Budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma (PRACTICAL): a 52-week, open-label, multicentre, superiority, randomised controlled trial.

Background: In adults with mild asthma, a combination of an inhaled corticosteroid with a fast-onset long-acting β-agonist (LABA) used as reliever monotherapy reduces severe exacerbations compared with short-acting β-agonist (SABA) reliever therapy. We investigated the efficacy of combination budesonide-formoterol reliever therapy compared with maintenance budesonide plus as-needed terbutaline.

Methods: We did a 52-week, open-label, parallel-group, multicentre, superiority, randomised controlled trial at 15 primary care or hospital-based clinical trials units and primary care practices in New Zealand.

Oxygen versus air-driven nebulisers for exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial.

Background: In exacerbations of chronic obstructive pulmonary disease, administration of high concentrations of oxygen may cause hypercapnia and increase mortality compared with oxygen titrated, if required, to achieve an oxygen saturation of 88-92%. Optimally titrated oxygen regimens require two components: titrated supplemental oxygen to achieve the target oxygen saturation and, if required, bronchodilators delivered by air-driven nebulisation. The effect of repeated air vs oxygen-driven bronchodilator nebulisation in acute exacerbations of chronic obstructive pulmonary disease is unknown.

Description of the protocol for the PRACTICAL study: a randomised controlled trial of the efficacy and safety of ICS/LABA reliever therapy in asthma.

Introduction: In adult asthma, combination inhaled corticosteroid (ICS)/fast-onset long-acting beta agonist (LABA) used solely as reliever therapy may represent an effective and safe alternative to ICS maintenance and short-acting beta agonist (SABA) reliever therapy.

Objective: To compare the efficacy and safety of ICS/fast-onset LABA reliever therapy with ICS maintenance and SABA reliever therapy in adults with asthma.

Methods And Analysis: A 52-week, open-label, parallel group, multicentre, phase III randomised controlled trial with 1:1 randomisation to either budesonide/formoterol Turbuhaler 200/6 µg, one actuation as required for symptom relief, or budesonide Turbuhaler 200 µg, one actuation twice daily and terbutaline Turbuhaler 250 µg, two actuations as required for symptom relief.

Three-month validation of a turbuhaler electronic monitoring device: implications for asthma clinical trial use.

Background: Electronic monitoring of inhaled asthma therapy is suggested as the 'gold standard' for measuring patterns of medication use in clinical trials. The SmartTurbo (Adherium (NZ) Ltd, Auckland, New Zealand) is an electronic monitor for use with a turbuhaler device (AstraZeneca, UK). The aim of this study was to determine the accuracy of the SmartTurbo in recording Symbicort actuations over a 12-week period of use.

The effect of 1g of acetaminophen twice daily for 12 weeks on alanine transaminase levels--A randomized placebo-controlled trial.

Objective: Acetaminophen is often used on a regular, daily basis for the treatment of chronic pain; however, the safety of regular acetaminophen is still debated. This study determined whether 12 weeks of treatment with acetaminophen at half the maximum recommended daily dose causes an increase in alanine transaminase (ALT) in healthy adults participating in a clinical trial of the effect of acetaminophen on asthma control and severity.

Design And Methods: 94 healthy adults aged 18-65 years with mild to moderate asthma and with no history of previous liver dysfunction and an ALT within 1.

Treatment responsiveness of phenotypes of symptomatic airways obstruction in adults.

Background: Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous disorders encompassing different phenotypes of airflow obstruction, which might differ in their response to treatment.

Objective: The aim of this study was to determine distinct phenotypes comprising the syndromes of asthma and COPD and the treatment responsiveness of these phenotypes to inhaled β-agonist, antimuscarinic, and corticosteroid therapy.

Methods: We undertook a cross-sectional study with 3 phases.

Randomised placebo-controlled study of the effect of paracetamol on asthma severity in adults.

Objective: To investigate the effect of regular paracetamol on bronchial hyper-responsiveness (BHR) and asthma control in adult asthma.

Setting: Single research-based outpatient clinic.

Participants: 94 adults with mild-to-moderate asthma received randomised treatment; 85 completed the study.

Combination corticosteroid/β-agonist inhaler as reliever therapy: a solution for intermittent and mild asthma?

The recommended treatment of mild asthma is regular maintenance inhaled corticosteroids (ICSs) with a short-acting β-agonist as a separate inhaler used when needed for symptom relief. However, the benefits of regular ICS use in actual clinical practice are limited by poor adherence and low prescription rates. An alternative strategy would be the symptom-driven (as-required or "prn") use of a combination ICS/short-acting β-agonist or ICS/long-acting β-agonist inhaler as a reliever rather than regular maintenance use.

What risks do women face when seeking advice during pregnancy from pharmacies and natural health retailers?

Aim: Potential risks to mother and foetus exist with the incorrect use of complementary and alternative medicine (CAM) products during pregnancy. This study aimed to identify the risks that a woman may face when seeking advice during pregnancy from pharmacies and health food stores (HFS) in Greater Wellington (New Zealand).

Methods: 21 HFS and 21 geographically-matched pharmacies were visited by a researcher who sought advice regarding vitamin supplementation and nausea in early pregnancy using a standardised scenario.

Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial.

Background: Intravenous magnesium has been shown to cause bronchodilation in acute severe asthma and in small trials in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). There is also some evidence of benefit from nebulised magnesium in acute severe asthma. Our hypothesis was that adjuvant magnesium treatment administered via repeated nebulisation was effective in the management of AECOPD.

The β-2 agonist debate: is there still a problem?

