CME:Unlocking the Door to Asthma Control: Key Factors for Therapy Selection and Medication Management

Juan Carlos Ivancevich Monday, 18 February 2019 12:24

Intended Audience: Physicians, Pharmacists, Nurses, and Case Managers

Frequent asthma flare-ups lock patients out of their own lives by preventing them from fully participating in work/school, getting restful sleep, and engaging in social activities. In this CE accredited program, leading experts in asthma and managed care pharmacy will provide you with the keys to asthma control. Hear the latest evidence from recent conferences while discovering how novel therapies can tame and prevent flare-ups, reduce the impact of asthma-related comorbidities, and avoid the need for costly hospitalizations. Why leave those with severe asthma on the outside of life looking in when you can open the door?

Physicians completing this program will earn AMA PRA Category 1 Credit™ classified as Enduring material.

Pharmacists completing this program will earn Home Study credit in Disease State Mgmt/Drug therapy (H01).


The Electronic Asthma Management System (eAMS) Improves Primary Care Asthma Management

Juan Carlos Ivancevich Thursday, 14 February 2019 12:01

Samir GuptaCourtney PriceGina AgarwalDavid ChanSanjeev GoelLouis-Philippe BouletAlan G. KaplanGerald LebovicMuhammad MamdaniSharon E. Straus


A high prevalence of suboptimal asthma control is attributable to known evidence-practice gaps. We developed a computerised clinical decision support system (the Electronic Asthma Management System – eAMS) to address major care gaps and sought to measure its impact on care in adults with asthma.

This was a 2-year interrupted time series study of usual care (year 1) versus eAMS (year 2) at 3 Canadian primary care sites. We included asthma patients aged ≥16 years receiving an asthma medication within the last 12 months. The eAMS consisted of a touch tablet patient questionnaire completed in the waiting room, with real-time data processing producing electronic medical record-integrated clinician decision support.

Action plan delivery (primary outcome) improved from 0/412 (0%) to 79/443 (17.8%) eligible patients [absolute increase 0.18 (0.14,0.22)]. Time series analysis indicated a 30.5% increase in physician visits with action plan delivery with the intervention (p<0.0001). Assessment of asthma control level increased from 173/3497 (4.9%) to 849/3062 (27.7%) eligible visits [adjusted OR 8.62 (5.14, 12.45)]. Clinicians escalated controller therapy in 108/3422 (3.2%) baseline visits versus126/3240 (3.9%) intervention visits (p=0.12). At baseline, a short-acting beta-agonist alone was added in 62 visits and a controller added in 54 visits; with the intervention, this occurred in 33 and 229 visits, respectively (p<0.001).

The eAMS improved asthma quality of care in real-world primary care settings. Strategies to further increase clinician uptake and a randomised controlled trial to assess impact on patient outcomes are now required.

Registration: ClinicalTrials.govNCT01070095



Airway obstruction and bronchial reactivity from age 1 month until 13 years in children with asthma: A prospective birth cohort study

Juan Carlos Ivancevich Saturday, 09 February 2019 11:22


PLoS Med 16(1): e1002722.

Henrik Wegener Hallas, Bo Lund Chawes, Morten Arendt Rasmussen, Lambang Arianto, Jakob Stokholm, Klaus Bønnelykke, Hans Bisgaard

Investigators assessed 411 children from the at-risk COPSAC2000 birth cohort born to mothers with asthma to examine if low lung function and bronchial hyperreactivity are inherent features that increase the risk of developing airway inflammation and asthmatic symptoms. They observed that children who developed asthma had decreased lung function from 1 month of age throughout childhood as vs children without asthma. This lung function characteristic was evident prior to the development of airway inflammation and asthma, and did not worsen with prolonged duration of asthma symptoms. Findings, therefore, suggested that airway obstruction and bronchial hyperreactivity may be stable traits of childhood asthma, indicating that symptomatic disease may be a result of these traits but not their cause.

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Pharmacokinetics and pharmacodynamics of monoclonal antibodies for asthma treatment

Juan Carlos Ivancevich Monday, 11 February 2019 18:59


Expert Opinion on Drug Metabolism & Toxicology, 15:2,113-120, DOI: 10.1080/17425255.2019.1568409

Introduction: Asthma is a chronic inflammatory airway disease. It occurs in a ‘severe’ form in about 8–10% of asthmatic patients. In the last decade, the development of biological drugs (e.g. monoclonal antibodies) allowed to efficiently approach severe asthma. The current therapeutic targets available are mainly those related to TH2 inflammation.

Areas covered: The main pharmacokinetic and pharmacodynamic characteristics of the monoclonal antibodies against IL-5, IL-5Ra, IL4-IL13, and IgE, that are currently marketed or understood for severe asthma are discussed in this paper.

Expert opinion: The currently available biological drugs represent an excellent therapeutic add-on to traditional drugs, especially in replacing systemic corticosteroid therapies. The different pharmacokinetic and pharmacodynamic characteristics of the drugs, despite sometime sharing the same target, would allow a better personalization of the therapy, tailoring the treatment to the characteristics of the patient.

GINA: Newly designed website

Juan Carlos Ivancevich Thursday, 24 January 2019 15:51

“GINA is proud to announce the launch a newly designed website with a clean, modern layout and content that focuses on our mission to increase awareness of asthma among health professionals, health authorities, and the general public.”

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Editor: Juan C. Ivancevich, MD

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