Whole-genome sequencing in critically ill infants and emerging ethical challenges.
نویسنده
چکیده
www.thelancet.com/respiratory Vol 3 May 2015 333 inhaled corticosteroids, such as leukotriene inhibitors or slow-release theophylline? A small study showed that add-on montelukast to low-dose budesonide was better than add-on tiotropium in terms of control of asthma and FEV1. Further studies are needed. Addition of tiotropium to combined inhaled corticosteroids and LABA could also be an alternative approach at step 4 of the GINA guidelines (when medium-dose or high-dose inhaled corticosteroid with LABA is used), and already many such patients with uncontrolled asthma are being prescribed addon tiotropium. These emerging benefi cial eff ects of tiotropium in patients with asthma should give encouragement for other LAMAs that are now established for use in patients with COPD to be tested in asthma. At present, another LAMA—umeclidinium— has undergone phase 2 trials in patients with asthma, but the results have not yet been published (ClinicalTrials.gov, number NCT01573624). A study of glycopyrolate bromide in combination with inhaled corticosteroid and LABA in patients with asthma is ongoing (NCT02127866). The adverse and severe adverse eff ects recorded in Kerstjen and colleagues’ studies were similar between the two tiotropium groups, salmeterol, and placebo, as has been reported in other trials of tiotropium delivered by the Respimat Softmist inhaler for asthma. Debate is ongoing about the risk of mortality with treatment with tiopropium Respimat inhaler in patients with COPD, in particular in those with cardiovascular disease and cardiac arrhythmias. A note of caution should be taken regarding chronic use of this treatment in patients with asthma with such a cardiac background. Kian Fan Chung Experimental Studies, National Heart and Lung Institute, Imperial College, London SW3 6LY, UK; and Respiratory Biomedical Research Unit, Royal Brompton and Harefi eld National Health Service Trust and Imperial College London, London, UK [email protected]
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عنوان ژورنال:
- The Lancet. Respiratory medicine
دوره 3 5 شماره
صفحات -
تاریخ انتشار 2015