asif shaikh - Academia.edu (original) (raw)

Papers by asif shaikh

Research paper thumbnail of Citrate-Capped AuNP Fabrication, Characterization and Comparison with Commercially Produced Nanoparticles

Crystals

Gold nanoparticles (AuNPs) were synthesized using citrate reduction, also known as the Turkevich ... more Gold nanoparticles (AuNPs) were synthesized using citrate reduction, also known as the Turkevich method. The AuNPs were compared with the commercially available product and later subjected to characterization. The AuNPs were 13 nm in diameter with a 2.7 × 108 M−1cm−1 extension coefficient. The calculated concentration was 5.1 nM through the Beer–Lambert law using UV–vis absorbance spectra. Further detailed characterization was applied, such as scanning electron microscopy (SEM), high-resolution transmission electron microscopy (HR-TEM), elemental analysis using electro and DLS instruments, energy-dispersive X-ray spectroscopy (EDS), XRD, and Zeta potential. The synthesized AuNPs had a higher UV-absorbance peak of 0.93 in comparison to commercially available nanoparticles at 5.8 identical conditions. The characterization confirmed successful fabrication of colloidal-citrate-capped AuNPs and their dispersed and aggregated state with induced salt concentration. The shape and morphology...

Research paper thumbnail of Risk of hospitalization in a sample of COVID-19 patients with and without chronic obstructive pulmonary disease

Research paper thumbnail of COVID-19 associated anxiety and perceived risk among the pregnant women: a cross-sectional study

International Journal Of Community Medicine And Public Health, 2022

Background: COVID-19 is an infectious disease, categorized as a global pandemic. Daily implicatio... more Background: COVID-19 is an infectious disease, categorized as a global pandemic. Daily implications and coping strategies of pregnant women with coronavirus outbreak is currently unknown. This study will assess their knowledge, attitude, and practices (KAP), risk perceptions, anxiety and concerns related to COVID-19.Methods: A hospital-based cross-sectional survey was conducted in Karachi. Self-reported questionnaires including KAP, generalized anxiety disorder (GAD) scale and perception of pregnancy risk questionnaire were administered. Descriptive statistics were calculated for continuous variables and were reported as mean ± standard deviation. Frequencies and percentages were computed for categorical variables. Pearson correlation was calculated to explore linear associations among the perception of pregnancy risk, age, body mass index (BMI), and gestation. All data analysis was done using STATA 16.0.Results: The 575 pregnant women were enrolled with an average age of 26.07 year...

Research paper thumbnail of Study on Shopping Behavior of Youth in Western Casual Category Clothes

Reflections - Journal of Management, 2015

Apparel is one of the basic necessities of human civilization along with food, water and shelter.... more Apparel is one of the basic necessities of human civilization along with food, water and shelter. The Apparel Industry reflects people’s lifestyles and shows their social and economic status. The textile and apparel industry can be broadly divided into two segments - yarn and fibre, and processed fabrics and apparel. India accounts for approximately 14% of the world's production of textile fibers and yarns. The domestic textile and apparel industry in India is estimated to reach US$ 141 bn by 2021 from US$ 67 bn in 2014. Textile and apparel exports from India are expected to increase to US$ 82 billion by 2021 from US$ 40 billion in 2014. In FY15 the readymade garment segment had a share of 40% of all textile and apparel exports. Rising government focus and favorable policies is leading to growth in the textiles and clothing industry. Youth has gained significant importance from marketers in recent years because of their growing purchasing power.

Research paper thumbnail of Galois coverings of Schreier graphs of groups generated by bounded automata

arXiv: Combinatorics, 2017

We give a characterization of the covering Schreier graphs of groups generated by bounded automat... more We give a characterization of the covering Schreier graphs of groups generated by bounded automata to be Galois. We also investigate the zeta and LLL functions of Schreier graphs of few groups namely the Grigorchuk group, Gupta-Sidki ppp group, Gupta-Fabrykowski group and BSV torsion-free group.

