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Regular treatment with formoterol and inhaled steroids for chronic asthma: serious adverse events (Review)
Background
Epidemiological evidence has suggested a link between beta2-agonists and increases in asthma mortality. There has been much debate about possible causal links for this association, and whether regular (daily) long-acting beta2-agonists are safe when used alone or in conjunction with inhaled corticosteroids.
Objectives
The aim of this review is to assess the risk of fatal and non-fatal serious adverse events in trials that randomised patients with chronic asthma to regular formoterol with inhaled corticosteroids versus the same dose of inhaled corticosteroids alone.
Search strategy
Trials were identified using the Cochrane Airways Group Specialised Register of trials. Web sites of clinical trial registers were checked for unpublished trial data and Food and Drug Administration (FDA) submissions in relation to formoterol were also checked. The date of the most recent search was October 2008.
Selection criteria
Controlled parallel design clinical trials on patients of any age and severity of asthma were included if they randomised patients to treatment with regular formoterol and inhaled corticosteroids, and were of at least 12 weeks duration.
Data collection and analysis
Two authors independently selected trials for inclusion in the review. Outcome data were independently extracted by two authors. Unpublished data on mortality and serious adverse events were obtained from the sponsors.
Main results
The review included 14 studies on adults and adolescents (8,028 participants) and seven studies on children and adolescents (2,788 participants). Data on all cause fatal and non-fatal serious adverse events were found for all studies, and the overall risk of bias was low.Four deaths occurred on regular formoterol with inhaled corticosteroids, and none on regular inhaled corticosteroids alone. All the deaths were in adults, and one was reported to be asthma-related. The difference was not statistically significant. Non-fatal serious adverse events of any cause were very similar in adults [Peto Odds Ratio 0.99 (95% CI 0.74 to 1.33)], and an increase in events in children on regular formoterol was not statistically significant [Peto Odds Ratio 1.62 (95% CI 0.80 to 3.28)]. Asthma related serious adverse events on formoterol were lower in adults [Peto Odds Ratio 0.53 (95% CI 0.28 to 1.00)] and although they were higher in children [Peto Odds Ratio 1.49 ( 95% CI 0.48 to 4.61)], this was not statistically significant.
Authors' conclusions
It is not possible, from the data in this review, to reassure people with asthma that inhaled corticosteroids with regular formoterol carries no risk of increasing mortality in comparison to inhaled corticosteroids alone as all four deaths occurred among 6,594 people using inhaled corticosteroids with formoterol. On the other hand, we have found no conclusive evidence of harm and there was only one asthma related death registered during over 3,000 patient year observation on formoterol. In adults, the decrease in asthma-related serious adverse events on regular formoterol with inhaled corticosteroids was not accompanied by a decrease in all cause serious adverse events. In children the number of events was too small, and consequently the results too imprecise, to determine whether the increase in all cause non-fatal serious adverse events found in the previous meta-analysis on regular formoterol alone is abolished by the additional use of inhaled corticosteroids. Clinical decisions and information for patients regarding regular use of formoterol have to take into account the balance between known symptomatic benefits of formoterol and the degree of uncertainty and concern associated with its potential harmful effects
Mondros'a giden yol
Taha Toros Arşivi, Dosya Adı: Milli MücadeleUnutma İstanbul projesi İstanbul Kalkınma Ajansı'nın 2016 yılı "Yenilikçi ve Yaratıcı İstanbul Mali Destek Programı" kapsamında desteklenmiştir. Proje No: TR10/16/YNY/010
As ciências naturais e as ciências do espírito na era da globalização
Este artigo, o autor apresenta, primeiramente, reflexões de cunho histórico sobre a relação entre as Ciências Naturais e as Ciências do Espírito, seguidas de observações, de caráter mais sistemático, sobre o conceito das próprias Ciências do Espírito. Com fundamento nessas observações, tece algumas reflexões sobre até que ponto podemos esperar da globalização efeitos sobre as Ciências Naturais e as Ciências do Espírit
Methods of waste heat recovery. Comparison of organic rankine cycle and stirling engine.
Ogromne ilości ciepła są wyrzucane do środowiska,
jako odpady z procesów produkcyjnych. W toku wieloletnich badań
wynaleziono kilka sposobów odzysku tego ciepła i jego zamiany
na energię elektryczną. W niniejszym artykule porównane są dwie z nich:
obieg ORC i silnik Stirlinga. Obieg ORC zyskuje coraz szersze
zastosowania w energetyce, podczas gdy silnik Stirlinga jest technologią
mało znaną. Obieg ORC ma zastosowanie przy siłowniach większej mocy,
zaś silnik Stirlinga jest bardziej odpowiedni dla energetyki rozproszonej.Huge amount of heat is dumped into environment as a waste
of production processes. During years of research few technologies
of recovery of this heat and converting it into electric energy were
invented. This paper is focused on comparison of two of them: the Organic
Rankine Cycle and the Stirling engine. Although ORC has more and more
applications in energetics, the Stirling engine is not well known. ORC can
be applied to power plants of higher power, the Stirling engine, on the
other hand, is more suitable for distributed generation
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