Pulmonary & Respiratory Medicine

Background and Objective: To identify the factors associated with asthma-related emergency department (ED)/ urgent care visits and to explore the relationship between ED/urgent care visits and both inhaled corticosteroid (ICS) use and symptom control.

Methods: Cross-sectional design used to analyze whether ED/urgent care visits are associated with ICS use in the Behavioral Risk Factor Surveillance System (BRFSS)-Asthma Call-Back Survey (ACBS) 2010 using complex sample multivariate logistic regression.

Results: Thirty-one percent of asthmatics had uncontrolled symptoms and 9.5% required ED/ urgent care in the previous 12 months. Only 41.1% of those with uncontrolled symptoms were on ICS. Bivariate analysis found women, Blacks and non-Hispanic minorities, those with income below $25,000, ICS users, and those with uncontrolled symptoms during the past 2 weeks were more likely to have visited an ED/urgent care center. Multivariate analysis showed women, low income, being ever taught to recognize signs and symptoms, and the interaction between ICS use and symptom control were all associated with an ED/urgent care visit.

Conclusion: Asthmatics with controlled symptoms on ICS were more likely to have visited an ED/urgent care center compared to controlled asthmatics not on ICS. This implies that ICS use may be a marker of exacerbation risk in symptom-controlled asthmatics. While many asthmatics have uncontrolled symptoms and required emergent/ urgent care, a significant number of uncontrolled asthmatics were not on ICS medications. In order to reduce health care utilization, morbidity, and mortality in asthma patients, preventative and treatment efforts should focus on highrisk groups (i.e., women, low income, and ICS-requiring asthmatics).

In clinical practice with patients with chronic obstructive disease (COPD), clinicians should consider patients
symptoms and health status, or quality of life, which are evaluated with patient-reported outcomes (PROs).
Combination bronchodilators proved to be more effective about PROs than monotherapy. Inhaled corticosteroid
(ICS) is associated with risk of pneumonia in COPD patients. Adding ICS to combination bronchodilators, so-called
triple therapy could be effective on dyspnea and health status in patients with elevated blood eosinophil counts.
Therefore, clinicians are advised to assess and re-assess COPD patients in order to get benefits of pharmacological
therapy and reduce risks of adverse events while referring to eosinophil counts.

Background: The optimal duration of antibiotic treatment has not been established for pneumonia patients.
Methods: We retrospectively enrolled hospitalized community-acquired or healthcare-associated pneumonia
patients in whom antibiotics were discontinued on the day or next day of procalcitonin (PCT) measurement between
2014 and 2017 (PCT-guided group, n=272). During the period, PCT was measured serially, and physicians were
encouraged to discontinue antibiotics according to the predefined PCT levels. The remaining patients admitted
during the same period were included as control 1 (n=133). Those admitted between 2010 and 2014, during which
period PCT was not measured serially, were also included in the study as control 2 (n=287). Primary endpoints were
duration of antibiotic treatment and recurrence of pneumonia within 30 days after antibiotic discontinuation.
Results: Though PCT-guided group included significantly more severe pneumonia patients than control 1 group
(p<0.001), duration of antibiotic treatment of the former (median 8.0 days) was not significantly different from the
latter (median 9.0 days, p=0.9043). While pneumonia severity was not different between the PCT-guided and control
2 groups, duration of antibiotic treatment of the former was significantly shorter than that of the latter (median
10.0 days, p<0.001). Multivariable regression analysis revealed that PCT-guided antibiotic discontinuation was
significantly related to duration of antibiotic treatment in both of PCT-guided and control 1 groups (p=0.0131), and
PCT-guided and control 2 groups (p<0.001). Pneumonia recurrence within 30 days after antibiotic discontinuation
of PCT-guided group (6.6%) was not statistically different from control 1 (3.0%) and 2 (5.9%) groups, respectively.
Analysis regarding pneumonia patients with low PCT levels on admission revealed similar results.
Conclusion: PCT-guided antibiotic discontinuation might be useful for shortening the duration of antibiotic
treatment without increasing pneumonia recurrence in daily clinical practice irrespective of PCT levels on admission