Dual-Controller Asthma Therapy: Rationale and Clinical Benefits
|
|
- Lesley Wright
- 6 years ago
- Views:
Transcription
1 B/1 Dual-Controller Asthma Therapy: Rationale and Clinical Benefits MODULE B The 1997 National Heart, Lung, and Blood Institute (NHLBI) Expert Panel guidelines on asthma management recommend a 4-step approach to asthma therapy based on the level of asthma severity: mild intermittent asthma, mild persistent asthma, moderate persistent asthma, or severe persistent asthma. For any patient with persistent asthma (steps 2, 3, or 4), inhaled corticosteroids are the cornerstone of care because of their robust efficacy and potent anti-inflammatory effects. This slide set reviews the newest clinical data regarding asthma management at steps 3 and 4, when combination therapy (that includes inhaled corticosteroids) is nearly always warranted. National Asthma Education and Prevention Program. Guidelines for the Diagnosis and Management of Asthma. Bethesda, Md: US Dept of Health and Human Services, National Institutes of Health; NIH Publication no Advanced Studies in Medicine 21
2 B/2 Dual-Controller Therapy Concurrent administration of two medications with complementary mechanisms of action A recommended treatment strategy for patients with persistent asthma in the 1997 National Heart, Lung, and Blood Institute (NHLBI) guidelines One of two broad strategies for patients inadequately controlled on inhaled corticosteroids alone Increase dose of inhaled corticosteroid (ie( ie,, remain on monotherapy) Add second complementary therapy (ie( ie,, initiate dual-controller therapy) National Asthma Education and Prevention Program. Guidelines for the Diagnosis and Management of Asthma. Bethesda, Md: US Dept of Health and Human Services, National Institutes of Health; NIH Publication no The use of dual-controller therapy that is, the concurrent administration of two controller medications with complementary mechanisms of action is one of the treatment strategies recommended in the 1997 National Heart, Lung, and Blood Institute (NHLBI) guidelines for patients with persistent asthma. Dual-controller therapy is one of two broad treatment strategies for patients whose asthma is inadequately controlled with inhaled corticosteroids, which are longterm controller medications that improve asthma symptoms, normalize lung function, and help to mitigate damage to the airways by virtue of their anti-inflammatory mechanism of action. In patients whose asthma is inadequately controlled with inhaled corticosteroids, the NHLBI guidelines suggest either increasing the dose of inhaled corticosteroids (ie, remaining on monotherapy) or adding another long-term controller therapy (ie, initiating dual-controller therapy). National Asthma Education and Prevention Program. Guidelines for the Diagnosis and Management of Asthma. Bethesda, Md: US Dept of Health and Human Services, National Institutes of Health; NIH Publication no Advanced Studies in Medicine 22
3 B/3 Comparing the Therapeutic Options Dual-controller therapy versus increasing inhaled corticosteroid dose Dual-controller therapy versus monotherapy with a leukotriene modifier Comparisons among dual-controller regimens A substantial body of data, which postdates the 1997 NHLBI guidelines, demonstrates that dualcontroller therapy confers better efficacy than monotherapy (ie, than either increasing the dose of inhaled corticosteroids or using a leukotriene modifier alone) for initial maintenance therapy as well as for asthma inadequately controlled on inhaled corticosteroids alone. Moreover, the data suggest that certain combination regimens used in dual-controller therapy are more effective than others. This slide set reviews these data. First, studies comparing the efficacy of dual-controller therapy with that of increasing the dose of the inhaled corticosteroid are considered. Then, studies comparing the efficacy of dual-controller therapy with that of monotherapy with a leukotriene modifier are discussed. Finally, studies comparing different dual-controller regimens (ie, an inhaled corticosteroid plus a long-acting β 2 -agonist versus an inhaled corticosteroid plus a leukotriene modifier) are reviewed. Advanced Studies in Medicine 23
4 B/4 Asthma Has Two Pathophysiologic Components Smooth muscle dysfunction Airway inflammation Bronchoconstriction Bronchial hyperreactivity Hyperplasia/hypertrophy Inflammatory mediator release Inflammatory cell infiltration/activation Mucosal edema Cellular proliferation Epithelial damage Basement membrane thickening Symptoms/Exacerbations Chung KF, Adcock IM. Pathophysiological mechanisms of asthma. Application of cell and molecular biology techniques. Mol Biotechnol. 2001;18: Why should dual-controller therapy be more effective than monotherapy with inhaled corticosteroids? It is now well established that asthma arises from two main pathophysiologic components: (1) dysfunction of the airway smooth muscles, which leads to bronchoconstriction, bronchial hyperreactivity, and smooth muscle hypertrophy and hyperplasia; and (2) inflammation of the airways, which leads to activation and accumulation of inflammatory cells; edema; damage to the airway epithelium; and thickening of the airway basement membrane. 1 Medications used with inhaled corticosteroids in dual-controller regimens include long-acting β 2 -agonists and leukotriene modifiers. Neither of these classes of medication has a mechanism of action that overlaps completely with that of the inhaled corticosteroids with which they are combined in dual-controller regimens. The complementary mechanisms of components of dualcontroller regimens are hypothesized to lead to enhanced control of asthma relative to that achievable with single mechanism-of-action therapies. With some dual-controller regimens as with those involving a long-acting bronchodilator and an inhaled corticosteroid both the bronchoconstrictive and the inflammatory components of asthma are targeted. Chung KF, Adcock IM. Pathophysiological mechanisms of asthma. Application of cell and molecular biology techniques. Mol Biotechnol. 2001;18: Advanced Studies in Medicine 24
