Assuntos
Hematemese/etiologia , Hemoptise/etiologia , Leptospirose/diagnóstico , Pulmão/diagnóstico por imagem , Adulto , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Broncoscopia , Barreiras de Comunicação , Diagnóstico Tardio , Emigrantes e Imigrantes , Febre/etiologia , Hemorragia Gastrointestinal/diagnóstico , Humanos , Leptospirose/complicações , Leptospirose/tratamento farmacológico , Pulmão/patologia , Masculino , México/etnologia , Plasmaferese , Tomografia Computadorizada por Raios X , ViagemRESUMO
BACKGROUND: Safety concerns associated with long-acting ß2-agonists (LABAs) have led to many US Food and Drug Administration (FDA) regulatory activities for this class of drugs. Little is known about the effect of these regulatory activities on use of LABA-containing agents or other asthma medications. METHODS: We created rolling cohorts of pediatric and adult asthmatic patients in the Mini-Sentinel Distributed Database between January 2005 and June 2011. The proportions of asthmatic patients using LABA-containing products, inhaled corticosteroids (ICSs), leukotriene modifiers, short-acting ß2-agonists, oral corticosteroids, other bronchodilators, and no medications were measured on a monthly basis, and the changes were evaluated by using interrupted time series with segmented regression analysis. RESULTS: When the 2005 regulatory activity was announced, there were statistically significant decreases in the use of fixed-dose ICS-LABA agents in children (-0.98 percentage points) and adults (-1.24 percentage points). Increased use of ICSs and leukotriene modifiers was observed just after the regulatory activities were announced in both children and adults. Although of smaller magnitude, continued favorable changes in the use of LABA agents were observed after the 2010 FDA regulatory activity. CONCLUSION: The 2005 and 2010 FDA regulatory activities might have contributed to reduced use of LABA agents, as intended; however, their effect, independent of other factors, cannot be determined. Use of other classes of asthma medications was similarly affected.