***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT . A double blind controlled trial of Becotide ® ( beclomethasone diproprionate ) inhalations was carried out for treating cystic fibrosis patients with chronic P. aeruginosa lung infection to determine its efficacy and safety . The aim of the treatment was to diminish the inflammatory response in the lungs of these patients , a response which is initiated by an allergic type III reaction . Pulmonary inflammation was evaluated by measurements of proteolytic activity , albumin concentration and immune complex activity in the sputum solphase before , during , and after the 16 weeks the trial lasted . 26 cystic fibrosis patients participated ( 13 received Becotide ® and 13 placebo )  and the results showed that local steroids have no effect on the inflammatory response in the lungs of cystic fibrosis patients with chronic P. aeruginosa lung infection .  No adverse effects were demonstrated . There was , however , a significant increase in the inflammatory parameters for all 26 cystic fibrosis patients when the trial period was over , compared to the insidious pulmonary destruction which takes place in the lungs of these patients , and it corresponded to a significant decrease ( p<0.05 ) in forced vital capacity which took place at the same time . Therefore , chronic P. aeruginosa lung infection in these patients should be treated as efficiently as possible Long-term treatment with ibuprofen twice daily , at doses that achieve peak plasma concentration ( Cmax ) > 50 μg/ml , slows progression of lung disease in patients with cystic fibrosis ( CF ) . Previous data suggest that Cmax > 50 μg/ml is associated with a reduction in neutrophil ( PMN ) migration into the lung and that lower concentrations are associated with an increase in PMN migration . To estimate the threshold concentration at which ibuprofen is associated with a decrease in PMN migration in vivo , we measured the PMN content of oral mucosal washes in 35 healthy ( age 19 - 40 years ) and 16 CF ( age 18 - 32 years ) subjects who took ibuprofen twice daily for 10 days in doses that achieved Cmax 8 to 90 μg/ml . Cmax > 50 μg/ml was associated with a 31 ± 7 % ( mean ± S.E.M. ) reduction in PMNs in CF ( n = 11 , p < 0.001 ) and 25 ± 6 % reduction in PMNs in healthy subjects ( n = 16 , p < 0.001 ) . Increasing concentrations above 50 μg/ml was not associated with a greater decrease in PMNs . The reduction in PMN migration was consistently present 12 h after a dose , but not after 24 h. Cmax < 50 μg/ml was associated with an increase in PMNs of approximately 40 % . These results suggest that Cmax > 50 μg/ml and twice daily dosing of ibuprofen are required to decrease PMN migration , and reinforce the current recommendation that pharmacokinetics should be performed in CF patients prescribed ibuprofen Abstract A double-blind r and omised cross-over trial of aerosol carbenicillin and gentamicin treatment in young adult cystic-fibrosis patients chronically infected with Pseudomonas aeruginosa has shown that aerosol antibiotic treatment produces both subjective and objective improvement . This treatment therefore appears to be useful in selected patients BACKGROUND Inhaled hypertonic saline acutely increases mucociliary clearance and , in short-term trials , improves lung function in people with cystic fibrosis . We tested the safety and efficacy of inhaled hypertonic saline in a long-term trial . METHODS In this double-blind , parallel-group trial , 164 patients with stable cystic fibrosis who were at least six years old were r and omly assigned to inhale 4 ml of either 7 percent hypertonic saline or 0.9 percent ( control ) saline twice daily for 48 weeks , with quinine sulfate ( 0.25 mg per milliliter ) added to each solution to mask the taste . A bronchodilator was given before each dose , and other st and ard therapies were continued during the trial . RESULTS The primary outcome measure , the rate of change ( slope ) in lung function ( reflected by the forced vital capacity [ FVC ] , forced expiratory volume in one second [ FEV1 ] , and forced expiratory flow at 25 to 75 percent of FVC [ FEF25 - 75 ] ) during the 48 weeks of treatment , did not differ significantly between