5 B/5 Dual-Controller Therapy Compared With Increasing Inhaled Corticosteroid Dose Randomized, double-blind, parallel-group, multicenter trial 437 patients with an FEV 1 of 40% to 80% of predicted Randomized to receive either a combination of salmeterol (42 mcg bid) and fluticasone propionate (88 mcg bid) or high-dose fluticasone propionate alone (220 mcg bid) for 24 weeks Condemi JJ, Goldstein S, Kalberg C, et al. The addition of salmeterol to fluticasone propionate versus increasing the dose of fluticasone propionate in patients with persistent asthma. Ann Allergy Asthma Immunol. 1999;82: Several studies have compared the efficacy of dual-controller regimens including a long-acting β 2 -agonist or a leukotriene modifier plus an inhaled corticosteroid with that of increasing the dose of an inhaled corticosteroid in patients whose asthma is poorly controlled on inhaled corticosteroids alone. Uniformly across studies, the addition of a long-acting β 2 -agonist to inhaled regimens of the corticosteroids beclomethasone dipropionate, 1-3 fluticasone propionate, 4,5 or budesonide 6 yields better control of lung function as measured by forced expiratory volume in 1 second (FEV 1 ) or peak expiratory flow rate (PEF) as well as better control of respiratory symptoms than does increasing the dose of inhaled corticosteroids. For example, one randomized, double-blind, parallel-group, multicenter trial enrolled 437 patients (FEV 1 40% to 80% of predicted) who had used fluticasone propionate 88 mcg bid for at least 2 weeks for control of asthma. These patients were randomized to receive either a combination regimen of the long-acting β 2 -agonist salmeterol (42 mcg bid) and the inhaled corticosteroid fluticasone propionate (88 mcg bid) or high-dose fluticasone propionate alone (220 mcg bid) for 24 weeks. 4 s 1. Woolcock A, Lundback B, Ringdal N, et al. Comparison of addition of salmeterol to inhaled steroids with doubling the dose of inhaled steroids. Am J Respir Crit Care Med. 1996;153: Murray JJ, Church NL, Anderson WH, et al. Concurrent use of salmeterol with inhaled corticosteroids is more effective than inhaled corticosteroid dose increases. Allergy Asthma Proc. 1999;20: Greening AP, Ind PW, Northfield M, et al. Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid. Lancet. 1994;344: Condemi JJ, Goldstein S, Kalberg C, et al. The addition of salmeterol to fluticasone propionate versus increasing the dose of fluticasone propionate in patients with persistent asthma. Ann Allergy Asthma Immunol. 1999;82: van Noord JA, Schreurs AJM, Mol SJM, et al. Addition of salmeterol versus doubling the dose of fluticasone propionate in patients with mild to moderate asthma. Thorax. 1999;54: Pauwels RA, Löfdahl C-G, Postma DS, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. N Engl J Med. 1997;337: Advanced Studies in Medicine 25
6 Results: Dual-Controller Therapy Compared With Increasing Inhaled Corticosteroid Dose MEAN CHANGE FROM BASELINE OVER THE 24-WEEK TREATMENT PERIOD B/6 Variable AM PEF PM PEF Fluticasone + Salmeterol High-Dose Fluticasone 46.5 L/min* 23.8 L/min 38.2 L/min* 21.2 L/min FEV L/min* 0.33 L/min Total symptoms -0.43* % nights no waking 14.9%* 10.1% Mean daily albuterol puffs* puffs *P<0.05 versus higher-dose fluticasone propionate. Note: Symptoms were scored on a 5-point scale (0 = no symptoms; 4 = symptoms causing severe discomfort). Condemi JJ, Goldstein S, Kalberg C, et al. The addition of salmeterol to fluticasone propionate versus increasing the dose of fluticasone propionate in patients with persistent asthma. Ann Allergy Asthma Immunol. 1999;82: The results show that although lung function and symptoms improved compared with baseline in both treatment groups, the group receiving the salmeterol-fluticasone propionate combination exhibited greater improvement than did the high-dose fluticasone propionate group in morning and evening PEF; FEV 1 ; symptoms including wheezing, shortness of breath, and chest tightness; frequency of night awakenings; and supplemental albuterol use. The superiority of the combination regimen to the high-dose corticosteroid regimen at improving lung function was evident by the end of the first treatment week for PEF and by the end of the second treatment week for FEV 1. Condemi JJ, Goldstein S, Kalberg C, et al. The addition of salmeterol to fluticasone propionate versus increasing the dose of fluticasone propionate in patients with persistent asthma. Ann Allergy Asthma Immunol. 1999;82: Advanced Studies in Medicine 26
7 B/7 Dual-Controller Therapy Compared With Monotherapy With a Leukotriene Modifier Randomized, double-blind, parallel-group, multicenter trial 423 patients with an FEV 1 of 50% to 80% of predicted Randomized to receive either fluticasone/salmeterol combination product (100( mcg/50 mcg twice daily) or oral montelukast (10 mg once daily) for 12 weeks ADVAIR Diskus Clinical Monograph. The GlaxoSmithKline Group of Companies; April Dual-controller therapy has also been shown to confer better control of asthma than monotherapy with leukotriene modifiers. The effects of dual-controller therapy with a combination product containing the inhaled corticosteroid fluticasone propionate and the long-acting β 2 -agonist salmeterol have been compared with those of monotherapy with a leukotriene modifier in two studies that yielded comparable results. For example, in the first study a randomized, double-blind, parallel-group, multicenter trial 423 patients remaining symptomatic on short-acting β 2 -agonist were randomized to treatment with the fluticasone/salmeterol combination product (100 mcg/50 mcg twice daily) or the leukotriene modifier montelukast (10 mg once daily) for 12 weeks. ADVAIR Diskus Clinical Monograph. The GlaxoSmithKline Group of Companies; April Advanced Studies in Medicine 27
8 Results: Dual-Controller Therapy Compared With Monotherapy With a Leukotriene Modifier MEAN CHANGE FROM BASELINE OVER THE 24-WEEK TREATMENT PERIOD Variable Fluticasone + Salmeterol Montelukast AM PEF 89.9 L/min* 34.2 L/min PM PEF 69.9 L/min* 31.1 L/min FEV L/min* 0.27 L/min Daytime symptoms -1.0* -0.6 % nights no waking 49.2%* 31.4% B/8 *P<0.05 versus montelukast. Note: Symptoms were scored on a 5-point scale (0 = no symptoms; 4 = symptoms causing severe discomfort). ADVAIR Diskus Clinical Monograph. The GlaxoSmithKline Group of Companies, April The results show that mean morning predose FEV 1 increased by 23% from baseline in patients treated with fluticasone propionate/salmeterol compared with 11% in patients treated with montelukast (P<0.05). Secondary end points including mean changes in PEF and symptom scores also favored the fluticasone/salmeterol combination over montelukast. Similar results were reported in a second 12-week study comparing the fluticasone/salmeterol combination product (100 mcg/50 mcg twice daily) with montelukast (10 mg once daily) for 12 weeks in 432 patients. The more robust efficacy of this dual-controller regimen may be attributable to the dual mechanism of action of the combination, which combats both the inflammatory and bronchoconstrictive components of asthma. ADVAIR Diskus Clinical Monograph. The GlaxoSmithKline Group of Companies; April Advanced Studies in Medicine 28
