Add-on therapy options in asthma not adequately controlled by inhaled corticosteroids: a comprehensive review

Many patients with persistent asthma can be controlled with inhaled corticosteroids (ICS). However, a considerable proportion of patients remain symptomatic, despite the use of ICS. We present systematically evidence that supports the different treatment options. A literature search was made of Medline/PubMed to identify randomised and blinded trials. To demonstrate the benefit that can be obtained by increasing the dose of ICS, dose-response studies with at least three different ICS doses were identified. To demonstrate whether more benefit can be obtained by adding long-acting β(2)-agonist (LABA), leukotriene antagonist (LTRA) or theophylline than by increasing the dose of ICS, studies comparing these options were identified. Thirdly, studies comparing the different "add-on" options were identified. The addition of a LABA is more effective than increasing the dose of ICS in improving asthma control. By increasing the dose of ICS, clinical improvement is likely to be of small magnitude. Addition of a LTRA or theophylline to the treatment regimen appears to be equivalent to doubling the dose of ICS. Addition of a LABA seems to be superior to an LTRA in improving lung function. However, addition of LABA and LTRA may be equal with respect to asthma exacerbations. However, more and longer studies are needed to better clarify the role of LTRAs and theophylline as add-on therapies

Medical students of Kyrgyzstan: smoking prevalence and attitudes to smoking cessation counseling

Study objective: To determine the current prevalence of smoking among medical students and to ascertain their readiness for counseling on smoking cessation. Methods: Cross-sectional randomized study, in which 297 medical students (146 males and 151 females) completed a questionnaire and exhaled carbon monoxide(CO). Setting: Kyrgyz State Medical Academy in Bishkek, Kyrgyzstan. Results: The overall prevalence of smoking among medical students was 35% (47.9% among men and 22.5% among women), with the highest rate among year 6 students(85.7% for men and 58% for women). The CO-adjusted prevalence for the entire sample was 44.8%. Overall 69% of students believed that smoking is related to cancer and chronic diseases however, the longer students were in school, the less confidence they demonstrated in this relationship. While 85.2% reported that advice should be given to smokers to stop, only 63% considered it potentially effective. Only 17.2% were aware of the Framework Convention on Tobacco Control, 90% of these supported its ratification, women significantly more so than men OR = 2.24, p < 0.05. Non-smokers expressed a greater demand for more information on smoking-related diseases and treatment of tobacco dependence (OR = 2.94, p < 0.05). Smokers were more likely to consume alcohol (OR = 4.0, p < 0.001) with no-alcohol students being more committed to tobacco control. Conclusions: Across the years of study, the prevalence of smoking among medical students increased, and reached its peak at year 6. The lack of knowledge about tobacco control along with a decreased potential for anti-smoking advocacy likely reflect deficiencies in the educational curricula. There is an urgent need to address relevant changes in the educational curricula for medical students