Long-term Outcomes After Stepping Down Asthma Controller Medications: A Claims-Based, Time-to-Event Analysis.

Abstract:

BACKGROUND:Long-term outcomes after stepping down asthma medications are not well described. METHODS:This study was a retrospective time-to-event analysis of individuals diagnosed with asthma who stepped down their asthma controller medications using a US claims database spanning 2000 to 2012. Four-month intervals were established and a step-down event was defined by a ≥ 50% decrease in days-supplied of controller medications from one interval to the next; this definition is inclusive of step-down that occurred without health-care provider guidance or as a consequence of a medication adherence lapse. Asthma stability in the period prior to step-down was defined by not having an asthma exacerbation (inpatient visit, ED visit, or dispensing of a systemic corticosteroid linked to an asthma visit) and having fewer than two rescue inhaler claims in a 4-month period. The primary outcome in the period following step-down was time-to-first asthma exacerbation. RESULTS:Thirty-two percent of the 26,292 included individuals had an asthma exacerbation in the 24-month period following step-down of asthma controller medication, though only 7% had an ED visit or hospitalization for asthma. The length of asthma stability prior to stepping down asthma medication was strongly associated with the risk of an asthma exacerbation in the subsequent 24-month period: < 4 months' stability, 44%; 4 to 7 months, 34%; 8 to 11 months, 30%; and ≥ 12 months, 21% (P < .001). CONCLUSIONS:In a large, claims-based, real-world study setting, 32% of individuals have an asthma exacerbation in the 2 years following a step-down event.

journal_name

Chest

journal_title

Chest

authors

Rank MA,Johnson R,Branda M,Herrin J,van Houten H,Gionfriddo MR,Shah ND

doi

10.1378/chest.15-0301

subject

Has Abstract

pub_date

2015-09-01 00:00:00

pages

630-639

issue

3

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)50640-5

journal_volume

148

pub_type

杂志文章

相关文献

CHEST文献大全
  • Atmospheric pressure changes and outdoor temperature changes in relation to spontaneous pneumothorax.

    abstract:STUDY AIMS:To examine the influence of atmospheric pressure (AP) and temperature changes on the incidence of idiopathic spontaneous pneumothorax (SP). METHODS:From December 1991 through November 1993, 115 consecutive SP cases were selected. Patients were included after being in Amsterdam at least 1 full day before con...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.116.3.676

    authors: Smit HJ,Devillé WL,Schramel FM,Schreurs JM,Sutedja TG,Postmus PE

    更新日期:1999-09-01 00:00:00

  • Effects of short-term 28% and 100% oxygen on PaCO2 and peak expiratory flow rate in acute asthma: a randomized trial.

    abstract:STUDY OBJECTIVE:We conducted the first randomized controlled study to assess the effects of short-term 28% and 100% oxygen on PaCO(2) and peak expiratory flow rate (PEFR) in patients with acute severe asthma. PATIENTS AND INTERVENTIONS:Seventy-four patients (mean age, 37.9 +/- 9.7 years [+/- SD]; PEFR, 41.0 +/- 12.1% ...

    journal_title:Chest

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1378/chest.124.4.1312

    authors: Rodrigo GJ,Rodriquez Verde M,Peregalli V,Rodrigo C

    更新日期:2003-10-01 00:00:00

  • Stability of blood gases in ice and at room temperature.

    abstract::Arterial blood samples from 75 patients were analyzed for PO2, PCO2, and pH at 0, 15, and 30 min. After the baseline analysis, 60 samples were kept in ice while 59 samples were left at room temperature. There was a statistically significant increase in the PO2 at 15 min and again at 30 min in both groups. There was a ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.103.4.1120

    authors: Liss HP,Payne CP Jr

    更新日期:1993-04-01 00:00:00

  • Comparison of four methods for calculating diffusing capacity by the single breath method.

    abstract::In 283 patients referred for testing in an outpatient pulmonary function laboratory, we studied the single-breath diffusing capacity of the lungs for carbon monoxide (Dco) using the Ogilvie (Og), Jones-Meade (JM), Epidemiological Standardization Project (ESP), and three-phase iterative methods (3PIT, similar to the th...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.105.2.594

    authors: Beck KC,Offord KP,Scanlon PD

    更新日期:1994-02-01 00:00:00

  • Roxithromycin reduces the degree of bronchial hyperresponsiveness in children with asthma.

    abstract::We evaluated the effects of a new semisynthetic macrolide antibiotic, roxithromycin, on the bronchial hyperresponsiveness to histamine in children with asthma. Twelve hospitalized asthmatic children, aged 11 to 15 years (mean age, 12.9 years), were enrolled in this study. They were treated with 150 mg of roxithromycin...

