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Seasonal patterns of Asthma medication fills among diverse populations of the United States.
Turi KN, Gebretsadik T, Lee RL, Hartert TV, Evans AM, Stone C, Sicignano NM, Wu AC, Iribarren C, Butler MG, Mitchel E, Morrow J, Larkin EK, Wu P
(2018) J Asthma 55: 764-770
MeSH Terms: Administration, Inhalation, Administration, Oral, Adolescent, Adrenergic beta-Agonists, Adult, Anti-Asthmatic Agents, Asthma, Child, Child, Preschool, Drug Prescriptions, Drug Therapy, Combination, Female, Glucocorticoids, Humans, Male, Medication Adherence, Middle Aged, Retrospective Studies, Seasons, United States, Young Adult
Show Abstract · Added March 14, 2018
OBJECTIVE - Nonadherence to controller and overuse of reliever asthma medications are associated with exacerbations. We aimed to determine patterns of seasonal asthma medication use and to identify time period(s) during which interventions to improve medication adherence could reduce asthma morbidity.
METHODS - We conducted a retrospective cohort study of asthmatics 4-50 years of age and enrolled in three diverse health insurance plans. Seasonal patterns of medications were reported by monthly prescription fill rates per 1000 individuals with asthma from 1998 to 2013, and stratified by healthcare plan, sex, and age.
RESULTS - There was a distinct and consistent seasonal fill pattern for all asthma medications. The lowest fill rate was observed in the month of July. Fills increased in the autumn and remained high throughout the winter and spring. Compared with the month of May with high medication fills, July represented a relative decrease of fills ranging from 13% (rate ratio, RR: 0.87, 95% confidence interval, 95%CI: 0.72-1.04) for the combination of inhaled corticosteroids (ICS) + long acting beta agonists (LABA) to 45% (RR: 0.55, 95%CI: 0.49-0.61) for oral corticosteroids. Such a seasonal pattern was observed each year across the 16-year study period, among healthcare plans, sexes, and ages. LABA containing control medication (ICS+LABA and LABA) fill rates were more prevalent in older asthmatics, while leukotriene receptor antagonists were more prevalent in the younger population.
CONCLUSIONS - A seasonal pattern of asthma medication fill rates likely represents a reactive response to a loss of disease control and increased symptoms. Adherence to and consistent use of asthma medications among individuals who use medications in reaction to seasonal exacerbations might be a key component in reducing the risk of asthma exacerbations.
0 Communities
1 Members
0 Resources
21 MeSH Terms
Aerosol Delivery of Curcumin Reduced Amyloid-β Deposition and Improved Cognitive Performance in a Transgenic Model of Alzheimer's Disease.
McClure R, Ong H, Janve V, Barton S, Zhu M, Li B, Dawes M, Jerome WG, Anderson A, Massion P, Gore JC, Pham W
(2017) J Alzheimers Dis 55: 797-811
MeSH Terms: Administration, Inhalation, Alzheimer Disease, Amyloid beta-Peptides, Amyloid beta-Protein Precursor, Analysis of Variance, Animals, Anti-Inflammatory Agents, Non-Steroidal, Cognition Disorders, Curcumin, Dendritic Spines, Disease Models, Animal, Hippocampus, Humans, Maze Learning, Memory, Short-Term, Mice, Mice, Inbred C57BL, Mice, Transgenic, Microscopy, Electron, Transmission, Mutation, Neurons, Presenilin-1
Show Abstract · Added April 10, 2017
We report a novel approach for the delivery of curcumin to the brain via inhalation of the aerosol for the potential treatment of Alzheimer's disease. The percentage of plaque fraction in the subiculum and hippocampus reduced significantly when young 5XFAD mice were treated with inhalable curcumin over an extended period of time compared to age-matched nontreated counterparts. Further, treated animals demonstrated remarkably improved overall cognitive function, no registered systemic or pulmonary toxicity associated with inhalable curcumin observed during the course of this work.
0 Communities
3 Members
0 Resources
22 MeSH Terms
Recommendations for the Use of Inhaled Nitric Oxide Therapy in Premature Newborns with Severe Pulmonary Hypertension.
