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1. Inhaled corticosteroids in COPD and onset of type 2 diabetes and osteoporosis: matched cohort study

Author

Price, D.B. (David B.), Voorham, J. (Jaco), Brusselle, G.G. (Guy), Clemens, A. (Andreas), Kostikas, K. (Konstantinos), Stephens, J.W. (Jeffrey W.), Park, H.Y. (Hye Yun), Roche, N. (Nicolas), Fogel, R. (Robert), Price, D.B. (David B.), Voorham, J. (Jaco), Brusselle, G.G. (Guy), Clemens, A. (Andreas), Kostikas, K. (Konstantinos), Stephens, J.W. (Jeffrey W.), Park, H.Y. (Hye Yun), Roche, N. (Nicolas), and Fogel, R. (Robert)

Abstract

Some studies suggest an association between onset and/or poor control of type 2 diabetes mellitus and inhaled corticosteroid (ICS) therapy for chronic obstructive pulmonary disease (COPD), and also between increased fracture risk and ICS therapy; however, study results are contradictory and these associations remain tentative and incompletely characterized. This matched cohort study used two large UK databases (1983–2016) to study patients (≥ 40 years old) initiating ICS or long-acting bronchodilator (LABD) for COPD from 1990–2015 in three study cohorts designed to assess the relation between ICS treatment and (1) diabetes onset (N = 17,970), (2) diabetes progression (N = 804), and (3) osteoporosis onset (N = 19,898). Patients had ≥ 1-year baseline and ≥ 2-year outcome data. Matching was via combined direct matching and propensity scores. Conditional proportional hazards regression, adjusting for residual confounding after matching, was used to compare ICS vs. LABD and to model ICS exposures. Median follow-up was 3.7–5.6 years/treatment group. For patients prescribed ICS, compared with LABD, the risk of diabetes onset was significantly increased (adjusted hazard ratio 1.27; 95% CI, 1.07–1.50), with overall no increase in risk of diabetes progression (adjusted hazard ratio 1.04; 0.87–1.25) or osteoporosis onset (adjusted hazard ratio 1.13; 0.93–1.39). However, the risks of diabetes onset, diabetes progression, and osteoporosis onset were all significantly increased, with evident dose–response relationships for all three outcomes, at mean ICS exposures of 500 µg/day or greater (vs. < 250 µg/day, fluticasone propionate–equivalent). Long-term ICS therapy for COPD at mean daily exposure of ≥ 500 µg is associated with an increased risk of diabetes, diabetes progression, and osteoporosis.

Published
2019
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2. Next-generation ARIA care pathways for rhinitis and asthma: A model for multimorbid chronic diseases