    journal_title:Chest

    pub_type: 临床试验,杂志文章

    doi:10.1378/chest.106.2.458

    authors: Shimizu T,Kato M,Mochizuki H,Tokuyama K,Morikawa A,Kuroume T

    更新日期:1994-08-01 00:00:00

  • Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea.

    abstract:STUDY OBJECTIVES:Precise epidemiologic data regarding nontuberculous mycobacterial (NTM) lung infection in many Asian countries have been relatively unavailable. In order to determine the clinical significance of NTM isolated from respiratory specimens, we reviewed medical records from all patients from whom NTM isolat...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.129.2.341

    authors: Koh WJ,Kwon OJ,Jeon K,Kim TS,Lee KS,Park YK,Bai GH

    更新日期:2006-02-01 00:00:00

  • Validation of the Exhaled Breath Temperature Measure: Reference Values in Healthy Subjects.

    abstract:BACKGROUND:Exhaled breath temperature (EBT) is a new noninvasive method for the study of inflammatory respiratory diseases with a potential to reach clinical practice. However, few studies are available regarding the validation of this method, and they were mainly derived from small, pediatric populations; thus, the ra...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1016/j.chest.2016.11.013

    authors: Carpagnano GE,Foschino-Barbaro MP,Crocetta C,Lacedonia D,Saliani V,Zoppo LD,Barnes PJ

    更新日期:2017-04-01 00:00:00

  • The use of 201thallium for myocardial perfusion imaging in sarcoid heart disease.

    abstract::Cardiac dysfunction due to systemic sarcoidosis is most of ten due to severe restrictive pulmonary diseases. Although the diagnosis is frequently missed during life, direct granulomatous infiltration of the myocardium may occur with systemic sarcoidosis and, when present in the heart, is a major cause of death. To exp...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.72.1.27

    authors: Bulkley BH,Rouleau JR,Whitaker JQ,Strauss HW,Pitt B

    更新日期:1977-07-01 00:00:00

  • Adenovirus bronchiolitis in Manitoba: epidemiologic, clinical, and radiologic features.

    abstract::We reviewed our experience with 41 children hospitalized from 1974 to 1978 for adenovirus (ADV) bronchiolitis. Thirty-two patients (78 percent) were native Indians between four and 12 months old. In 18 of the 41 patients (43.9 percent) acute complications developed. The five fatal cases (12.2 percent) were confined to...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.81.5.605

    authors: Wenman WM,Pagtakhan RD,Reed MH,Chernick V,Albritton W

    更新日期:1982-05-01 00:00:00

  • Whole-lung lavage in alveolar proteinosis by a modified lavage technique.

    abstract::Whole-lung lavage is the only efficient treatment in pulmonary alveolar proteinosis. A 36-year-old woman with severe pulmonary alveolar proteinosis confirmed by video-assisted thoracoscopic lung biopsies underwent repetitive whole-lung lavages without improvement. A modified technique consisting of manual ventilation ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.113.6.1718

    authors: Bingisser R,Kaplan V,Zollinger A,Russi EW

    更新日期:1998-06-01 00:00:00

  • Comparison of lung expansion techniques on thoracoabdominal mechanics and incidence of pulmonary complications after upper abdominal surgery: a randomized and controlled trial.

    abstract:OBJECTIVE:Lung expansion techniques (LETs) are widely used to prevent postoperative pulmonary complications (PPCs). However, the effects of each of these techniques on thoracoabdominal mechanics and PPC incidence after abdominal surgery remain unclear. The objective of this study was to compare the effects of LET on pu...

    journal_title:Chest

    pub_type: 杂志文章,随机对照试验

    doi:10.1378/chest.14-2696

    authors: Lunardi AC,Paisani DM,Silva CCBMD,Cano DP,Tanaka C,Carvalho CRF

    更新日期:2015-10-01 00:00:00

  • Intravegetation antimicrobial distribution in aortic endocarditis analyzed by computer-generated model. Implications for treatment.

    abstract::The distribution of antibiotics into cardiac valvular tissues is incompletely understood. By integrative computer modeling, we have used previously obtained pharmacokinetic data in experimental endocarditis to characterize aminoglycoside distribution within various geographic sectors of aortic vegetations of rabbits a...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.97.3.611

    authors: Bayer AS,Crowell D,Nast CC,Norman DC,Borrelli RL

    更新日期:1990-03-01 00:00:00

  • Vasodilators and primary pulmonary hypertension. Variability of long-term response.

    abstract::Long-term response to vasodilator therapy was assessed in six patients with PPH. Following an acute trial, each patient was restudied after (1) two months of drug administration, (2) one month of abstinence from therapy, and (3) an additional two months of therapy. Three of six patients had no long-term reduction of P...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.95.6.1185

    authors: Dantzker DR,D'Alonzo GE,Gianotti L,Fuentes F,Nickeson D,Emerson M

    更新日期:1989-06-01 00:00:00

  • The induction of ventricular arrhythmias in acute myocardial ischemia by atrial pacing with long-short cycle sequences.

