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dc.contributor.authorAlahmadi, Fahad H
dc.contributor.authorKeevil, Brian
dc.contributor.authorElsey, Lynn
dc.contributor.authorGeorge, Kate
dc.contributor.authorNiven, Robert
dc.contributor.authorFowler, Stephen J; email: stephen.fowler@manchester.ac.uk
dc.date.accessioned2021-07-05T00:33:21Z
dc.date.available2021-07-05T00:33:21Z
dc.date.issued2021-06-18
dc.date.submitted2020-12-09
dc.identifierpubmed: 34153519
dc.identifierpii: S2213-2198(21)00669-3
dc.identifierdoi: 10.1016/j.jaip.2021.05.041
dc.identifier.citationThe journal of allergy and clinical immunology. In practice
dc.identifier.urihttp://hdl.handle.net/10034/625140
dc.descriptionFrom PubMed via Jisc Publications Router
dc.descriptionHistory: received 2020-12-09, revised 2021-05-15, accepted 2021-05-31
dc.descriptionPublication status: aheadofprint
dc.description.abstractDaily inhaled corticosteroids (ICS) are fundamental to asthma management, but adherence is low. To investigate: 1. whether liquid chromatography tandem mass spectrometry (LC-MS/MS) could be used to detect ICS in serum; and 2. whether serum levels related to markers of disease severity. We collected blood samples over an 8 hr period from patients with severe asthma prescribed at least 1000mcg daily of beclomethasone dipropionate (BDP) equivalent. Following baseline sampling, patients were observed taking their usual morning dose. Subsequent blood samples were obtained 1, 2, 4 and 8hrs post-inhalation and analysed by LC-MS/MS. Correlations between serum ICS levels and severity markers were investigated. 60 patients were recruited, 41 female, 39 prescribed maintenance prednisolone, mean (SD) age 49 (12) yrs, FEV 63 (20) %predicted. 8hrs post-inhalation, all patients using budesonide (n=10) and BDP (15), and all but one using fluticasone propionate (FP, 28) had detectable serum drug levels. Fluticasone furorate was detected in two patients (of four), ciclesonide in none (of seven). Low adherence by repeat prescription records (less than 80%) was identified in 43%. Blood ICS levels correlated negatively with exacerbation rate, and (for FP only) positively with FEV %predicted. Commonly used ICS can be reliably detected in the blood at least 8 hrs after dosing, and could therefore be used as a measure of adherence in severe asthma. Higher exacerbation rates and poorer lung function (for FP) were associated with lower blood levels. [Abstract copyright: Copyright © 2021. Published by Elsevier Inc.]
dc.languageeng
dc.sourceeissn: 2213-2201
dc.subjectadherence
dc.subjectasthma
dc.subjectdisease severity
dc.subjectinhaled corticosteroids
dc.titleSerum inhaled corticosteroid detection for monitoring adherence in severe asthma.
dc.typearticle
dc.date.updated2021-07-05T00:33:21Z
dc.date.accepted2021-05-31


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