Author

Bousquet, J.J. (J. Jean), Schünemann, H.J. (Holger), Togias, A., Erhola, M. (Marina), Hellings, P.W. (Peter), Zuberbier, T. (Torsten), Agache, I. (Ioana), Ansotegui, I.J. (I.), Anto, J.M. (Josep), Bachert, C. (Claus), Becker, S. (Sven), Bedolla-Barajas, M. (Martin), Bewick, M. (Michael), Bosnic-Anticevich, S. (Sinthia), Bosse, I. (Isabelle), Boulet, L.P., Bourrez, J.M. (Jean Marc), Brusselle, G.G. (Guy), Chavannes, N.H. (Nicolas), Costa, E. (Elisio), Cruz, A.A. (Alvaro), Czarlewski, W. (Wienczyslawa), Fokkens, W.J. (Wytske), Fonseca, J.A. (Joao A.), Gaga, M. (Mina), Haahtela, T. (Tari), Illario, M. (Maddalena), Klimek, L. (Ludger), Kuna, P. (Piotr), Kvedariene, V. (Violeta), Le, L.T., Larenas-Linnemann, D. (Désirée), Laune, D. (Daniel), Lourenço, O.M. (Olga M.), Menditto, E. (Enrica), Mullol, J. (Joaquin), Okamoto, Y. (Yashitaka), Papadopoulos, N., Pham-Thi, N. (Nhân), Picard, R. (Robert), Pinnock, H. (Hilary), Roche, N. (Nicolas), Roller-Wirnsberger, R.E. (Regina E.), Rolland, C. (Christine), Samolinski, B. (Boleslaw), Sheikh, A. (Aziz), Toppila-Salmi, S. (Sanna), Tsiligianni, I.G. (Ioanna G), Valiulis, A. (Arunas), Valovirta, E. (Erkka), Vasankari, T. (Tuula), Ventura, M.-T. (Maria-Teresa), Walker, S. (Samantha), Williams, S. (Sian), Akdis, C.A. (Cezmi A.), Annesi-Maesano, I. (Isabella), Arnavielhe, S. (Sylvie), Basagaña, X. (Xavier), Bateman, E.D. (Eric), Bedbrook, A. (Anna), Bennoor, K.S. (K.), Benveniste, S. (Samuel), Bergmann, K.-C. (Karl-Christian), Bialek, S. (Slawomir), Billo, N. (Nils), Bindslev-Jensen, C. (Carsten), Bjermer, L. (Leif), Blain, H. (Hubert), Bonini, M. (Matteo), Bonniaud, P. (Philippe), Bouchard, J. (Jacques), Briedis, V. (Vitalis), Brightling, C.E. (Christofer E.), Brozek, J., Buhl, R. (Roland), Buonaiuto, R. (Roland), Canonica, G.W. (Giorgo W.), Cardona, D. (Doris), Carriazo, A.M. (Ana M.), Carr, W.W. (Warner), Cartier, C. (Christine), Casale, T.B. (Thomas), Cecchi, L. (Lorenzo), Cepeda Sarabia, A.M. (Alfonso M.), Chkhartishvili, E. (Eka), Chu, D.K. (Derek K.), Cingi, C. (Cemal), Colgan, E. (Elaine), De Sousa, J.C. (Jaime Correia), Courbis, A.L. (Anne Lise), Custovic, A. (Adnan), Cvetkosvki, B. (Biljana), Damato, G. (Gennaro), Da Silva, J. (Jane), Dantas, C. (Carina), Dokic, D. (D.), Dauvilliers, Y. (Yves), Dedeu, A. (Antoni), De Feo, G. (Giulia), Devillier, P. (Philippe), Di Capua, S. (Stefania), Dykewickz, M. (Marc), Dubakiene, R. (R.), Ebisawa, M. (Motohiro), El-Gamal, Y. (Y.), Eller, E. (Esben), Emuzyte, R., Farrell, J. (John), Fink-Wagner, A. (Antjie), Fiocchi, A. (Alessandro), Fontaine, J.F. (Jean F.), Gemicioǧlu, B. (Bilun), Schmid-Grendelmeir, P. (Peter), Gamkrelidze, A. (Amiran), Garcia-Aymerich, J. (Judith), Gomez, M. (Maximiliano), Diaz, S.G. (Sandra González), Gotua, M. (M.), Guldemond, N. (Nick), Guzmán, M.A. (M.), Hajjam, J. (Jawad), O'Hourihane, J.B. (John B.), Humbert, M. (Marc), Iaccarino, G. (Guido), Ierodiakonou, D. (Despo), Ivancevich, J.C. (Juan), Joos, G.F. (Guy), Jung, K.