Kinsella JP, Steinhorn RH, Krishnan US, Feinstein JA, Adatia I, Austin ED, Rosenzweig EB, Everett AD, Fineman JR, Hanna BD, Hopper RK, Humpl T, Ivy DD, Keller RL, Mullen MP, Raj JU, Wessel DL, Abman SH
(2016) J Pediatr 170: 312-4
MeSH Terms: Administration, Inhalation, Bronchopulmonary Dysplasia, Endothelium-Dependent Relaxing Factors, Humans, Hypertension, Pulmonary, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Nitric Oxide, Severity of Illness Index
Added February 21, 2017
0 Communities
1 Members
0 Resources
10 MeSH Terms
Effect of acute arteriolar vasodilation on capacitance and resistance in pulmonary arterial hypertension.
Newman JH, Brittain EL, Robbins IM, Hemnes AR
(2015) Chest 147: 1080-1085
MeSH Terms: Administration, Inhalation, Cardiac Catheterization, Endothelium-Dependent Relaxing Factors, Female, Humans, Hypertension, Pulmonary, Male, Middle Aged, Nitric Oxide, Pulmonary Wedge Pressure, Stroke Volume, Vascular Remodeling, Vascular Resistance, Vasodilation, Ventricular Function, Right
Show Abstract · Added October 30, 2014
BACKGROUND - Pulmonary vascular capacitance (PVC) is reduced in pulmonary arterial hypertension (PAH). In normal lung, PVC is largely a function of vascular compliance. In PAH, increased pulmonary vascular resistance (PVR) arises from the arterioles. PVR and PVC share pressure and volume variables. The dependency between the two qualities of the vascular bed is unclear in a state of intense vasoconstriction.
METHODS - We compared PVC and PVR before and during nitric oxide (NO) inhalation during right-sided heart catheterization in eight NO-responsive patients with PAH. NO only directly affects tone in parenchymal vessels.
RESULTS - During NO inhalation, pulmonary arterial systolic pressure decreased, 80 ± 20 SD to 48 ± 20 mm Hg, and stroke volume increased, 62 ± 19 mL to 86 ± 24 mL (P < .01). PVR dropped from 10 ± 4.4 Wood units to 4.7 ± 2.2 Wood units (P < .012), and PVC increased from 1.4 ± 1.1 mL/mm Hg to 3.2 ± 1.8 mL/mm Hg (P < .018). The magnitude of PVR drop was 57% ± 6% and the decrease in 1/PVC was 54% ± 14% (P = not significant).
CONCLUSIONS - In vasoresponsive PAH, PVC is a function of the pressure response of the vasoconstricted arterioles to stroke volume. Immediately upon vasodilation, the capacitance increases markedly. The compliance vessels are, thus, the same as the resistance vessels. The immediate reduction in pulmonary arterial pressure during NO inhalation suggests that large vessel remodeling is not a major contributor to systolic pressure in these patients.
0 Communities
2 Members
0 Resources
15 MeSH Terms
Inhalable curcumin: offering the potential for translation to imaging and treatment of Alzheimer's disease.
McClure R, Yanagisawa D, Stec D, Abdollahian D, Koktysh D, Xhillari D, Jaeger R, Stanwood G, Chekmenev E, Tooyama I, Gore JC, Pham W
(2015) J Alzheimers Dis 44: 283-95
MeSH Terms: Administration, Inhalation, Alzheimer Disease, Amyloid beta-Protein Precursor, Animals, Anti-Inflammatory Agents, Non-Steroidal, Brain, Curcumin, Diagnostic Imaging, Disease Models, Animal, Humans, Mice, Mice, Inbred C57BL, Mice, Transgenic, Mutation, Plaque, Amyloid, Presenilin-1, Tissue Distribution
Show Abstract · Added January 20, 2015
Curcumin is a promising compound that can be used as a theranostic agent to aid research in Alzheimer's disease. Beyond its ability to bind to amyloid plaques, the compound can also cross the blood-brain barrier. Presently, curcumin can be applied only to animal models, as the formulation needed for iv injection renders it unfit for human use. Here, we describe a novel technique to aerosolize a curcumin derivative, FMeC1, and facilitate its safe delivery to the brain. Aside from the translational applicability of this approach, a study in the 5XFAD mouse model suggested that inhalation exposure to an aerosolized FMeC1 modestly improved the distribution of the compound in the brain. Additionally, immunohistochemistry data confirms that following aerosol delivery, FMeC1 binds amyloid plaques expressed in the hippocampal areas and cortex.