    abstract::Recent studies emphasize the importance of heart rate in the genesis of ventricular arrhythmias during myocardial ischemia. The role of alterations in rhythm has not previously been systematically investigated. In 20 dogs subjected to acute myocardial ischemia and crushing of the sinus node, standard electrocardiograp...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.71.5.651

    authors: Hope RR,Lazzara R,Scherlag BJ

    更新日期:1977-05-01 00:00:00

  • Perspectives on continuing education in the health professions: improving health care through lifelong learning.

    abstract::In November 2007, the Josiah Macy, Jr. Foundation convened a conference to address a number of complex issues concerning continuing education (CE) in the health professions. Participants concluded that CE, as currently practiced, does not focus adequately on improving clinician performance and patient care, is too dep...

    journal_title:Chest

    pub_type: 杂志文章,评审

    doi:10.1378/chest.08-1022

    authors: Leach DC,Fletcher SW

    更新日期:2008-12-01 00:00:00

  • Psychological defenses and coping styles in patients following a life-threatening attack of asthma.

    abstract::Twenty-five patients who have suffered a near miss asthma death (NMAD) have undergone a comprehensive psychiatric evaluation on average 13 months following this event. Forty percent of the patients were judged to have psychiatric disorders at the time of assessment. All patients had very high levels of denial and foll...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.95.6.1298

    authors: Yellowlees PM,Ruffin RE

    更新日期:1989-06-01 00:00:00

  • Accuracy of individual variables in the monitoring of long-term change in pulmonary sarcoidosis as judged by serial high-resolution CT scan data.

    abstract:BACKGROUND:In pulmonary sarcoidosis, the optimal means of quantifying change is uncertain. The comparative usefulness of simple lung function trends and chest radiography remains unclear. We aimed to explore and contrast the disease-monitoring strategies of serial pulmonary function tests (PFTs) and chest radiography c...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.12-2479

    authors: Zappala CJ,Desai SR,Copley SJ,Spagnolo P,Sen D,Alam SM,du Bois RM,Hansell DM,Wells AU

    更新日期:2014-01-01 00:00:00

  • The effect of regular salbutamol on lung function and bronchial hyperresponsiveness in normal subjects and nonasthmatic atopic subjects with allergic rhinitis.

    abstract:BACKGROUND:The effects of regular inhaled beta-agonist treatment on lung function remain a controversial issue. In an earlier study, the administration of regular inhaled salbutamol resulted in negative changes in FEV1 not only in asthmatics, but also in nonasthmatic atopic subjects. OBJECTIVE:The aim of this study wa...

    journal_title:Chest

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1378/chest.112.1.12

    authors: Boothman-Burrell D,Jones D,Herbison GP,Taylor DR

    更新日期:1997-07-01 00:00:00

  • Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values.

    abstract:BACKGROUND:Although diaphragmatic motion is readily studied by ultrasonography, the procedure remains poorly codified. The aim of this prospective study was to determine the reference values for diaphragmatic motion as recorded by M-mode ultrasonography. METHODS:Two hundred ten healthy adult subjects (150 men, 60 wome...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.08-1541

    authors: Boussuges A,Gole Y,Blanc P

    更新日期:2009-02-01 00:00:00

  • ICU Telemedicine Program Financial Outcomes.

    abstract:BACKGROUND:ICU telemedicine improves access to high-quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following ICU telemedicine implementation and after the addition of logistic center function has not been publishe...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1016/j.chest.2016.11.029

    authors: Lilly CM,Motzkus C,Rincon T,Cody SE,Landry K,Irwin RS,UMass Memorial Critical Care Operations Group.

    更新日期:2017-02-01 00:00:00

  • Interpretation of cough provoked by airway challenges.

    abstract:STUDY OBJECTIVE:To analyze the cough response to three airway challenges in order to clarify whether the recording of the provoked coughs would be beneficial in the management of asthma. DESIGN:A prospective study. SETTING:University hospital. PARTICIPANTS:Fifteen healthy subjects, 16 steroid-naïve subjects with ast...

    journal_title:Chest

    pub_type: 杂志文章,随机对照试验

    doi:10.1378/chest.128.5.3329

    authors: Koskela HO,Kontra KM,Purokivi MK,Randell JT

    更新日期:2005-11-01 00:00:00

  • Acute lung disease in the immunocompromised host. Diagnostic accuracy of the chest radiograph.

