The effect of high-dose fluticasone propionate and budesonide on lung function and asthma exacerbations in patients with severe asthma

AbstractThe purpose of this study was to investigate the comparative efficacy and safety of equal doses of inhaled fluticasone propionate (FP) and inhaled budesonide (BUD) using their respective dry powder inhalers in a population of severe asthmatics requiring high doses of inhaled corticosteroid. This double-blind double-dummy parallel-group study compared the effects of 24 weeks of treatment with FP (2000 μg daily via a Diskhaler® inhaler; Glaxo Wellcome, Evreux, France) and BUD (2000 μg daily via a Turbuhaler® inhaler; Astra Pharmaceuticals, Rijswijka, Netherlands) on lung function and asthma exacerbations in 395 patients with asthma.FP was statistically significantly superior to BUD with respect to the percentage of symptom-free days (P = 0·02), the incidence of days free from rescue bronchodilator usage (P = 0·02) and the distribution of change in peak expiratory flow (PEF) expressed as a percentage of the predicted PEF (P = 0·04). During the treatment period FP was statistically significantly superior to BUD for change in forced expiratory volume in 1 sec (FEV1) at 8, 16 and 24 weeks, change in the median daytime symptom score during weeks 5–16, for incidence of symptomfree days and incidence of days free from rescue bronchodilator usage during weeks 17–24. There was no significant difference between FP and BUD with respect to the number of patients experiencing one or more asthma exacerbation (33·8 and 28·4% of patients, respectively). There was, however, evidence that the exacerbations were clinically less severe in patients treated with FP, in that the time to resolution was quicker (11·0 vs. 14·7 days; P = 0·035), mean duration of all exacerbations (for an individual patient) tended to be shorter (18·5 vs. 23·6 days; P = 0·12), the time off work was reduced (4·2 vs. 7·6 days; P = 0·012) and the lowest PEF recorded during the exacerbation was higher (301 vs. 263 1 min−1; P = 0·07). There were no clinically relevant differences in the safety (serum cortisol levels, markers of bone turnover, adverse events) of FP and BUD at these microgram equivalent doses.The patients recruited into this study, in retrospect, probably had no need for such high doses of inhaled corticosteroid but, irrespective of this, FP at microgram equivalent doses showed evidence of superior efficacy to BUD with respect to lung function and severity of asthma exacerbations without producing any greater adverse systemic effect

Landform evolution in the headwaters area of Araguaia river (Mato Grosso and Goiás states, Brazil).

Editors: Francisco Gutiérrez, Mateo Gutiérrez, Gloria Desir, Jesús Guerrero, Pedro Lucha, Cinta Marín, José María García-Ruiz

Interaction of surface acoustic waves with a two-dimensional electron gas in the presence of spin splitting of the Landau bands

The absorption and variation of the velocity of a surface acoustic wave of frequency $f$= 30 MHz interacting with two-dimensional electrons are investigated in GaAs/AlGaAs heterostructures with an electron density $n=(1.3 - 2.8) \times 10^{11} cm^{-2}$ at $T$=1.5 - 4.2 K in magnetic fields up to 7 T. Characteristic features associated with spin splitting of the Landau level are observed. The effective g factor and the width of the spin-split Landau bands are determined: $g^* \simeq 5$ and $A$=0.6 meV. The greater width of the orbital-split Landau bands (2 meV) relative to the spin-split bands is attributed to different shielding of the random fluctuation potential of charged impurities by 2D electrons. The mechanisms of the nonlinearities manifested in the dependence of the absorption and the velocity increment of the SAW on the SAW power in the presence of spin splitting of the Landau levels are investigated.Comment: Revtex 5 pages + 5 EPS Figures, v.2 - minor corrections in text and pic

Three dimensional graphics station for computer integrated manufacturing research

Issued as Final report, Project no. E-25-69

Optimal Management of Severe/Refractory Asthma

Asthma is a chronic inflammatory disease of the airways, affecting approximately 300 million people worldwide. Asthma results in airway hyperresponsiveness, leading to paroxysmal symptoms of wheeze, cough, shortness of breath, and chest tightness. When these symptoms remain uncontrolled, despite treatment with high doses of inhaled and ingested corticosteroids, asthmatic patients are predisposed to greater morbidity and require more health care support. Treating patients with severe asthma can be difficult and often poses a challenge to physicians when providing ongoing management. This clinical review aims to discuss the definition, prevalence and evaluation of severe asthmatics, and provides a review of the existing pharmacologic and non-pharmacologic treatment options

Electron localization in sound absorption oscillations in the quantum Hall effect regime

The absorption coefficient for surface acoustic waves in a piezoelectric insulator in contact with a GaAs/AlGaAs heterostructure (with two-dimensional electron mobility $\mu= 1.3\times 10^5 cm^2/V\cdot s)$ at T=4.2K) via a small gap has been investigated experimentally as a function of the frequency of the wave, the width of the vacuum gap, the magnetic field, and the temperature. The magnetic field and frequency dependencies of the high-frequency conductivity (in the region 30-210 MHz) are calculated and analyzed. The experimental results can be explained if it assumed that there exists a fluctuation potential in which current carrier localization occurs. The absorption of the surface acoustic waves in an interaction with two-dimensional electrons localized in the energy "tails" of Landau levels is discussed.Comment: RevTeX 6 pages+6 EPS pic