0 Communities
4 Members
0 Resources
17 MeSH Terms
Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids.
Wu AC, Li L, Fung V, Kharbanda EO, Larkin EK, Vollmer WM, Butler MG, Miroshnik I, Rusinak D, Davis RL, Hartert T, Weiss ST, Lieu TA
(2014) J Allergy Clin Immunol Pract 2: 607-13
MeSH Terms: Administration, Inhalation, Adolescent, Adrenal Cortex Hormones, Adrenergic beta-Agonists, Anti-Asthmatic Agents, Asthma, Child, Child, Preschool, Emergency Service, Hospital, Female, Hospitalization, Humans, Leukotriene Antagonists, Male, Retrospective Studies, Rhinitis, Allergic, Risk, Treatment Outcome, United States
Show Abstract · Added January 20, 2015
BACKGROUND - Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS.
OBJECTIVE - To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy.
METHODS - This was a retrospective cohort study of subjects who were part of the Population-Based Effectiveness in Asthma and Lung Diseases Network. We conducted Cox regression analyses by adjusting for baseline covariates, adherence by using proportion of days covered, and high-dimensional propensity scores. The main outcome measurements were emergency department visits, hospitalizations, or oral corticosteroid use.
RESULTS - Our population included 15,567 health plan subjects and 10,624 TennCare Medicaid subjects with uncontrolled asthma. Overall adherence to controller medications was low, with no more than 50% of the subjects refilling the medication after the initial fill. For subjects with allergic rhinitis, the subjects in TennCare Medicaid treated with LTRAs were less likely to experience ED visits (hazard ratio 0.44 [95% CI, 0.21-0.93]) compared with the subjects treated with ICS. For all other groups, the subjects treated with LTRA or ICS-LABA were just as likely to experience ED visits or hospitalizations, or need oral corticosteroids as the subjects treated with ICS.
CONCLUSION - Risks of asthma-related exacerbations did not differ between children who initiated LTRA and ICS. These findings may be explainable by LTRA, which has similar effectiveness as ICS in real-life usage by residual confounding by indication or other unmeasured factors.
Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
0 Communities
1 Members
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19 MeSH Terms
Biologic comparison of inhaled insulin formulations: Exubera™ and novel spray-dried engineered particles of dextran-10.
Kuehl PJ, Cherrington A, Dobry DE, Edgerton D, Friesen DT, Hobbs C, Leach CL, Murri B, Neal D, Lyon DK, Vodak DT, Reed MD
(2014) AAPS PharmSciTech 15: 1545-50
MeSH Terms: Administration, Inhalation, Aerosols, Animals, Area Under Curve, Blood Glucose, Chemistry, Pharmaceutical, Cross-Over Studies, Dextrans, Dogs, Drug Carriers, Female, Hypoglycemic Agents, Insulin, Metabolic Clearance Rate, Particle Size, Powders, Technology, Pharmaceutical
Show Abstract · Added February 12, 2015
Inhaled peptides and proteins have promise for respiratory and systemic disease treatment. Engineered spray-dried powder formulations have been shown to stabilize peptides and proteins and optimize aerosol properties for pulmonary delivery. The current study was undertaken to investigate the in vitro and in vivo inhalation performance of a model spray-dried powder of insulin and dextran 10 in comparison to Exubera™. Dextrans are a class of glucans that are generally recognized as safe with optimum glass transition temperatures well suited for spray drying. A 70% insulin particle loading was prepared by formulating with 30% (w/v) dextran 10. Physical characterization revealed a "raisin like" particle. Both formulations were generated to produce a similar bimodal particle size distribution of less than 3.5 μm MMAD. Four female Beagle dogs were exposed to each powder in a crossover design. Similar presented and inhaled doses were achieved with each powder. Euglycemia was achieved in each dog prior and subsequent to dosing and blood samples were drawn out to 245 min post-exposure. Pharmacokinetic analyses of post-dose insulin levels were similar for both powders. Respective dextran 10-insulin and Exubera exposures were similar producing near identical area under the curve (AUC), 7,728 ± 1,516 and 6,237 ± 2,621; concentration maximums (C max), 126 and 121 (μU/mL), and concentration-time maximums, 20 and 14 min, respectively. These results suggest that dextran-10 and other dextrans may provide a novel path for formulating peptides and proteins for pulmonary delivery.