9 B/9 Comparisons Among Dual-Controller Regimens Two identical randomized, double-blind, parallel- group studies 948 patients with an FEV 1 of 68% to 69% of predicted Randomized to receive either salmeterol (50( mcg twice daily) or oral montelukast (10 mg once daily) in addition to stable inhaled corticosteroid regimen for 12 weeks Fish JE, Israel E, Murray JJ, et al. Salmeterol powder provides significantly better benefit than montelukast in asthmatic patients receiving concomitant inhaled corticosteroid therapy. Chest. 2001;120: Based on the different mechanisms of action of long-acting β 2 -agonists and leukotriene modifiers, dual-controller regimens composed of inhaled corticosteroid long-acting bronchodilator combinations might be expected to be more effective than dual-controller regimens composed of inhaled corticosteroids and leukotriene modifiers. Whereas the former dual-controller regimen has activity against both major pathophysiologic components of asthma (ie, inflammation and smooth muscle dysfunction), the latter dual-controller regimen is primarily anti-inflammatory. In fact, clinical studies suggest that the combination of an inhaled corticosteroid and a long-acting β 2 -agonist is more effective than the combination of an inhaled corticosteroid with a leukotriene modifier. For example, Fish et al reported the results of two identical, randomized, double-blind, doubledummy, parallel-group studies of 948 patients with persistent asthma whose symptoms were inadequately controlled with inhaled corticosteroids alone. Either the long-acting β 2 -agonist salmeterol (50 mcg twice daily by inhalation) or the leukotriene modifier montelukast (10 mg once daily by mouth) was added to stable doses of patients inhaled corticosteroids (ie, beclomethasone dipropionate, budesonide, fluticasone propionate, flunisolide, or triamcinolone acetonide) for a 12-week treatment period. Fish JE, Israel E, Murray JJ, et al. Salmeterol powder provides significantly better benefit than montelukast in asthmatic patients receiving concomitant inhaled corticosteroid therapy. Chest. 2001;120: Advanced Studies in Medicine 29
10 B/10 Results: Comparisons Among Dual-Controller Regimens MEAN CHANGE FROM BASELINE OVER THE 24-WEEK TREATMENT PERIOD Variable Corticosteroid + Salmeterol Corticosteroid + Montelukast AM PEF 35.0 L/min* 21.7 L/min PM PEF 27.8 L/min* 19.0 L/min % symptom-free days 24%* 16% Daytime symptoms -0.55* Nights waking/week -1.42* *P<0.05 versus inhaled corticosteroid + montelukast. Note: Symptoms were scored on a 5-point scale (0 = no symptoms; 4 = symptoms causing severe discomfort). Fish JE, Israel E, Murray JJ, et al. Salmeterol powder provides significantly better benefit than montelukast in asthmatic patients receiving concomitant inhaled corticosteroid therapy. Chest 2001;120: The results demonstrate that the addition of salmeterol compared with the addition of montelukast to the inhaled corticosteroid regimen was associated with significantly greater improvement from baseline in lung function as measured by morning PEF (35.0 vs 21.7 L/min, P<.001) and evening PEF (27.8 vs 19.0 L/min, P = 0.002). Furthermore, dual-controller therapy with salmeterol plus an inhaled corticosteroid compared with dual-controller therapy with montelukast plus an inhaled corticosteroid: Improved total symptom scores for shortness of breath and chest tightness; Increased the number of symptom-free days and days with no requirement for rescue medications; Decreased supplemental albuterol use; and Reduced the number of nighttime awakenings per week. 1 A similar pattern of results was reported in a randomized, double-blind clinical trial comparing the efficacy and tolerability of fluticasone propionate (100 mcg) plus salmeterol (50 mcg) twice daily with that of fluticasone propionate (100 mcg) twice daily plus oral montelukast (10 mg) once daily in 447 patients with asthma who remained symptomatic on the inhaled corticosteroid alone. 2 s 1. Fish JE, Israel E, Murray JJ, et al. Salmeterol powder provides significantly better benefit than montelukast in asthmatic patients receiving concomitant inhaled corticosteroid therapy. Chest. 2001;120: Nelson HS, Busse WW, Kerwin E, et al. Fluticasone propionate/salmeterol combination provides more effective asthma control than low-dose inhaled corticosteroid plus montelukast. J Allergy Clin Immunol. 2000;106: Advanced Studies in Medicine 30
11 B/11 Conclusions Data support NHLBI recommendations for dual-controller therapy with an inhaled corticosteroid plus a long-acting β 2 -agonist in patients with moderate persistent or severe persistent asthma Combination of an inhaled corticosteroid plus a long- acting β 2 -agonist is more effective than: Increasing the dose of an inhaled corticosteroid; Monotherapy with a leukotriene modifier; or Dual-controller therapy involving an inhaled corticosteroid and a leukotriene modifier. Considered together, these data support NHLBI recommendations for dual-controller therapy with an inhaled corticosteroid and a long-acting β 2 -agonist in patients with moderate persistent or severe persistent asthma. The results show that the combination of an inhaled corticosteroid and a long-acting β 2 -agonist is more effective at improving lung function and asthma symptoms than is (1) increasing the dose of an inhaled corticosteroid; (2) monotherapy with a leukotriene modifier; or (3) dual-controller therapy involving an inhaled corticosteroid and a leukotriene modifier. Advanced Studies in Medicine 31
Dual-controller therapy, or combinations REVIEW DUAL-CONTROLLER REGIMENS I: DATA FROM RANDOMIZED, CONTROLLED CLINICAL TRIALS.
