ABSTRACT
BACKGROUND: Limited data exist regarding outcomes after stepping down asthma medication. OBJECTIVE: We sought to compare the safety and costs of stepping down asthma controller medications with maintaining current treatment levels in patients with controlled asthma. METHODS: Patients with persistent asthma were identified from the US Medical Expenditure Panel Survey years 2000-2010. Each patient had Medical Expenditure Panel Survey data for 2 years, and measurement was divided into 5 periods of 4 to 5 months each. Eligibility for stepping down asthma controller medications included no hospitalizations or emergency department visits for asthma in periods 1 to 3 and no systemic corticosteroid and 3 or less rescue inhalers dispensed in periods 2 and 3. Steps were defined by type and dose of chronic asthma medication based on current guidelines when comparing period 4 with period 3. The primary outcome of complete asthma control in period 5 was defined as no asthma hospitalizations, emergency department visits, and dispensed systemic corticosteroids and 2 or fewer dispensed rescue inhalers. Multivariable analyses were conducted to assess safety and costs after step down compared with those who maintained the treatment level. RESULTS: Overall, 29.9% of patients meeting the inclusion criteria (n = 4235) were eligible for step down; 89.4% (95% CI, 86.4% to 92.4%) of those who stepped down had preserved asthma control compared with 83.5% (95% CI, 79.9% to 87.0%) of those who were similarly eligible for step down but maintained their treatment level. The average monthly asthma-related cost savings was $34.02/mo (95% CI, $5.42/mo to $61.24/mo) with step down compared with maintenance of the treatment level. CONCLUSION: Stepping down asthma medications in those whose symptoms were controlled led to similar clinical outcomes at reduced cost compared with those who maintained their current treatment level.
Subject(s)
Anti-Asthmatic Agents/economics , Asthma/economics , Administration, Inhalation , Adolescent , Adrenal Cortex Hormones/economics , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-Agonists/economics , Adrenergic beta-Agonists/therapeutic use , Adult , Aged , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Child , Child, Preschool , Cost Savings , Female , Humans , Leukotriene Antagonists/economics , Leukotriene Antagonists/therapeutic use , Lipoxygenase Inhibitors/economics , Lipoxygenase Inhibitors/therapeutic use , Male , Middle Aged , Young AdultABSTRACT
UNLABELLED: Pineapple stem has been extensively used for bromelain extraction; however, almost no attention has been given to the waste obtained during bromelain manufacturing. In this regard, antioxidant, antimicrobial, and inhibitions against 15-lipoxygenase and advanced glycation end product formations by pineapple stem waste (PSW) obtained during bromelain manufacturing process were studied. The PSW had moderate bioactivities in all the performed assays. It also showed a considerable inhibition against fungal growth, probably due to high amounts of the benzoic acid present in the sample. These results indicate that PSW could be utilized as an economic source of preventive or therapeutic agent in disease and in different functional food industries. PRACTICAL APPLICATION: A large amount of wastes are generated during bromelain manufacturing from pineapple stem. So far, these wastes are not utilized and are often considered as a burden while disposing them. However, we found some important phytochemicals with considerable bioactivities in these wastes. We believe that these wastes may have a promising usage as a cheap source of one of the ingredients in functional food based industries.
