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Category Archives: Asthma

Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled Steroids: Comment

Recently, it has been demonstrated that serum osteocalcin, a marker of osteoblast activity, is depressed in premenopausal adult women given 1 week of high-dose inhalational beclomethasone and not in those given a lower dose. The lack of consistent correlation of these risk factors with all four skeletal regions studied may be due to the small sample size.
The results of our study demonstrate that longterm use of inhalational steroids for the treatment of asthma is associated with decreased BMD at several sites comprised predominantly of trabecular bone, which is compatible with the known effect of corticosteroids on bone. Buy antibiotics add comment Relevant risk factors identified in this study include being female, receiving a higher average daily inhaled steroid dose, and a low BMI. The clinical significance of this decrease is not apparent from the present study, but there is good evidence that bone mass in the spine and proximal femur as measured by bone density, correlates with risks of vertebral and hip fractures, respectively.
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Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled Steroids: Conclusion

Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled Steroids: ConclusionWe have excluded all those in whom the history of steroid intake was uncertain, such as irregular use of inhaled steroids, possible use of systemic steroids in the distant past, or prescription for their use by practitioners outside our clinics. Thus, patients in this study received steroids predominantly by the topical route, with an average of about three short courses of systemic steroids during their chronic disease. The z scores of BMD of the two groups with and without intermittent systemic steroid use were not significantly different, suggesting that the decrease in BMD was not related to the systemic steroid. buy antibiotics

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Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled Steroids: Discussion

For the female patient group, significant correlations were found between the following parameters: average daily dose of inhaled steroids and BMD of the lumbar area of the spine (r= —0.46, p=0.054 [Fig 4]) and the trochanter of femur (r= —0.47, p=0.047); BMI and BMD of the trochanter of femur (r=0.51, p=0.03). There was no correlation between BMI and trochanteric BMD in the female control group.
Osteoporosis is a well-documented side effect of chronic systemic use of corticosteroids. Prolonged systemic steroid use in the treatment of bronchial asthma has been reported to be associated with a decrease in bone mass and an increase in bone fractures.’ There is growing concern about the possible adverse effects of inhaled corticosteroids on bone. Studies about their effect on bone turnover using biochemical indices suggest that they may depress bone formation as evidenced by depressed serum osteocalcin and increase bone resorption as shown by increased hydroxyproline output in urine 2 Studies of their effect on bone mass have yielded conflicting results. Some of the problems encountered included the different methods and skeletal sites used to assess bone mass, the small number of patients in the study uncertainty concerning the effect of intermittent systemic steroid use on bone loss and the use of suboptimally matched control subjects for comparison. generic allegra

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Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled Steroids: Results

Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled Steroids: ResultsThirty patients were recruited for the study. Their demographic and clinical data are shown in Table 1, and details of steroid use are shown in Table 2. Of the 30,17 had never received systemic steroids, while the other 13 had a medical history of some systemic steroid use in the past, within the limits as defined by the inclusion criteria previously mentioned. Their age, sex, BMI, and menstrual status were similar to those of the control group. All of these patients were fully ambulatory carrying on an independent active lifestyle. Their mean dietary calcium intake was 536 mg/d, which was similar to that of the healthy population in the comparable age range in Hong Kong at about 500 mg/d.
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Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled Steroids: Bone Mass

Bone mineral content and BMD measurements were done with dual energy x-ray absorptiometry using a Norland XR-26 densitometer (Fort Atkinson, Wis). The equipment has an accuracy and precision of 99 percent as documented with a phantom. Regions of interest that were assessed included total body, lumbar area of the spine (L2-4), and left hip (trochanter major, neck of femur, Ward’s triangle).
Quantitation of Inhaled Steroid
The total topical steroid doses, including both inhaled and nasal preparations and booster courses of systemic steroids, were calculated based on medical records. Drug compliance was checked by patient interview at the time of this study, and those who did not take inhaled steroids regularly as prescribed were excluded from the study. Only beclomethasone dipropionate (BDP) and budesonide (BUD) had been used. In the calculation of cumulative dose, they were considered to be equipotent Here generic allegra. In the evaluation of correlation between total cumulative dose and bone density, analysis was done twice: (1) the two preparations were considered equipotent, and (2) BUD was considered as having 50 percent of the systemic potency as BDP.
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Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled Steroids

Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled SteroidsInhaled corticosteroids have become a key element in the maintenance treatment of chronic bronchial asthma there generic claritin. It is well accepted that compared with systemic administration of steroids, the inhaled route is efficacious and has fewer side effects. Osteoporosis is a known side effect of chronic systemic steroid use, but the effect of long-term use of inhaled steroids on bone mass largely is unknown. There have been recent studies on the biochemical effect of inhaled steroids on bone turnover, suggesting that these drugs may cause depressed bone formation or increased bone resorption2 and, hence, the risk of osteoporosis. Information about the effect on bone mass is scanty and the results are conflicting.” The aim of the present study was to investigate bone mineral density (BMD) in a group of asthmatic patients who have been treated with inhaled steroids with or without nasal steroids.
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A 1-Week Dose-Ranging Study of Inhaled Salmeterol in Patients With Asthma: Assessments of Safety

No serious adverse events occurred during this study and no patient required hospitalization for worsening of asthma. Adverse events occurred in 24 percent to 34 percent of patients (Table 5). Headache, the most common adverse event, was reported at similar rates within each treatment group. Tremor, the only statistically significant adverse event, was reported on five occasions by patients receiving the 84-fig dose of salmeterol.
Small but statistically significant increases (up to 8 beats/min) in resting pulse rates were found in patients who received the 84-/*g dose of salmeterol at treatment day 1 (p<0.02) compared with those in the placebo group. Compared with placebo, salmeterol did not produce any clinically significant changes in systolic or diastolic blood pressures or respiratory rates. There were no clinically significant changes in laboratory values during the study.
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A 1-Week Dose-Ranging Study of Inhaled Salmeterol in Patients With Asthma: Peak Expiratory Flow

A 1-Week Dose-Ranging Study of Inhaled Salmeterol in Patients With Asthma: Peak Expiratory FlowA comparison of pretreatment (during screening) and treatment period PEF measurements showed that the degree of improvement in morning PEF was dose related in patients who received salmeterol, with mean increases ranging from 0.5 to 29.4 L/min (Fig 3). In contrast, patients in the placebo group experienced a mean decrease of 15.3 L/min (p=0.001). Similar dose-related effects were seen for PEFs measured in the evening before the patient took the evening dose of study drug.
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A 1-Week Dose-Ranging Study of Inhaled Salmeterol in Patients With Asthma: Spirometric Assessments of Efficacy

A covariate analysis of the serial FEVi values was performed to adjust for these differences in baseline characteristics.
Figure 1 illustrates the unadjusted mean percent change in FEVi on treatment days 1 and 8. After 12 h postdosing on treatment day 1, patients receiving the two higher doses of salmeterol still had mean improvements in FEVi >20 percent above baseline. Each of the salmeterol treatments produced significantly greater bronchodilation than placebo (p=0.001), and the 42-jug or 84-ng dose produced significantly greater responses than the two lower doses (p<0.023). On treatment day 8, all but the 21-tig dose of salmeterol remained significantly better than placebo (p<0.006). The four salmeterol groups had considerably higher predose FEVi values than those established at baseline 1 week earlier, with the 42-/ng group showing the greatest increase (27 percent). All salmeterol treatments produced mean FEVi responses >15 percent above baseline values throughout the 12 h of evaluation. However, no statistically significant differences between the salmeterol doses were observed on the last day of treatment.
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A 1-Week Dose-Ranging Study of Inhaled Salmeterol in Patients With Asthma: Results

A 1-Week Dose-Ranging Study of Inhaled Salmeterol in Patients With Asthma: ResultsAssessments of Safety
Clinical adverse events and laboratory abnormalities occurring between the screening visit and the end of study drug treatment were recorded and monitored. Exacerbations of asthma were not assessed as adverse events, but rather recorded in detail as reflections of both safety and efficacy of study drug.
Statistical Methods
The Cochran-Mantel-Haenszel test was used to compare sex and ethnic origin across treatment groups. Age and results of pulmonary function tests at the screening visit were compared across groups using the F test. Among-treatment changes in FEVi and PEF were tested using analysis of variance F tests cialis professional canadian health care mall. Nonparametric methods were used to evaluate patient-rated symptoms and area under the curve (AUC). The two-sided Fisher’s Exact Test was used to test differences in adverse event frequency.
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