DUAL-CONTROLLER REGIMENS I: DATA FROM RANDOMIZED, CONTROLLED CLINICAL TRIALS Samy Suissa, PhD ABSTRACT Dual-controller therapy, or combinations of 2 or more pharmacotherapies with complementary mechanisms
More informationFour of 10 patients with asthma suffer moderate REVIEW DUAL-CONTROLLER REGIMENS II: OBSERVATIONAL DATA. Michael S. Blaiss, MD ABSTRACT
DUAL-CONTROLLER REGIMENS II: OBSERVATIONAL DATA Michael S. Blaiss, MD ABSTRACT The differences between clinical trials and clinical practice often create difficulty for generalizing results of controlled
More informationThe recent guidelines from the
...PRESENTATIONS... Adjunctive Therapy for Asthma: Treatment Options Robert A. Nathan, MD Abstract The National Heart, Lung, and Blood Institute guidelines on the diagnosis and management of asthma recommend
More informationAsthma Update A/Prof. John Abisheganaden. Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital
Asthma Update - 2013 A/Prof. John Abisheganaden Senior Consultant, Dept Of Respiratory & Crit Care Medicine Tan Tock Seng Hospital Asthma A complex syndrome Multifaceted disease Heterogeneous Genetic and
More informationJames P. Kemp, MD; Margaret C. Minkwitz, PhD; Catherine M. Bonuccelli, MD; and Marshelle S. Warren, MD
Therapeutic Effect of Zafirlukast as Monotherapy in Steroid-Naive Patients With Severe Persistent Asthma* James P. Kemp, MD; Margaret C. Minkwitz, PhD; Catherine M. Bonuccelli, MD; and Marshelle S. Warren,
More informationThe 3 components of evidence. Economic Analysis of Asthma Practices ...PRESENTATIONS... Based on a presentation by David A.
...PRESENTATIONS... Economic Analysis of Asthma Practices Based on a presentation by David A. Stempel, MD Presentation Summary When deciding on treatment for patients with asthma, clinicians should consider
More informationAlthough elucidation of the basic physiologic
Salmeterol Powder Provides Significantly Better Benefit Than Montelukast in Asthmatic Patients Receiving Concomitant Inhaled Corticosteroid Therapy* James E. Fish, MD, FCCP; Elliot Israel, MD, FCCP; John
More information12/18/2017. Disclosures. Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationBUDESONIDE AND FORMOTEROL (SYMBICORT ): Α A REVIEW
Volume 23, Issue 3 December 2007 BUDESONIDE AND FORMOTEROL (SYMBICORT ): A REVIEW Donna L. Smith, Pharm. D. Candidate More than 22 million people in the United States have asthma according to the Centers
More informationDR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL
DR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL Definition Guidelines contact complicated definitions Central to this is Presence of symptoms Variable airflow obstruction Diagnosis
More informationAsthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing
Asthma Management Updates: A Focus on Long-acting Muscarinic Antagonists and Intermittent Inhaled Corticosteroid Dosing Diana M. Sobieraj, PharmD, BCPS Assistant Professor University of Connecticut School
More informationTHE NHLBI GUIDELINES: WHERE DO WE STAND AND WHAT IS THE NEW DIRECTION FROM THE NAEPP?
THE NHLBI GUIDELINES: WHERE DO WE STAND AND WHAT IS THE NEW DIRECTION FROM THE NAEPP? Peter S. Creticos, MD ABSTRACT In 1991 and 1997, the National Heart, Lung, and Blood Institute s National Asthma Education
More informationClinical efficacy of montelukast in anti-inflammatory treatment of asthma and allergic rhinitis
Clinical efficacy of montelukast in anti-inflammatory treatment of asthma and allergic rhinitis Kim Hyun Hee, MD, PhD. Dept. of Pediatrics The Catholic University of Korea College of Medicine Achieving
More informationAbstract Background Theophylline is widely used in the treatment of asthma, and there is evidence that theophylline has antiinflammatory
Thorax 2000;55:837 841 837 National Heart and Lung Institute, Imperial College School of Medicine and Royal Brompton Hospital, London SW3 6LY, UK S Lim A Jatakanon K F Chung P J Barnes Napp Laboratories
More informationMeta-analysis of increased dose of inhaled steroid or addition of salmeterol in symptomatic asthma (MIASMA)
GlaxoWellcome UK, Stockley Park West, Uxbridge, Middlesex UB11 1BT Stephen Shrewsbury associate medical director Stephen Pyke section head, respiratory statistics St Peter s Hospital, Chertsey, Surrey
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationII: Moderate Worsening airflow limitations Dyspnea on exertion, cough, and sputum production; patient usually seeks medical
Table 3.1. Classification of COPD Severity Stage Pulmonary Function Test Findings Symptoms I: Mild Mild airflow limitations +/ Chronic cough and sputum production; patient unaware of abnormal FEV 1 80%
More informationChronic obstructive pulmonary disease (COPD) is characterized
DANIEL E. HILLEMAN, PharmD ABSTRACT OBJECTIVE: To review the role of long-acting bronchodilators in the treatment of chronic obstructive pulmonary disease (COPD), including the importance of treatment
More informationDual components of optimal asthma therapy: scientific and clinical rationale for the use of long-acting -agonists with inhaled corticosteroids
Review article Dual components of optimal asthma therapy: scientific and clinical rationale for the use of long-acting -agonists with inhaled corticosteroids RONNANN NAEDELE-RISHA, DO PAUL DORINSKY, MD
More informationASTRAZENECA v GLAXOSMITHKLINE
CASE AUTH/1833/5/06 ASTRAZENECA v GLAXOSMITHKLINE CONCEPT study leavepiece AstraZeneca complained that a leavepiece issued by Allen & Hanburys, part of GlaxoSmithKline, did not present a fair and balanced
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More information#1 cause of school absenteeism in children 13 million missed days annually
Asthma Update 2013 Jennifer W. McCallister, MD, FACP, FCCP Associate Professor Pulmonary & Critical Care Medicine The Ohio State University Wexner Medical Center Disclosures None 2 Objectives Review burden
More informationAsthma in Pregnancy. Asthma. Chronic Airway Inflammation. Objective Measures of Airflow. Peak exp. flow rate (PEFR)
Chronic Airway Inflammation Asthma in Pregnancy Robin Field, MD Maternal Fetal Medicine Kaiser Permanente San Francisco Asthma Chronic airway inflammation increased airway responsiveness to a variety of
More informationCombination Therapy with Inhaled Long-Acting
Combination Therapy with Inhaled Long-Acting 2 -Agonists and Inhaled Corticosteroids: A Paradigm Shift in Asthma Management Stuart Stoloff, M.D., Kim Poinsett-Holmes, Pharm.D., and Paul M. Dorinsky, M.D.
More informationGINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017
GINA At-A-Glance Asthma Management Reference for adults, adolescents and children 6 11 years Updated 2017 This resource should be used in conjunction with the Global Strategy for Asthma Management and
More informationChildhood Asthma. The pathophysiology of asthma is an interplay. CME Case Study. Case Study. By Moyez B. Ladhani, MD, CCFP, FAAP, FRCPC
CME Case Study Childhood Asthma By Moyez B. Ladhani, MD, CCFP, FAAP, FRCPC Case Study A two-year-old child presents to your office with a cough, which has been present for three weeks. It is worse at nighttime
More informationDiagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma
Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma Magnitude of Asthma - India Delhi Childhood asthma: 10.9% Adults: 8% Other Cities 3 to 18% Chhabra SK et al Ann Allergy Asthma
More informationG. Boyd on behalf of a UK Study group
Eur Respir J, 1995, 8, 1494 1498 DOI: 10.1183/09031936.95.08091494 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1995 European Respiratory Journal ISSN 0903-1936 Salmeterol xinafoate in
More informationQ: Should patients with mild asthma
1-MINUTE CONSULT CME CREDIT EDUCATIONAL OBJECTIVE: Readers will consider prescribing inhaled corticosteroids to their patients who have mild persistent asthma brief answers to specific clinical questions
More informationBudesonide treatment of moderate and severe asthma in children: A doseresponse
Budesonide treatment of moderate and severe asthma in children: A doseresponse study Soren Pedersen, MD, PhD, and Ove Ramsgaard Hansen, MD Kolding, Denmark Objective: The purpose of the study was to evaluate
More informationOutcome measures in asthma
S70 Thorax 2000;55(Suppl 1):S70 S74 Outcome measures in asthma N C Barnes Department of Respiratory Medicine, The London Chest Hospital, London E2 9JX, UK Introductory articles Exacerbations of asthma:
More informationInternational Journal of Medical Research & Health Sciences
International Journal of Medical Research & Health Sciences www.ijmrhs.com Volume 2 Issue 3 July - Sep Coden: IJMRHS Copyright @2013 ISSN: 2319-5886 Received: 23 th May 2013 Revised: 24 th Jun 2013 Accepted:
More informationMeeting the Challenges of Asthma
Presenter Disclosure Information 11:05 11:45am Meeting the Challenge of Asthma SPEAKER Christopher Fanta, MD The following relationships exist related to this presentation: Christopher Fanta, MD: No financial
More informationAchieving guideline-based asthma control: does the patient benefit?
Eur Respir J ; : 88 9 DOI:.8/99..97 Printed in UK all rights reserved Copyright #ERS Journals Ltd European Respiratory Journal ISSN 9-9 Achieving guideline-based asthma control: does the patient benefit?
More informationW e have shown in a previous meta-analysis of placebo
16 ASTHMA Clinical dose-response relationship of fluticasone propionate in adults with asthma M Masoli, M Weatherall, S Holt, R Beasley... See end of article for authors affiliations... Correspondence
More informationAsthma training. Mike Levin Division of Asthma and Allergy Red Cross Hospital
Asthma training Mike Levin Division of Asthma and Allergy Red Cross Hospital Introduction Physiology Diagnosis Severity Treatment Control Stage 3 of guidelines Acute asthma Drug delivery Conclusion Overview
More informationPotency ratio fluticasone propionate (Flixotide Diskus)/budesonide (Pulmicort Turbuhaler)
Respiratory Medicine (2007) 101, 610 615 Potency ratio fluticasone propionate (Flixotide Diskus)/budesonide (Pulmicort Turbuhaler) Björn Ställberg a, Eva Pilman b, Bengt-Eric Skoogh c,, Bengt Arne Hermansson
More informationMedications Affecting The Respiratory System
Medications Affecting The Respiratory System Overview Asthma is a chronic inflammatory disorder of the airways. It is an intermittent and reversible airflow obstruction that affects the bronchioles. The
More informationAir Flow Limitation. In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation.
Asthma Air Flow Limitation In most serious respiratory disease, a key feature causing morbidity and functional disruption is air flow imitation. True whether reversible, asthma and exercise-induced bronchospasm,
More informationAdjustment of Inhaled Controller Therapy of Asthma in the Yellow Zone, Based on the Inhaler Product Used in the Green Zone Age 16 Years and Older
Adjustment of Inhaled Controller Therapy of Asthma in the Yellow Zone, Based on the Inhaler Product Used in the Green Zone Age 16 Years and Older The Canadian Thoracic Society and other international asthma
More informationImproved asthma control with budesonide/formoterol in a single inhaler, compared with budesonide alone
Eur Respir J 2001; 18: 262 268 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2001 European Respiratory Journal ISSN 0903-1936 Improved asthma control with budesonide/formoterol in a single
More informationAsthma for Primary Care: Assessment, Control, and Long-Term Management
Asthma for Primary Care: Assessment, Control, and Long-Term Management Learning Objectives After participating in this educational activity, participants should be better able to: 1. Choose the optimal
More informationSYNOPSIS THIS IS A PRINTED COPY OF AN ELECTRONIC DOCUMENT. PLEASE CHECK ITS VALIDITY BEFORE USE.
