor...
Journal of Allergy and Clinical Immunology, 2002
BACKGROUND: There have been several reports on the patterns of use of asthma medication as report... more BACKGROUND: There have been several reports on the patterns of use of asthma medication as reported by persons with asthma. However, little or no published information has been reported regarding medication use in a high-risk community.
D57. PEDIATRIC AIRWAY DISEASES: MANAGEMENT, 2010
Journal of Allergy and Clinical Immunology, 2003
GlaxoSmithKline, Research Triangle Park, NC. RATIONALE: Compare asthma exacerbations rates and qu... more GlaxoSmithKline, Research Triangle Park, NC. RATIONALE: Compare asthma exacerbations rates and quantify direct medical costs during treatment with fluticasone propionate/salmeterol combination product (FSC; 100/50 BID) vs fluticasone propionate (FP; 88 mcg BID) or montelukast (MEN; 10 mg QD). METHODS: Data from four double-blind, double-dummy, randomized controlled trials that compared FSC with MeN ( 12-weeks trials) or MeN with FP (24-weeks trials) in patients previously uncontrolled on albuterol alone. The 12-week data from all studies was analyzed, A Cox proportional hazard analysis was performed on time to asthma exacerbation while direct costs were determined by applying standard costs to physician office visits; asthma related emergency department visits and hospitalizations that occurred during the exacerbations. RESULTS: The analysis included 1910 patients _>15 years symptomatic on albuterol alone. Baseline characteristics were similar between groups. Compared with FSC, FP patients had a 2.6 (95% CI 1.04, 6.49) times greater risk of having an asthma related exacerbation while MeN patients had a 3.6 (95% CI 1.52, 8.31 ) times greater risk of having an asthma related exacerbation within 12 weeks of starting therapy. Exacerbation cost per RATIONALE: Nebulizers vary in the amount of inhaled mass delivered and the time required to administer treatment. METHODS: We compared the performance of ultrasonic and pneumatic nebulizers with a prototype nebulizer (Aerogen). Albuterol sulfate (3 mL) was administered to a breath simulator (Vt 500 mL, rate 15, and 0.35 duty cycle) with each device (n=3). Drug deposited on an absolute filter (Inhaled Mass) was assayed (HPLC). Flow rate (mL/min) of emitted aerosol, and residual volume (mL) remaining in the nebulizer were determined gravimetrically. Treatment time to end of dose or sputter was recorded. Volume Median Diameter (VMD) was determined by laser diffraction (SpraytecbTm).
A31. OPTIMIZING THERAPEUTIC STRATEGIES IN AIRWAYS DISEASE, 2011
Journal of Allergy and Clinical Immunology, 2005
The Patient: Patient-Centered Outcomes Research, 2010
: Effective management of allergic rhinitis requires ongoing monitoring of its control. This arti... more : Effective management of allergic rhinitis requires ongoing monitoring of its control. This article describes the qualitative phase of development of a patient-completed instrument, the Rhinitis Control Assessment Test (RCAT), designed to assist patients and providers in the detection of problems with rhinitis symptom control. : To identify concepts to be measured and to develop initial questionnaire items to be tested further in the next phase of development. : A literature review and input from patient focus groups were utilized to generate concepts to be measured in the draft questionnaire. The draft items were subjected to cognitive testing to ensure that the items were understood by patients and to eliminate ambiguity as well as to select an optimal recall period and meaningful response scales. Patients aged ≥18 years self-reporting a rhinitis diagnosis who had experienced rhinitis symptoms in the past 12 months were eligible for participation in the focus groups (n = 39) and the cognitive interviews (n = 23). : This qualitative process yielded a draft instrument with 26 items assessing five constructs of rhinitis symptom control: frequency and bothersomeness of nasal and non-nasal symptoms, symptom impact, activity interference, symptom control, and medication use. A five-point Likert response scale and a 1-week recall period for each item were adopted based on patient input. : The qualitative phase of development of the RCAT produced constructs and items for an instrument that is anticipated to facilitate accurate assessment of rhinitis control and improve the quality of care for patients with allergic rhinitis.
