ABSTRACT
Calcifediol is the prohormone of the vitamin D endocrine system (VDES). It requires hydroxylation to move to 1,25(OH)2D3 or calcitriol, the active form that exerts its functions by activating the vitamin D receptor (VDR) that is expressed in many organs, including the lungs. Due to its rapid oral absorption and because it does not require first hepatic hydroxylation, it is a good option to replace the prevalent deficiency of vitamin D (25 hydroxyvitamin D; 25OHD), to which patients with respiratory pathologies are no strangers. Correcting 25OHD deficiency can decrease the risk of upper respiratory infections and thus improve asthma and COPD control. The same happens with other respiratory pathologies and, in particular, COVID-19. Calcifediol may be a good option for raising 25OHD serum levels quickly because the profile of inflammatory cytokines exhibited by patients with inflammatory respiratory diseases, such as asthma, COPD or COVID-19, can increase the degradation of the active metabolites of the VDES. The aim of this narrative revision is to report the current evidence on the role of calcifediol in main respiratory diseases. In conclusion, good 25OHD status may have beneficial effects on the clinical course of respiratory diseases, including COVID-19. This hypothesis should be confirmed in large, randomized trials. Otherwise, a rapid correction of 25(OH)D deficiency can be useful for patients with respiratory disease.
Subject(s)
Asthma , COVID-19 Drug Treatment , Pulmonary Disease, Chronic Obstructive , Asthma/drug therapy , Calcifediol , Cholecalciferol/therapeutic use , Humans , Pulmonary Disease, Chronic Obstructive/drug therapy , Receptors, Calcitriol/metabolism , Vitamin D/therapeutic use , VitaminsABSTRACT
OBJETIVOS: valorar el cumplimiento de la medicación en pacientes asmáticos comparando lo estimado por el Test de Adhesión a los Inhaladores (TAI) con el control electrónico de la retirada del medicamento en farmacia así como el grado de control del asma medido por el ACT (test de control del asma). PACIENTES Y MÉTODOS: estudio descriptivo y transversal, con una muestra de 87 pacientes (60 mujeres y 27 hombres) diagnosticados de asma y en tratamiento con glucocorticoides inhalados ± un segundo controlador inhalado, al menos un año antes del inicio del estudio. A todos se les realizó TAI, ACT y se calculó la cantidad de medicación que teóricamente debería de haber retirado en el último año, en función del medicamento y la dosis prescrita. RESULTADOS: edad media 54,71 ± 14,41 años. Puntuación media en el TAI 47,77 ± 3,04 puntos. Puntuación media en el ACT 20 ± 4,08 puntos. Medicación: la dosis teórica media prescrita fue de 12,36 ± 4,74 envases por paciente al año. Cada paciente retiró una media de 7,52 ± 3,96 envases, porcentaje medio de cumplimiento (≥ 80% de retirada de la medicación prescrita correspondiente) de 64,41% ± 29,38. Los pacientes que presentaron buen cumplimiento (TAI 50, n = 43) presentaron un porcentaje de retirada significativamente mayor que el resto: 70,67 ± 28,37 vs 58,24 ± 29,37 (p = 0,048) De los 43 pacientes que tuvieron puntuación de 50 en el TAI, 22 (51,16%) no habían retirado al menos el 80% de la medicación. No se encontraron diferencias significativas en la puntuación ACT entre las diferentes categorías del TAI. (Anova, p = 0,609). CONCLUSIONES: un 51,16% de los pacientes con buen cumplimiento en el TAI no retira, al menos, el 80% de la medicación
OBJECTIVES: To evaluate medication compliance in asthmatic patients comparing estimates from the Test of the Adhesion to Inhalers (TAI) with the electronic control from medication withdrawal in a pharmacy as well as the degree of asthma control measured by the ACT (Asthma Control Test). PATIENTS AND METHODS: A transversal, descriptive study with a sample of 87 patients (60 women and 27 men) diagnosed with asthma who had undergone treatment with inhaled glucocorticoids ± a second inhaled controller for at least a year before the start of the study. All of them completed the TAI, ACT, and the amount of medication they should have theoretically used in the past year was calculated based on the medication and the prescribed dose. RESULTS: average age 54.71 ± 14.41 years. Average TAI score 47.77 ± 3.04 points. Average ACT score 20 ± 4.08 points. Medication: the theoretical average dose prescribed was 12.36 ± 4.74 canisters per patient per year. Each patient withdrew an average of 7.52 ± 3.96 cannisters, for an average compliance percentage (≥ 80% of the corresponding prescribed medication withdrawn) of 64.41% ± 29.38. The patients who had good compliance (TAI 50, n = 43) had a significantly higher percentage of withdrawal than the rest: 70.67 ± 28.37 vs 58.24 ± 29.37 (p = 0.048). Of the 43 patients who had a score of 50 on the TAI, 22 (51.16%) had not withdrawn at least 80% of their medication. No significant differences were found in ACT scores between the different TAI categories (Anova, p = 0.609). CONCLUSIONS: 51.16% of patients with good compliance in the TAI do not withdraw at least 80% of their medication
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Medication Adherence , Asthma/drug therapy , Asthma/diagnosis , Glucocorticoids/therapeutic use , Cross-Sectional Studies , Administration, Inhalation , Confidence IntervalsABSTRACT
BACKGROUND: Patients with severe allergic and eosinophilic asthma could qualify for different biologic therapies. OBJECTIVE: To evaluate the efficacy and safety of weight-based intravenous reslizumab dosing in patients who have previously failed therapy with omalizumab. METHODS: We carried out a 24-week prospective, multicenter, open-label, single-group, self-controlled study in patients with severe eosinophilic asthma who had previously failed to respond to omalizumab. The main objective was to determine whether treatment with reslizumab significantly improved asthma symptoms assessed by the Asthma Control Test (ACT) at week 24. Secondary objectives were to evaluate symptoms at weeks 4 and 12, change in FEV1 at week 24, and the incidence of severe exacerbations over the study period. RESULTS: Twenty-nine patients (62.1% women, median age, 50.8 years) were included in the study. The median ACT score significantly increased from 13.0 (interquartile range, 8.0-18.0) at baseline to 21.0 (interquartile range, 14.0-24.0) at 24 weeks (P = .002). Only 2 of 29 patients developed at least 1 severe exacerbation during follow-up and none of them required hospitalization. Overall, 15 of 25 patients (60%) were considered as being controlled (ACT score of ≥20 and no exacerbations) at week 24. The percentage of patients who were receiving daily systemic corticosteroids significantly decreased from 72.4% to 52.0% (P = .019). Adverse events were mostly moderate and within the range of previously reported side effects with reslizumab. CONCLUSION: Reslizumab is an effective and safe option for patients with severe eosinophilic asthma and a history of omalizumab failure.