Drug product: Drug substance(s): Document No.: Edition No.: 1 Study code: Accolate Zafirlukast (ZD9188) 9188IL/0138 Date: 02 May 2007 SYNOPSIS A Multicenter, Randomized, Double-blind, -controlled, Parallel
More informationCopyright General Practice Airways Group Reproduction prohibited
Primary Care Respiratory Journal (2006) 15, 271 277 REVIEW Long-Acting Beta-Agonists in Adult Asthma: Evidence that these Drugs are Safe Harold S. Nelson a,b, a National Jewish Medical and Research Center,
More informationAsthma Upate 2018: What s New Since the 2007 Asthma Guidelines of NAEPP?
10:50-11:50am Asthma Update 2018: What s New Since the 2007 National Asthma Guidelines? SPEAKER Christopher H. Fanta, MD Disclosures The following relationships exist related to this presentation: Christopher
More informationTORCH: Salmeterol and Fluticasone Propionate and Survival in COPD
TORCH: and Propionate and Survival in COPD April 19, 2007 Justin Lee Pharmacy Resident University Health Network Outline Overview of COPD Pathophysiology Pharmacological Treatment Overview of the TORCH
More informationStudy No.: SAM40012 Title: A multicentre, randomised, double-blind, double-dummy, parallel group comparison of three treatments : 1)
Study No.: SAM40012 Title: A multicentre, randomised, double-blind, double-dummy, parallel group comparison of three treatments : 1) salmeterol/fluticasone propionate () (mcg strength) bd via DISKUS/ACCUHALER
More informationType of intervention Treatment. Economic study type Cost-effectiveness analysis.
Cost-effectiveness of salmeterol/fluticasone propionate combination product 50/250 micro g twice daily and budesonide 800 micro g twice daily in the treatment of adults and adolescents with asthma Lundback
More informationSearching for Targets to Control Asthma
Searching for Targets to Control Asthma Timothy Craig Distinguished Educator Professor Medicine and Pediatrics Penn State University Hershey, PA, USA Inflammation and Remodeling in Asthma The most important
More informationObjectives. Asthma in Primary Care. Definition. Epidemiology. Pathophysiology
Objectives Asthma in Primary Care Jed Grant, PA-C Program Director, SJVC PA Program Staff PA, AMCH Emergency Department Apply the NAEPP guideline measures of severity and control including current impairment
More informationT he use of inhaled corticosteroids to control the inflammatory
791 ORIGINAL ARTICLE Early asthma control and maintenance with eformoterol following reduction of inhaled corticosteroid dose D Price, D Dutchman, A Mawson, B Bodalia, S Duggan, P Todd on behalf of the
More informationThe New England Journal of Medicine
A COMPARISON OF LOW-DOSE INHALED BUDESONIDE PLUS THEOPHYLLINE AND HIGH-DOSE INHALED BUDESONIDE FOR MODERATE ASTHMA DAVID J. EVANS, M.B., DAVID A. TAYLOR, M.B., OLLE ZETTERSTROM, M.D., K. FAN CHUNG, M.D.,
More informationTreatment with budesonide/formoterol pressurized metered-dose inhaler in patients with asthma: a focus on patient-reported outcomes
Patient Related Outcome Measures open access to scientific and medical research Open Access Full Text Article Review Treatment with budesonide/formoterol pressurized metered-dose inhaler in patients with
More informationAsthma is a chronic inflammatory condition of
CONTINUING PHARMACY EDUCATION Efficacy of Inhaled Corticosteroids Administered Once Daily for Asthma Timothy H. Self, PharmD; and Roya M. Sameri, PharmD AUDIENCE This activity is designed for pharmacists,
More informationLearning the Asthma Guidelines by Case Studies
Learning the Asthma Guidelines by Case Studies Timothy Craig, DO Professor of Medicine and Pediatrics Distinguished Educator Penn State University Hershey Medical Center Objectives 1. Learn the Asthma
More informationAsthma Management for the Athlete
Asthma Management for the Athlete Khanh Lai, MD Assistant Professor Division of Pediatric Pulmonary and Sleep Medicine University of Utah School of Medicine 2 nd Annual Sports Medicine Symposium: The Pediatric
More informationAsthma: Chronic Management. Yung-Yang Liu, MD Attending physician, Chest Department Taipei Veterans General Hospital April 26, 2015
Asthma: Chronic Management Yung-Yang Liu, MD Attending physician, Chest Department Taipei Veterans General Hospital April 26, 2015 Global Strategy for Asthma Management and Prevention Evidence-based Implementation
More informationAsthma Therapy 2017 JOSHUA S. JACOBS, M.D.
Asthma Therapy 2017 JOSHUA S. JACOBS, M.D. BACKGROUND-PREVALENCE Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals Prevalence is increasing
More informationStep-down approach in chronic stable asthma: A comparison of reducing dose Inhaled Formoterol/ Budesonide with maintaining Inhaled Budesonide.