A31. OPTIMIZING THERAPEUTIC STRATEGIES IN AIRWAYS DISEASE, 2011
Journal of The American Chemical Society, 1974
The Open Respiratory Medicine Journal, 2010
Objective: The objective of this survey was to assess adult primary care physicians' and pediatri... more Objective: The objective of this survey was to assess adult primary care physicians' and pediatricians' perceptions of asthma exacerbation management, including beliefs concerning the discharge of patients from the emergency department (ED) following asthma exacerbations.
C58. ASTHMA EPIDEMIOLOGY: ETIOLOGY AND OUTCOMES, 2009
Journal of the American College of Cardiology, 2004
Background: Randomized clinical trials (RCT) are performed in a very different environment from c... more Background: Randomized clinical trials (RCT) are performed in a very different environment from community practice. Heart failure patients in the community tend to be older, have more comorbidities and are not cared for by the teams of heart failure specialists who recruit patients into RCT, which may be especially important when beta-adrenergic blocking drugs are prescribed to patients with heart failure. Methods: In order to explore these prescribing effects we determined the dose of carvedilol at end-titration in 4,113 patients in the practice setting and related this to physician type (cardiologists vs. non-cardiologists), heart failure severity, and the risks of hospitalization and death. Results: Dose achieved was not related to patients' age, sex, race, history of diabetes or other major demographic/clinical factors. The table shows factors that are influenced by dose.
Journal of Asthma, 2010
Despite the availability of effective asthma treatments and evidence-based management guidelines ... more Despite the availability of effective asthma treatments and evidence-based management guidelines focusing on asthma control, many patients have asthma that is inadequately controlled. The objective of this analysis was to identify risk factors for uncontrolled asthma among adult and pediatric patients. Two cross-sectional surveys assessing asthma control status were conducted between January 25 and May 2, 2008, among adult and pediatric patients with asthma. Participants completed a self-administered questionnaire including demographics, medical history, and current asthma medication use. In addition, participants completed either the Asthma Control Test (ACT) or Childhood ACT (C-ACT). Uncontrolled asthma was defined as a score of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 19 on the ACT or C-ACT. Multiple logistic regression was used to identify factors related to uncontrolled asthma. A sample of 64 primary care provider sites (35 for adults and 29 for pediatric patients) across the United States enrolled. One study enrolled 2238 adults (aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 18 years) and the other 2429 children (aged 4-17 years) with asthma. The patients were visiting their health care provider for a scheduled appointment for any reason. The overall prevalence of uncontrolled asthma was 58% and 46% in adult and pediatric patients, respectively. Multivariate analysis identified predictors of uncontrolled asthma in both adults and children including self-reported asthma severity, lack of adherence, and recent history of cold, flu, or sinus infection. The predictors of uncontrolled asthma seen only in adults were less education, insurance status, current smoker, body mass index (BMI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;30 kg/m(2), and history of gastroesophageal symptoms. The predictors of uncontrolled asthma seen only in children were female aged 12-17 years, caregiver unemployment, and history of asthma exacerbation. A high proportion of patients with asthma seen in primary care settings are not well controlled. Recognition of specific predictors can signal who may be at higher risk of uncontrolled asthma and provide the opportunity for early interventions.