Research paper thumbnail of Smart Irrigation System Using IOT And Raspberry Pi

Water is the important source in human life. Around 80 % to 90 % water used in agriculture field.... more Water is the important source in human life. Around 80 % to 90 % water used in agriculture field. As due to day by day growth in globalization and population water consumption is also increases. There is challenge in front of every country to reduce the farm water consumption and provide fresh and healthy food. Today automation is one of the important role in human life. The system is not only provides comfort but also reduce energy, efficiency and time saving. Whenever there is a change in temperature, humidity and current status of rain of the surroundings these sensors senses the change in temperature and humidity and gives an interrupt signal to the raspberry pi. Now a day the industries are using an automation and control machines which are high in cost and not suitable for using in a farm & garden field. So in this work we design a smart irrigation technology based on IOT using Raspberry pi. The system can be used to control the water motor automatically and can also monitor t...

Research paper thumbnail of Optimization of plant layout

Research paper thumbnail of Shapes and sizes of pollen grains of some common herbs and shrubs of Karachi

A palynological study of 29 common plant species representing 28 genera and belonging to 23 famil... more A palynological study of 29 common plant species representing 28 genera and belonging to 23 families present in Karachi has been carried out. This study is based on the flowering conditions of plants. The flowers were divided into two major groups i.e., plants with full flowering bloom and rare flowering in different months of the year. This study is the first phase of our research work and provides some basic information about the size and shape (under ordinary microscope) of some common pollen grains found in Karachi.

Research paper thumbnail of Shadow-IT system and Insider Threat: Opportunity as a Situational Perspective

Shadow IT is taken as a key example of unauthorized use of IT resources/tools and is defined as c... more Shadow IT is taken as a key example of unauthorized use of IT resources/tools and is defined as collaborative systems for communication and sharing content among employees of an organization. Currently, organizations are struggling to understand the threats to their sensitive information assets and the necessary means to combat them. Shadow-IT systems are taken as a form of a workaround that represents deviations from existing work systems (Alters, 2014). This ability of end-users to bypass the central Information technology (IT) system at the workplace by using technologies that are often unsanctioned by the organizational network policy has challenged the authority to control IT use. The unauthorized use of information systems may expose organizations to various types of threats that can causes damage that might lead to significant financial losses. Information security damages and effects of those threats vary considerably: some affect the confidentiality or integrity of data whi...

Research paper thumbnail of Finitely generated subgroups of free groups as formal languages and their cogrowth

journal of Groups, complexity, cryptology, 2021

For finitely generated subgroups HHH of a free group FmF_mFm of finite rank mmm, we study the langu... more For finitely generated subgroups HHH of a free group FmF_mFm of finite rank mmm, we study the language LHL_HLH of reduced words that represent HHH which is a regular language. Using the (extended) core of Schreier graph of HHH, we construct the minimal deterministic finite automaton that recognizes LHL_HLH. Then we characterize the f.g. subgroups HHH for which LHL_HLH is irreducible and for such groups explicitly construct ergodic automaton that recognizes LHL_HLH. This construction gives us an efficient way to compute the cogrowth series LH(z)L_H(z)LH(z) of HHH and entropy of LHL_HLH. Several examples illustrate the method and a comparison is made with the method of calculation of LH(z)L_H(z)LH(z) based on the use of Nielsen system of generators of HHH.

Research paper thumbnail of Survey on Database Tampering Monitoring System to Enhance Security

International Journal of Scientific Engineering and Technology, 2017

In today's era, internet has become essential part of our lifestyle. It is used for banki... more In today's era, internet has become essential part of our lifestyle. It is used for banking , social media , online shopping etc. but like anything else even internet has its vulnerabilities and soft corners .Online stores majorly depends on data stored in their respective databases. These databases can be tampered with using dedicated tools and techniques. Once attacker has access to data in database ,the attacker can tamper the data and create havoc. There are tools and techniques present which provide Intrusion detection through monitoring sessions by users, and inform about breach in the network and tamper in the database. This paper focuses on encapsulating all the techniques under single platform by using Intrusion detection, Hashing algorithms and finding the data leakage and tampered database preventing various attacks and unauthorized access to the data.