Step-down approach in chronic stable asthma: A comparison of reducing dose Inhaled Formoterol/ Budesonide with maintaining Inhaled Budesonide. By: DR MOHD SHAMSUL AMRI Supervisor: Associate Professor Dr
More informationOmalizumab (Xolair ) ( Genentech, Inc., Novartis Pharmaceuticals Corp.) September Indication
( Genentech, Inc., Novartis Pharmaceuticals Corp.) September 2003 Indication The FDA recently approved Omalizumab on June 20, 2003 for adults and adolescents (12 years of age and above) with moderate to
More informationAlberta Childhood Asthma Pathway for Primary Care
Asthma Diagnosis Box 1 Diagnosis: Based on symptom pattern, careful and thorough history of symptoms (wheeze, cough, night waking and activity limitations), and assessment of family history of asthma and
More informationEnhanced synergy between fluticasone propionate and salmeterol inhaled from a single inhaler versus separate inhalers
Enhanced synergy between fluticasone propionate and salmeterol inhaled from a single inhaler versus separate inhalers Harold S. Nelson, MD, a Kenneth R. Chapman, FACP, b Stephen D. Pyke, MSc, c Malcolm
More informationDrug Class Monograph
Drug Class Monograph Class: Inhaled Corticosteroids Drugs: Aerospan (flunisolide), Advair Diskus, Advair HFA (fluticasone/salmeterol), Alvesco (ciclesonide), Arnuity Ellipta (fluticasone furoate), Asmanex
More informationThe Acute & Maintenance Treatment of Asthma via Aerosolized Medications
The Acute & Maintenance Treatment of Asthma via Aerosolized Medications Douglas S. Gardenhire, EdD, RRT-NPS, FAARC Associate Professor and Chairman Department of Respiratory Therapy Objectives Define Asthma.
More informationEvidence-based recommendations or Show me the patients selected and I will tell you the results
Respiratory Medicine (2006) 100, S17 S21 Evidence-based recommendations or Show me the patients selected and I will tell you the results Leif Bjermer Department of Respiratory Medicine & Allergology, 221
More informationBreakfast Session Prof Neil Barnes Professor of Respiratory Medicine London Chest Hospital & The Royal London Hospital United Kingdom
Breakfast Session Prof Neil Barnes Professor of Respiratory Medicine London Chest Hospital & The Royal London Hospital United Kingdom 2 BEYOND SYMPTOMS ADDRESSING FUTURE RISK IN ASTHMA South GP CME 2013,
More informationPharmacological Management of Obstructive Airways in Humans. Introduction to Scientific Research. Submitted: 12/4/08
Pharmacological Management of Obstructive Airways in Humans Introduction to Scientific Research Submitted: 12/4/08 Introduction: Obstructive airways can be characterized as inflammation or structural changes
More informationSUMMARY THIS IS A PRINTED COPY OF AN ELECTRONIC DOCUMENT. PLEASE CHECK ITS VALIDITY BEFORE USE.
i SUMMARY ZENECA PHARMACEUTICALS FINISHED PRODUCT: ACTIVE INGREDIENT: ACCOLATE zafirlukast (ZD9188) Trial title (number): A Dose-ranging, Safety and Efficacy Trial with Zafirlukast (ACCOLATE ) in the Treatment
More informationLong Term Care Formulary RS -29
RESTRICTED USE Asthma/COPD Management 1 of 6 PROTOCOL: Asthma Glossary of Medication Acronyms: SABA: short-acting beta agonist (e.g. salbutamol) SABD: short-acting bronchodilator (e.g. ipratropium or SABA)
More informationRobert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network
Robert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network Robert.kruklitis@lvh.com Correlation of a Asthma pathophyisology with basic science Asthma (Physiology) Bronchodilators
More informationInternational Journal of Medical Science and Education pissn eissn
COMPARISON OF MONTELUKAST AND KETOTIFEN AS ADD ON THERAPY IN MODERATE AND SEVERE PERSISTENT BRONCHIAL ASTHMA Dr. Gaurav Chhabra 1, Dr. Shubhakaran Sharma 2* Original research article 1,2 Associate professor,
More informationTips on managing asthma in children
Tips on managing asthma in children Dr Ranjan Suri Consultant in Respiratory Paediatrics Bupa Cromwell Hospital Clinics: Friday (pm) Asthma in Children Making the diagnosis Patterns of childhood asthma
More informationCLINICAL PRACTICE. Clinical Practice. N Engl J Med, Vol. 345, No. 17 October 25,
CLINICAL PRACTICE Clinical Practice This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review
More informationThe Asthma Guidelines: Diagnosis and Assessment of Asthma
The Asthma Guidelines: Diagnosis and Assessment of Asthma Christopher H. Fanta, M.D. Partners Asthma Center Brigham and Women s Hospital Harvard Medical School Objectives Know how the diagnosis of asthma
More informationDO NOT COPY. Asthma is characterized by variable airflow obstruction,
Do inhaled corticosteroid/long-acting beta 2 -agonist fixed combinations provide superior clinical benefits compared with separate inhalers? A literature reappraisal Peter J. Barnes, M.D., 1 Gabriele Nicolini,
More informationSponsor. Generic drug name. Trial indication(s) Protocol number. Protocol title. Clinical trial phase. Study Start/End Dates.
