The ADMIT series - issues in inhalation therapy. 1) The goals of asthma treatment: can they be achieved?

Contains fulltext : 51643.pdf (publisher's version ) (Closed access)The widespread use of inhaled corticosteroids (ICS) since the early 1970's has meant that asthma is generally better controlled in comparison with previous decades. Nevertheless, recent patient interview surveys indicate that there is still a lot to gain in terms of abolishing daytime and nocturnal symptoms, and asthma exacerbations. It is important to use the terms asthma 'control' and asthma 'severity' in a correct way. Whereas asthma control reflects fluctuation in symptoms and lung function (or lack of them) over time, asthma severity reflects both asthma control and the need for medication. Thus, 'severity' is a property of the disease which reflects the degree of pathophysiological abnormality, whereas 'control' refers to the reduction of the clinical manifestations of disease achieved by treatment - thereby reflecting the adequacy of treatment. This introductory review, the first of a series of review papers to be published in this journal by the ADMIT team (see Appendix), discusses briefly our present knowledge of asthma control, its components, factors that may limit patients' ability to achieve optimal asthma control, and instruments to measure asthma control

Effects of beraprost sodium, an oral prostacyclin analogue, in patients with pulmonary arterial hypertension: a randomized, double-blind, placebo-controlled trial. J Am Coll Cardiol. 2002 May 1;39(9):1496-502.

The purpose of this study was to assess the efficacy and safety of beraprost sodium, an orally active prostacyclin analogue, in New York Heart Association (NYHA) functional class II and III patients with pulmonary arterial hypertension (PAH). BACKGROUND Pulmonary arterial hypertension is a life-threatening disease for which continuous intravenous infusion of prostacyclin has been proven effective. However, this treatment is associated with serious complications arising from the complex delivery system. METHODS In this double-blind, placebo-controlled study, 130 patients with PAH were randomized to the maximal tolerated dose of beraprost (median dose 80 g four times a day) or to placebo for 12 weeks. The primary end point was the change in exercise capacity assessed by the 6-min walk test. Secondary end points included changes in Borg dyspnea index, cardiopulmonary hemodynamics and NYHA functional class. RESULTS Patients treated with beraprost improved exercise capacity and symptoms. The difference between treatment groups in the mean change of 6-min walking distance at week 12 was 25.1 m (95% confidence interval [CI]: 1.8 to 48.3, p 0.036). The difference in the mean change of Borg dyspnea index was 0.94 (95% CI: 1.63 to 0.24, p 0.009). In the sub-group of patients with primary pulmonary hypertension, the difference in the mean change of 6-min walking distance was 46.1 m (95% CI: 3.0 to 89.3, p 0.035). Cardiopulmonary hemodynamics and NYHA functional class had no statistically significant changes. Drug-related adverse events were common in the titration phase and decreased in the maintenance period. CONCLUSIONS Beraprost improves exercise capacity and symptoms in NYHA functional class II and III patients with PAH and, in particular, in those with primary pulmonary hypertension