Browsing by Subject "asthma"
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Item Assessment of Asthma Inhaler Technique in Two Community Pharmacies(University of Minnesota, College of Pharmacy, 2014) Farabaugh, Nicole; McMillan, Ashlee; Garofoli, GretchenObjectives: To 1) assess inhaler technique in patients with asthma who present to a community pharmacy and 2) determine if patients find it desirable to have further inhaler education from pharmacists. Methods: Participants were recruited when picking up their inhalers at either one chain or one independent pharmacy from May 2012 to December 2012. Any person 18 years of age or older, diagnosed with asthma, and currently prescribed an inhaler was eligible for inclusion in the study. Those who voluntarily agreed to participate were provided a written survey to evaluate current inhaler usage and past education from pharmacists. Participants were then asked to demonstrate how they currently operate their inhalers and observations regarding technique were recorded. Participants were then educated on what improvements could be made in their technique, if applicable. Results: A total of 31 surveys were completed for this study, of which only 3(9.6%) of the respondents were observed to be using their inhalers properly; however 18(58%) rated their technique as a 5 out of 5 on a Likert scale with 5 being the best. Almost all respondents (96.7%) classified their inhalers as “easy” or “very easy” to use, and 13 (41.9%) would prefer more education from pharmacists regarding their inhalers. Conclusion: The results of this study identified a significant need for patients to be educated on proper inhaler technique. It also revealed a high patient preference for pharmacists to offer additional education to patients using asthma inhalers upon initiation of inhaler therapy and with inhaler refills.Item Asthma Risk and the Co-occurrence of Thunderstorms and Elevated Pollen: Measuring the Strength of Association, Investigating the Effects in Subgroups, and Leveraging Data Across Large Areas.(2022-05) Smith, MorrisonAbstract Severe asthma has been shown to occur in the combined presence of high pollen and thunderstorms, termed thunderstorm asthma. Previous research has focused on rare ‘epidemic’ events, such as in Melbourne, Australia 2016 where emergency room usage was 900% higher during a single thunderstorm asthma event. In my dissertation, we investigate thunderstorm asthma conditions in the Twin-Cities metro region, Minnesota, U.S.A., using detailed exposure estimates from a network of weather sensors along with daily pollen records, and asthma-related emergency department (ED) visits from 2007-2018. In manuscript 1, we investigate the association between asthma-related ED visits and thunderstorm asthma conditions within a study radius of 20 miles from the Minneapolis-St. Paul (MSP) airport using a time series model approach. We evaluated risk for the entire study area combined and at the individual zip code level to investigate potential effect heterogeneity and spatial auto-correlation. We find a 1.05 (95% CI: 1.012,1.083) times higher risk on the day of a thunderstorm asthma event with no evidence of spatial autocorrelation or effect heterogeneity. In manuscript 2, we investigate relative and absolute risk disparities of thunderstorm asthma by age and sex subpopulations. We find evidence that thunderstorm asthma has impacts across the life course for men and women, with variation in risk by individual age-sex groups contrary to typical baseline patterns of severe asthma incidence. For males 18-44 the RR of severe asthma was 1.123 times higher on storm days (95% CI: 1.042, 1.211) compared to non-storm days,] with 1.098 times higher risk of incident severe asthma on storm days for females over 45 (95% CI: 1.020, 1.181) compared to non-storm days. In manuscript 3, we investigate the ability to leverage exposure information from a single pollen site in MSP and land-use covariates to estimate thunderstorm asthma associations at 19 communities across the state of Minnesota. Using meta-regression, we find a positive association between deciduous tree and grassland land cover with the thunderstorm asthma effect size, and we find an attenuation of the thunderstorm asthma risk as distance increases from the MSP pollen site.Item Asthma Treatment in Children: Information for Parents(2008-09-02) Chomilo, NathanParents are often worried about long-term inhaled steroid use in their children with asthma. This handout explains asthma as a disease as well as going over the risks and benefits of inhaled steroid use.Item Asthma Treatment: Do I need a nebulizer?(2009-05-04) Donahue, ReneeAsthma is chronic respiratory disease commonly treated using inhaled beta-agonist medications, or bronchodilators, such as albuterol. Medical research has shown that for the treatment of asthma with betaagonists, inhalers are equally as effective as nebulizers. Either treatment is helpful at reducing the symptoms of asthma which may include wheezing, chest tightness, shortness of breath and cough. Inhalers have some practical benefits over nebulizers for everyday use as inhalers are faster to use, are less expensive and do not require a power source or regular maintenance.Item Don’t Leave Without Them: Dispensing asthma medications to pediatric patients upon discharge is associated with decreased hospital readmissions(University of Minnesota, College of Pharmacy, 2012-12) Hiteshew, Kelly J.; Franz, Thaddeus; Lamberjack, Kristen; Chen, Aleda M.H.Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During the intervention phase, pharmacists promoted use of the outpatient pharmacy by patients admitted for these conditions using multiple methods. In each chart review, the patients readmitted for asthma or wheezing within thirty days were classified as either outpatient pharmacy users (OPP users) or non-OPP users. Differences in readmission rates between OPP users and non-OPP users, as well as differences in overall OPP utilization, were analyzed before and during the intervention phase using a Chi-square test. Results: The initial chart review found no significant difference in thirty day readmission rates between OPP users and non-OPP users (6.2% and 7.5%, respectively; χ2 = 1.15; p = 0.274). The number of OPP users increased significantly from the first chart review to the second (11.8% and 45.9%, respectively; χ2 = 929.04, p < 0.001). The second chart review revealed that OPP users had a significantly lower readmission rate than non-OPP users during the intervention phase (2.3% and 10.9%, respectively; χ2 = 52.5; p < 0.001). Conclusion: Obtaining discharge medications from the OPP was associated with a lower thirty-day readmission rate in children with asthma. Promoting use of the OPP for transitional care should continue to be part of future efforts to decrease hospital readmissions.Item Exploration of Platelet and Mast Cell Communication: A Study of Membrane Lipids, Asthma, and Inflammation(2016-05) Gruba, SarahThis work examines how environmental factors such as lipid membrane concentration, opioid agonist exposure, and inflammatory diseases impact cell communication. It explores the use of different cell models, specifically platelets and mast cells, to understand how disease states can impact cellular function. Throughout the thesis, a variety of analytical techniques including electrochemistry, mass spectrometry, dark field imaging, and microfluidics, are used to understand exocytosis, lipid concentration, manufactured inflammatory mediators, adhesion, and shape change in platelets and mast cells. Platelets are cell-like bodies that travel through the bloodstream and are known for their role in hemostasis and diseases like stroke and myocardial infarction. They have also been implicated in inflammatory diseases such as asthma. In addition, their anucleate nature and easy isolation make them an ideal model for studying variations in cell communication upon the modification of their lipid content. Platelets communicate through the exocytosis of their three distinct granule types (δ, α, and lysosome). These granules contain molecules that assist in the transmigration of immune cells to the site of activation and help with additional platelet aggregation and adhesion. In contrast, mast cells are found throughout the body in connective tissue and are one of the immune system’s first lines of defense. They are primarily known for their role in allergies and asthma. Upon detection of antigens that they are sensitized to, the mast cell secretes manufactured chemokines and pre-formed granule mediators, including histamine and serotonin, calling other inflammatory cells to the site of infection. Chapter One reviews single cell analysis techniques with a particular emphasis on the techniques used in this thesis, including electrochemistry and mass spectrometry. Chapter Two through four are focused on understanding how variations in membrane lipids and structure affect platelet function and exocytosis in general. Chapter Two focuses on understanding the variations that the fusion pore undergoes when granules are being exocytosed. Traditionally, a granule release event, monitored using carbon-fiber microelectrode amperometry, has a quick rise in current (spike) and gradual decay. The variations to this spike are classified as different forms of pre- and post-spike features and non-traditional granule secretion events. The role of cholesterol in changing the frequency and duration of these features is also discussed. Chapter Three discusses the role of phosphatidylserine (PS) in cellular communication using a platelet model. In this chapter, we explore how the stereochemistry of the head group and concentration of PS affects various platelet functions including granular content secretion, manufactured lipid release, and adhesion. The cholesterol level change upon addition of PS is also monitored. Finally, Chapter Four aims to understand how natural lipid variations affect cell function by comparing platelets from different species. This chapter highlights the importance of understanding your cell model relative to the actual cells involved in the disease or function being studied. Chapter Five and Six progresses from lipid function into developing a better understanding of how platelets respond to their environment, particularly in the context of inflammatory diseases. Chapter Five’s focus is on platelet response to opioids like those that are used in the treatment of pain due to inflammatory diseases, cancer, or surgery. Specifically, the effects on cell exocytosis as well as the presence of and role that opioid receptors play in platelets are characterized. Chapter Six focuses on studying how platelets respond to allergic asthma, including response to allergens and the chemoattractants (CXCL10 and CCL5) released during an asthma attack. Using bulk and single cell methods in conjunction allows us to obtain in-depth information on both the overall response and the granule fusion pore during exocytosis. Chapter Seven and Eight focus on mouse peritoneal mast cell (MPMC) function in the context of inflammatory diseases including allergic asthma and neurogenic inflammation, respectively. Chapter Seven aims to state the importance of understanding the cell line you are using since variations in response to allergens are noted between commonly used mast cell models (rat basophilic leukocytes cell line and primary culture MPMC). In addition, MPMC response to CXCL10 and CCL5 was monitored. Finally, Chapter Eight explores the role of MPMC in neurogenic