The Journal of family practice
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Primary care practitioners (PCPs) play a key role in asthma management since most patients with asthma are treated in primary care settings. Despite continual advances in asthma care, important practice gaps remain, and the high burden of asthma exacerbations persists, with 43% of children with asthma and 41% of adults with asthma in the United States experiencing an asthma exacerbation in 2020. Uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, reliance on systemic corticosteroids (SCS) or short-acting beta2-agonist (SABA)-only therapy, and lack of patient adherence to anti-inflammatory maintenance therapies are challenges clinicians face today with asthma care. ⋯ The symptoms that occur leading up to an asthma exacerbation provide a window of opportunity to intervene with ICS + fast-acting bronchodilators, potentially preventing the exacerbation and reducing the need for SCS. Incorporating patient perspectives and preferences when designing asthma regimens will help patients be more engaged in their therapy and may contribute to improved outcomes. In January 2023, a SABA-ICS combination rescue inhaler was approved by the US Food and Drug Administration (FDA) as the first asthma rescue inhaler for as-needed use to reduce the risk of exacerbations.
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Being fluent in new guidelines helps you meet the challenges of changing disease prevalence, rising antibiotic resistance, and evolving social patterns.
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New updates in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report include major changes to initial disease assessment and pharmacologic therapy, highlighting the clinical relevance of exacerbations. The updated GOLD 2023 algorithms offer a shorter path to consideration of triple therapy, including both initial and follow-up treatment. Most mild- or moderate-severity chronic obstructive pulmonary disease (COPD) exacerbations can be successfully managed in outpatient settings; primary care clinicians have many opportunities to identify, diagnose, and treat patients with COPD earlier to reduce lung damage and disease progression. COPD and cardiovascular disease share common mechanisms and risk factors that influence COPD management.
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Randomized Controlled Trial
Does use of continuous or flash glucose monitors decrease hypoglycemia episodes in T2D?
NO. In adults with insulin-treated type 2 diabetes (T2D), continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) do not decrease symptomatic hypoglycemia episodes (strength of recommendation [SOR], B) but do lower time in hypoglycemia (SOR, C; disease-oriented evidence). ⋯ FGM, in which glucose levels are sent on demand to a device, did not significantly reduce hypoglycemic episodes (SOR, B; 1 small RCT and 1 prospective study). Hypoglycemia duration was reduced significantly with FGM in a 6-month RCT (SOR, B) but not in a 1-year prospective study (SOR, B).
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Was this an infectious abscess, or something less common?