Sponsor Novartis Generic drug name Fluticasone propionate Trial indication(s) Moderate-severe bronchial asthma Protocol number CQAE397A2202 Protocol title A randomized open label study to assess the utility
More informationAsthma Management in Pregnancy HEATHER HOWE, MD UNIVERSITY OF UTAH PULMONARY DIVISION
Asthma Management in Pregnancy HEATHER HOWE, MD UNIVERSITY OF UTAH PULMONARY DIVISION Asthma Management in Pregnancy Effects of asthma on pregnancy outcomes Effects of pregnancy on asthma control Management
More informationASTHMA & RESPIRATORY FOUNDATION NZ ADULT ASTHMA GUIDELINES: A QUICK REFERENCE GUIDE 1
ASTHMA & RESPIRATORY FOUNDATION NZ ADULT ASTHMA GUIDELINES: A QUICK REFERENCE GUIDE 1 1. Richard Beasley, Bob Hancox, Matire Harwood, Kyle Perrin, Betty Poot, Janine Pilcher, Jim Reid, Api Talemaitoga,
More informationTreatment Responses. Ronald Dahl, Aarhus University Hospital, Denmark
Asthma and COPD: Are They a Spectrum Treatment Responses Ronald Dahl, Aarhus University Hospital, Denmark Pharmacological Treatments Bronchodilators Inhaled short-acting β -Agonist (rescue) Inhaled short-acting
More informationAlternative agents for anti-inflammatory treatment of asthma
Alternative agents for anti-inflammatory treatment of asthma Stanley J. Szefler, MD, a,b and Harold S. Nelson, MD, c Denver, Colo Recent guidelines for the management of asthma have emphasized the role
More informationNot available 100/6mcg 2 BD formoterol (Fostair MDI) 100/6mcg 33
COMMISSIONING POLICY RECOMMENDATION TREATMENT ADVISORY GROUP FLUTICASONE FUROATE/VILANTEROL COMBINATION INHALER - ASTHMA Policy agreed by Vale of York CCG (date) Drug, Treatment, Device name Fluticasone
More informationALLERGIC RHINITIS AND ASTHMA :
ALLERGIC RHINITIS AND ASTHMA : from the Link to Emerging Therapies Allergic rhinitis and asthma are both chronic heterogeneous disorders, with an overlapping epidemiology of prevalence, health care costs
More informationStarting with a Higher Dose of Inhaled Corticosteroids in Primary Care Asthma Treatment
Starting with a Higher Dose of Inhaled Corticosteroids in Primary Care Asthma Treatment THYS van der MOLEN, BETTY MEYBOOM-DE JONG, HELMA H. MULDER, and DIRKJE S. POSTMA Department of General Practice,
More informationAsthma in the Athlete
Asthma in the Athlete Jorge E. Gomez, MD Associate Professor Texas Children s Hospital Baylor College of Medicine Assist Team Physician UH Understand how we diagnose asthma Objectives Be familiar with
More informationBronchial asthma. MUDr. Mojmír Račanský Odd. Alergologie a klinické imunologie FNOL Ústav Imunologie LF UPOL
Bronchial asthma MUDr. Mojmír Račanský Odd. Alergologie a klinické imunologie FNOL Ústav Imunologie LF UPOL DEFINITION ASTHMA BRONCHIALE = Asthma is a chronic inflammatory disorder of the airways in which
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Co-Primary Outcomes/Efficacy Variables:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationPredicting, Preventing and Managing Asthma Exacerbations. Heather Zar Department of Paediatrics & Child Health University of Cape Town South Africa
Predicting, Preventing and Managing Asthma Exacerbations Heather Zar Department of Paediatrics & Child Health University of Cape Town South Africa Asthma exacerbations Predicting exacerbation recognising
More informationAsthma is characterized by airway hyperresponsiveness
Long-Acting Bronchodilator or Leukotriene Modifier as Add-on Therapy to Inhaled Corticosteroids in Persistent Asthma?* Graeme P. Currie, MD; Daniel K. C. Lee, MD; and Prasima Srivastava, MD Despite the
More informationBronchial Thermoplasty
Bronchial Thermoplasty Policy Number: 7.01.127 Last Review: 9/2014 Origination: 11/2010 Next Review: 3/2015 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide coverage for bronchial
More informationIs reslizumab effective in improving quality of life and asthma control in adolescent and adult patients with poorly controlled eosinophilic asthma?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2018 Is reslizumab effective in improving
More informationAPPENDIX 1 Printable point-of-care tables Asthma Action Plan Yellow Zone Formulation Table Region: Europe
APPENDIX 1 Printable point-of-care tables Asthma Action Plan Yellow Zone Formulation Table Region: Europe Instructions: Print on 8.5 x14 (216 x 279 mm) paper (Legal size) Medication in Green Zone Change
More informationPreschool Asthma What you need to know in 10 minutes
Preschool Asthma What you need to know in 10 minutes Alan Kaplan MD CCFP(EM) FCFP Family Physician Airways Group of Canada Respiratory Medicine section CFPC Faculty/Presenter Disclosure Faculty: Alan Kaplan
More informationCurrent Asthma Management: Opportunities for a Nutrition-Based Intervention
Current Asthma Management: Opportunities for a Nutrition-Based Intervention Stanley J. Szefler, MD Approximately 22 million Americans, including 6 million children, have asthma. It is one of the most prevalent
More informationNew Therapies for Asthma
New Therapies for Asthma Tracy Bridges, MD Speaker Disclosure: Dr. Bridges participates in speaker bureaus for Teva, Genetech & Astra Zeneca. Objectives: Discuss the use of LAMA s for Asthma Detail the
More informationEffective Date: 4/27/2016 Version: 1.0 Approval By: CCC Clinical Delivery Steering Planned Review Date: 4/27/2017
Protocol Title: Adult Asthma Protocol Effective Date: 4/27/2016 Version: 1.0 Approval By: CCC Clinical Delivery Steering Planned Review Date: 4/27/2017 1 Purpose & Objective This protocol provides evidence-based
More informationAsthma Description. Asthma is a disease that affects the lungs defined as a chronic inflammatory disorder of the airways.
Asthma Asthma Description Asthma is a disease that affects the lungs defined as a chronic inflammatory disorder of the airways. Symptoms of asthma In susceptible individuals, this inflammation causes recurrent
More informationStudy No.: SFCA3007 Title: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Trial Evaluating the Safety and Efficacy of the DISKUS
Study No.: A3007 Title: A Randomized, Double-Blind, -Controlled, Parallel-Group Trial Evaluating the Safety and Efficacy of the DISKUS Formulations of Salmeterol (SAL) 50mcg BID and Fluticasone Propionate
More informationAsthma Update: Clinical Aspects and
Article pulmonology Asthma Update: Clinical Aspects and Management Margaret F. Guill, MD* Objectives After completing this article, readers should be able to: 1. Discuss the treatment of children who have
More informationAirways hyperresponsiveness to different inhaled combination therapies in adolescent asthmatics
Airways hyperresponsiveness to different inhaled combination therapies in adolescent asthmatics Daniel Machado 1, MD Celso Pereira 1,2, MD, PhD Beatriz Tavares 1, MD Graça Loureiro 1, MD António Segorbe-Luís
More informationGuideline topic: Pharmacological management of asthma Evidence table 4.11b: Add-on drugs for inhaled steroids: Long acting or oral B2 agonists
1 of 8 09/05/2018, 11:41 Guideline topic: Pharmacological management of asthma Evidence table 4.11b: Add-on drugs for steroids: Long acting or oral B2 agonists Author Year Study type Quality rating Population
More information