groups ( P=0.79 ) . However , the absolute difference in lung function between groups was significant ( P=0.03 ) when averaged across all post-r and omization visits in the 48-week treatment period . As compared with the control group , the hypertonic-saline group had significantly higher FVC ( by 82 ml ; 95 percent confidence interval , 12 to 153 ) and FEV1 ( by 68 ml ; 95 percent confidence interval , 3 to 132 ) values , but similar FEF25 - 75 values . The hypertonic-saline group also had significantly fewer pulmonary exacerbations ( relative reduction , 56 percent ; P=0.02 ) and a significantly higher percentage of patients without exacerbations ( 76 percent , as compared with 62 percent in the control group ; P=0.03 ) . Hypertonic saline was not associated with worsening bacterial infection or inflammation . CONCLUSIONS Hypertonic saline preceded by a bronchodilator is an inexpensive , safe , and effective additional therapy for patients with cystic fibrosis . ( Clinical Trials.gov number , NCT00271310 . A r and omized cross-over study was undertaken to compare nebulized ( 1 ) ceftazidime with ( 2 ) a combination of gentamicin and carbenicillin , and ( 3 ) saline , each given for 4 months , in patients with cystic fibrosis infected with Pseudomonas aeruginosa .  Mean peak expiratory flow on ceftazidime , 299 litres/min , and on gentamicin and carbenicillin , 297 litres/min , were greater than on saline , 278 litres/min ( P less than 0.02 and P less than 0.05 respectively ) . Similarly mean forced expiratory volume in 1 second on ceftazidime , 1.70 litres , and on gentamicin and carbenicillin , 1.70 litres , were greater than on saline , 1.48 litres ( P less than 0.02 and P less than 0.01 respectively ) . Mean forced vital capacity on gentamicin and carbenicillin , 2.93 litres , was also greater than on saline ( P less than 0.05 ) . We were unable to demonstrate any difference in efficacy between the antibiotic regimens . The patients were admitted to hospital less frequently during the study year compared with the previous year ( P less than 0.05 ) . Sixty-nine per cent of patients had a clinical ly significant ( 20 % ) increase in forced expiratory volume in 1 second on an antibiotic regimen compared with that on entry to study , but a minority of patients appear not to respond to this form of treatment BACKGROUND Aztreonam lysine for inhalation ( AZLI ) is being developed for treatment of CF patients with Pseudomonas aeruginosa airway infection . METHODS This double-blind , r and omized , placebo-controlled Phase 2 study evaluated the safety , tolerability and efficacy of 75 and 225 mg AZLI administered BID for 14 days using the eFlow Electronic Nebulizer ( Pari Innovative Manufacturers , Inc. , Midlothian , VA ) . Patients were 13 years and older with FEV1>or=40 % predicted , chronic P. aeruginosa infection , and had used no anti-pseudomonal antibiotics for 56 days . RESULTS Of 131 patients screened , 105 received AZLI or placebo . Mean age was 26 years and mean FEV1 percent predicted was 77 % at baseline . There was a statistically significant reduction , compared to placebo , in P. aeruginosa CFU density in each AZLI group at Days 7 and 14 ( P<0.001 ) . The planned primary analysis , percent change in FEV1 at Day 14 , demonstrated no statistically significant difference . Post hoc analysis demonstrated significant increase in FEV1 at Day 7 for the subset of patients with baseline FEV1<75 % predicted in the 225 mg AZLI group . Bronchodilator use was associated with greater improvement in FEV1 , as well as greater reduction in P. aeruginosa bacterial density and higher plasma aztreonam concentrations in the 225 mg AZLI group . Adverse events were similar between placebo and AZLI although there was a trend toward increased respiratory symptoms in the 225 mg AZLI group . CONCLUSION These data support the further development of AZLI and provide information for the design of subsequent studies BACKGROUND Controlling lung inflammation may be the key to improving morbidity and mortality in cystic fibrosis . OBJECTIVE To assess the effects of inhaled corticosteroids on lung inflammation in cystic fibrosis . DESIGN Double blind placebo controlled r and omised sequence crossover