-S. (Ki-Suck), Jutel, M. (M.), Kaidashev, I. (Igor), Kalayci, O. (Omer), Kardas, P. (Przemyslaw), Keil, M. (Mark), Khaitov, M. (Mussa), Khaltaev, N., Kleine-Tebbe, J. (Jörg), Kowalski, M.L., Kritikos, V. (Vicky), Kull, C.A. (Christian), Leonardini, L. (Lisa), Lieberman, A.P. (Andrew), Lipworth, B., Lødrup Carlsen, K.C. (K. C.), Loureiro, C.C. (Claudia C.), Louis, R. (Renaud), Mair, A. (Alpana), Marien, G. (Gert), Mahboub, B., Malva, J. (Joao), Manning, P. (Patrick), De Manuel Keenoy, E. (Esteban), Marshall, G.D., Masjedi, M.R. (Mohamed R.), Maspero, J.F. (Jorge F.), Mathieu-Dupas, E. (Eve), Matricardi, P.M. (Poalo M.), Melén, E. (Eric), Melo-Gomes, E. (Elisabete), Meltzer, E.O., Mercier, J. (Jacques), Miculinic, N. (Neven), Mihaltan, F. (Florin), Milenkovic, B. (Branislava), Moda, G. (Giuliana), Mogica-Martinez, M.-D. (Maria-Dolores), Mohammad, Y., Montefort, S. (Steve), Monti, R. (Ricardo), Morais-Almeida, M. (Mario), Mösges, R. (Ralph), Münter, L. (Lars), Muraro, A. (Antonella), Murray, R. (Ruth), Naclerio, R., Napoli, L. (Luigi), Namazova-Baranova, L. (Leila), Neffen, H. (Hugo), Nekam, K. (Kristoff), Neou, A. (A.), Novellino, E. (Enrico), Nyembue, D. (Dieudonné), O'Hehir, R. (Robin), Ohta, K., Okubo, K. (Kimi), Onorato, G. (Gabrielle), Ouedraogo, S., Pali-Schöll, I. (I.), Palkonen, S. (Susanna), Panzner, P. (P.), Park, H.-S. (Hae-Sim), Pépin, J.-L. (Jean-Louis), Pereira, A.-M. (Ana-Maria), Pfaar, O. (Oliver), Paulino, E. (Ema), Phillips, J. (Jim), Plavec, D. (Davor), Popov, T.A. (Ted A.), Portejoie, F. (Fabienne), Price, D. (David), Prokopakis, E.P. (Emmanuel P.), Pugin, B. (Benoit), Raciborski, F. (Filip), Rajabian-Söderlund, R. (Rojin), Reitsma, S. (Sietze), Rodo, X. (Xavier), Romano, A., Rosario, N. (Nelson), Rottem, M. (Menahenm), Ryan, D. (Dermot), Salimäki, J. (Johanna), Sanchez-Borges, M.M. (Mario M.), Sisul, J.C. (J.), Solé, D. (Dirceu), Somekh, D. (David), Sooronbaev, T. (Talant), Sova, M. (Milan), Spranger, O., Stellato, C. (Cristina), Stelmach, R. (Rafael), Ulrik, C.S., Thibaudon, M. (Michel), To, T. (Teresa), Todo Bom, A., Tomazic, P.V. (Peter V.), Valero, A.A. (Antonio A.), Valenta, R. (Rudolph), Valentin-Rostan, M. (Marylin), Van Der Kleij, R.M. (Rianne Mjj), Vandenplas, O. (Olivier), Vezzani, G. (Giorgio), Viart, F. (Frédéric), Viegi, G., Wallace, D. (D.), Wagenmann, M. (Martin), Wang, D.Y. (De Y.), Waserman, S. (Susan), Wickman, M. (Magnus), Williams, D., Wong, G. (G.), Wroczynski, P. (Piotr), Yiallouros, P.K. (P.), Yorgancioglu, A. (Arzu), Yusuf, O.M. (Osman), Zar, H.J. (Heahter J.), Zeng, S. (Stéphane), Zernotti, M., Zhang, L. (Luo), Zhong, N.S. (Nan