Research paper thumbnail of Real-World Impact of Gold Compliant Copd Maintenance Therapy on Exacerbations and Treatment Patterns

Research paper thumbnail of TRONARTO: A Randomized, Placebo-Controlled Study of Tiotropium/Olodaterol Delivered via Soft Mist Inhaler in COPD Patients Stratified by Peak Inspiratory Flow

International Journal of Chronic Obstructive Pulmonary Disease, 2021

Background: Inhaled bronchodilator therapy is currently the mainstay of treatment for patients wi... more Background: Inhaled bronchodilator therapy is currently the mainstay of treatment for patients with chronic obstructive pulmonary disease (COPD). Some inhalers require patients to achieve certain inhalation efforts either to activate the device or to deliver medication to the site of action. For dry powder inhalers, low peak inspiratory flow (PIF) can result in poor medication delivery but the clinical significance of this is not well understood. Methods: TRONARTO was a 4-week, randomized, double-blind, placebo-controlled, multicenter, parallel-group study which stratified patients with moderate-to-severe COPD according to their PIF against medium-low resistance at screening. Patients were randomized to receive tiotropium/olodaterol (5 μg/5 μg) or matched placebo delivered via the Respimat ® Soft Mist™ inhaler (SMI). After 4 weeks of treatment, we assessed change from baseline in forced expiratory volume in 1 second (FEV 1) area under the curve 0-3 hours (FEV 1 AUC 0-3h) and trough FEV 1. Results: Overall, 213 patients were randomized, of whom 106 received tiotropium/olodaterol (PIF <60 L/min, 55; PIF ≥60 L/min, 51) and 107 received placebo (PIF <60 L/min, 55; PIF ≥60 L/min, 52). For FEV 1 AUC 0-3h , the adjusted mean change from baseline versus placebo was 336 mL (95% confidence interval [CI] 246-425 mL; P<0.0001) in the PIF <60 L/min group and 321 mL (95% CI 233-409 mL; P<0.0001) in the PIF ≥60 L/min group. For trough FEV 1 , the adjusted mean change from baseline versus placebo was 201 mL (95% CI 117-286 mL; P<0.0001) in the PIF <60 L/min group and 217 mL (95% CI 135-299 mL; P<0.0001) in the PIF ≥60 L/min group. Conclusion: In the TRONARTO study, which included patients with moderate-to-severe COPD and varying inspiratory flow abilities, treatment with tiotropium/olodaterol resulted in significant lung function improvements versus placebo. This SMI can be used irrespective of the PIF that a patient can generate.

Research paper thumbnail of Advancing the Patient EXperience (APEX) in COPD Registry: Study Design and Strengths

The Journal of the American Board of Family Medicine, 2021

The Advancing the Patient Experience (APEX) in Chronic Obstructive Pulmonary Disease (COPD) regis... more The Advancing the Patient Experience (APEX) in Chronic Obstructive Pulmonary Disease (COPD) registry (https:// www.apexcopd.org/) is the first primary care health system-based COPD registry in the United States. While its ultimate goal is to improve the care of patients diagnosed with COPD, the registry is also designed to describe real-life experiences of people with COPD, track key outcomes longitudinally, and assess the effectiveness of interventions. It will retrospectively and prospectively collect information from 3000 patients enrolled in 5 health care organizations. Information will be obtained from electronic health records, and from extended annual and brief questionnaires completed by patients before clinic visits. Core variables to be collected into the APEX COPD registry were agreed on by Delphi consensus and fall into 3 domains: demographics, COPD monitoring, and treatment. Main strengths of the registry include: 1) its size and scope (in terms of patient numbers, geographic spread and use of multiple information sources including patient-reported information); 2) collection of variables which are clinically relevant and practical to collect within primary care; 3) use of electronic data capture systems to ensure high-quality data and minimization of data-entry requirements; 4) inclusion of clinical, database development, management and communication experts; 5) regular sharing of key findings, both at international/national congresses and in peer-reviewed publications; and 6) a robust organizational structure to ensure continuance of the registry, and that research outputs are ethical, relevant and continue to bring value to both patients and physicians.

Research paper thumbnail of Development of the Advancing the Patient Experience in COPD Registry: A Modified Delphi Study

Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 2021

For personal use only. Permission required for all other uses.

