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Complex Patient Case 4: Diabetes, CKD, and Psoriasis

Reason for Visit:  Referred by primary care provider to pharmacy services for education and management; diabetes not responding to oral therapy.

Guest Authors: Jillian Cerullo, PharmD and Michelle Gauvin, PharmD, BCACP, BCGP, CDCES

Expert Panelists: Jennifer Trujillo, PharmD, BCPS, CDCES, BC-ADM and Joshua Neumiller, PharmD, CDCES

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Breaking the SABA-only Rescue Habit: Two Drugs Are Better Than One

It is well established that overuse of short-acting beta-agonists (SABA) increases the risk of poor asthma control, exacerbations, and increased mortality.  Several studies have combined a beta-agonist with an inhaled corticosteroid (ICS). The combination provides symptom relief and decreases the risk of poor outcomes.  The days of using albuterol monotherapy should be coming to an end; two drugs are better than one!

Guest Authors:  Katherine Montag Schafer, PharmD, BCACP, CDCES and Stefanie C. Nigro, PharmD, BCACP, CDCES

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Using Controllers PRN for Mild Persistent Asthma – An Oxymoron?

Two recent studies challenge our current approach to managing patients with mild persistent asthma. When patients with asthma are prescribed inhaled corticosteroids (ICSs), we instruct them to use the medication daily. In patients with persistent asthma, guidelines recommend maintenance therapy, with either an ICS or a combination ICS/long-acting beta-agonist (LABA), plus a short-acting beta-agonist (SABA) as needed for rescue treatment.  The Symbicort Given as Needed in Mild Asthma (SYGMA) 1 and SYGMA 2 trials challenge the traditional approach comparing combination ICS/LABA (budesonide-formoterol) as needed to traditional ICS maintenance with SABA rescue therapy.

Guest Author:  Brittany Schmidt, PharmD, BCACP

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Is it Time to “Step Up” Rescue Treatment for Asthma to Prevent Exacerbations?

We’ve been managing asthma, for the most part, the same way for quite some time now … short-acting beta agonist (SABA) for quick relief, inhaled corticosteroids (ICS) as first-line maintenance treatment, step up if needed, step down if possible … plus self-management education and a written asthma action plan.  Despite many treatment options, numerous adults, adolescents, and children still suffer from asthma exacerbations, leading to reduced quality of life, missed work and school, higher costs, and increased asthma-related morbidity and mortality. Exacerbations can be triggered by acute respiratory infections, exposure to allergens and other environmental conditions, and poor medication use behaviors. Regardless of cause, finding ways to reduce or prevent exacerbations should be a priority.

Guest Author:  Kristen A. Pate, Pharm.D., BCACP

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Azithromycin to Prevent Asthma Exacerbations: What AMAZES Us and What Doesn’t

Despite good adherence to high-dose inhaled corticosteroids (ICS) and concomitant long-acting beta agonists (LABA), millions of people with asthma continue to experience exacerbations.  What more can patients and clinicians do to reduce the risk of exacerbations?  Does the routine use of antibiotics reduce the frequency of exacerbations?  This is the question the recently published AMAZES study attempted to answer.

Guest Authors: Michael Nagy, Pharm.D. and Ashley Crowl, Pharm.D.

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Short-Course Dexamethasone for Asthma Exacerbations in Children

To treat acute asthma exacerbations in children, how about a single dose of dexamethasone and your done!  Sounds simple, easy, and convenient.  But is it too good to be true?

Community Health Workers to Improve Asthma Outcomes

Can deploying trained laypeople working directly with low income adults with asthma in the community improve outcomes? This is what the Home-Based Asthma Support and Education (HomeBASE) trial set out to answer.