S.), Zidarn, M. (Mihaela), Bousquet, J.J. (J. Jean), Schünemann, H.J. (Holger), Togias, A., Erhola, M. (Marina), Hellings, P.W. (Peter), Zuberbier, T. (Torsten), Agache, I. (Ioana), Ansotegui, I.J. (I.), Anto, J.M. (Josep), Bachert, C. (Claus), Becker, S. (Sven), Bedolla-Barajas, M. (Martin), Bewick, M. (Michael), Bosnic-Anticevich, S. (Sinthia), Bosse, I. (Isabelle), Boulet, L.P., Bourrez, J.M. (Jean Marc), Brusselle, G.G. (Guy), Chavannes, N.H. (Nicolas), Costa, E. (Elisio), Cruz, A.A. (Alvaro), Czarlewski, W. (Wienczyslawa), Fokkens, W.J. (Wytske), Fonseca, J.A. (Joao A.), Gaga, M. (Mina), Haahtela, T. (Tari), Illario, M. (Maddalena), Klimek, L. (Ludger), Kuna, P. (Piotr), Kvedariene, V. (Violeta), Le, L.T., Larenas-Linnemann, D. (Désirée), Laune, D. (Daniel), Lourenço, O.M. (Olga M.), Menditto, E. (Enrica), Mullol, J. (Joaquin), Okamoto, Y. (Yashitaka), Papadopoulos, N., Pham-Thi, N. (Nhân), Picard, R. (Robert), Pinnock, H. (Hilary), Roche, N. (Nicolas), Roller-Wirnsberger, R.E. (Regina E.), Rolland, C. (Christine), Samolinski, B. (Boleslaw), Sheikh, A. (Aziz), Toppila-Salmi, S. (Sanna), Tsiligianni, I.G. (Ioanna G), Valiulis, A. (Arunas), Valovirta, E. (Erkka), Vasankari, T. (Tuula), Ventura, M.-T. (Maria-Teresa), Walker, S. (Samantha), Williams, S. (Sian), Akdis, C.A. (Cezmi A.), Annesi-Maesano, I. (Isabella), Arnavielhe, S. (Sylvie), Basagaña, X. (Xavier), Bateman, E.D. (Eric), Bedbrook, A. (Anna), Bennoor, K.S. (K.), Benveniste, S. (Samuel), Bergmann, K.-C. (Karl-Christian), Bialek, S. (Slawomir), Billo, N. (Nils), Bindslev-Jensen, C. (Carsten), Bjermer, L. (Leif), Blain, H. (Hubert), Bonini, M. (Matteo), Bonniaud, P. (Philippe), Bouchard, J. (Jacques), Briedis, V. (Vitalis), Brightling, C.E. (Christofer E.), Brozek, J., Buhl, R. (Roland), Buonaiuto, R. (Roland), Canonica, G.W. (Giorgo W.), Cardona, D. (Doris), Carriazo, A.M. (Ana M.), Carr, W.W. (Warner), Cartier, C. (Christine), Casale, T.B. (Thomas), Cecchi, L. (Lorenzo), Cepeda Sarabia, A.M. (Alfonso M.), Chkhartishvili, E. (Eka), Chu, D.K. (Derek K.), Cingi, C. (Cemal), Colgan, E. (Elaine), De Sousa, J.C. (Jaime Correia), Courbis, A.L. (Anne Lise), Custovic, A. (Adnan), Cvetkosvki, B. (Biljana), Damato, G. (Gennaro), Da Silva, J. (Jane), Dantas, C. (Carina), Dokic, D. (D.), Dauvilliers, Y. (Yves), Dedeu, A. (Antoni), De Feo, G. (Giulia), Devillier, P. (Philippe), Di Capua, S. (Stefania), Dykewickz, M. (Marc), Dubakiene, R. (R.), Ebisawa, M. (Motohiro), El-Gamal, Y. (Y.), Eller, E. (Esben), Emuzyte, R., Farrell, J. (John), Fink-Wagner, A. (Antjie), Fiocchi, A. (Alessandro), Fontaine, J.F. (Jean F.), Gemicioǧlu, B. (Bilun), Schmid-Grendelmeir, P. (Peter), Gamkrelidze, A. (Amiran), Garcia-Aymerich, J. (Judith), Gomez, M. (Maximiliano), Diaz, S.G. (Sandra González), Gotua, M. (M.), Guldemond, N. (Nick), Guzmán, M.A. (M.), Hajjam, J. (Jawad), O'Hourihane, J.B. (John B.), Humbert, M. (Marc), Iaccarino, G. (Guido), Ierodiakonou, D. (Despo), Ivancevich, J.C. (Juan), Joos, G.F. (Guy), Jung, K.