Research paper thumbnail of Tiotropium Respimat® 2.5 μg Add-on to ICS or ICS+controller medications Improves Lung Function in Adults and Adolescents With Mild, Moderate, or Severe Symptomatic Asthma

Journal of Allergy and Clinical Immunology, 2017

RATIONALE: To investigate lung function in adults and adolescents (12-17 years old) taking tiotro... more RATIONALE: To investigate lung function in adults and adolescents (12-17 years old) taking tiotropium Respimat ® (TioR) 2.5 mg plus ICS or ICS+controller medications. METHODS: Patients with mild, moderate, or severe asthma (> _3 months asthma history; pre-bronchodilator FEV 1 60-90% of predicted normal); added once-daily TioR (2.5 mg or 5mg [2.5mg reported only]) in the evening or placebo Respimat ® (pboR) to ICS or ICS+controller medications in 5 phase III RCTs. In 4 trials, patients received TioR/placebo plus ICS: GraziaTinA-asthma ® (NCT01316380; 12 weeks; n5464 adults; mild asthma), 2 replicate MezzoTinA-asthma ® (NCT01172808/ NCT01172821; 24 weeks; n52100 adults; moderate asthma), and RubaTinA-asthma ® (NCT01257230; 48 weeks; n5397 adolescents; moderate asthma). In 1 trial patients received TioR/placebo plus ICS+controller medications: PensieTinA-asthma ® (NCT01277523; 12 weeks; n5392 adolescents; severe asthma). ICS doses ranged from 200-to > _800-mg budesonide or equivalent. All trials permitted LTRAs (except GraziaTinAasthma ®). Primary or secondary endpoints included change from baseline in peak FEV 1(0-3h) (response) and trough FEV 1. RESULTS: Overall, 925 patients received TioR 2.5 mg, and 951 received pboR. TioR 2.5 mg plus ICS significantly improved peak FEV 1(0-3h) response over placebo (GraziaTinA-asthma ® : 159 mL, P<0.0001; 2 replicate Mezzo TinA-asthma ® pooled: 223 mL, P<0.0001; RubaTinAasthma ® : 134 mL, P50.009). Similarly, TioR 2.5 mg plus ICS+controller medications improved peak FEV 1(0-3h) response (PensieTinA-asthma ® : 111 mL, P50.046). Differences with placebo in trough FEV 1 response were 110 mL (P50.003), 180 mL (P<0.0001), 84 mL (P50.131), and 115 mL (P50.051), respectively. Adverse events were similar between groups. CONCLUSIONS: TioR 2.5 mg plus ICS or ICS+controller medications improved lung function in adults and adolescents with asthma.

Research paper thumbnail of Initiation of triple therapy maintenance treatment among patients with COPD in the US

International Journal of Chronic Obstructive Pulmonary Disease, 2016

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends triple t... more Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends triple therapy (long-acting muscarinic receptor antagonists, long-acting beta-2 agonists, and inhaled corticosteroids) for patients with only the most severe COPD. Data on the proportion of COPD patients on triple therapy and their characteristics are sparse and dated. Objective 1 of this study was to estimate the proportion of all, and all treated, COPD patients receiving triple therapy. Objective 2 was to characterize those on triple therapy and assess the concordance of triple therapy use with GOLD guidelines. Patients and methods: This retrospective study used claims from the IMS PharMetrics Plus database from 2009 to 2013. Cohort 1 was selected to assess Objective 1 only; descriptive analyses were conducted in Cohort 2 to answer Objective 2. A validated claims-based algorithm and severity and frequency of exacerbations were used as proxies for COPD severity. Results: Of all 199,678 patients with COPD in Cohort 1, 7.5% received triple therapy after diagnosis, and 25.5% of all treated patients received triple therapy. In Cohort 2, 30,493 COPD patients (mean age =64.7 years) who initiated triple therapy were identified. Using the claimsbased algorithm, 34.5% of Cohort 2 patients were classified as having mild disease (GOLD 1), 40.8% moderate (GOLD 2), 22.5% severe (GOLD 3), and 2.3% very severe (GOLD 4). Using exacerbation severity and frequency, 60.6% of patients were classified as GOLD 1/2 and 39.4% as GOLD 3/4. Conclusion: In this large US claims database study, one-quarter of all treated COPD patients received triple therapy. Although triple therapy is recommended for the most severe COPD patients, spirometry is infrequently assessed, and a majority of the patients who receive triple therapy may have only mild/moderate disease. Any potential overprescribing of triple therapy may lead to unnecessary costs to the patient and health care system.

