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Biomedical subjects

Richard Beasley

Publications and source records attributed to Richard Beasley.

At least 37 records · Page 2Linked to original sources
PubMed2005

SIT (seated immobility thromboembolism) syndrome: a 21st century lifestyle hazard.

The association between prolonged seated immobility and venous thromboembolism (VTE) is well recognised in relation to travel. In this case series, we report the occurrence of deep vein thrombosis (DVT) or pulmonary embolism (PE) following prolonged sitting in relation to work and/or recreation. The cases were characterised by the considerable length of time the individuals sat, the extensive nature of the VTE events in young individuals without other recognised risk factors, and the lack of recognition by the attending doctors of seated immobility as the likely major risk factor. While recognising that the association may be coincidental rather than causal, we propose the acronym 'SIT' (seated immobility thromboembolism) syndrome to encompass all forms of seated immobility associated with VTE.

Adult↗
PubMed2005

Seasonal variation in asthma-related hospital and intensive care unit admissions.

Seasonal trends in asthma-related hospitalizations are widely recognized; however, little is known about trends in asthma-related intensive care unit (ICU) admissions or intubations. The objective of this study is to examine monthly rates of asthma-related ICU admissions and/or intubations as a percent of total asthma-related admissions and to identify seasonality. This analysis was performed in a database of 285 hospitals representing > 3 million annual inpatient visits. Asthma-related hospital admissions for patients aged 5 and older were identified with a primary diagnosis of asthma (493.xx) during calendar years 2001-2002. The percents of the total admissions per month were compared. Monthly means were calculated and data were presented as moving averages. A total of 76,916 hospital admissions were identified with a primary diagnosis of asthma. Just over 10% (n = 7,803) were admitted to the ICU and/or intubated, with the majority among patients > 35 years of age (> 70%). A peak in asthma-related hospitalizations occurred in the winter months (10.3%) and a nadir in the summer months (5.9%; p < 0.004) with similar trends for ICU admissions. Despite this finding, ICU admissions and intubations remained relatively constant as a percent of total asthma-related hospitalizations, ranging from 9.2 to 10.9% and did not dip during the summer months when the overall asthma-related hospitalization rates were lowest. Significant differences in seasonal variation were also noted by age group and by region, but not by gender. These findings suggest a need for year-round vigilance and improved compliance with asthma therapy, especially during the summer when asthma attacks are perceived to be infrequent.

Adolescent↗
PubMed2005

Metered dose inhalers: a need for dose counters.

OBJECTIVES: This study investigated the ability of patients to assess when a metered dose inhaler (MDI) is empty. METHODOLOGY: A total of 17 patients assessed, by shaking, the number of doses remaining in a salbutamol MDI that had been partially emptied. Another 100 patients were asked to collect all salbutamol MDIs they considered to be empty and would have thrown away. These MDI canisters were weighed and the number of doses that had been used was estimated. RESULTS: Using the 'shaking method', patients overestimated the amount remaining by around 40 doses. The mean number of doses delivered from an MDI labelled to contain 200 doses before it was discarded was 224 (range, 155-289). CONCLUSIONS: These findings confirm that patients are unable to determine when an MDI should be discarded, resulting in insufficient drug delivery at the end of the life of an MDI for the majority of patients, and wastage of the drug for others.

Administration, Inhalation↗
PubMed2005

Fluticasone given once versus twice a day: meta-analysis.

OBJECTIVE: The aim of this study was to examine the efficacy of fluticasone administered once daily compared to twice daily in asthma. METHODOLOGY: A meta-analysis was performed of randomized double-blind trials of at least 4 weeks duration that compared fluticasone administered once versus twice a day and presented data on at least one clinical outcome measure. RESULTS: Six studies of 1517 children and adults with asthma met the inclusion criteria. Studies were predominantly in subjects with moderate asthma, treated with doses of fluticasone ranging from 200 to 500 microg per day. Twice-daily dosing was associated with significantly greater efficacy compared with once-daily dosing, for all outcome measures except night wakenings. The mean (95% CI) differences between twice and once-daily administration for FEV(1) and peak expiratory flow were 0.11 L (0.07-0.16) and 12.9 L/min (8.6-17.1), respectively. Twice-daily fluticasone was associated with significantly fewer withdrawals due to asthma than once-daily fluticasone, with an odds ratio of 0.44 (0.30-0.67). CONCLUSION: The findings suggest that twice-daily administration of fluticasone will provide greater therapeutic benefit than a once-daily morning regimen.