-S. (Ki-Suck), Jutel, M. (M.), Kaidashev, I. (Igor), Kalayci, O. (Omer), Kardas, P. (Przemyslaw), Keil, M. (Mark), Khaitov, M. (Mussa), Khaltaev, N., Kleine-Tebbe, J. (Jörg), Kowalski, M.L., Kritikos, V. (Vicky), Kull, C.A. (Christian), Leonardini, L. (Lisa), Lieberman, A.P. (Andrew), Lipworth, B., Lødrup Carlsen, K.C. (K. C.), Loureiro, C.C. (Claudia C.), Louis, R. (Renaud), Mair, A. (Alpana), Marien, G. (Gert), Mahboub, B., Malva, J. (Joao), Manning, P. (Patrick), De Manuel Keenoy, E. (Esteban), Marshall, G.D., Masjedi, M.R. (Mohamed R.), Maspero, J.F. (Jorge F.), Mathieu-Dupas, E. (Eve), Matricardi, P.M. (Poalo M.), Melén, E. (Eric), Melo-Gomes, E. (Elisabete), Meltzer, E.O., Mercier, J. (Jacques), Miculinic, N. (Neven), Mihaltan, F. (Florin), Milenkovic, B. (Branislava), Moda, G. (Giuliana), Mogica-Martinez, M.-D. (Maria-Dolores), Mohammad, Y., Montefort, S. (Steve), Monti, R. (Ricardo), Morais-Almeida, M. (Mario), Mösges, R. (Ralph), Münter, L. (Lars), Muraro, A. (Antonella), Murray, R. (Ruth), Naclerio, R., Napoli, L. (Luigi), Namazova-Baranova, L. (Leila), Neffen, H. (Hugo), Nekam, K. (Kristoff), Neou, A. (A.), Novellino, E. (Enrico), Nyembue, D. (Dieudonné), O'Hehir, R. (Robin), Ohta, K., Okubo, K. (Kimi), Onorato, G. (Gabrielle), Ouedraogo, S., Pali-Schöll, I. (I.), Palkonen, S. (Susanna), Panzner, P. (P.), Park, H.-S. (Hae-Sim), Pépin, J.-L. (Jean-Louis), Pereira, A.-M. (Ana-Maria), Pfaar, O. (Oliver), Paulino, E. (Ema), Phillips, J. (Jim), Plavec, D. (Davor), Popov, T.A. (Ted A.), Portejoie, F. (Fabienne), Price, D. (David), Prokopakis, E.P. (Emmanuel P.), Pugin, B. (Benoit), Raciborski, F. (Filip), Rajabian-Söderlund, R. (Rojin), Reitsma, S. (Sietze), Rodo, X. (Xavier), Romano, A., Rosario, N. (Nelson), Rottem, M. (Menahenm), Ryan, D. (Dermot), Salimäki, J. (Johanna), Sanchez-Borges, M.M. (Mario M.), Sisul, J.C. (J.), Solé, D. (Dirceu), Somekh, D. (David), Sooronbaev, T. (Talant), Sova, M. (Milan), Spranger, O., Stellato, C. (Cristina), Stelmach, R. (Rafael), Ulrik, C.S., Thibaudon, M. (Michel), To, T. (Teresa), Todo Bom, A., Tomazic, P.V. (Peter V.), Valero, A.A. (Antonio A.), Valenta, R. (Rudolph), Valentin-Rostan, M. (Marylin), Van Der Kleij, R.M. (Rianne Mjj), Vandenplas, O. (Olivier), Vezzani, G. (Giorgio), Viart, F. (Frédéric), Viegi, G., Wallace, D. (D.), Wagenmann, M. (Martin), Wang, D.Y. (De Y.), Waserman, S. (Susan), Wickman, M. (Magnus), Williams, D., Wong, G. (G.), Wroczynski, P. (Piotr), Yiallouros, P.K. (P.), Yorgancioglu, A. (Arzu), Yusuf, O.M. (Osman), Zar, H.J. (Heahter J.), Zeng, S. (Stéphane), Zernotti, M., Zhang, L. (Luo), Zhong, N.S. (Nan S.), and Zidarn, M. (Mihaela)