Research paper thumbnail of System and method for forecasting demanufacturing requirements

Research paper thumbnail of Population, environment and development in Africa: dynamic linkages and their implications for future research and development programming

Research paper thumbnail of Citrate-Capped AuNP Fabrication, Characterization and Comparison with Commercially Produced Nanoparticles

Crystals

Gold nanoparticles (AuNPs) were synthesized using citrate reduction, also known as the Turkevich ... more Gold nanoparticles (AuNPs) were synthesized using citrate reduction, also known as the Turkevich method. The AuNPs were compared with the commercially available product and later subjected to characterization. The AuNPs were 13 nm in diameter with a 2.7 × 108 M−1cm−1 extension coefficient. The calculated concentration was 5.1 nM through the Beer–Lambert law using UV–vis absorbance spectra. Further detailed characterization was applied, such as scanning electron microscopy (SEM), high-resolution transmission electron microscopy (HR-TEM), elemental analysis using electro and DLS instruments, energy-dispersive X-ray spectroscopy (EDS), XRD, and Zeta potential. The synthesized AuNPs had a higher UV-absorbance peak of 0.93 in comparison to commercially available nanoparticles at 5.8 identical conditions. The characterization confirmed successful fabrication of colloidal-citrate-capped AuNPs and their dispersed and aggregated state with induced salt concentration. The shape and morphology...

Research paper thumbnail of Risk of hospitalization in a sample of COVID-19 patients with and without chronic obstructive pulmonary disease

Research paper thumbnail of COVID-19 associated anxiety and perceived risk among the pregnant women: a cross-sectional study

International Journal Of Community Medicine And Public Health, 2022

Background: COVID-19 is an infectious disease, categorized as a global pandemic. Daily implicatio... more Background: COVID-19 is an infectious disease, categorized as a global pandemic. Daily implications and coping strategies of pregnant women with coronavirus outbreak is currently unknown. This study will assess their knowledge, attitude, and practices (KAP), risk perceptions, anxiety and concerns related to COVID-19.Methods: A hospital-based cross-sectional survey was conducted in Karachi. Self-reported questionnaires including KAP, generalized anxiety disorder (GAD) scale and perception of pregnancy risk questionnaire were administered. Descriptive statistics were calculated for continuous variables and were reported as mean ± standard deviation. Frequencies and percentages were computed for categorical variables. Pearson correlation was calculated to explore linear associations among the perception of pregnancy risk, age, body mass index (BMI), and gestation. All data analysis was done using STATA 16.0.Results: The 575 pregnant women were enrolled with an average age of 26.07 year...

Research paper thumbnail of Study on Shopping Behavior of Youth in Western Casual Category Clothes

Reflections - Journal of Management, 2015

Apparel is one of the basic necessities of human civilization along with food, water and shelter.... more Apparel is one of the basic necessities of human civilization along with food, water and shelter. The Apparel Industry reflects people’s lifestyles and shows their social and economic status. The textile and apparel industry can be broadly divided into two segments - yarn and fibre, and processed fabrics and apparel. India accounts for approximately 14% of the world's production of textile fibers and yarns. The domestic textile and apparel industry in India is estimated to reach US$ 141 bn by 2021 from US$ 67 bn in 2014. Textile and apparel exports from India are expected to increase to US$ 82 billion by 2021 from US$ 40 billion in 2014. In FY15 the readymade garment segment had a share of 40% of all textile and apparel exports. Rising government focus and favorable policies is leading to growth in the textiles and clothing industry. Youth has gained significant importance from marketers in recent years because of their growing purchasing power.

Research paper thumbnail of Galois coverings of Schreier graphs of groups generated by bounded automata

arXiv: Combinatorics, 2017

We give a characterization of the covering Schreier graphs of groups generated by bounded automat... more We give a characterization of the covering Schreier graphs of groups generated by bounded automata to be Galois. We also investigate the zeta and LLL functions of Schreier graphs of few groups namely the Grigorchuk group, Gupta-Sidki ppp group, Gupta-Fabrykowski group and BSV torsion-free group.