Journal of Asthma, 2011
The benefits of inhaled corticosteroids in asthma are well established. Early use of inhaled anti... more The benefits of inhaled corticosteroids in asthma are well established. Early use of inhaled anti-inflammatories following and exacerbation could be beneficial. A retrospective observational cohort study compared the risk of asthma-related exacerbations [hospitalization, emergency department visit, and/or treatment with systemic corticosteroid] in patients receiving treatment with fluticasone propionate/salmeterol in a single inhaler (FSC) within 90 days following an initial asthma-related exacerbation (early treatment) versus patients receiving the treatment subsequently (late treatment). Data were from a large health insurance claims database spanning from January 1998 to April 2008. Subjects included patients with ≥1 prescription for FSC ≤ 1 year after first asthma-related exacerbation. Patients with early treatment were matched to those with late treatment by propensity score and compared in terms of healthcare utilization and costs after initiation of FSC. A total of 14,861 patients met study inclusion criteria, including 10,793 early and 4068 late treatment patients. After matching, 3555 pairs were well matched on all pretreatment characteristics and duration of follow-up (mean 722 vs. 717 days, p = .634). Early versus late treatment was associated with longer time to first asthma-related exacerbation (hazard ratio = 0.82, 95% CI 0.75-0.88, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), fewer short-acting β-agonists prescriptions (3.3 vs. 3.6, p = .031), higher outpatient yearly per patient pharmacy costs ($1320 vs. 1163,p=.008),andloweryearlyperpatientasthma−relatedemergencydepartmentvisitcosts(1163, p = .008), and lower yearly per patient asthma-related emergency department visit costs (1163,p=.008),andloweryearlyperpatientasthma−relatedemergencydepartmentvisitcosts(80 vs. 105,p=.032).Totalyearlyperpatientasthma−relatedcostsweresimilar(105, p = .032). Total yearly per patient asthma-related costs were similar (105,p=.032).Totalyearlyperpatientasthma−relatedcostsweresimilar(2197 vs. $2064, p = .203). Earlier use of FSC following an asthma exacerbation was associated with reduced risk of future asthma-related exacerbation and lower use of rescue medications.
Journal of Asthma, 2013
National asthma treatment guidelines recommend low/medium-dose inhaled corticosteroids (ICSs) as ... more National asthma treatment guidelines recommend low/medium-dose inhaled corticosteroids (ICSs) as initial therapy in mild asthma patients. However, low doses of a fixed-dose combination of ICS and long-acting β-agonists are sometimes used. This study compares asthma-related outcomes and health care utilization and costs in clinical practice in patients starting fluticasone propionate 100 μg and salmeterol 50 μg via Diskus (FSC) or mometasone furoate (MF). A retrospective cohort study was conducted to compare asthma-related outcomes in asthma patients who received FSC or MF, using a large health insurance claims dataset spanning January 2004-December 2008. Patients with ≥1 claim with an asthma ICD-9-CM diagnosis code and ≥2 FSC or MF prescriptions were included, stratified into FSC or MF groups by study drug received first and matched using propensity score. A total of 18,283 patients met inclusion criteria (14,044 FSC and 4239 MF); 3799 matched pairs were identified (mean follow-up: FSC 548 days, MF 537 days). FSC patients had lower risk of asthma-related exacerbation (Hazard ratio = 0.88, 95% CI 0.81-0.95, p = .002), defined as either asthma-related emergency department (ED) visits/hospitalizations or receipt of systemic corticosteroids (SCSs); fewer SCS claims (mean 0.28 vs. 0.33, p = .021); and fewer asthma-related physician office (PO) and hospital outpatient (HO) visits (mean 1.17 vs. 1.63, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). However, asthma-related ED visits were higher with FSC (p = .004), and FSC patients had higher total costs of asthma-related health care ($953 vs. $862, p = .002). In asthma patients initiating ICS therapy, MF had lower asthma-related ED visits. However, FSC may reduce the use of SCS and asthma-related PO/HO visits.
The American journal of managed care, 2013
To assess the predictive ability of the ratio of controller-to-total asthma medication in commerc... more To assess the predictive ability of the ratio of controller-to-total asthma medication in commercially insured and Medicaid patients. Retrospective cohort. Medical and pharmacy claims were used to identify asthma patients between 2004 and 2006. Ratios were computed during 3-, 6-, and 12-month assessment periods and asthma exacerbations were assessed during a subsequent 12-month follow-up period. Receiver operating characteristic curve analyses and logistic regression were used to select optimal ratio number, assessment time period, and incremental ratio analysis. The ratio significantly predicted future asthma exacerbations. An optimal value of >0.7 was identified in pediatric and adult Medicaid patients with a shorter assessment period in adults (3 months) than in children (6 months). In commercially insured patients, an optimal value of >0.5 during a 6-month assessment period was identified for children and adults. In commercially insured patients, a 0.1-unit increase in the...