Adolescent↗
PubMed2005

Fixed and adjustable dose asthma action plans based on combination therapy: a pilot study.

OBJECTIVE: The use of combination inhaled corticosteroid/long-acting beta-agonist therapy within the framework of a self-management plan has yet to be investigated. METHODOLOGY: In this randomized open-label study, 69 adult asthmatic patients taking >or= 1,000 microg per day of beclomethasone dipropionate (BDP) or equivalent were treated for 3 months with Symbicort Turbuhaler (200 microg budesonide/6 microg formoterol). Patients were assigned to one of two self-management plans, based on either a fixed or adjustable dose regimen. The primary outcome variable was episode-free days. RESULTS: Both regimens resulted in good asthma control, at least comparable to that obtained with previous high dose inhaled corticosteroid therapy. There were no significant differences in clinical outcome measures between the regimens. The mean (+/- SD) usage of Symbicort was similar for the fixed and adjustable dose regimens (3.8 +/- 0.68 vs 3.6 +/- 1.54 puffs per day, respectively). CONCLUSION: We conclude that Symbicort is effective when administered as either a fixed or adjustable dose regimen as part of a self-management plan.

Adolescent↗
PubMed2005

Aerosolized magnesium sulfate for acute asthma: a systematic review.

BACKGROUND: The use of MgSO(4) is one of numerous treatment options available during exacerbations of asthma. While the efficacy of therapy with IV MgSO(4) has been demonstrated, little is known about inhaled MgSO(4). OBJECTIVES: A systematic review of the literature was performed to examine the effect of inhaled MgSO(4) in the treatment of patients with asthma exacerbations in the emergency department. METHODS: Randomized controlled trials were eligible for inclusion and were identified from the Cochrane Airways Group "Asthma and Wheez*" register, which consists of a combined search of the EMBASE, CENTRAL, MEDLINE, and CINAHL databases and the manual searching of 20 key respiratory journals. Reference lists of published studies were searched, and a review of the gray literature was also performed. Studies were included if patients had been treated with nebulized MgSO(4) alone or in combination with beta(2)-agonists and were compared to the use of beta(2)-agonists alone or with an inactive control substance. Trial selection, data extraction, and methodological quality were assessed by two independent reviewers. The results from fixed-effects models are presented as standardized mean differences (SMDs) for pulmonary functions and the relative risks (RRs) for hospital admission. Both are displayed with their 95% confidence intervals (CIs). RESULTS: Six trials involving 296 patients were included. There was a non-significant increase [corrected] in pulmonary function between patients whose treatments included nebulized MgSO(4) and those whose treatments [corrected] did not (SMD, 0.22; 95% CI, -0.02 to 0.47 [corrected] five studies); there was also a trend toward reduced [corrected] hospitalizations in patients whose treatments included nebulized MgSO(4) (RR, 0.67; 95% CI, 0.41 to 1.09; four studies). Subgroup analyses demonstrated that lung function improvement was similar in adult patients and in those patients who received nebulized MgSO(4) in addition to a beta(2)-agonist. CONCLUSIONS: The use of nebulized MgSO(4), particularly in addition to a beta(2)-agonist, in the treatment of an acute asthma exacerbation appears to produce benefits with respect to improved pulmonary function and may reduce the number of hospital admissions.

Acute Disease↗
PubMed2004

Specific oral contraceptive use and venous thromboembolism resulting in hospital admission.