inflammation, a process wherein neurons release the neuropeptides substance P and calcitonin gene-related peptide. Mast cell response to these neuropeptides has been highly disputed, and this chapter focuses on the impact of IgE on MPMC bulk granular content secretion. It also aims to understand how these neuropeptides affect the fusion pore opening and closing during exocytosis.Item Microrna Regulation On The Expression Of CD38 And Other Asthma Related Genes In Human Airway Smooth Muscle Cells(2015-04) Dileepan, MythiliCD38 is a multifunctional enzyme that regulates intracellular calcium ([Ca++]i ) homeostasis. It is expressed in airway smooth muscle (ASM) cells where it elevates [Ca++]i through its enzymatic product cyclic ADPribose (cADPR) and increases ASM contractility. Increased expression of CD38 in the ASM cells derived from the asthmatic patients (AS-HASM) and attenuated airway hyperresponsiveness to contractile stimuli shown by CD38-/- mice implicate the importance of CD38 in asthma. The proinflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) is considered to be an important mediator for airway pathology in asthma. The reason for the differential expression of TNF-alpha-induced-CD38 in AS-HASM cells, does not involve transcriptional regulation of CD38 which is through signaling pathways mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase (PI3K), and transcription factors nuclear factor kappa-B (NF-kB) and AP-I. Thus I hypothesized that post-transcriptional regulation of CD38 by microRNAs account for the differential expression of TNF-alpha induced -CD38 in AS-HASM cells. Among the several potential microRNAs predicted for CD38 by microRNA target-predicting algorithms, I selected miR-140-3p and miR-708 for further studies, as these showed differential expression in the AS-HASM cells compared to those from healthy subjects. Overexpression of these either microRNAs in ASM cells inhibited the TNF-alpha induced expression of CD38 at messenger RNA (mRNA) and protein levels. Luciferase-reporter assays with a mutated 3'UTR of the CD38 transcript confirmed the specific target sites for both microRNAs. Transcript stability assays revealed that mRNA degradation is not the mechanism underlying regulation by microRNAs. Examination of the expression and activation levels of proteins in the upstream signaling pathways of CD38 revealed that miR-140-3p, by inactivating p38 MAPK and NF-kB, and miR-708, by inactivating c-Jun N-terminal kinase (JNK) MAPK and Akt by elevating the expression of their phosphatases MKP-1 and PTEN respectively, control the expression of CD38 indirectly. Further, we found that miR-708 downregulates the expression of many chemokines and inhibits the serum induced proliferation of human ASM cells. We conclude that both microRNAs have therapeutic potential in controlling asthma related symptoms through regulating the expression of CD38 and chemokines and controlling the proliferation of human ASM cells.Item A new therapy for the treatment of allergic rhinitis(2009-05-04) Holden, TimothyA patient’s guide to allergic rhinitis and sublingual immunotherapy (SLIT). SLIT has been shown to offer progressively better relief of allergy symptoms and prevention of new sensitizations compared to daily oral allergy medications. SLIT is a more effective long-term treatment option for patients with persistent respiratory allergies than daily medication alone, and is a safe, although possibly less effective, alternative to allergy shots.Item Patient And phaRmacit Telephonic Encounters (PARTE) in an Underserved Rural Population with Asthma: Methods and Rationale(University of Minnesota, College of Pharmacy, 2011) Young, Henry N.; Havican, S. Nadra; Chewning, Betty A.; Sorkness, Christine A.; Ruppel, Xin; Griesbach, SaraPurpose: Methods used to deliver and test a pharmacy-based asthma care telephonic service for an underserved, rural patient population are described. Summary: In a randomized controlled trial (RCT), the Patient And phaRmacist Telephonic Encounters (PARTE) project is assessing the feasibility, acceptability, and preliminary impact of providing pharmacy-based asthma care service telephonically. The target audience is a low income patient population across a large geographic area served by a federally qualified community health center. Ninety-eight participants have been randomized to either standard care or the intervention group who received consultation and direct feedback from pharmacists via telephone regarding their asthma self-management and medication use. Pharmacists used a counseling framework that incorporates the Indian Health Services 3 Prime Questions and the RIM Technique (Recognition, Identification, and Management) for managing medication use problems. Pharmacists encouraged patients to be active partners in the decision-making process to identify and address the underlying cause of medication use problems. Uniquely, this trial collected process and summative data using qualitative and quantitative approaches. Pharmacists’ training, the fidelity and quality of pharmacists’ service delivery, and short term patient outcomes are being evaluated. This evaluation will improve our ability to address research challenges and intervention barriers, refine staff training, explore patient perspectives, and evaluate measures’ power to provide preliminary patient outcome findings. Conclusion: A mixed method evaluation of a structured pharmacist intervention has the potential to offer insights regarding staff training, service fidelity and short term outcomes using quantitative and qualitative data in an RCT. Results will provide evidence regarding the feasibility and quality of carrying out the study and service delivery from the multiple perspectives of participants, clinicians, and researchers.