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Biomedical subjects

David A Stempel

Publications and source records attributed to David A Stempel.

10 recordsLinked to original sources
PubMed2003

The pharmacologic management of childhood asthma.

Asthma treatment is based on the appropriate recognition and classification of children warranting treatment. Adequate treatment requires that children and parents have a good understanding of the disease and expectations for good control. Assessment requires a thorough history of symptoms, impairments of physical activity, past history of exacerbations, and understanding of triggering events. Therapy then must be appropriately implemented to reverse the symptoms and prevent future exacerbations. The approach in pediatrics is to be conservative, to use the safe and proven therapy, and to prevent the potential morbidity of the disease. These goals provide the rationale in childhood immunization. The literature suggests that the appropriate and conservative approach for children with persistent asthma, of any disease severity, is the use of low-dose inhaled corticosteroids that may be combined with an inhaled long-acting bronchodilator. This therapy is the most effective in reducing symptoms and exacerbations and preventing the potential mortality from the disease. It also allows children to be able to enjoy physical activity with their friends. Expectations should be high. Concerns about the potential for adverse effects should always be addressed proactively and should be balanced with the potential of adverse events from the disease.

Anti-Asthmatic Agents↗
PubMed2002

The cost of treating allergic rhinitis.

Allergic rhinitis is a high-cost, high-prevalence disease. In the year 2000, over $6 billion was spent on prescription medications to treat this illness. Although it is not associated with severe morbidity and mortality, allergic rhinitis has a major effect on the quality of life of the more than 50 million Americans with this illness. Intranasal corticosteroids (INCS) and nonsedating antihistamines (NSAH) are the most common prescription medications for this disease. INCS are recognized as the most effective treatment regimen for chronic symptoms. NSAH are perceived as important in the treatment of patients with mild disease, or as add-on therapy to INCS. When the literature is reviewed, the INCS produce the greatest decrease in total nasal symptom scores, the largest effect size, when compared with NSAH. Both classes of medications produce similar effects on concurrent allergic conjunctivitis. Further recent studies indicate that the INCS are also superior when used on an as-needed basis, and that there is little clinical benefit from the addition of loratadine to intranasal fluticasone. INCS have lower average wholesale prices as a class than the NSAH. Since the INCS are the dominant medication in efficacy studies and cost less, cost-effectiveness studies always favor intranasal corticosteroids.

Anti-Allergic Agents↗
PubMed2002

Inhaled corticosteroids plus salmeterol or montelukast: effects on resource utilization and costs.

BACKGROUND: Experimental clinical studies have demonstrated that the addition of salmeterol to inhaled corticosteroids (ICSs) is superior to the addition of montelukast to ICSs. Observational research from real-world clinical practice is needed to confirm these results. OBJECTIVE: The present study was designed to assess, in clinical practice, the comparative impact on health care utilization and cost of 2 dual-controller therapies, ICS + salmeterol and ICS + montelukast. METHODS: This study involved the use of a 24-month pre/post retrospective design in patients continuously enrolled in any of 14 United HealthCare plans. Outcomes assessed were post-index pharmacy costs, rates of emergency department visits and hospitalizations, numbers of filled prescriptions for short-acting beta-agonists (SABAs), total asthma costs, and total health care costs. RESULTS: Subjects in the ICS + salmeterol group had 35% fewer post-index SABA claims than subjects in the montelukast add-on group (P <or=.05). Subjects using ICS + montelukast were 2.5 times more likely to have an asthma-related hospitalization than subjects using ICS + salmeterol (P <or=.065). Total adjusted asthma costs were 63% higher for the patients receiving ICS + montelukast than for the patients receiving ICS + salmeterol (P <or=.0001). In addition, total health care costs were 25% lower in the ICS + salmeterol group. (P <or=.0004). Additional reductions in hospitalization and emergency department visits were observed when the patients on FP + salmeterol were studied separately. CONCLUSION: In comparison with the use of montelukast and ICS, the use of salmeterol and ICS was associated with a significant reduction in SABA use, decreased hospital event rates, and significantly lower total asthma care costs.

Acetates↗
PubMed2002

Foreword.

Explore the source record for details and available documents.

Anti-Asthmatic Agents↗
PubMed2002

Approaching value in asthma management: the need to integrate clinical and economic research with the basic science.

In the management of asthma, clinical decision making is primarily directed toward achieving the best outcome for the patient. However, the interests of the provider, insurer, and employer must also be taken into account. Integral to this process is an understanding of the need to weigh therapeutic objectives against economic concerns. This process involves consideration of the potential for clinical benefit as opposed to adverse treatment effects, as well as direct and indirect costs. Data from clinical trials provide the foundation for evaluating these factors. Randomized clinical trials, postmarketing studies, surveillance programs, and observational claims analyses all contribute valuable information to facilitate this process. Taken together, the results of such analyses form a foundation for providing effective, safe, and cost-efficient care through the practice of evidence-based medicine.

Anti-Asthmatic Agents↗
PubMed2002

Asthma: addressing consistency in results from basic science, clinical trials, and observational experience.

The basic science understanding of the pathophysiology of a disease often serves as the basis for clinical investigations. This knowledge is used to propose new directions in care and confirm initial concepts. The basic science of asthma demonstrates that the most comprehensive management of inflammation appears to be associated with the use of inhaled corticosteroids and proposes a mechanism for combination therapy with the addition of salmeterol. Randomized clinical trials are performed to confirm these initial observations and demonstrate both the safety and efficacy of therapeutic agents. These investigations are either placebo-controlled or direct comparisons of 2 medications. For the treatment of asthma, these studies have all consistently demonstrated that inhaled corticosteroids are the most effective primary controller therapy. Greater improvement in both lung function and patient-oriented symptom control is observed with the use of inhaled corticosteroids. For patients whose symptoms are not controlled with single-drug therapy, the addition of a long-acting bronchodilator appears to be the most effective add-on treatment with the greatest improvement in lung function and symptom control. Clinical trials have been used for the purposes of cost modeling. Therapies that produce the greatest effect size at the lowest incremental costs produce the greatest improvement in cost-effectiveness. Retrospective claims analysis, more recently, have been used to validate these observations from clinical trials. These studies measure both resource use and costs or charges. These analyses have confirmed that initial treatment with inhaled corticosteroids and combined treatment with inhaled corticosteroids and long-acting bronchodilators are the most effective stepwise approaches to the treatment of asthma.

Anti-Asthmatic Agents↗
PubMed2002

The risk of hospitalization in patients with asthma switched from an inhaled corticosteroid to a leukotriene receptor antagonist.

Asthma-related hospitalization rates were compared over a 2-year period between a cohort of patients with asthma who switched from an inhaled corticosteroid in year 1 to a leukotriene modifier in year 2 (n = 285) and a matched cohort continuously treated with an inhaled corticosteroid (n = 570). During year 1, patients were well maintained, with a hospitalization rate of 1.1% to 1.4%. During year 2, 2.5% of the patients switched to a leukotriene modifier had one or more asthma-related hospitalizations compared with 0.6% of the patients continuously receiving an inhaled corticosteroid. Patients treated with a leukotriene modifier were at 7 times greater risk for an asthma-related hospitalization compared with patients who continued to receive an inhaled corticosteroid (risk-adjusted odds ratio, 7.1; 95% CI, 2.79-17.95). These data are consistent with the results of well-controlled clinical trials showing that leukotriene modifiers may be associated with deterioration of asthma control relative to inhaled corticosteroids. Considered in aggregate, the data support the conclusion that leukotriene modifiers should not be substituted for inhaled corticosteroids as a single-controller therapy for asthma.

Administration, Inhalation↗