    abstract:PURPOSE:To assess the diagnostic accuracy of the chest radiograph in the evaluation of acute pulmonary complications in immunocompromised patients. METHODS:The study included the chest radiographs in 149 consecutive acute pulmonary complications seen in immunocompromised patients in whom a definitive diagnosis was mad...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.108.5.1283

    authors: Logan PM,Primack SL,Staples C,Miller RR,Müller NL

    更新日期:1995-11-01 00:00:00

  • Primary pulmonary hypertension in a patient with CD8/T-cell large granulocyte leukemia: amelioration by cladribine therapy.

    abstract::We report a case of primary pulmonary hypertension in an adult man with CD8/T-cell large granulocyte leukemia. Successful treatment of his leukemia with cladribine resulted in dramatic and sustained improvement of his pulmonary hypertension. ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.112.2.551

    authors: Rossoff LJ,Genovese J,Coleman M,Dantzker DR

    更新日期:1997-08-01 00:00:00

  • Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis : data from a population-based survey.

    abstract:BACKGROUND:Asthma and rhinosinusitis are common medical conditions among adults. Alternative treatments could have important impacts on health status among those individuals with these conditions, but specific prevalence data for these treatments are limited. OBJECTIVE:To estimate the prevalence of specific alternativ...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.120.5.1461

    authors: Blanc PD,Trupin L,Earnest G,Katz PP,Yelin EH,Eisner MD

    更新日期:2001-11-01 00:00:00

  • The "lung shift" in treated schistosomiasis. Bronchoalveolar lavage evidence of eosinophilic pneumonia.

    abstract::There is conflicting and incomplete information in the literature on the pulmonary reaction which can occur following treatment of schistosomiasis. We examined the pulmonary function, bronchoalveolar lavage profile, and lung histopathology of a patient with pneumonia and peripheral eosinophilia following oxaminquine c...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.89.3.455

    authors: Davidson BL,el-Kassimi F,Uz-Zaman A,Pillai DK

    更新日期:1986-03-01 00:00:00

  • The assessment of major airway function in a ventilator-dependent patient with tracheomalacia.

    abstract::A 60-pack-year smoker presented with cough, dyspnea and orthopnea of three months' duration. Spirometry revealed severe reduction in maximal expiratory flow; CT of the chest and bronchoscopy demonstrated expiratory collapse of a mid-tracheal segment, and a presumptive diagnosis of tracheomalacia was made. A right late...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.97.4.939

    authors: Dunn WF,Hubmayr RD,Pairolero PC,Sheedy PF,Edell ES,Nelson SB

    更新日期:1990-04-01 00:00:00

  • Pneumothorax in cystic fibrosis.

    abstract:BACKGROUND:Spontaneous pneumothorax is a complication that is commonly reported in patients with cystic fibrosis (CF). An understanding of the pathophysiology of this complication and its consequences is important for the management of patients with CF. OBJECTIVE:To identify risk factors associated with pneumothorax a...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.128.2.720

    authors: Flume PA,Strange C,Ye X,Ebeling M,Hulsey T,Clark LL

    更新日期:2005-08-01 00:00:00

  • Phrenic nerve dysfunction after cardiac operations: electrophysiologic evaluation of risk factors.

    abstract:BACKGROUND AND STUDY OBJECTIVE:Phrenic nerve injury may occur after cardiac surgery; however, its cause has not been extensively investigated with electrophysiology. The purpose of this study was to determine by electrophysiologic means the importance of various possible risk factors in the development of phrenic nerve...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.113.1.8

    authors: Dimopoulou I,Daganou M,Dafni U,Karakatsani A,Khoury M,Geroulanos S,Jordanoglou J

    更新日期:1998-01-01 00:00:00

  • Cardiac ultrastructure in primary restrictive cardiomyopathy.

    abstract::A five-year clinical follow-up and the results of myocardial biopsies are described in a patient with primary restrictive cardiomyopathy. Histologic examination of a right ventricular endomyocardial biopsy taken early in the course of the illness was not contributory. Histologic examination of a left ventricular endom...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.84.2.236

    authors: Arbustini E,Buonanno C,Trevi G,Pennelli N,Ferrans VJ,Thiene G

    更新日期:1983-08-01 00:00:00

  • Is pulmonary arterial hypertension really a late complication of systemic sclerosis?

    abstract:BACKGROUND:Pulmonary arterial hypertension (PAH) is a frequent cause of morbidity and mortality in patients with systemic sclerosis (SSc). PAH is generally considered to be a late complication of limited cutaneous SSc. This study identified and investigated a subset of SSc patients with early-onset PAH. METHODS:Clinic...

    journal_title:Chest

    pub_type: 杂志文章

    doi:10.1378/chest.08-3042

    authors: Hachulla E,Launay D,Mouthon L,Sitbon O,Berezne A,Guillevin L,Hatron PY,Simonneau G,Clerson P,Humbert M,French PAH-SSc Network.

    更新日期:2009-11-01 00:00:00