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Biomedical subjects

A T Luskin

Publications and source records attributed to A T Luskin.

At least 19 recordsLinked to original sources
PubMed2003

Hydrofluoroalkane-134a beclomethasone as a dominant economic asthma therapy.

Inhaled corticosteroids for asthma treatment have become mainstay of therapy for patients with persistent asthma. Numerous inhaled corticosteroids are available but to date no prospective cost-effectiveness studies have been reported using exclusively US patients and costs. The purpose of this study was to examine the cost-effectiveness of HFA-bectomethasone (QVAR) compared to CFC-beclomethasone (Vanceril) using data from a year-long prospective randomized, open label, parallel multicenter trial. Eligibility criteria required patients to have been on a stable dose of CFC-BDP prior to enrollment. Patients were randomized to either HFA-BDP at approximately half their previous daily dose of CFC-BDP or to continue CFC-BDP Effectiveness data, in terms of symptom-free days (SFDs), were used in a cost-effectiveness analysis conducted from the viewpoint of managed care. Patients receiving HFA-BDP reported a greater increase (median = 22.1) in the number of SFDs than those receiving CFC-BDP (median = 14.3) (P = 0.03). Total costs of care were less for patients taking HFA-BDP (median = dollars 668) compared to CFC-BDP (median = dollars 977). The median incremental cost-effectiveness ratio was dollars -5.77 (95% CI: dollars -68.08 to dollars -4.08). The results of this analysis indicate that HFA-BDP was a dominant therapy (more effective, less costly) compared to CFC-BDP.

Administration, Inhalation↗
PubMed2001

A comparison of asthma-related expenditures for patients started on montelukast versus fluticasone propionate as monotherapy.

BACKGROUND: The prevalence of asthma is increasing, and this chronic condition imposes a substantial economic burden worldwide. It is not known whether newer therapies, such as leukotriene receptor antagonists (LTRAs), can ease this burden. OBJECTIVE: This analysis examined the association between choice of first-line asthma control therapy and health care resource utilization and expenditures in patients with mild asthma. METHODS: A retrospective cohort analysis of claims data for patients who started therapy with fluticasone propionate or montelukast between January 1, 1997, and February 28, 1999, was performed, adjusting for baseline differences. RESULTS: Data from 343 patients (229 fluticasone; 114 montelukast) were analyzed. Patients starting therapy with fluticasone were significantly older (33.3 vs 27.6 years; P = 0.015) and significantly less likely than patients starting therapy with montelukast to have been started on control therapy by an asthma specialist (52.0% vs 69.3%; P = 0.007). There were no significant differences in mean changes in total asthma-related health care expenditures, oral steroid and antibiotic prescriptions, hospitalizations, or emergent care visits. The mean increase in total asthma-related pharmacy expenses was significantly greater for patients who were prescribed montelukast than for those prescribed fluticasone (P < 0.001). Treatment adherence was better in patients prescribed montelukast versus fluticasone (5.1 vs 3.1 prescriptions filled per year, respectively; P < 0.001). Montelukast patients had a significantly lower increase in the number of beta-agonist prescriptions filled per year than fluticasone patients (0.19 vs 0.66; P = 0.03). In the subsequent year, 4% (10/229) of fluticasone patients added or switched to an LTRA. No montelukast patients added to or switched control therapy. CONCLUSION: The mean change in total asthma-related health care expenditures was not significantly different in patients started on fluticasone propionate versus montelukast. Montelukast patients had better adherence to their treatment regimen and required fewer beta-agonist prescriptions, which is an indicator of asthma control and possibly therapeutic effectiveness.

Acetates↗
PubMed2001

The relationship between prescribed and delivered doses of inhaled corticosteroids in adult asthmatics.

A model was developed to estimate the impact of adherence and inhalation technique over time on delivered doses of inhaled corticosteroids (ICS) for asthmatics using metered-dose inhalers (MDIs) and dry powder inhalers (DPIs). Factors affecting inhalation technique include ongoing training, inhalation device, spacer use (with MDIs), and natural ability. Model parameters were derived from a literature review or were estimated from clinical experience. Analyses demonstrated that most patients receive a fraction of prescribed ICS doses over time. The model may be used to better understand the impact of increasing ICS dosages and to estimate the likelihood of patients being underdosed.

Administration, Inhalation↗
PubMed1999

An overview of the recommendations of the Working Group on Asthma and Pregnancy. National Asthma Education and Prevention Program.

Asthma is the most common potentially serious medical disease complicating pregnancy, and uncontrolled asthma during pregnancy may produce both maternal and fetal complications. The Working Group on Asthma and Pregnancy was established by the National Asthma Education and Prevention Program (NAEPP) to address the issues surrounding asthma management during pregnancy, working within the background of the NAEPP's published asthma guidelines. The Working Group's report, published in 1993, presents recommendations and information for diagnosing and managing asthma during pregnancy. Some key points are: (1) asthma should be treated as aggressively in pregnant women as in nonpregnant women; (2) asthma care and obstetric care should be carefully integrated and should include monitoring of fetal growth and development, maternal symptoms, and maternal lung function; (3) as for nonpregnant women with asthma, medications used to treat asthma during pregnancy should include a short-acting symptom reliever medication (usually an inhaled short-acting beta2 -agonist) and long-term daily medication to address the underlying inflammation for all patients with more than mild, intermittent disease.

