P.M. van Grunsven
Radboud University Nijmegen
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Featured researches published by P.M. van Grunsven.
Thorax | 1999
P.M. van Grunsven; C.P. van Schayck; J P Derenne; Huib Kerstjens; Tej Renkema; Dirkje S. Postma; T Similowski; R.P. Akkermans; P.C.M. Pasker-de Jong; P.N.R. Dekhuijzen; C.L.A. van Herwaarden; C. van Weel
BACKGROUND The role of inhaled corticosteroids in the long term management of chronic obstructive pulmonary disease (COPD) is still unclear. A meta-analysis of the original data sets of the randomised controlled trials published thus far was therefore performed. The main question was: “Are inhaled corticosteroids able to slow down the decline in lung function (FEV1) in COPD?” METHODS A Medline search of papers published between 1983 and 1996 was performed and three studies were selected, two of which were published in full and one in abstract form. Patients with “asthmatic features” were excluded from the original data. Ninety five of the original 140 patients treated with inhaled corticosteroids (81 with 1500 μg beclomethasone daily, six with 1600 μg budesonide daily, and eight with 800 μg beclomethasone daily) and 88 patients treated with placebo (of the initial 144 patients) were included in the analysis. The effect on FEV1 was assessed by a multiple repeated measurement technique in which points of time in the study and treatment effects (inhaled corticosteroids compared with placebo) were investigated. RESULTS No baseline differences were observed (mean age 61 years, mean FEV145% predicted). The estimated two year difference in prebronchodilator FEV1 was +0.034 l/year (95% confidence interval (CI) 0.005 to 0.063) in the inhaled corticosteroid group compared with placebo. The postbronchodilator FEV1 showed a difference of +0.039 l/year (95% CI –0.006 to 0.084). No beneficial effect was observed on the exacerbation rate. Worsening of the disease was the reason for drop out in four patients in the treatment group compared with nine in the placebo group. In the treatment group six of the 95 subjects dropped out because of an adverse effect which may have been related to the treatment compared with two of the 88 patients in the placebo group. CONCLUSIONS This meta-analysis in patients with clearly defined moderately severe COPD showed a beneficial course of FEV1 during two years of treatment with relatively high daily dosages of inhaled corticosteroids.
Thorax | 1999
P.M. van Grunsven; C.P. van Schayck; J. Molema; R.P. Akkermans; C. van Weel
BACKGROUND Inhaled corticosteroids are the most efficacious anti-inflammatory drugs in asthma. International guidelines also advocate the early introduction of inhaled corticosteroids in corticosteroid naive patients. A study was undertaken to assess the effects of inhaled corticosteroids on bronchial hyperresponsiveness in patients with corticosteroid naive asthma by conventional meta-analysis. METHODS A Medline search of papers published between January 1966 and June 1998 was performed and 11 papers were selected in which the patients had no history of treatment with inhaled or oral corticosteroids. Bronchial responsiveness to bronchoconstricting agents was considered as the main outcome parameter. Doubling doses (DD) of histamine or methacholine were calculated. RESULTS The total effect size of inhaled corticosteroids (average daily dose 1000 μg) versus placebo in the 11 studies was +1.16 DD (95% confidence interval (CI) +0.76 to +1.57). When only the eight short term studies (2–8 weeks) were analysed the effect size of the bronchoconstricting agent was +0.91 DD (95% CI +0.65 to +1.16). No relationship was found between the dose of inhaled corticosteroid used and the effect on bronchial responsiveness. CONCLUSION This meta-analysis in patients with corticosteroid naive asthma indicates that, on average, high doses of inhaled corticosteroids decrease bronchial hyperresponsiveness in 2–8 weeks. It remains unclear whether there is a dose-response relationship between inhaled corticosteroids and effect on bronchial hyperresponsiveness.
Journal of Asthma | 2000
P.M. van Grunsven; C.P. van Schayck; M. van Deuveren; C.L.A. van Herwaarden; R.P. Akkermans; C. van Weel
In a prospective study, we investigated the long-term compliance to fluticasone propionate (FP) by dry powder inhalation (Rotadisk®) in subjects with early signs of asthma and chronic obstructive pulmonary disease (COPD) without an established diagnosis. Subjects were selected from a large screening program on early stages of asthma and COPD (Detection, Intervention, and Monitoring Program of COPD and Asthma [DIMCA] program) in the general practice. Forty-eight adult subjects with “early signs of COPD” (slightly increased forced expiratory volume in 1 sec [FEV1] decline of >0.04L/year) and 29 adult subjects with “early signs of asthma” (signs of bronchial hyperresponsiveness or reversibility) participated in a randomized placebo-controlled trial with FP (Flixotide® 500 jag daily) versus placebo with a duration of 2 years or 1 year, respectively. Compliance was measured by counting Rotadisks returned. By means of a questionnaire, participants were asked about perceived effects and/or side effects of the trial drug. The mean overall individual compliance rates of 72% (range 7%-102%) in the early COPD trial and 71% (range 8%-99%) in the early asthma trial were maintained throughout the study. Perceived effectiveness (12% of the participants) or side effects (30% of the participants) of the trial drug were not related to compliance. The willingness of patients to use the trial drug in daily practice if efficacy would be proved was statistically significantly related to compliance during the trial (p = 0.017). It was concluded that the compliance rates found were relatively high in patients with symptoms of mild asthma or COPD without an established diagnosis. Conviction of the importance of treatment influenced compliance more positively than perceived (side) effects. These results again emphasize the importance of patient education in establishing early treatment with inhaled corticosteroids.
