RESUMEN
Inhaler combination formulations consisting of an inhaled corticosteroid (ICS) (fluticasone propionate) and a long-acting ß2 agonist (salmeterol xinafoate) are indicated as maintenance treatments for patients with asthma and/or for selected patients with chronic obstructive pulmonary disease. The emergence of generic equivalents to branded inhalers is expected to offer economic edge/savings; however, some may argue that cost advantages offered by generic inhalers may be offset by worsening outcomes due to improper inhaler use, reduced adherence, and consequently worse disease control. To understand how unsupervised and unconsented switch of dry-powder inhalers and/or metered-dose inhalers affects clinical and humanistic outcomes in asthma, comprehensive searches of Embase and MEDLINE were conducted to identify research articles published in the English language since 2011. Patients with asthma of any age who underwent an unsupervised and unconsented switch from an ICS/long-acting ß2 agonist to another (brand-to-generic or brand-to-brand) for non-medical reasons were the target of this research. Relevant outcomes included asthma control, medication adherence, and healthcare resource utilization. In total, 11 studies were identified for review (ten non-interventional and one post hoc); cohorts ranged from 19 to 42,553 patients. Six studies indicated that unsupervised and unconsented inhaler switch had a negative impact on asthma control; six studies indicated reduced medication adherence post-switching; and five studies reporting healthcare resource utilization showed it was unchanged or increased post-switching. Findings from this targeted review support concerns that unsupervised and unconsented inhaler switch has a largely negative impact on asthma-associated outcomes. Additional studies are warranted to further explore unsupervised and unconsented switch in asthma.
RESUMEN
PURPOSE: There has been an increased interest in simple measures of physical function and muscle strength that can be used in all clinical settings to assess individuals with chronic obstructive pulmonary disease (COPD) and predict their prognosis. The main objective was to examine the prognostic value of simple measures of physical function and muscle strength in relation to exacerbation, hospitalization and mortality in individuals with COPD. METHODS: Medline, EMBASE, Cochrane and Web of Science were searched. We included prospective observational studies that examined the prognostic value of simple performed-based tests or self-reported measures of physical function or muscle strength in relation to exacerbation, hospitalization and mortality in individuals with COPD. RESULTS: Seven articles met the inclusion criteria. The most commonly used tests were the handgrip strength (HGS) (n = 4) and 1-min sit-to-stand (STS) (n = 2). There were considerable variations in terms of characteristics of patients included, setting of recruitment, type of tests used, duration of follow-up and outcome measures of interest. The majority of the studies were classified as having "fair" or "poor" methodological quality. CONCLUSIONS: There is a limited number of studies examining the prognostic value of simple measures of physical function and muscle strength in relation to exacerbations, hospitalizations and mortality in individuals with COPD. To date, the HGS and 1-min STS tests are the most studied tests and seem to be suitable for prognosis purposes in individuals with COPD. However, more studies with better methodological quality are needed to confirm these findings.