Cost-effectiveness of budesonide/formoterol maintenance and rescue therapy in Thailand.

Background: The prevalence of asthma has increased significantly in Thailand. Budesonide/formoterol maintenance and reliever therapy has been available for several years. However, cost-effectiveness of such treatment has never been examined in Thailand. Objective: Design a cost-effectiveness (CE) analysis conducted from a Thai healthcare perspective as a piggyback study accompanying a recent clinical trial. Methods: The CE analysis was conducted from the healthcare provider’s perspective. Data were collected from a six-month, double-blind, multi-national study involving 3321 symptomatic asthma patients randomized to either: bud/form maintenance and reliever therapy, bud/form 320/9 μg bid plus terbutaline as needed, or salmeterol/ fluticasone (salm/flut) 25/125 μg two inhalations bid plus terbutaline as needed. Efficacy was determined as the number of exacerbations per patient during a six-month period. Thai unit costs were collected from the national sources and expert opinions, and applied to the resource use data for a deterministic economic evaluation. Results: There were significantly fewer exacerbations in the bud/form maintenance and reliever therapy (0.12 events/patient/6 months) group vs. the bud/form (0.16 events/patient/6 months, p <0.01), or salm/flut groups (0.19 events/patient/6 months, p <0.001). Total direct costs (healthcare visits and drug costs) were 27.0% and 5.9% lower in the bud/form maintenance and reliever therapy group than in the bud/form and salm/flut groups, respectively. Conclusion: Bud/form maintenance and reliever therapy was associated with significantly fewer exacerbations, compared to other fixed combination treatments in a recent multi-national clinical trial. This might result in lower direct costs if applied to the Thai healthcare system.

HIV-associated primary pulmonary hypertension: a first case report in Thailand and literature review.

A 32-year-old woman had asymptomatic HIV infection diagnosed with primary pulmonary hypertension simultaneously. She presented after a three-month rapid progression of symptoms and hemodynamic change. Physical examination and laboratory findings were compatible with pulmonary hypertension. No sensible cause could be found for the pulmonary hypertension except the HIV seropositivity; therefore, HIV-associated primary pulmonary hypertension was diagnosed. She was treated with diltiazem and oral anti-coagulation. After four months, her functional status improved from a NYHA functional class of II to I and improved in right venticular function. Since HIV is epidemic, the authors recommend HIV testing in cases of primary pulmonary hypertension.

Prevalence of gastroesophageal reflux symptoms in asthma patients at Srinagarind Hospital.

OBJECTIVE: To determine the prevalence of gastroesophageal reflux symptoms in asthma patients at Srinagarind Hospital and compare them with a non-asthmatic control group. MATERIAL AND METHOD: A prospective study consisted of 151 asthma patients at the outpatient asthma clinic Srinagarind Hospital and 147 non-asthmatic patients as the control group. The study group and the control group were interviewed with questionnaire. RESULTS: Among the asthmatics, 26.5%, 30.5% and 12.6% experienced heartburn, regurgitation and both symptoms, respectively. While in the control group, 15.6%, 26.5% and 10.2% experienced heartburn, regurgitation and both symptoms. CONCLUSION: The present study showed the prevalence of gastroesophageal reflux symptoms in asthmatic Thai patients and the control group to be 57% and 42.1%. Asthmatic patients had a greater prevalence than the control group but there was no statistically significant difference.

Diagnostic yield of adenosine deaminase in bronchoalveolar lavage.

Adenosine deaminase (ADA) activity rises in various body fluids in patients with tuberculosis. A prospective study was conducted to determine the diagnostic value of ADA activity in bronchoalveolar lavage. Between March 2001 and February 2003, 148 patients were enrolled in our study, mean age 55.6 years (SD 14.6), and a male to female ratio of 2.4:1. The mean duration of symptoms was 66.2 days. All patients were either sputum-smear negative for AFB or failed to produce sputum. The final diagnosis resulted in three patient groups: 43 with pulmonary tuberculosis, 70 malignancy, and 35 miscellaneous causes. The mean ADA activity in the bronchoalveolar lavage for the pulmonary tuberculosis, malignancy, and miscellaneous causes groups was 8.98 (95% CI, 3.79-14.17), 7.63 (95% CI, 4.12-11.14), and 11.61 U/l (95% CI, 3.59-19.62), respectively. No difference was detected in the ADA level in the pulmonary tuberculosis vs other groups (p=0.56, one-way ANOVA). A high level of ADA activity was found in non-tuberculous conditions such as bronchogenic carcinoma, pulmonary hemosiderosis, chronic pneumonia with empyema thoracis and chronic myeloid leukemia. We concluded that ADA activity in the bronchoalveolar lavage was not clearly diagnostic of smear-negative pulmonary tuberculosis. Early diagnosis required histopathology of biopsied transbronchial specimens obtained by fiberoptic bronchoscopy.

Comparison of high-resolution computed tomography with pulmonary function testing in symptomatic smokers.

PURPOSE: To compare high-resolution computed tomography (HRCT) of lungs with pulmonary function in smokers diagnosed with emphysema. MATERIAL AND METHOD: The authors retrospectively reviewed 17 patients with a history of smoking and dyspnea, who underwent HRCT of the lungs and pulmonary function testing. HRCT scores were determined and compared to pulmonary function (FEV1, FEV1/FVC, and DLCO). RESULTS: The HRCT of all 17 patients (17/17; 100%) were typical of centrilobular emphysema; with a mean score of 12.88+/-9.18 (range, 4 to 34). Decreased FEV1 (<80% predicted) was found in 8 patients (47%), decreased FEV1/FVC (<70% predicted) in 13 patients (76%) and decreased DLCO (<80% predicted) in 3 patients (18%). The severity of emphysema revealed by HRCT was inversely correlated with the pulmonary function test: DLCO (r=-0.842, p=0.000) and FEV1 (r=-0.597, p= 0.011), but not FEV1/FVC (r=-0.400, p=0.112). CONCLUSION: HRCT allows detection of emphysema in symptomatic smokers even when pulmonary function appears to be normal. The greater the involvement of emphysema revealed by the HRCT, the poorer the pulmonary function. The authors, therefore, conclude that HRCT is the most sensitive modality for diagnosing early emphysema in smokers with dyspnea.

Bronchial adenoma presenting with chronic asthma and obstructive pneumonia: a case report.

A rare case of primary pulmonary neoplasm is reported. The patient was a 38-year-old woman presenting with obstructive pneumonia. Fiberoptic bronchoscopy revealed an endobronchial mass obstructing the left main bronchus: a reddish polypoid mass which bled on contract that was suggestive of bronchial adenoma. The patient also had a long-standing history of bronchial asthma and hemoptysis and the delay in establishing the eventured diagnosis was caused by the minor symptoms mimicking those of asthma. A persistent restrictive lung and the presentation of obstructive pneumonia were important clues which warranted further investigation by computed tomography (CT) scan and bronchoscopy. The patient underwent rigid bronchoscopy with CO2-laser ablation under general anesthesia. Histopathology confirmed a bronchial adenoma. The clinical response was excellent. Bronchial adenoma should be considered in young patients presenting with asthma, hemoptysis and obstructive pneumonia. Bronchoscopic CO2-laser ablation is an effective treatment and provides an alternative to aggressive thoracotomy.