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Two recent studies challenge our current approach to managing patients with mild persistent asthma. When patients with asthma are prescribed inhaled corticosteroids (ICSs), we instruct them to use the medication daily. In patients with persistent asthma, guidelines recommend maintenance therapy, with either an ICS or a combination ICS/long-acting beta-agonist (LABA), plus a short-acting beta-agonist (SABA) as needed for rescue treatment.  The Symbicort Given as Needed in Mild Asthma (SYGMA) 1 and SYGMA 2 trials challenge the traditional approach comparing combination ICS/LABA (budesonide-formoterol) as needed to traditional ICS maintenance with SABA rescue therapy.

Guest Author:  Brittany Schmidt, PharmD, BCACP

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We now have two vaccinations to protect against herpes zoster — a live-attenuated vaccine (Zostavax) and the new recombinant subunit vaccine (Shingrix). While the live-attenuated vaccine has been available for more than a decade and a CDC-recommended vaccine in older adults, only one in three eligible patients have received it.  Based on the results of two recently published studies, the new recombinant subunit vaccine appears to provide substantially improved efficacy and duration.

Guest Author:  Katherine Montag Schafer, PharmD, BCACP

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Critically-evaluating the literature is essential to engage in evidence-based practice.  A key component of assessing studies involves determining whether the comparator groups are appropriate.  Most pharmacists are familiar with the use of placebos for evaluating drug treatments, but how many of us have considered the comparator groups in behavioral interventions?  For these situations, employing attention placebo controls (APC) is important.

Guest Authors:  Elizabeth A. Cook, PharmD, BCACP, CDE, AE-C and Rachel A. Sharpton, PharmD, BCACP

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We’ve been managing asthma, for the most part, the same way for quite some time now … short-acting beta agonist (SABA) for quick relief, inhaled corticosteroids (ICS) as first-line maintenance treatment, step up if needed, step down if possible … plus self-management education and a written asthma action plan.  Despite many treatment options, numerous adults, adolescents, and children still suffer from asthma exacerbations, leading to reduced quality of life, missed work and school, higher costs, and increased asthma-related morbidity and mortality. Exacerbations can be triggered by acute respiratory infections, exposure to allergens and other environmental conditions, and poor medication use behaviors. Regardless of cause, finding ways to reduce or prevent exacerbations should be a priority.

Guest Author:  Kristen A. Pate, Pharm.D., BCACP

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For the treatment of cancer-associated VTE, LMWHs are recommended over warfarin (Grade 2B) and DOACs (all Grade 2C).  Warfarin therapy in cancer-associated VTE is often made more difficult by wildly fluctuating international normalized ratios, procedure-related interruptions, as well as numerous drug-drug and drug-food interactions.  While DOACs have been widely used in the treatment of VTE, there is very little data supporting their use in patients with active cancer until now with the publication of the Hokusai VTE Cancer study.

Guest Authors:  Elizabeth Scheffel, PharmD and Christa George, PharmD, BCPS, BCACP, CDE

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Traditionally, the management of hypertension requires routine blood pressure checks by a health professional to adjust medications. Could self-monitoring lead to better outcomes?  Would a greater percentage of patients achieve their goal blood pressure (BP)?  Self-monitoring may be an efficient method to improve blood pressure control; however, results from published reports are inconsistent. The authors of the TASMINH4 study sought to compare the effectiveness of three different approaches to BP monitoring.

Guest Authors:  Vicky Shah, PharmD, BCPS and Daniel Longyhore, MS, PharmD, BCPS

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While multi-drug combination therapies for HIV has resulted in longer lifespans, simplified medication regimens are needed to reduce pill-burden in an aging population with HIV. Two-drug regimens are potentially attractive because they may minimize drug exposure; reduce risks for adverse effects, drug-drug interactions, and long-term toxicities; and potentially increase patient adherence.  The SWORD-1 and SWORD-2 trials evaluated the efficacy and safety of a two-drug regimen to maintain viral suppression in HIV infected patients.

Guest Authors Tinh An (April) Nguyen, PharmD and Jihae Lim, PharmD

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Forty-five percent of all adults in the United States have high blood pressure — that’s more than 100 million people! Of those treated with pharmacotherapy, more than half are not achieving their blood pressure goals. Thus, millions of Americans are receiving suboptimal care.  A recently published systematic review and meta-analysis examined various implementation strategies to improve BP control in patients with high blood pressure. Which implementation strategies work best?

Guest Author: Lauren G Pamulapati, PharmD

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Overuse of broad-spectrum antibiotics can lead to antimicrobial resistance, increased cost, and higher prevalence of adverse drug reactions. Nearly 2 million infections and 23,000 deaths are caused by bacteria that are antibiotic-resistant each year in the United States costing the healthcare system an estimated 20 billion dollars. Moreover, adverse reactions to antibiotics are the most common reason for pediatric patients to visit the emergency department.  Narrow-spectrum antimicrobials are generally preferred, but there are instances where broader coverage is recommended.  A recent study attempts to “clean up” the debate by examining the benefits and risks of using narrow- versus broad-spectrum antibiotics in children with acute respiratory tract infections.

Guest Authors:  Amber Giles, PharmD, MPH, BCPS, AAHIVP  and Paige Hughes, PharmD

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Patients with type 1 diabetes often have sub-optimal glycemic control.  The gold standard of treatment is basal-bolus insulin or continuous subcutaneous insulin infusion via an insulin pump.  However, only a third of patients with type 1 diabetes achieve the American Diabetes Association A1C goal