Research paper thumbnail of Smart Irrigation System Using IOT And Raspberry Pi

Water is the important source in human life. Around 80 % to 90 % water used in agriculture field.... more Water is the important source in human life. Around 80 % to 90 % water used in agriculture field. As due to day by day growth in globalization and population water consumption is also increases. There is challenge in front of every country to reduce the farm water consumption and provide fresh and healthy food. Today automation is one of the important role in human life. The system is not only provides comfort but also reduce energy, efficiency and time saving. Whenever there is a change in temperature, humidity and current status of rain of the surroundings these sensors senses the change in temperature and humidity and gives an interrupt signal to the raspberry pi. Now a day the industries are using an automation and control machines which are high in cost and not suitable for using in a farm & garden field. So in this work we design a smart irrigation technology based on IOT using Raspberry pi. The system can be used to control the water motor automatically and can also monitor t...

Research paper thumbnail of Optimization of plant layout

Research paper thumbnail of Shapes and sizes of pollen grains of some common herbs and shrubs of Karachi

A palynological study of 29 common plant species representing 28 genera and belonging to 23 famil... more A palynological study of 29 common plant species representing 28 genera and belonging to 23 families present in Karachi has been carried out. This study is based on the flowering conditions of plants. The flowers were divided into two major groups i.e., plants with full flowering bloom and rare flowering in different months of the year. This study is the first phase of our research work and provides some basic information about the size and shape (under ordinary microscope) of some common pollen grains found in Karachi.

Research paper thumbnail of Shadow-IT system and Insider Threat: Opportunity as a Situational Perspective

Shadow IT is taken as a key example of unauthorized use of IT resources/tools and is defined as c... more Shadow IT is taken as a key example of unauthorized use of IT resources/tools and is defined as collaborative systems for communication and sharing content among employees of an organization. Currently, organizations are struggling to understand the threats to their sensitive information assets and the necessary means to combat them. Shadow-IT systems are taken as a form of a workaround that represents deviations from existing work systems (Alters, 2014). This ability of end-users to bypass the central Information technology (IT) system at the workplace by using technologies that are often unsanctioned by the organizational network policy has challenged the authority to control IT use. The unauthorized use of information systems may expose organizations to various types of threats that can causes damage that might lead to significant financial losses. Information security damages and effects of those threats vary considerably: some affect the confidentiality or integrity of data whi...

Research paper thumbnail of Finitely generated subgroups of free groups as formal languages and their cogrowth

journal of Groups, complexity, cryptology, 2021

For finitely generated subgroups HHH of a free group FmF_mFm of finite rank mmm, we study the langu... more For finitely generated subgroups HHH of a free group FmF_mFm of finite rank mmm, we study the language LHL_HLH of reduced words that represent HHH which is a regular language. Using the (extended) core of Schreier graph of HHH, we construct the minimal deterministic finite automaton that recognizes LHL_HLH. Then we characterize the f.g. subgroups HHH for which LHL_HLH is irreducible and for such groups explicitly construct ergodic automaton that recognizes LHL_HLH. This construction gives us an efficient way to compute the cogrowth series LH(z)L_H(z)LH(z) of HHH and entropy of LHL_HLH. Several examples illustrate the method and a comparison is made with the method of calculation of LH(z)L_H(z)LH(z) based on the use of Nielsen system of generators of HHH.

Research paper thumbnail of Survey on Database Tampering Monitoring System to Enhance Security

International Journal of Scientific Engineering and Technology, 2017

In today&#39;s era, internet has become essential part of our lifestyle. It is used for banki... more In today&#39;s era, internet has become essential part of our lifestyle. It is used for banking , social media , online shopping etc. but like anything else even internet has its vulnerabilities and soft corners .Online stores majorly depends on data stored in their respective databases. These databases can be tampered with using dedicated tools and techniques. Once attacker has access to data in database ,the attacker can tamper the data and create havoc. There are tools and techniques present which provide Intrusion detection through monitoring sessions by users, and inform about breach in the network and tamper in the database. This paper focuses on encapsulating all the techniques under single platform by using Intrusion detection, Hashing algorithms and finding the data leakage and tampered database preventing various attacks and unauthorized access to the data.

