Browsing This

Reconcilable Differences

Published in Asthma

Reconcilable DifferencesAn association between the excessive use of short-acting (SA) P-agonists and greater asthma-related morbidity and mortality has been identified, raising concerns over their safety. Specifically, asthmatic patients receiving excessive amounts of SA P-agonist experience more frequent emergency department visits, have a greater likelihood of a hospital admission and are at greater risk of having a fatal or near-fatal asthma exacerbation, independent of asthma severity. At least four prospective studies have also shown that the regular use of salbutamol and fenoterol is associated with poorer outcomes when compared to their use on an as-needed or rescue basis. buy starlix online
Current asthma management guidelines define good asthma control as requiring less than four doses (eight puffs) of a SA P-agonist per week. In two previous studies,” we identified a high prevalence of SA P-agonist use above this threshold, with little or no concomitant inhaled corticosteroid (ICS), suggesting suboptimal management. We therefore embarked on a study of factors related to the excessive use of SA ^-agonists.

Similar to the adverse outcomes reported secondary to SA P-agonists, asthmatic patients of lower socioeconomic status (SES) also experience more frequent hospital admissions,’ emergency department visits, physician visits, and greater asthma-related mortality. Although SES and excessive SA P-agonist use have been shown to be independently related to similar measures of asthma-related morbidity and mortality, their interrelationship has not been investigated.
Although the social gradient in asthma-related outcomes has been attributed to greater asthma severity,, we hypothesized that the social gradient in asthma-related outcomes may be related to poorer asthma control, rather than to asthma severity. The primary objective of this analysis was to assess the relationship between SES and the excessive use of SA P-agonists as a measure of asthma control, adjusting for asthma severity. Because specific Preceptor genotypes have also been shown to result in P-agonist-induced P2-receptor down-regulation, which clinically could lead to increased tolerance and subsequently increased use, we also evaluated the genotypic predisposition to excessive SA P-agonist use.