OBJECTIVE: To determine whether there is an increased risk of venous thromboembolism (VTE) with anti-androgen oral contraceptives containing cyproterone acetate and ethinyloestradiol. METHODS: Comparison of the frequency of specific oral contraceptive use in patients aged 15 to 55 years discharged from hospital with radiologically confirmed deep vein thrombosis (DVT) and/or pulmonary embolism (PE) with the expected frequency of use derived from national prescription data. MAIN OUTCOME MEASURE: Ratio of observed frequency of specific oral contraceptive use in patients with VTE versus expected frequency of use. RESULTS: The rank order for observed versus expected use was anti-androgen > third-generation, > second-generation, > progestogen-only oral contraceptive agents with ratios of 1.93, 1.36, 0.70, and 0.39, respectively. CONCLUSION: The risk of VTE resulting in hospital admission associated with anti-androgen oral contraceptive use is at least as high as with third generation use.

Adolescent↗
PubMed2004

The 24 h duration of bronchodilator action of the salmeterol/fluticasone combination inhaler.

INTRODUCTION: The duration of bronchodilator action of the long-acting beta agonist salmeterol when administered in the evening has not been investigated. In this study we have investigated whether a single evening dose of salmeterol, administered from the combination salmeterol/fluticasone (SFC) Accuhaler significantly attenuates the circadian rhythm in airway tone over 24 h. METHODS: Eighteen subjects with mild to moderate asthma (mean FEV1 84% predicted) participated in a double-blind, double dummy, placebo controlled, cross-over study. Subjects inhaled, in random order, placebo, salbutamol (200 microg) or SFC (50/100 microg) administered in the evening (2000 h) on three separate occasions. Lung function measurements including FEV1, specific airways conductance (sGaw) and maximum expiratory flow at 25-75% of vital capacity (MEF(25-75%)) were assessed at baseline, at 1 h and subsequently every 4 h post-dose for 24 h. RESULTS: Compared with placebo, SFC significantly improved the three measures of airways function throughout the 24 h period, with a difference in FEV1 at 24 h of 0.24 l (0.00-0.47 l). SFC abolished the biphasic pattern of the circadian rhythm in airway tone. In contrast, salbutamol had a significant bronchodilator action of 4-8 h, depending on the lung function parameter measured. CONCLUSION: The single evening administration of SFC via the Accuhaler resulted in a duration of bronchodilation of at least 24 h, with the abolition of the accentuated biphasic circadian variation in airway tone observed in asthma.

Administration, Inhalation↗
PubMed2004

The dose-response relationship of inhaled corticosteroids in asthma.

Inhaled corticosteroids are the only class of asthma medication that can reduce symptoms, improve lung function, reduce the frequency of severe exacerbations, including hospital and ICU admissions, and decrease the risk of mortality. The therapeutic dose range for all clinical outcome measures in adults is 100 to 1000 mg/d of beclomethasone dipropionate or budesonide, or 50 to 500 mg/d of fluticasone propionate. Doses in excess of this range are not recommended for routine use because they are likely to increase the risk of systemic side-effects without further major improvement in efficacy. The recommendations are qualified by the recognition that there is considerable individual variability in the response to inhaled corticosteroids in asthma, which would suggest that some patients might obtain greater benefit at higher doses, just as some might obtain maximum benefit at lower doses.

Administration, Inhalation↗
PubMed2004

The use of the self-management plan system of care in adult asthma.

The development of self-management plans arose as clinicians tried to design better methods by which they could deliver asthma care and reduce the significant mortality and morbidity associated with this disease. The basic principles that resulted have been widely endorsed, and self-management plans are now recommended in the long-term management of adult asthma. Self-management plans essentially focus on the early recognition of unstable or deteriorating asthma, by monitoring peak flow or symptoms. Through the use of written guidelines, patients are then able to determine when it is necessary to adjust therapy or obtain medical assistance. There is now convincing evidence that the use of self-management plans by patients with asthma leads to a marked reduction in morbidity and a reduced requirement for acute medical treatment including hospital admissions. Recent research has also clarified many of the different issues concerning their structure and implementation. In some respects the skill in the use of the asthma self-management plan system of care is the ability to modify the standard plans to meet the particular needs of the individual asthmatic patient, including their preferences.