Research paper thumbnail of Real-World Impact of Gold Compliant Copd Maintenance Therapy on Exacerbations and Treatment Patterns

Research paper thumbnail of TRONARTO: A Randomized, Placebo-Controlled Study of Tiotropium/Olodaterol Delivered via Soft Mist Inhaler in COPD Patients Stratified by Peak Inspiratory Flow

International Journal of Chronic Obstructive Pulmonary Disease, 2021

Background: Inhaled bronchodilator therapy is currently the mainstay of treatment for patients wi... more Background: Inhaled bronchodilator therapy is currently the mainstay of treatment for patients with chronic obstructive pulmonary disease (COPD). Some inhalers require patients to achieve certain inhalation efforts either to activate the device or to deliver medication to the site of action. For dry powder inhalers, low peak inspiratory flow (PIF) can result in poor medication delivery but the clinical significance of this is not well understood. Methods: TRONARTO was a 4-week, randomized, double-blind, placebo-controlled, multicenter, parallel-group study which stratified patients with moderate-to-severe COPD according to their PIF against medium-low resistance at screening. Patients were randomized to receive tiotropium/olodaterol (5 μg/5 μg) or matched placebo delivered via the Respimat ® Soft Mist™ inhaler (SMI). After 4 weeks of treatment, we assessed change from baseline in forced expiratory volume in 1 second (FEV 1) area under the curve 0-3 hours (FEV 1 AUC 0-3h) and trough FEV 1. Results: Overall, 213 patients were randomized, of whom 106 received tiotropium/olodaterol (PIF <60 L/min, 55; PIF ≥60 L/min, 51) and 107 received placebo (PIF <60 L/min, 55; PIF ≥60 L/min, 52). For FEV 1 AUC 0-3h , the adjusted mean change from baseline versus placebo was 336 mL (95% confidence interval [CI] 246-425 mL; P<0.0001) in the PIF <60 L/min group and 321 mL (95% CI 233-409 mL; P<0.0001) in the PIF ≥60 L/min group. For trough FEV 1 , the adjusted mean change from baseline versus placebo was 201 mL (95% CI 117-286 mL; P<0.0001) in the PIF <60 L/min group and 217 mL (95% CI 135-299 mL; P<0.0001) in the PIF ≥60 L/min group. Conclusion: In the TRONARTO study, which included patients with moderate-to-severe COPD and varying inspiratory flow abilities, treatment with tiotropium/olodaterol resulted in significant lung function improvements versus placebo. This SMI can be used irrespective of the PIF that a patient can generate.

Research paper thumbnail of Advancing the Patient EXperience (APEX) in COPD Registry: Study Design and Strengths

The Journal of the American Board of Family Medicine, 2021

The Advancing the Patient Experience (APEX) in Chronic Obstructive Pulmonary Disease (COPD) regis... more The Advancing the Patient Experience (APEX) in Chronic Obstructive Pulmonary Disease (COPD) registry (https:// www.apexcopd.org/) is the first primary care health system-based COPD registry in the United States. While its ultimate goal is to improve the care of patients diagnosed with COPD, the registry is also designed to describe real-life experiences of people with COPD, track key outcomes longitudinally, and assess the effectiveness of interventions. It will retrospectively and prospectively collect information from 3000 patients enrolled in 5 health care organizations. Information will be obtained from electronic health records, and from extended annual and brief questionnaires completed by patients before clinic visits. Core variables to be collected into the APEX COPD registry were agreed on by Delphi consensus and fall into 3 domains: demographics, COPD monitoring, and treatment. Main strengths of the registry include: 1) its size and scope (in terms of patient numbers, geographic spread and use of multiple information sources including patient-reported information); 2) collection of variables which are clinically relevant and practical to collect within primary care; 3) use of electronic data capture systems to ensure high-quality data and minimization of data-entry requirements; 4) inclusion of clinical, database development, management and communication experts; 5) regular sharing of key findings, both at international/national congresses and in peer-reviewed publications; and 6) a robust organizational structure to ensure continuance of the registry, and that research outputs are ethical, relevant and continue to bring value to both patients and physicians.

Research paper thumbnail of Development of the Advancing the Patient Experience in COPD Registry: A Modified Delphi Study

Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 2021

For personal use only. Permission required for all other uses.

