Measured and perceived bronchodilation: results of a placebo-controlled cross-over trial comparing formoterol and salmeterol in asthma patients

A scientific correlational study on human resource and organisational policy-oriented study, which was conducted in the Mara Region of Tanzania. It specifically investigates major factors, which correlate to interprofessional collaborative behaviours in the context of health service delivery between traditional and modern medical practitioners. Interprofessional collaboration is a sine qua non stage towards fully integrated health care encapsulated in a coined Swahili concept of afya jumuishi. The sample population in this study includes medical practitioners from both Modern Medicine (MM) and Traditional Medicine (TM) systems in the Mara Region. The operationalisation of the concept of interprofessional collaboration as used in the analytical model of this study follows the definition by the ‘Centre for Advancement of Collaborative Strategies in Health’ (2003), which defines it as behavioural patterns as part of synergy formation among different professionals. Such behavioural patterns have two interrelated components of dependent factors which include: the behavioural patterns of sharing resources; and - the behavioural patterns of working jointly for clients. The analytical model used is based on Slikkerveer (1990) which is built up on seven blocks of variables. These variables are independent variables, which include socio-demographic, psycho-social, enabling, trustworthiness, organisational and intervening variables as well as the dependent variables which include collaborative behavioural patterns of exchange of resources and collaborative behavioural patterns of working jointly for clients and patients. The general major challenges of the Twenty-First Century facing Traditional Medicine (TM) in the country include: - Lack of enabling environment towards Traditional Medicine (TM); - Absence of a mechanism, which promotes integration between modern and Traditional Medicine (TM); - Weak protection of indigenous intellectual property rights and unsustainable harvesting of medicinal plants; - Dwindling of natural resources; - Lack of indigenous information system and reliable data bank; - The need to carry out education, research and development on Traditional Medicine (TM); - The problem of safety of products of Traditional Medicine (TM); contextualization of the world’s eligions on teachings about Traditional Medicine (TM); - Moral degradation and the breaking of social structures;- Shocking poverty in the society. </div

Profiles of measured and perceived bronchodilation. A placebo-controlled cross-over trial comparing formoterol and salmeterol in moderate persistent asthma.

BACKGROUND AND OBJECTIVE: Long-acting beta(2)-agonists have acquired an indispensable position in the management of bronchial symptoms in patients with asthma. The objective of this study was to compare onset-of-action and clinical effectiveness of formoterol and salmeterol during 2 weeks of treatment. We also investigated the association between bronchodilator effects and perceived relieve of dyspnoea. METHODS: A multi-centre randomized double-blind placebo-controlled cross-over trial was performed in 35 subjects with moderate persistent asthma. Treatment periods existed of 2 weeks formoterol (12 microg bid), salmeterol (50 microg bid) and placebo, all administered by pressurized metered dose inhaler. FEV(1) and Visual Analogue Scale (VAS) scores were repeatedly measured until 180 min post-bronchodilation (post-BD), before as well as after each treatment period. Onset-of-action was defined as a >/=15% increase in FEV(1). Subjects kept diaries of morning and evening PEFR values and use of rescue bronchodilator. RESULTS: Formoterol and salmeterol both caused a significant increase in FEV(1) (0.45L [95% CI 0.01, 0.80] and 0.27L [95% CI 0.08, 0.62] respectively). At 3' post-BD, three times as many subjects demonstrated onset-of-action on formoterol compared to salmeterol (36% versus 13%, P = 0.063), at 6' post-BD 42% versus 27% (P = 0.063). VAS scores were similar for formoterol and salmeterol at pre-treatment assessment, but tended to be higher for formoterol after 2weeks treatment. No differences between formoterol and salmeterol were observed for PEFR values or use of rescue medication. 50% of the subjects preferred formoterol, 29% salmeterol (P < 0.001). Significant associations between FEV(1) and VAS ratings existed only at 10', 15' and 30' post-BD, not before or after these time points. CONCLUSION: The earlier described faster onset-of-action of formoterol as compared to a equipotent dosage of salmeterol was confirmed in this study. Perception of decreasing airflow obstruction may be delayed after acute bronchodilation

Zafirlukast improves asthma control in patients receiving high-dose inhaled corticosteroids

Not all asthma can be adequately controlled, despite the use of high-dose inhaled corticosteroids. Because cysteinyl-leukotrienes (Cys-LT) have been implicated in the pathogenesis of asthma, we hypothesized that the leukotriene receptor antagonist zafirlukast, in combination with high-doses of inhaled corticosteroids, might be efficacious in severe asthma. In a double-blind, parallel group study, 368 chronic adult asthmatic patients treated with inhaled corticosteroids (1,000 to 4,000 μg/d), who had a predefined level of asthma symptoms during the run in period of the study, were randomly assigned to receive additional treatment with a high dose of zafirlukast (80 mg twice daily) (n = 180) or placebo (n = 188) for 6 wk. Compared with placebo, zafirlukast produced a significant improvement over baseline in the primary study endpoint of mean morning peak expiratory flow rate (PEFR) (18.7 L/min versus 1.5 L/min, p &lt; 0.001), as well as in evening PEFR (p &lt; 0.01), FEV1 (p &lt; 0.05), daytime symptom score (p &lt; 0.001), and β2-agonist use (p &lt; 0.001). Furthermore, zafirlukast significantly reduced the risk of an exacerbation of asthma (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.38 to 0.99) and the risk of patients requiring a further increase in asthma controller therapy (OR: 0.4; 95% CI; 0.2 to 0.8). In conclusion, in patients taking high-dose inhaled corticosteroids, zafirlukast improves pulmonary function and asthma symptoms, and reduces the risk of an asthma exacerbation, suggesting that the contribution of leukotrienes to asthma symptoms and exacerbations is not adequately controlled by high-dose inhaled corticosteroids