Serum Inhaled Corticosteroid Detection for Monitoring Adherence in Severe Asthma

被引:5
作者
Alahmadi, Fahad H. [1 ,2 ,3 ]
Keevil, Brian [1 ,2 ]
Elsey, Lynn [1 ,2 ]
George, Kate [1 ,2 ]
Niven, Robert [1 ,2 ]
Fowler, Stephen J. [1 ,2 ]
机构
[1] Univ Manchester, Manchester Acad Hlth Sci Ctr, Fac Biol Med & Hlth, Sch Biol Sci, Manchester, Lancs, England
[2] Manchester Univ Hosp NHS Fdn Trust, NIHR Manchester Biomed Res Ctr, Manchester, Lancs, England
[3] Taibah Univ, Coll Med Rehabil Sci, Resp Therapy Dept, Madinah, Saudi Arabia
关键词
Asthma; Adherence; Inhaled corticosteroids; Disease severity; BUDESONIDE FOLLOWING INHALATION; NITRIC-OXIDE LEVELS; FLUTICASONE PROPIONATE; PLASMA-CONCENTRATIONS; MEDICATION ADHERENCE; DIFFICULT ASTHMA; CHILDREN; NONADHERENCE; CICLESONIDE; PHARMACOKINETICS;
D O I
10.1016/j.jaip.2021.05.041
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
BACKGROUND: Daily inhaled corticosteroids (ICSs) are fundamental to asthma management, but adherence is low. OBJECTIVES: To investigate (1) whether LC-MS/MS could be used to detect ICSs in serum and (2) whether serum levels related to markers of disease severity. METHODS: We collected blood samples over an 8-hour period from patients with severe asthma prescribed at least 1000 mu g daily of beclomethasone dipropionate equivalent. Following baseline sampling, patients were observed taking their usual morning dose. Subsequent blood samples were obtained 1, 2, 4, and 8 hours postinhalation and analyzed by LC-MS/MS. Correlations between serum ICS levels and severity markers were investigated. RESULTS: A total of 60 patients were recruited (41 females; 39 prescribed maintenance prednisolone; mean age, 49 +/- 12 years; FENT1, 63 +/- 20 %predicted). Eight hours postinhalation, all patients using budesonide (n = 10) and beclomethasone dipropionate (15), and all but 1 using fluticasone propionate (28), had detectable serum drug levels. Fluticasone furorate was detected in 2 patients (of 4), ciclesonide in none (of 7). Low adherence by repeat prescription records (<80%) was identified in 43%. Blood ICS levels correlated negatively with exacerbation rate, and (for fluticasone propionate only) positively with FEV1 %predicted. CONCLUSIONS: Commonly used ICSs can be reliably detected in the blood at least 8 hours after dosing, and could therefore be used as a measure of adherence in severe asthma. Higher exacerbation rates and poorer lung function (for fluticasone propionate) were associated with lower blood levels. (C) 2021 American Academy of Allergy, Asthma & Immunology
引用
收藏
页码:4279 / +
页数:15
相关论文
共 39 条
  • [11] Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma
    Derendorf, H.
    Nave, R.
    Drollmann, A.
    Cerasoli, F.
    Wurst, W.
    [J]. EUROPEAN RESPIRATORY JOURNAL, 2006, 28 (05) : 1042 - 1050
  • [12] Dietzel K, 2001, PROG R RES, V31, P91
  • [13] An Official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications
    Dweik, Raed A.
    Boggs, Peter B.
    Erzurum, Serpil C.
    Irvin, Charles G.
    Leigh, Margaret W.
    Lundberg, Jon O.
    Olin, Anna-Carin
    Plummer, Alan L.
    Taylor, D. Robin
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2011, 184 (05) : 602 - 615
  • [14] The Prevalence of Nonadherence in Difficult Asthma
    Gamble, Jacqueline
    Stevenson, Michael
    McClean, Elizabeth
    Heaney, Liam G.
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2009, 180 (09) : 817 - 822
  • [15] Is the MARS questionnaire a reliable measure of medication adherence in childhood asthma?
    Garcia-Marcos, Patricia W.
    Brand, Paul L. P.
    Kaptein, Adrian A.
    Klok, Ted
    [J]. JOURNAL OF ASTHMA, 2016, 53 (10) : 1085 - 1089
  • [16] A pilot study to investigate the use of serum inhaled corticosteroid concentration as a potential marker of treatment adherence in severe asthma
    George, Kate E.
    Ryan, Dorothy M.
    Keevil, Brian
    Niven, Robert
    Fowler, Stephen J.
    [J]. JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2017, 139 (03) : 1037 - 1039
  • [17] Global Initiative for Asthma, 2022, Global Strategy for Asthma Management and Prevention
  • [18] Urinary fluticasone propionate-17beta-carboxylic acid to assess asthma therapy adherence
    Hagan, John B.
    Netzel, Brian C.
    Matthews, Marc R.
    Korpi-Steiner, Nichole L.
    Singh, Ravinder J.
    [J]. ALLERGY AND ASTHMA PROCEEDINGS, 2012, 33 (04) : E35 - E39
  • [19] Plasma concentrations of fluticasone propionate and budesonide following inhalation from dry powder inhalers by healthy and asthmatic subjects
    Harrison, TW
    Tattersfield, AE
    [J]. THORAX, 2003, 58 (03) : 258 - 260
  • [20] Measurement of adherence in pharmacy administrative databases: A proposal for standard definitions and preferred measures
    Hess, Lisa M.
    Raebel, Marsha A.
    Conner, Douglas A.
    Malone, Daniel C.
    [J]. ANNALS OF PHARMACOTHERAPY, 2006, 40 (7-8) : 1280 - 1288