Journal of Allergy and Clinical Immunology, 2005
The goal of asthma therapy is to maintain consistent control. We sought to examine the patterns o... more The goal of asthma therapy is to maintain consistent control. We sought to examine the patterns of asthma control recorded over 3 years using administrative claims and resource utilization definition. We performed a retrospective observational study with a nationally representative patient-level database containing pharmacy and medical claims. Patients with asthma (International Classification of Diseases, Ninth Revision-Clinical Modification code 493.xx), patients undergoing treatment with at least 1 asthma medication, and patients with 36 months of continuous claims coverage during the calendar years 1996 through 2002 were identified. A total of 63,324 patients were included in the study. Patients were classified as having controlled asthma in year 1 if they had less than 4 claims for a short-acting beta 2 -agonist, no claims for an OCS, and no asthma-related emergency department visits or hospitalizations. Patients were then followed over the next 8 quarters (2 years) to observe whether control was maintained. Control during a quarter was defined with the same criteria, except the reliever threshold was adjusted to 2 or more claims per quarter. Thirty-nine thousand ninety-five (57%) patients were defined as having controlled asthma during year 1. During the 2-year follow-up period, a range of 10% to 14% of these patients with controlled asthma met the criteria of uncontrolled asthma during any given quarter. Overall, 46,227 (73%) patients identified met the criteria for uncontrolled asthma at least once during the 3-year period. This study demonstrates that almost 75% of asthmatic patients experience an uncontrolled asthma episode 1 or more times over a 3-year period. Furthermore, we found that significant fluctuations in asthma control exist, even in patients with prior controlled asthma.
Journal of Allergy and Clinical Immunology, 2001
Background: Randomized clinical trials have demonstrated that fluticasone propionate (FP) has bet... more Background: Randomized clinical trials have demonstrated that fluticasone propionate (FP) has better objective as well as subjective clinical outcomes than zafirlukast (ZA) in the treatment of asthma. Objective: The goal of this study was to determine whether the superiority of FP over ZA observed in clinical trials is supported under actual practice conditions. Methods: A retrospective cohort analysis of pharmacy and medical claims for asthma was performed. Patients were identified who had at least 1 ICD-9 (493.XX) claim for asthma and were recently prescribed inhaled FP or ZA. Subjects could not have had a claim for any inhaled corticosteroid or oral leukotriene modifier in the 9 months before initiation of FP or ZA. They were subsequently observed for 12 months. Results: A total of 725 persons were new users of FP and 309 of ZA. FP was associated with a 70% reduced risk for hospitalization (P = .0232), a 49% lower risk for an emergency department event (P = .0546), and a 51% reduction in combined emergency department events and hospitalizations (P = .0268) when compared with ZA. Adjusted annual asthma care costs declined significantly for FP and increased for ZA. The adjusted mean difference in annual asthma costs was $215 less per patient for FP (P < .0001). Conclusion: Asthma care costs decreased for patients treated with FP and increased for patients treated with ZA. Furthermore, FP-treated patients had significantly lower risks of asthma-related hospitalization than ZA patients. This study supports results seen in clinical trials comparing these two medications. (J Allergy Clin Immunol 2001;107:94-8.)
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2008
To assess the burden of nasal symptoms in the United States (U.S.) and the comorbid conditions as... more To assess the burden of nasal symptoms in the United States (U.S.) and the comorbid conditions associated with nasal symptoms. A self-administered screening questionnaire and follow-up survey was sent to targeted households from a representative sample of 15,000 households in the U.S. Subjects with comorbid asthma completed the Asthma Control Test (ACT). Out of 7024 evaluable subjects who responded, 3831 subjects were classified as rhinitis "sufferers." Individuals with active rhinitis symptoms were 1.5 to 4.5 times more likely to suffer from comorbid conditions including asthma, conjunctivitis, otitis media, sinusitis, eczema, food and insect bite allergies, migraine, and depression. Almost half of all respondents with moderate or severe rhinitis symptoms and comorbid asthma had poorly controlled asthma as defined by an ACT score of < or =19. A strong relationship exists between rhinitis symptoms and various comorbidities, including asthma, in the U.S. population. Poor...