trial . Fluticasone propionate ( 400 μg/day ) was given as a dry powder inhaler for six weeks with a four week washout period before crossover . OUTCOME MEASURES Sputum inflammatory markers ( interleukin-8 , tumour necrosis factor-α ( TNF-α ) and neutrophil elastase — both free and bound to α1-antiprotease ) , sputum interleukin-10 , lung function , and symptomatology . SUBJECTS Twenty three children from a regional cystic fibrosis centre were enrolled into the study , with mean age 10.3 years ( range 7 to 17 years ) and mean baseline forced expiratory volume in one second ( FEV1 ) of 64 % ( range 21 % to 102 % ) predicted for sex and height . One patient was excluded for non-compliance to the study protocol . RESULTS No significant benefit was shown for the use of fluticasone propionate in any of the outcomes . For sputum interleukin-8 there was an estimated true treatment median difference of 142 pg/ml ( 95 % confidence interval ( CI ) 8 to 2866 pg/ml ) in favour of placebo ; while for maximal expiratory flow at 25 % ( MEF25 % ) remaining forced vital capacity predicted for sex and height there was a 15 percentage points ( pp ) ( 95 % CI 4 to 26 pp ) mean treatment difference in favour of placebo . Sputum interleukin-10 was undetected in any sample s and unaffected by fluticasone propionate . Neither atopic status , baseline FEV1 , nor concomitant DNase therapy had any effect on response to treatment . CONCLUSIONS Lack of benefit from fluticasone propionate was most likely due to failure of the drug to penetrate the viscid mucus lining the airways . It is suggested a large multicentre trial with higher doses given for a longer time by a different delivery system is required to assess efficacy Background : Macrolides display immunomodulatory effects that may be beneficial in chronic inflammatory pulmonary diseases . The aim of the study was to document whether long term use of azithromycin may be associated with respiratory benefits in young patients with cystic fibrosis . Methods : A multicentre , r and omised , double blind , placebo controlled trial was conducted from October 2001 to June 2003 . The criteria for enrolment were age older than 6 years and forced expiratory volume in 1 second ( FEV1 ) of 40 % or more . The active group received either 250 mg or 500 mg ( body weight < or ⩾40 kg ) of oral azithromycin three times a week for 12 months . The primary end point was change in FEV1 . Results : Eighty two patients of mean ( SD ) age 11.0 ( 3.3 ) years and mean ( SD ) FEV1 85 (22)% predicted were r and omised : 40 in the azithromycin group and 42 in the placebo group . Nineteen patients were infected with Pseudomonas aeruginosa . The relative change in FEV1 at month 12 did not differ significantly between the two groups . The number of pulmonary exacerbations ( count ratio 0.50 ( 95 % CI 0.32 to 0.79 ) , p<0.005 ) , the time elapsed before the first pulmonary exacerbation ( hazard ratio 0.37 ( 95 % CI 0.22 to 0.63 ) , p<0.0001 ) , and the number of additional courses of oral antibiotics were significantly reduced in the azithromycin group regardless of the infectious status ( count ratio 0.55 ( 95 % CI 0.36 to 0.85 ) , p<0.01 ) . No severe adverse events were reported . Conclusion : Long term use of low dose azithromycin in young patients with cystic fibrosis has a beneficial effect on lung disease expression , even before infection with Pseudomonas aeruginosa BACKGROUND Persistent endobronchial inflammation is in part responsible for the attrition of lung function seen in cystic fibrosis . Leukotrienes act as pro-inflammatory mediators . The aim of this study was to assess the efficacy of the leukotriene receptor antagonist zafirlukast as a potential anti-inflammatory agent in the treatment of adult patients with cyst 
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We addressed the questions in one of three ways , based on available evidence : ( 1 ) commissioned systematic review , ( 2 ) modified systematic review , or ( 3 ) summary of existing Cochrane review s. CONCLUSIONS It is hoped that the guidelines provided in this article will facilitate the appropriate application of these treatments to improve and extend the lives of all individuals with cystic fibrosis