Abstract

Background: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. Main body: As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhi-nitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally-enabled, integrated, person-centred care. Conclusion: In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.

Published
2019
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3. Determinants and impact of suboptimal asthma control in Europe: The INTERNATIONAL CROSS-SECTIONAL AND LONGITUDINAL ASSESSMENT ON ASTHMA CONTROL (LIAISON) study

Author

Braido, F. (Fulvio), Brusselle, G.G. (Guy), Guastalla, D. (Daniele), Ingrassia, E. (Eleonora), Nicolini, G. (Gabriele), Price, D. (David), Roche, N. (Nicolas), Soriano, J.B. (Joan B.), Worth, H. (Heinrich), Braido, F. (Fulvio), Brusselle, G.G. (Guy), Guastalla, D. (Daniele), Ingrassia, E. (Eleonora), Nicolini, G. (Gabriele), Price, D. (David), Roche, N. (Nicolas), Soriano, J.B. (Joan B.), and Worth, H. (Heinrich)

Abstract

Background: According to the Global Initiative of Asthma, the aim of asthma treatment is to gain and maintain control. In the INTERNATIONAL CROSS-SECTIONAL AND LONGITUDINAL ASSESSMENT ON ASTHMA CONTROL (LIAISON) study, we evaluated the level of asthma control and quality of life (Q

Published
2016
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4. Real-world research and its importance in respiratory medicine

Author

Price, D. (David), Brusselle, G.G. (Guy), Roche, N. (Nicolas), Freeman, D. (Daryl), Chisholm, A. (Alison), Price, D. (David), Brusselle, G.G. (Guy), Roche, N. (Nicolas), Freeman, D. (Daryl), and Chisholm, A. (Alison)

Abstract

Clinical practice requires a complex interplay between experience and training, research, guidelines and judgement, and must not only draw on data from traditional or classical randomised controlled trials (cRCTs), but also from pragmatically designed studies that better reflect real-life clinical practice. To minimise extraneous variables and to optimize their internal validity, cRCTs exclude patients, clinical characteristics and variations in care that could potentially confound outcomes. The result is that respiratory cRCTs often enrol a small, non-representative subset of patients and overlook the important interplay and interactions between patients and the real world, which can effect treatment outcomes. Evidence from real-life studies (e.g. naturalistic or pragmatic clinical trials and observational studies encompassing healthcare database studies and cohort studies) can be combined with cRCT evidence to provide a fuller picture of intervention effectiveness and realistic treatment outcomes, and can provide useful insights into alternative management approaches in more challenging asthma patients. The Respiratory Effectiveness Group (REG), in collaboration with the European Academy of Allergy and Clinical Immunology (EAACI) and the European Respiratory Society (ERS), is developing quality appraisal tools and methods for integrating different sources of evidence. A REG/EAACI taskforce aims to help support future guideline developers to avoid a one-size-fits-all approach to recommendations and to tailor the conclusions of their meta-analyses to the populations under consideration.

Published
2015
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