Journal Article↗
PubMed2004

Association of asthma therapy and Churg-Strauss syndrome: an analysis of postmarketing surveillance data.

BACKGROUND: Churg-Strauss syndrome (CSS), also known as allergic granulomatous angiitis (AGA), is a rare vasculitis that occurs in patients with bronchial asthma. The nature of the association of CSS with various asthma therapies is unclear. OBJECTIVE: This study investigated the associations of different multidrug asthma therapy regimens and the reporting of AGA (the preferred code for CSS in the coding dictionary for the Adverse Event Reporting System [AERS]) by applying an iterative method of disproportionally analysis to th AERS database maintained by the US Food and Drug Administration. METHODS: The public-release version of the AERS database was used to identify reports of AGA in patients receiving asthma therapy. Reporting of AGA was examined using iterative disproportionality methods in patients receiving > or =1 of the following drug classes: inhaled corticosteroid (ICS), leukotriene receptor antagonist (LTRA), short-acting beta(2)-agonist (SABA), or long-acting beta(2)-agonist (LABA). The Bayesian data-mining algorithm known as the multi-item gamma poisson shrinker was used to determine the relative reporting rates by calculation of the empirical Bayes geometric mean (EBGM) and its 90% CI (EB05 = lower limit and EB95 = upper limit) for each drug. Subset analyses were performed for each drug with different medication combinations to differentiate the relative reporting of AGA for each. RESULTS: A strong association was found between LTRA use and AGA (EBGM = 104.0, EB05 = 95.0, EB95 = 113.8) that persisted with all combinations of therapy studied. AGA was also associated with the ICS, SABA and LABA classes (EBGM values of 27.8, 14.6 and 40.4, respectively). However, the latter associations were mostly dependent on the presence of concurrent LTRA and, to a lesser extemt, oral corticosteroid therapy and became negligible (ie, EB05 < 2) for patients who were not receiving these concurrent treatments. CONCLUSIONS: Differences based on relative reporting were observed in the patterns of association of AGA with LTRA, ICS, and beta(2)-agonist therapies. A strong association between LTRA use and AGA was present regardless of the use of other asthma drugs.

Administration, Inhalation↗
PubMed2004

Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations.

BACKGROUND: A life-threatening attack of asthma that leads to intensive care unit (ICU) admission, intubation, or both identifies patients at high risk of subsequent morbidity and mortality and represents a major cost burden. OBJECTIVE: To assess the rates, characteristics, and costs of ICU admissions and intubations among asthma-related hospitalizations. METHODS: This analysis was performed using a database of 215 hospitals representing more than 3 million annual inpatient visits. Asthma-related hospital admissions were identified by a primary diagnosis code for asthma during 2000. Logistic regression was used to estimate the odds ratios (ORs) for predictors of ICU admission, intubation, and in-hospital mortality. Ordinary least squares regression was used to estimate adjusted mean costs and length of stay. RESULTS: Of 29,430 admissions with a primary diagnosis of asthma, 10.1% were admitted to the ICU and 2.1% were intubated. The risk of in-hospital death was significantly greater in patients who were intubated but not admitted to the ICU (OR, 96.20; 95% confidence interval [CI], 50.24-184.20), those who were admitted to the ICU and intubated (OR, 62.69; 95% CI, 38.17-102.96), and patients with more severe comorbidities (OR, 1.53; 95% CI, 1.38-1.70). On average, intubated patients stayed in the hospital 4.5 days longer and incurred more than $11,000 in additional costs; patients admitted to the ICU stayed 1 day longer and accounted for $3,000 in additional costs vs standard admissions. CONCLUSIONS: The inpatient mortality, morbidity, and cost burden of life-threatening asthma in the United States is considerable. This study characterizes patients with asthma at risk of ICU admissions and intubations. Appropriate recognition and treatment are needed to prevent these severe and potentially life-threatening events.

Adolescent↗