Asthma↗
PubMed1989

Pharmacokinetic evaluation of the terfenadine-theophylline interaction.

Based on results of studies of a possible terfenadine-theophylline interaction on file with Merrell Dow, Inc., a randomized, crossover study was undertaken to determine if there were a pharmacokinetic interaction between these two medications. Seventeen normal volunteers were randomized to receive theophylline or a theophylline-terfenadine combination for 14 days, followed by a 2-week washout period, with crossover to the other treatment for 14 days. Serum theophylline concentrations were measured on the last day of each treatment phase for determination of pharmacokinetic parameters. No differences were found in elimination rate constant, elimination half-life, area under the concentration-time curve, time to peak concentration, or maximum theophylline concentration. It is concluded that concomitant terfenadine therapy does not affect the pharmacokinetic profile of theophylline in healthy male volunteers.

Adult↗
PubMed1989

Single-dose study of the effect of terfenadine on theophylline absorption and disposition.

Terfenadine, a nonsedating antihistamine, and theophylline, a methylxanthine used extensively in the treatment of asthma, have potential for frequent concomitant administration. A single-dose pharmacokinetic study was performed to investigate the potential for a drug-drug interaction affecting serum theophylline concentrations. No statistically significant effect on theophylline absorption or elimination was found when 60 mg of terfenadine was concomitantly administered with 4 mg/kg of theophylline in 17 normal healthy male volunteers. The results of this single-dose study suggest there is no significant acute pharmacokinetic interaction affecting serum theophylline concentrations when terfenadine and theophylline are administered concomitantly as single isolated doses. Further investigation is needed to determine if repeated administration of terfenadine is equally without effect on theophylline absorption or disposition.

Adult↗
PubMed1986

Sensitivity to non-acetylated salicylates in a patient with asthma, nasal polyps, and rheumatoid arthritis.

A woman experienced exacerbations of bronchial asthma after taking aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. On oral challenges, she developed an urticarial reaction after tartrazine; urticarial and bronchospastic reactions after salicylsalicylic acid; and urticarial and bronchospastic reactions after choline magnesium trisalicylate. Non-acetylated salicylates have been recommended for use in aspirin- and/or tartrazine-sensitive patients. The results of sensitivity studies of our patient indicates that such patients may also be sensitive to non-acetylated salicylates.

Albuterol↗
PubMed1982

Clear cell sarcoma and selective IgM deficiency: a case report.

A case of clear cell sarcoma of tendons and aponeuroses and a co-existent IgM deficiency is reported. The tumor arose in the Achilles tendon with metastases to the skin, bone, and lymph nodes. The tumor, examined by light and electron microscopy, consisted of glycogen-containing clear cells with melanotic and amelanotic features. There was no detectable serum IgM. The IgA levels were normal and IgG levels were elevated. Peripheral blood lymphocytes contained a normal amount (4.5%) of IgM-bearing cells. Cultured mononuclear cells from the patient suppressed production of IgM by normal lymphocytes, suggesting a role of suppressor cells in the IgM deficiency. The co-existence of soft tissue sarcomas and immunoglobulin deficiency states is reviewed.

Achilles Tendon↗
PubMed1981

Immunologic tests of value in diagnosis. 1. Acute phase reactants and autoantibodies.

Acute phase reactants are nonspecific indicators of tissue necrosis and/or inflammation but may be helpful in determining activity of disease. Rheumatoid factor is likewise rather nonspecific, but its presence is helpful in predicting the course, severity, and complications of rheumatoid arthritis. Numerous antinuclear antibodies have been identified in collagen vascular diseases; perhaps the most specific association is between anti-Sm antibody and systemic lupus erythematosus. Anti-smooth-muscle and antimitochondrial antibodies can aid in differential diagnosis of liver disease, while antithyroid antibodies can perform a similar function in diffuse goiter. Anti-parietal-cell and anti-intrinsic-factor antibodies are quite specific for pernicious anemia.

Acute Disease↗
PubMed1981

Immunologic tests of value in diagnosis. 2. Complement.

Laboratory tests are available to assess the function of the complement pathway and to measure levels of individual complement components. The pattern of complement abnormalities is often helpful in suggesting diagnostic possibilities. For example, when when total hemolytic complement, C3, and C4 are all decreased, one of the rheumatoid diseases is likely. In addition, complement levels in spinal and synovial fluid may provide helpful diagnostic clues.

Arthritis, Rheumatoid↗
PubMed1978

Inherited deficiency of second component of complement and HLA haplotype A10,B18 associated with inflammatory bowel disease.

A patient with inflammatory bowel disease and sacroiliitis had haplotypes A10,B18 and Aw32,b18 at the major histocompatibility locus. Serum total complement and C2 hemolytic complement activities were undetectable; levels of the remaining C1-C9 components were normal. The parents, both siblings, and a child each had half-normal levels of C2 and either the A10,B18 or the Aw32,b18 hla haplotype. In a second unrelated family, an only child and both parents developed inflammatory bowel disease. The father and child had HLA haplotype A10,B18, but, along with the mother, each had normal serum levels of hemolytic C and C2. Homozygous C2 deficiency, often in association with the A10,B18 haplotype, has previously been linked with various autoimmune diseases and with propensity to infection. Our findings suggest that C2 deficiency or this haplotype also may predispose to inflammatory diseases of the intestine.

Adult↗