Research paper thumbnail of Tiotropium Respimat® 2.5 μg Add-on to ICS or ICS+controller medications Improves Lung Function in Adults and Adolescents With Mild, Moderate, or Severe Symptomatic Asthma

Journal of Allergy and Clinical Immunology, 2017

RATIONALE: To investigate lung function in adults and adolescents (12-17 years old) taking tiotro... more RATIONALE: To investigate lung function in adults and adolescents (12-17 years old) taking tiotropium Respimat ® (TioR) 2.5 mg plus ICS or ICS+controller medications. METHODS: Patients with mild, moderate, or severe asthma (> _3 months asthma history; pre-bronchodilator FEV 1 60-90% of predicted normal); added once-daily TioR (2.5 mg or 5mg [2.5mg reported only]) in the evening or placebo Respimat ® (pboR) to ICS or ICS+controller medications in 5 phase III RCTs. In 4 trials, patients received TioR/placebo plus ICS: GraziaTinA-asthma ® (NCT01316380; 12 weeks; n5464 adults; mild asthma), 2 replicate MezzoTinA-asthma ® (NCT01172808/ NCT01172821; 24 weeks; n52100 adults; moderate asthma), and RubaTinA-asthma ® (NCT01257230; 48 weeks; n5397 adolescents; moderate asthma). In 1 trial patients received TioR/placebo plus ICS+controller medications: PensieTinA-asthma ® (NCT01277523; 12 weeks; n5392 adolescents; severe asthma). ICS doses ranged from 200-to > _800-mg budesonide or equivalent. All trials permitted LTRAs (except GraziaTinAasthma ®). Primary or secondary endpoints included change from baseline in peak FEV 1(0-3h) (response) and trough FEV 1. RESULTS: Overall, 925 patients received TioR 2.5 mg, and 951 received pboR. TioR 2.5 mg plus ICS significantly improved peak FEV 1(0-3h) response over placebo (GraziaTinA-asthma ® : 159 mL, P<0.0001; 2 replicate Mezzo TinA-asthma ® pooled: 223 mL, P<0.0001; RubaTinAasthma ® : 134 mL, P50.009). Similarly, TioR 2.5 mg plus ICS+controller medications improved peak FEV 1(0-3h) response (PensieTinA-asthma ® : 111 mL, P50.046). Differences with placebo in trough FEV 1 response were 110 mL (P50.003), 180 mL (P<0.0001), 84 mL (P50.131), and 115 mL (P50.051), respectively. Adverse events were similar between groups. CONCLUSIONS: TioR 2.5 mg plus ICS or ICS+controller medications improved lung function in adults and adolescents with asthma.

Research paper thumbnail of Initiation of triple therapy maintenance treatment among patients with COPD in the US

International Journal of Chronic Obstructive Pulmonary Disease, 2016

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends triple t... more Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends triple therapy (long-acting muscarinic receptor antagonists, long-acting beta-2 agonists, and inhaled corticosteroids) for patients with only the most severe COPD. Data on the proportion of COPD patients on triple therapy and their characteristics are sparse and dated. Objective 1 of this study was to estimate the proportion of all, and all treated, COPD patients receiving triple therapy. Objective 2 was to characterize those on triple therapy and assess the concordance of triple therapy use with GOLD guidelines. Patients and methods: This retrospective study used claims from the IMS PharMetrics Plus database from 2009 to 2013. Cohort 1 was selected to assess Objective 1 only; descriptive analyses were conducted in Cohort 2 to answer Objective 2. A validated claims-based algorithm and severity and frequency of exacerbations were used as proxies for COPD severity. Results: Of all 199,678 patients with COPD in Cohort 1, 7.5% received triple therapy after diagnosis, and 25.5% of all treated patients received triple therapy. In Cohort 2, 30,493 COPD patients (mean age =64.7 years) who initiated triple therapy were identified. Using the claimsbased algorithm, 34.5% of Cohort 2 patients were classified as having mild disease (GOLD 1), 40.8% moderate (GOLD 2), 22.5% severe (GOLD 3), and 2.3% very severe (GOLD 4). Using exacerbation severity and frequency, 60.6% of patients were classified as GOLD 1/2 and 39.4% as GOLD 3/4. Conclusion: In this large US claims database study, one-quarter of all treated COPD patients received triple therapy. Although triple therapy is recommended for the most severe COPD patients, spirometry is infrequently assessed, and a majority of the patients who receive triple therapy may have only mild/moderate disease. Any potential overprescribing of triple therapy may lead to unnecessary costs to the patient and health care system.

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