0 Communities
2 Members
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17 MeSH Terms
Reactive versus proactive patterns of inhaled corticosteroid use.
Sloan CD, Gebretsadik T, Wu P, Mitchel EF, Hartert TV
(2013) Ann Am Thorac Soc 10: 131-4
MeSH Terms: Administration, Inhalation, Asthma, Child, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Glucocorticoids, Humans, Male, Medicaid, Morbidity, Patient Compliance, Prescription Drugs, Retrospective Studies, Time Factors, Treatment Outcome, United States
Show Abstract · Added May 27, 2014
For patients with persistent asthma, inhaled corticosteroids (ICS) are a mainstay of controller therapy. These medications are usually prescribed to be taken daily and have been shown to be associated with decreased asthma morbidity. Adherence to daily treatment is very low in many populations in the United States. The purpose of this study is to evaluate the seasonal use of ICS prescription filling as reactive behavior primarily after an asthma exacerbation in a pediatric population. The study population is a subgroup of the Tennessee Asthma and Bronchiolitis Study. The children in this study were enrolled in Tennessee Medicaid (TennCare). The subjects had asthma and were 6 to 9 years of age during the years 2005 to 2010. Prescription filling was determined using claims data, and asthma exacerbations were defined by use of systemic rescue corticosteroids (RCS). In this cohort of 13,114 children with asthma, ICS and RCS filling were highly seasonal and trended with fall and winter peaks in asthma exacerbations. Prescription refilling was very low, with an average of three ICS fills per child who filled at least one during the study period. Among these children, 54.1% (7,096) had an asthma exacerbation during the study period. Among ICS users, 68.5% (3,441/5,020) had a disease exacerbation. ICS filling occurred overwhelmingly on the same day as RCS fills. The seasonal filling patterns of ICS coincide with asthma exacerbations. ICS adherence is low and inconsistent in this population of children with asthma. Increased adherence to ICS, particularly before the seasonal virus epidemics, could greatly reduce asthma morbidity.
0 Communities
1 Members
0 Resources
18 MeSH Terms
Amping up effort: effects of d-amphetamine on human effort-based decision-making.
Wardle MC, Treadway MT, Mayo LM, Zald DH, de Wit H
(2011) J Neurosci 31: 16597-602
MeSH Terms: Administration, Inhalation, Adolescent, Adult, Decision Making, Dextroamphetamine, Dopamine Uptake Inhibitors, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Models, Psychological, Motivation, Neuropsychological Tests, Probability, Psychomotor Performance, Reward, Young Adult
Show Abstract · Added May 27, 2014
Animal studies suggest the neurotransmitter dopamine (DA) plays an important role in decision-making. In rats, DA depletion decreases tolerance for effort and probability costs, while drugs enhancing DA increase tolerance for these costs. However, data regarding the effect of DA manipulations on effort and probability costs in humans remain scarce. The current study examined acute effects of d-amphetamine, an indirect DA agonist, on willingness of healthy human volunteers to exert effort for monetary rewards at varying levels of reward value and reward probability. Based on preclinical research, we predicted amphetamine would increase exertion of effort, particularly when reward probability was low. Over three sessions, 17 healthy normal adults received placebo, d-amphetamine 10 mg, and 20 mg under counterbalanced double-blind conditions and completed the Effort Expenditure for Rewards Task. Consistent with predictions, amphetamine enhanced willingness to exert effort, particularly when reward probability was lower. Amphetamine did not alter effects of reward magnitude on willingness to exert effort. Amphetamine sped task performance, but its psychomotor effects were not strongly related to its effects on decision-making. This is the first demonstration in humans that dopaminergic manipulations alter willingness to exert effort for rewards. These findings help elucidate neurochemical substrates of choice, with implications for neuropsychiatric diseases characterized by dopaminergic dysfunction and motivational deficits.
0 Communities
1 Members
0 Resources
18 MeSH Terms
The dilemma of albuterol dosing for acute asthma exacerbations in pediatric patients.
Arnold DH, Moore PE, Abramo TJ, Hartert TV
(2011) Chest 139: 472
MeSH Terms: Acute Disease, Administration, Inhalation, Albuterol, Asthma, Bronchodilator Agents, Child, Humans, Practice Patterns, Physicians', Surveys and Questionnaires, Tennessee
Added May 27, 2014
0 Communities
2 Members
0 Resources
10 MeSH Terms