European Respiratory Journal | 1996
C.P. van Schayck; P.M. van Grunsven; P.N.R. Dekhuijzen
In the past few years, treatment with inhaled corticosteroids has become increasingly important in asthma [1, 2]. It appears that inflammation of the airway wall is a major pathophysiological mechanism underlying asthma [3], and perhaps also chronic obstructive pulmonary disease (COPD) [4]. Some long-term studies in asthmatic patients over 1 and 2 yrs have shown that maintenance treatment with inhaled corticosteroids is beneficial [5‐ 7]. In contrast to asthma, the efficacy and therefore the precise role of inhaled corticosteroids is less clear in the treatment of patients with COPD [8, 9]. Corticosteroids are generally given in COPD, in order to treat exacerbations, for a relatively short period of time. The efficacy of long-term treatment with inhaled steroids is not yet established. Whilst in asthma the response is rapid, there are indications that (some) patients with COPD may only respond adequately to (oral) corticosteroids after 6 months to 2 yrs of therapy [10]. We have, therefore, investigated the literature over the past 15 yrs on short-term as well as long-term response to inhaled steroids in COPD. This was done by means of a Medline Search (MeSH headings and/or free text words: antiinflammatory-agents-steroidal; chronic airflow obstruction; COPD-chronic obstructive pulmonary disease). Only randomized controlled studies (English-written) with inhaled steroids were included. Special attention was paid to possible predictors of a long-term response to inhaled steroids in COPD.
Journal of Asthma | 2001
P.M. van Grunsven
The extent and reasons for nonparticipation in preventive drug intervention programs were reviewed. Special attention was payed to the magnitude of “steroid-phobia” in cases of early treatment of asthma patients, with inhaled steroids. A Medline search yielded 11 studies. One study addressed the topic of treatment, with inhaled steroids, in early asthma patients. Nonparticipation rates to “early” drug treatment ranged from 0.3% to 48%. Fear of adverse effects and lack of knowledge about the treatment were given as the most important reasons for nonparticipation. Educational measures to increase knowledge about the drug were advised by most of the authors. In the asthma study a specific “steroid-phobia” was not indicated, possibly due to the continuous education about the steroid treatment throughout the study. Proper and repeating information about the safety and the minimal adverse effects of preventive drug treatment, especially inhaled steroids, seems essential to improve the treatment rate.The extent and reasons for nonparticipation in preventive drug intervention programs were reviewed. Special attention was payed to the magnitude of “steroid-phobia” in cases of early treatment of asthma patients, with inhaled steroids.A Medline search yielded 11 studies. One study addressed the topic of treatment, with inhaled steroids, in early asthma patients.Nonparticipation rates to “early” drug treatment ranged from 0.3% to 48%. Fear of adverse effects and lack of knowledge about the treatment were given as the most important reasons for nonparticipation. Educational measures to increase knowledge about the drug were advised by most of the authors. In the asthma study a specific “steroid-phobia” was not indicated, possibly due to the continuous education about the steroid treatment throughout the study.Proper and repeating information about the safety and the minimal adverse effects of preventive drug treatment, especially inhaled steroids, seems essential to improve the treatment rate.
Huisarts En Wetenschap | 2001
P.M. van Grunsven; C.P. van Schayck; J P Derenne; Huib Kerstjens; Cla van Herwaarden; C. van Weel
SamenvattingVraagstelling Kunnen inhalatiecorticosteroïden bij COPD de achteruitgang van de longfunctie (FEV1) vertragen?Methoden Er werden wee artikelen geselecteerd en één abstract. Patiënten met ‘astmatische kenmerken’ werden uitgesloten. In deze meta-analyse werden 95 geselecteerde patiënten behandeld met inhalatiecorticosteroïden (87 met 1500/1600 µg beclomethason of budesonide per dag, 8 met 800 µg beclomethason per dag), en 88 met placebo. Het effect op FEV1 werd geanalyseerd met behulp van de multiple repeated measurement-methode.Resultaten De patiënten waren gemiddeld 61 jaar oud en hadden matig tot ernstig COPD (FEV1 = 45 % van voorspeld). Er was een significant verschil in de prebronchodilatoire FEV1 over twee jaar van +0,034 l/jaar (95%-BI +0,005-0,063) in het voordeel van de met inhalatiecorticosteroïden behandelde groep, vergeleken met placebo, maar niet in postbronchodilatoire FEV1 (95%-BI -0,006-0,084). Het aantal exacerbaties werd niet beïnvloed door de behandeling.Conclusies De meta-analyse van patiënten met duidelijk gedefinieerd matig tot ernstig COPD liet een beter verloop van de FEV1 zien bij behandeling met relatief hoge doseringen inhalatiecorticosteroïden over twee jaar. In vier andere grote onderzoeken werd geen effect van inhalatiecorticosteroïden vastgesteld op het longfunctieverloop bij patiënten met diversen ernstgraden van COPD.
American Journal of Respiratory and Critical Care Medicine | 1998
G. van den Boom; C.P. van Schayck; M.P.M.H. Rutten; P.R.S. Tirimanna; J.J. den Otter; P.M. van Grunsven; M.J. Buitendijk; C.L.A. van Herwaarden; C. van Weel
British Journal of General Practice | 1996
P.R.S. Tirimanna; C.P. van Schayck; J.J. den Otter; C. van Weel; C.L.A. van Herwaarden; G. van den Boom; P.M. van Grunsven; W.J.H.M. van den Bosch
European Respiratory Journal | 1992
E. Dompeling; C.P. van Schayck; J. Molema; R.P. Akkermans; H.T.M. Folgering; P.M. van Grunsven; C. van Weel
European Respiratory Journal | 1992
E. Dompeling; C.P. van Schayck; J. Molema; H.T.M. Folgering; P.M. van Grunsven; C. van Weel