scholarly journals Availability, cost, and affordability of asthma and chronic obstructive pulmonary disease medications in The Gambia

2020 ◽  
Vol 0 ◽  
pp. 1-9
Author(s):  
Baboucarr Sanyang ◽  
Emily Jagne ◽  
Nana Sefa ◽  
Sunkaru Touray
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Fluticasone Propionate ◽  
Pulmonary Disease ◽  
The Gambia ◽  
Chronic Obstructive ◽  
Line Treatment ◽  
First Line ◽  
Obstructive Pulmonary Disease ◽  
Long Acting ◽  
First Line Treatment

Objectives: Guidelines for asthma and chronic obstructive pulmonary disease (COPD) have undergone significant changes. Specifically, inhaled corticosteroids (ICSs) either alone or in combination with a long-acting beta2-agonist (LABA) are now first-line treatment for asthma, while long-acting muscarinic antagonists alone or in combination with LABAs are first-line treatment of COPD. Data on local availability, cost, and affordability of these medicines in The Gambia are unknown. Materials and Methods: We surveyed all registered pharmacists in Gambia and calculated affordability indices relative to the prevailing wage of the lowest government worker. Results: Eight out of 18 registered pharmacists responded to the survey. Respondents were responsible for stocking 19 out 26 registered pharmacies in the country, resulting in a response rate of 44%. Salbutamol inhalers were widely available, stocked by the central medical stores and 6 out of 8 surveyed pharmacists. Only one pharmacist reported stocking beclometasone 50 mcg, budesonide 100 mcg, and fluticasone propionate 125 mcg inhalers. Aminophylline was stocked by 4/8 pharmacists. The price of salbutamol 100 mcg inhaler was Gambian Dalasi (GMD) 200 (US$ 4, 4 days’ wages), while ipratropium bromide 20 mcg cost GMD 675 (US$ 14, 15 days’ wages). ICS maintenance inhalers at private pharmacies cost 15, 26, and 28 days’ wages for beclomethasone 50 mcg, fluticasone propionate 125 mcg, and budesonide 100 mcg, respectively. Combination of ICS/LABA inhaler was 26 days’ wages while tiotropium bromide 18 mcg affordability was 95 days’ wages. Conclusion: Guideline recommended medications for the management of asthma and COPD in The Gambia are unavailable, expensive, and unaffordable.

A generic fluticasone propionate and salmeterol dry powder inhaler: Evidence of usability, function, and robustness

2021 ◽  
Vol 42 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Donald P. Tashkin ◽  
Arkady Koltun ◽  
Róisín Wallace
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Fluticasone Propionate ◽  
Healthy Volunteers ◽  
Pulmonary Disease ◽  
Dry Powder Inhaler ◽  
Chemical Degradation ◽  
Chronic Obstructive ◽  
Dry Powder ◽  
Obstructive Pulmonary Disease ◽  
Flow Rates

Background: A generic combination of fluticasone propionate and salmeterol xinafoate inhalation powder in a premetered, multidose, nonreusable inhaler was recently approved. Objective: To assess the performance of the generic device. Methods: Findings from three studies with regard to device usability, function, and robustness were reviewed. Results: In a study to assess device function in patients and healthy volunteers, the generic device was successfully used by patients with asthma and chronic obstructive pulmonary disease who were either dry powder inhaler users or dry powder inhaler‐naive, even though they were not trained beyond being provided the instructions for use. In a study to measure inhaled flow rates generated by patients and healthy volunteers, the generic device consistently simulated the delivery of a full dose of drug, even to patients with severe respiratory disease and reduced inspiratory flow rates. Although the generic device had a slightly higher airflow resistance, this study demonstrated that this difference did not result in any clinically meaningful differences in terms of drug delivery. Pressure drop, a key parameter that drives the fluidization and aerosolization of the powder dose, was found to be comparable between the devices. In an open-label study, the generic device met all U.S. Food and Drug Administration specifications for device robustness after 21.5 days of twice-daily dosing via oral inhalation among 111 participants with asthma or chronic obstructive pulmonary disease. All inhalers tested demonstrated conformity with a pharmacopeia with respect to key quality parameters (assay, delivered dose uniformity, aerodynamic size distribution). There was no evidence of chemical degradation of the active ingredients, nor of microbial or water ingress into the powder, as a result of inhaler use.