Purpose Of Review: To present an evidence-based review of the US Food and Drug Administration (FDA) recommendations for long-acting β agonist (LABA) use in asthma.

Recent Findings: The FDA recommendation contraindicating the use of LABAs without a concomitant asthma-controller medication such as an inhaled corticosteroid (ICS) is supported, with the caveat that concomitant use of an asthma-controller medication applies only to ICS therapy and not other asthma controller medications (such as leukotriene receptor antagonist therapy or theophylline). The recommendation that LABA therapy be stopped once asthma control is achieved is restrictive.

The effect of hyperoxia following cardiac arrest - A systematic review and meta-analysis of animal trials.

Aim: There are conflicting findings from observational studies regarding the nature of the association between hyperoxia and risk of mortality in patients admitted to intensive care following cardiac arrest. This systematic review and meta-analysis evaluates animal data investigating the effect of administration of high concentrations of oxygen following cardiac arrest on neurological outcome and the clinical applicability of this data.

Methods: A systematic search of Medline and Embase identified controlled animal studies modelling cardiac arrest with subsequent cardiopulmonary resuscitation that compared ventilation with 100% oxygen to lower concentrations following return of spontaneous circulation.

What risk do consumers face when seeking medical advice from health food stores?

Aim: There is currently no specific legislation to regulate either complementary and alternative medicine (CAM) products or the majority of those promoting them. This study sought to highlight the general risk a consumer may face when they seek help/advice from a pharmacy or health food store (HFS).

Methods: 21 HFS, matched with pharmacies, were visited by a researcher complaining of tiredness, who stated he had been taking warfarin over the previous 2 months.

Incidental findings from lung CT scans: implications for research.

Introduction: We aimed to evaluate the number and nature of incidental findings in CT chest scans in the context of a study of the pulmonary effects of cannabis.

Methods: Three hundred fifty-seven participants were recruited: 78 cannabis-only smokers, 92 tobacco-only smokers, 106 smokers of cannabis and tobacco and 81 never smokers. All participants underwent a high-resolution CT scan of their thorax.

The multiple dimensions of airways disease: targeting treatment to clinical phenotypes.

Purpose Of Review: The recognition that asthma and chronic obstructive pulmonary disease (COPD) are not single diseases, but syndromes made up of multiple separate disorders that overlap, has led to attempts to develop a new taxonomy for the disorders of airflow obstruction. A better understanding of the distinct disorders of airways disease has the potential to inform on underlying mechanisms, risk factors, natural history, monitoring and treatment.

Recent Findings: Recent attempts to describe the different phenotypes have largely been based on cluster analysis.

The effect on mortality of antipyretics in the treatment of influenza infection: systematic review and meta-analysis.

Objective: To determine whether antipyretic treatment for influenza infection influences the risk of mortality in animal models and humans.

Design: A systematic search of Medline, Embase and the Cochrane Register of Controlled Trials was undertaken to identify randomized placebo-controlled trials of antipyretic use in influenza infection in animal models or humans that reported mortality. A quantitative meta-analysis of the risk of death using Peto's one step odds ratio with calculation of the pooled risk of death and standard evaluation of heterogeneity was undertaken.

An audit of the effect of oxygen prescription charts on clinical practice.

Problem: The need to improve the prescription, administration and monitoring of oxygen therapy.

Design: An interventional, prospective audit.

Background And Setting: Wellington Hospital, a teaching and tertiary referral hospital in New Zealand in 2007 and 2008.

Frequency of dosing and comparative doses of mometasone furoate: a meta-analysis.

Background And Objective: To examine the evidence for the efficacy of once daily dosing of mometasone furoate (MF) and to establish the dose-response relationship for MF in asthma.

Methods: Meta-analysis of double-blind, randomized controlled clinical trials, identified through a Medline and EMBASE search, comparing once versus twice daily dosing with the same dose and/or comparing two different doses that presented data on measurements of clinical efficacy. Main outcome measures were FEV(1) change from baseline, PEF, withdrawals for any reason and treatment failure as defined by the authors.

Dose-response relationship of inhaled corticosteroids and cataracts: a systematic review and meta-analysis.

Background And Objective: The risk of cataracts associated with the long-term use of inhaled corticosteroids (ICS) is poorly recognized, yet may be of major public health importance. The aim of this study was to determine the dose-response relationship of ICS use and risk of cataracts in adults.

Methods: A systematic review and meta-analysis was performed of case-control studies of cataracts and ICS use, which included at least two doses of ICS and in which the number of cases and controls using each dose of ICS was reported.

Reference ranges for exhaled nitric oxide derived from a random community survey of adults.

Rationale: Measurement of the fraction of nitric oxide in exhaled breath (Fe(NO)) has been proposed as a noninvasive marker of airway inflammation. Before the widespread use of this test, there is a need to develop reference ranges to allow clinicians to interpret Fe(NO) measurements.

Objectives: To derive reference ranges for Fe(NO) and to determine which factors in health and disease influence Fe(NO) levels.

Utility of lung density measurements in the diagnosis of emphysema.

Background: The role of computerised tomography (CT) lung density measurements in objective quantification of emphysema is uncertain. The aim of this study was to determine normal reference values for CT lung density measurements and investigate their utility in identifying subjects with clinical emphysema.

Methods: Normal subjects (non-smokers, no respiratory disease, n=185) and subjects with clinical emphysema (post-bronchodilator FEV(1)/FVC <70%, > or =10 pack years tobacco smoking, no childhood asthma and, either D(LCO)/VA <80% predicted and/or macroscopic emphysema on CT, n=22) were identified from a random population survey.