Journal of Allergy and Clinical Immunology, 2002
BACKGROUND: There have been several reports on the patterns of use of asthma medication as report... more BACKGROUND: There have been several reports on the patterns of use of asthma medication as reported by persons with asthma. However, little or no published information has been reported regarding medication use in a high-risk community.
D57. PEDIATRIC AIRWAY DISEASES: MANAGEMENT, 2010
Journal of Allergy and Clinical Immunology, 2003
GlaxoSmithKline, Research Triangle Park, NC. RATIONALE: Compare asthma exacerbations rates and qu... more GlaxoSmithKline, Research Triangle Park, NC. RATIONALE: Compare asthma exacerbations rates and quantify direct medical costs during treatment with fluticasone propionate/salmeterol combination product (FSC; 100/50 BID) vs fluticasone propionate (FP; 88 mcg BID) or montelukast (MEN; 10 mg QD). METHODS: Data from four double-blind, double-dummy, randomized controlled trials that compared FSC with MeN ( 12-weeks trials) or MeN with FP (24-weeks trials) in patients previously uncontrolled on albuterol alone. The 12-week data from all studies was analyzed, A Cox proportional hazard analysis was performed on time to asthma exacerbation while direct costs were determined by applying standard costs to physician office visits; asthma related emergency department visits and hospitalizations that occurred during the exacerbations. RESULTS: The analysis included 1910 patients _>15 years symptomatic on albuterol alone. Baseline characteristics were similar between groups. Compared with FSC, FP patients had a 2.6 (95% CI 1.04, 6.49) times greater risk of having an asthma related exacerbation while MeN patients had a 3.6 (95% CI 1.52, 8.31 ) times greater risk of having an asthma related exacerbation within 12 weeks of starting therapy. Exacerbation cost per RATIONALE: Nebulizers vary in the amount of inhaled mass delivered and the time required to administer treatment. METHODS: We compared the performance of ultrasonic and pneumatic nebulizers with a prototype nebulizer (Aerogen). Albuterol sulfate (3 mL) was administered to a breath simulator (Vt 500 mL, rate 15, and 0.35 duty cycle) with each device (n=3). Drug deposited on an absolute filter (Inhaled Mass) was assayed (HPLC). Flow rate (mL/min) of emitted aerosol, and residual volume (mL) remaining in the nebulizer were determined gravimetrically. Treatment time to end of dose or sputter was recorded. Volume Median Diameter (VMD) was determined by laser diffraction (SpraytecbTm).
A31. OPTIMIZING THERAPEUTIC STRATEGIES IN AIRWAYS DISEASE, 2011
Journal of Allergy and Clinical Immunology, 2005
The Patient: Patient-Centered Outcomes Research, 2010
: Effective management of allergic rhinitis requires ongoing monitoring of its control. This arti... more : Effective management of allergic rhinitis requires ongoing monitoring of its control. This article describes the qualitative phase of development of a patient-completed instrument, the Rhinitis Control Assessment Test (RCAT), designed to assist patients and providers in the detection of problems with rhinitis symptom control. : To identify concepts to be measured and to develop initial questionnaire items to be tested further in the next phase of development. : A literature review and input from patient focus groups were utilized to generate concepts to be measured in the draft questionnaire. The draft items were subjected to cognitive testing to ensure that the items were understood by patients and to eliminate ambiguity as well as to select an optimal recall period and meaningful response scales. Patients aged ≥18 years self-reporting a rhinitis diagnosis who had experienced rhinitis symptoms in the past 12 months were eligible for participation in the focus groups (n = 39) and the cognitive interviews (n = 23). : This qualitative process yielded a draft instrument with 26 items assessing five constructs of rhinitis symptom control: frequency and bothersomeness of nasal and non-nasal symptoms, symptom impact, activity interference, symptom control, and medication use. A five-point Likert response scale and a 1-week recall period for each item were adopted based on patient input. : The qualitative phase of development of the RCAT produced constructs and items for an instrument that is anticipated to facilitate accurate assessment of rhinitis control and improve the quality of care for patients with allergic rhinitis.
A31. OPTIMIZING THERAPEUTIC STRATEGIES IN AIRWAYS DISEASE, 2011