Current opportunities of inhaled corticosteroid therapy in patients with chronic obstructive pulmonary disease

2021 ◽  
Vol 31 (1) ◽  
pp. 75-87
Author(s):  
I. V. Leshchenko ◽  
A. S. Meshcheryakova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Fixed Combination ◽  
Chronic Obstructive ◽  
Delivery Device ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Long Acting ◽  
Blood Eosinophils

Chronic obstructive pulmonary disease (COPD) is the leading cause of death in the structure of respiratory diseases. The problem of rational pharmacotherapy of COPD have attracted attention of the medical scientific society for many years. The understanding of the pathogenesis of the disease has deepened and approaches to the therapy have changed. Some COPD patients need regular fixed-combination therapy: long-acting bronchodilators (LABD) and inhaled corticosteroids (ICS) in order to prevent exacerbations and reduce the severity of symptoms of the disease. Blood eosinophils count is one of criteria for choosing regular therapy. The appearance of fixed triple combinations of ICS/LABD increased the effectiveness of COPD therapy, and a new delivery device for fixed combination of budesonide/formoterol makes it possible to use ICS successfully in the most severe patients.

Possibilities of cardiovascular events in patients with chronic obstructive pulmonary disease and newly diagnosed tuberculosis, including those associated with HIV infection, when prescribing long-acting β2-agonists

MedAlliance ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 32-39
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
External Respiration ◽  
Obstructive Pulmonary Disease ◽  
Tb Treatment ◽  
Long Acting ◽  
Β2 Agonists

Chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis (TB) are a common pathology among respiratory diseases. Both conditions may have common risk factors, aggravating each other, accom-panied by the development of bronchial obstructive syndrome, requiring mandatory medical correction to increase the effectiveness of therapy for both the main and concomitant pathologies. The aim of the study was to study the effectiveness of treatment of TB in patients with COPD first diagnosed with tuberculosis, including those associated with HIV when prescribing long-acting β2-agonists. Materials and methods. A simple com-parative study included 60 patients of a TB dispensary aged 30–65 years. Patients were divided into 2 groups of 30 people (TB+COPD and TB+COPD+HIV), each of whom for 2 months received a long-acting β-agonist (indacaterol) as an accompanying therapy for the cor-rection of bronchial obstructive syndrome (BOS), with subsequent assessment of the effectiveness of therapy. Results. Subjectively, patients of both groups noted the rapid development of positive dynamics (short-ness of breath decreased from 1–3 days of taking the drug, coughing — within a week, tolerance to physical exertion improved), which was confirmed by indica-tors of the function of external respiration (FEV1). The state of the cardiovascular system was assessed by the results of daily monitoring of blood pressure (BPM). In the COPD+TB group, there is a certain average daily systolic blood pressure (SBP) with a tendency to nor-malize indicators, which is possibly associated with a decrease in the severity of hypoxia during bronchodi-lator therapy. In the COPD+TB+HIV group, the average daily level of SBP increased by 1 mm Hg, but given the very low starting rates, the increase in blood pressure had a positive effect on the patients' condition. The average heart rate (HR) during bronchodilator thera-py did not tend to increase. The best TB treatment re-sults were obtained in the TB+COPD group. In terms of the closure rate of TB+COPD decay cavities — 26.6%, TB+COPD+HIV — 20.0%), the TB+COPD+HIV group had longer periods of abacillation and closure of decay cav-ities, which is associa ted with the severity of the under-lying and associated diseases. The drug was well toler-ated in both groups. Conclusion. The use of 300 mcg long-acting β-adrenomimetics in the complex therapy of β2-adrenergic agonists for patients with TB+COPD and TB+ COPD+HIV can reduce the severity of bronchial obstruction syndrome, improve quality of life, increase adherence to TB treatment, thereby shortening hospi-talization and reduce the likelihood of disability of pa-tients, without the development of side effects from other organs and systems.

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