المؤلفون: Sarah Gehlert, Mario Castro, Kaharu Sumino, Juanita Taylor, Tiffany Dy, Leonard B. Bacharier, Ericka M. Lewis, Vithya Murugan, Jane Garbutt

المصدر: Respiratory Medicine. 137:201-205

مصطلحات موضوعية: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, Coding (therapy), Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Adrenal Cortex Hormones, Patient-Centered Care, 030225 pediatrics, Administration, Inhalation, medicine, Humans, Anti-Asthmatic Agents, Pediatricians, Child, Asthma, business.industry, Communication, Guideline, Focus Groups, medicine.disease, Focus group, Bronchodilator Agents, Black or African American, Clinical trial, Caregivers, 030228 respiratory system, Corticosteroid therapy, Family medicine, Guideline Adherence, business, Patient education, Qualitative research

الوصف: Objectives Guidelines recommend that healthcare providers adjust the dose of inhaled corticosteroids (ICS) in asthma patients based on the degree of symptom severity and control. Symptom-based, intermittent ICS therapy (use of ICS together with short acting bronchodilators- symptom-based adjustment: SBA) has been demonstrated to be comparable to guideline-based management by providers in controlled clinical trials. We sought input from African American caregivers and pediatricians on the acceptability and barriers for this alternative management strategy. Methods Focus group interviews of caregivers and individual interviews with community providers of African-American children ages 6–17 years with mild-moderate persistent asthma were conducted by trained facilitators to assess perceptions of how asthma affects children and their caregivers, and of SBA as a management strategy. Interview data were transcribed and analyzed using inductive thematic based coding. Results Twenty-six parents participated in six focus groups. Fourteen pediatricians were interviewed. Caregivers reported facing financial burden and difficulty with tracking medications. Caregivers and pediatricians were favorable about SBA, citing its potential for decreased use of medications and cost and similarity to actual care provided. Some caregivers voiced concern that SBA would not be as effective as daily ICS. Caregivers suggested that education on symptom recognition and close communication between physician and patient would facilitate the implementation of SBA. Conclusions SBA was generally viewed favorably by caregivers and providers of African American children. However, concerns regarding effectiveness of SBA were voiced by both caregivers and providers. Patient education and provider-patient communication is important in implementing this alternative asthma management strategy.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::153e05790f83c4caeb4a85581c02ae8dTest
https://doi.org/10.1016/j.rmed.2018.03.001Test

المؤلفون: Chananya Goldman, Marc A. Judson

المصدر: Respiratory Medicine. 171:106081

مصطلحات موضوعية: Pulmonary and Respiratory Medicine, Drug, 2019-20 coronavirus outbreak, medicine.medical_specialty, medicine.drug_class, media_common.quotation_subject, 03 medical and health sciences, 0302 clinical medicine, Sarcoidosis, Pulmonary, Refractory, Adrenal Cortex Hormones, Internal medicine, Humans, Medicine, Treatment Failure, 030212 general & internal medicine, Significant risk, media_common, business.industry, medicine.disease, Clinical trial, 030228 respiratory system, Corticosteroid therapy, Patient Compliance, Corticosteroid, Sarcoidosis, business, hormones, hormone substitutes, and hormone antagonists

الوصف: A sarcoidosis patient may be refractory to corticosteroid therapy. This may be because corticosteroids are ineffective in relieving the sarcoidosis patient's symptoms/dysfunction or because the clinician has determined that the risks of corticosteroids outweigh their benefits. Interestingly, when corticosteroids truly fail to improve a sarcoidosis patient's condition, it is very rarely because of failure of the drug as an anti-granulomatous agent; rather, it is usually because the patient's symptoms were unrelated to active sarcoid granulomas. In this manuscript, we review the causes of corticosteroid refractory sarcoidosis. The clinician should consider these causes when confronted with a sarcoidosis patient who is either not responding to corticosteroids, developing corticosteroid side-effects, or is at significant risk of developing such side-effects. We believe that determining the cause of corticosteroid refractory sarcoidosis may aid the clinicians in optimizing the care of sarcoidosis patients and clinical researchers in appropriately stratifying patients for clinical trials.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::745806cf32bc44375e9726ac5a71321aTest
https://doi.org/10.1016/j.rmed.2020.106081Test